Root-Cause Analysis Reveals Better Recognition of Cancer-Related Suicide Triggers Is Needed

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Analysis of the RCAs revealed several root causes of cancer-related suicide that could be improved.
Analysis of the RCAs revealed several root causes of cancer-related suicide that could be improved.

Recognizing and addressing various factors may help to mitigate the risk of cancer-related suicide, according to study findings published in Psycho-Oncology.

Although patients with cancer have a higher risk of psychological symptoms and distress, most cancer-related research is dedicated to cure or management. Previous studies have suggested that these patients have a 60% increased risk of suicide, but only a few studies have investigated health system or organizational factors that can be tapped to address mental health in this population. 

For this study, researchers analyzed 64 Root Cause Analyses (RCA) — a method of evaluating medical errors and root causes that focuses on factors of systematic and organizational origin — of cancer-related suicides from the Veterans Health Administration National Center for Patient Safety RCA database. Selected suicide cases occurred between initial diagnosis and 5 years of follow-up, a period in which the risk of suicide is the highest. All cases were men aged 60 to 69 years.

Of the selected cases, 44% (28) of suicide cases occurred during palliative therapy; prostate and lung cancer were the most common primary cancer types, and the most common method of suicide was by firearm. The majority of suicides (67%; n = 43) occurred within 7 days of a medical visit, particularly after the first 24 hours (41%; n = 26). 

Common risk factors included depression (59%; n = 38), medical comorbidities (59%; n = 38), and pain (47%; n = 30). 

Further analysis of the RCAs revealed that root causes that could be improved are recognition of triggers to assess for distress, communication problems, response to mental health problems, mental health treatment, and pain. 

Based on their findings, the researchers recommend using “comprehensive cancer centers and case managers for improved coordination of patient centered care, and referral to the NCCN Distress Management and Adult Cancer Pain Guidelines to ensure patients receive the highest quality of care and achieve the highest quality of life.”


Aboumrad M, Shiner B, Riblet N, Mills PD, Watts BV. Factors contributing to cancer-related suicide: a study of root-cause analysis reports[published online July 18, 2018]. Psych Onc. doi: 10.1002/pon.4815

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