From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom \ud \ud Corresponding author: Jane Walker, 8th floor, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, United Kingdom EH10 5HF; e-mail: firstname.lastname@example.org\ud \ud Purpose Cancer is associated with an increased risk of suicide and attempted suicide. However, we do not know how many cancer patients have thoughts that they would be better off dead or thoughts of hurting themselves. This study aimed to determine the prevalence of such thoughts in cancer outpatients and which patients are most likely to have them. \ud \ud Patients and Methods A survey of consecutive patients who attended the outpatient clinics of a regional cancer center in Edinburgh, United Kingdom. Patients completed the Patient Health Questionnaire-9 (PHQ-9), which included Item 9 that asks patients if they have had thoughts of being better off dead or of hurting themselves in some way in the previous 2 weeks. Those who reported having had such thoughts for at least several days in this period were labeled as positive responders. Patients also completed the Hospital Anxiety and Depression Scale (HADS) and a pain scale. The participating patients’ cancer diagnoses and treatments were obtained from the cancer center clinical database. \ud \ud Results Data were available on 2,924 patients; 7.8% (229 of 2,924; 95% CI, 6.9% to 8.9%) were positive responders. Clinically significant emotional distress, substantial pain, and—to a lesser extent—older age, were associated with a positive response. There was strong evidence of interactions between these effects, and emotional distress played the most important role. \ud \ud Conclusion A substantial number of cancer outpatients report thoughts that they would be better off dead or thoughts of hurting themselves. Management of emotional distress and pain should be a central aspect of cancer care
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