Characteristics of terminal cancer patients who committed suicide during ahome palliative care program

Cancer patients may commit suicide at any stage of the disease and many ris k factors of suicide have been described in the literature. To identify the possible vulnerability factors of suicide in five terminal cancer patients who committed suicide while they were cared for at home by well-trained pa lliative care teams, a psychological autopsy study was carried out by revie wing their medical records; their report of symptoms at the time of care; a nd with the caregivers', doctors', and nurses' recollection of events by me ans of a structured interview prepared ad hoc. We collected data regarding the physical, emotional, and social suffering of the patients, their person ality profile, and their feelings with respect to the illness and disabilit y. The interviews lasted for a mean of two hours and were performed from 2- 8 years after the suicide events by the social worker at the Rehabilitation and Palliative Care Division. The interviews took place between June 1996 and January 1998. All the patients showed great concern about the lack of a utonomy and independence, refused dependence on others and had fear/worry o f losing their autonomy. Four patients presented functional and physical im pairments, uncontrolled pain, awareness of being in the terminal stage, and mild to moderate depression. They had a feeling a hopelessness consequent to their clinical conditions, fear of suffering, and feeling of being a bur den on others. They had a strong character and managerial professions. They had isolated themselves from others and they had previously talked about s uicide. Before committing suicide, three patients had adverse physical/emot ional consequences to the oncological treatments-they showed aggressiveness towards their family and one towards the home care physician. Multiple vul nerability factors were present simultaneously in all patients. However; th e loss of, and the fear of losing, autonomy and their independence and of b eing a burden on others were the most relevant. The identification of a can cer patient at risk of committing suicide forms the first step for the prev ention of and the setting up of adequate psychosocial rehabilitation of the se patients whenever possible. J Pain Symptom Manage 2991; 22:544-553. (C) U.S. Cancer Pain Relief Committee, 2001.