Palliative care could reduce suicide risk among veterans with advanced lung cancer

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Donald Sullivan

Palliative care appeared to reduce the risk for suicide among a cohort of more than 20,000 U.S. veterans with advanced-stage lung cancer, according to study results published in Annals of the American Thoracic Society.

“Suicide is a significant national public health problem, especially among [people with lung cancer] and among veterans. As a result, manifestations of this impact — like social isolation, depression and anxiety — can go undiagnosed and untreated,” Donald Sullivan, MD, MA, MCR, assistant professor of medicine at Oregon Health & Science University School of Medicine and core investigator at Center to Improve Veteran Involvement in Care at Veterans Affairs Portland Health Care System, said in a press release.

Sullivan and colleagues assessed the impact of palliative care, which aims to relieve physical pain and address psychological issues, on suicide rates among 20,900 veterans diagnosed with stage IIIB or stage IV lung cancer included in the VA Central Cancer Registry.

Results showed 30 patients (0.14%) committed suicide, a rate more than five times greater than the average among all age- and sex-matched veterans who use VA health care.

Patients who received at least one palliative care visit after diagnoses were 81% less likely to die by suicide.

HemOnc Today spoke with Sullivan about why the risk for suicide among veterans with lung cancer is so great, how he and his colleagues conducted the study, the potential implications of the results, and ways clinicians can respond in their practice.

Question: Can you explain the prevalence of suicide among veterans with lung cancer?

Answer: Among patients with lung cancer in my study, it was about 210 per 100,000 person-years. In the general population, the suicide rate is about 13 per 100,000 person-years.

Q: Why is the risk so much higher in this subgroup?

A: Patients with lung cancer — compared with those who have other types of cancer — have high symptom burden, including both psychological and physical symptoms that impact their quality of life. Additionally, patients with advanced-stage lung cancer have a poor prognosis, which can spur feelings of hopelessness. There is a lot of stigma around a lung cancer diagnosis because, in most cases, it is a self-inflicted disease and patients with lung cancer tend to not share their diagnosis until the very end of life. They, therefore, do not have a lot of support.

Q: How did this study come about?

A: I am a health services outcomes researcher, and more recently I have been focusing on how to improve the quality of care among patients with lung cancer, especially in the VA. I had been looking at use of palliative care in our database and I found remarkable and unexpected results.

Q: How did you conduct the study?

A: These data — which come from a large, retrospective, observational study — were derived from a database of about 25,000 patients with advanced-stage lung cancer treated across the national VA health system from 2007 to 2013. This database was devised from a VA cancer registry, a well-validated source. I connected it with some other data registries, one of which is a suicide data repository within the VA.

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