Recklitis C.J., Zhou E.S., Zwemer E.K., Hu J.C., Kantoff P.W.
Cancer 2014 120:21 (3393-3400)
BACKGROUND Epidemiological studies have shown prostate cancer (PC) survivors are at an increased risk of suicide compared with the general population, but to the authors’ knowledge very little is known regarding what factors are associated with this increased risk. The current study examined the prevalence of suicidal ideation (SI) and its association with cancer treatment and posttreatment physical and emotional health in a cohort of long-term PC survivors. METHODS A total of 693 PC survivors (3-8 years after diagnosis) completed a mailed survey on physical and psychological functioning, including cancer treatments, the Short Form-12 (SF-12), the Expanded Prostate Cancer Index Composite Instrument (EPIC-26), a depression rating scale, and 8 items regarding recent suicidal thoughts and behaviors. RESULTS A total of 86 PC survivors (12.4%) endorsed SI, with 10 individuals (1.4%) reporting serious SI. Serious SI was more common in this sample compared with age-adjusted and sex-adjusted normative data. SI was not associated with most demographic variables, or with PC stage or treatments. However, SI was found to be significantly associated with employment status, poor physical and emotional functioning, greater symptom burden on the EPIC-26, higher frequency of significant pain, and clinically significant depression (P<.01). In an adjusted logistic model, poor physical and emotional function, including disability status and pain, were found to be associated with SI (P<.05), even after adjusting for depression. CONCLUSIONS A significant percentage of PC survivors report recent SI, which is associated with both physical and psychological dysfunction, but not PC treatments. The results of the current study help to explain the increased risk of suicide previously reported in PC survivors and have important implications for identifying and treating those survivors at greatest risk of suicidality.