Can oncologists reduce the risk of suicide in their prostate cancer patients?

SAN DIEGO – Whether due to side effects of local and systemic therapies or the diagnosis itself, men with prostate cancer are at increased risk for mental distress and suicide.

The mental health burden associated with diagnosis and treatment is significant, Zachary Klaassen, MD, of Augusta University’s Georgia Cancer Center, pointed out during a session of the Society of Urologic Oncology’s annual meeting.

For example, Klaassen referenced a population-based study of approximately 50,000 older men with prostate cancer, which found that 20% developed mental illness over a 55-month follow-up period.

In addition, he noted, studies have indicated that the administration of systemic therapy, such as androgen deprivation therapy (ADT), can have serious implications for the mental health of patients with AD. a localized and advanced disease. A study in The oncologist found that of more than 37,000 men with prostate cancer treated with ADT, 11% received a new diagnosis of depression or anxiety within a median of 9.3 months of starting ADT .

“Only 50% of these men received treatment for their depression or anxiety,” Klaassen said.

As for the question of suicide risk, a study co-signed by Klaassen in Cancer discovered 2,268 suicides among 1.2 million people with genitourinary cancers from 1988 to 2010. Risk factors included white race, male gender, advanced age and distant disease.

“What’s particularly interesting is that if we disentangle the prostate cancer data, even 15 years after diagnosis, the standardized mortality rate was 1.84 compared to the general population,” said Klaassen. “It really lends to the fact that these men are going to be at high risk even years and years after their diagnosis.”

So how can oncologists help reduce these risks in their prostate cancer patients?

“It’s not easy to talk about it — there are definite barriers to identifying suicidality,” Klaassen said.

He cited a 2018 study in Psycho-oncology which found that a majority of oncologists and nurses caring for cancer patients reported at least one patient who had had suicidal thoughts or died by suicide during their career.

The 61 oncology healthcare professionals surveyed said there were a number of barriers to identifying suicide risk, including:

• Difficulty differentiating between suicidality and mental distress
• Patients gave no warning or hidden suicidal
• A fear of asking about suicidality
• A lack of coping resources and training to deal with suicidal patients

“One of the main things I see in our clinics is our lack of time,” Klaassen said. “The benefit of this study in identifying suicidal risk is to be attentive to verbal cues, to look for explicit actions in our patients, to pay attention to their history of mental health disorders…and to be really attentive to acute mental health.”

One way to do this, he said, is to use the National Comprehensive Cancer Network’s Distress Thermometer, a scale of 0 to 10 (none to extreme) in which patients indicate their level of distress over the course of the week before the assessment.

Be on the lookout for depression, mental illness and suicidal ideation in patients, Klaassen said. “It should be easy to do this with the Mental Stress Thermometer and by training your staff to understand what it is, administer it and bring it to your attention if they see a signal with a score of 3. or more.”

“We’re all prostate cancer doctors here,” he said. “Your job is to treat prostate cancer as best you can, but refer to your fellow urologists who deal with sexual issues and urinary incontinence, because it is in this localized state that they are going to have their issues. And make friends with your psycho-oncology team at the same time.”

Klaassen noted that he works closely with a multidisciplinary team that includes a psycho-oncologist and a sexual medicine oncologist “who are very important in this prostate cancer journey.”

“At this point between biopsy and treatment, we offer [patients] a visit with these two doctors to discuss the side effects of the treatment and the mental stress, and then we give them that opportunity again after their primary treatment,” Klaassen said. “Don’t be afraid to make appropriate referrals, and sometimes they can be urgent, to psycho-oncology or psychiatry teams.”

If you or someone you know is having suicidal thoughts, please call 988 Suicide & Crisis Lifeline.