Palliative care reduces suicide risk among veterans with lung cancer
Palliative care appeared to reduce the risk for suicide among veterans with advanced lung cancer, according to findings presented at the American Thoracic Society International Conference.
“Suicide is a significant national public health problem, especially among lung cancer patients and among veterans,” Donald R. Sullivan, MD, MA, assistant professor of medicine at Oregon Health & Science University, said in a press release. “We wanted to see if palliative care, which has been shown to improve quality of life, reduced suicides among veterans with stage IIIb and IV lung cancer.”
The researchers reviewed health care information about patients in the VA health care system diagnosed with advanced lung cancer between 2007 and 2013.
Researchers used VA inpatient, outpatient and fee-basis encounter data, as well as data from the Central Cancer Registry and the Suicide Data Repository. Researchers considered suicide to be the cause of death for records listed as ICD9-CM (E950.x) or ICD10-CM (X60-X84) and defined receipt of palliative care as a documented specialty palliative care encounter following lung cancer diagnosis.
Among 20,900 patients with lung cancer, 87% had lung cancer listed as the cause of death. Other common causes included other cancers, heart disease and COPD.
A total of 30 deaths were attributed to suicide, yielding an overall rate of 200 per 100,000 patient-years. This represented more than a fivefold increase compared with the overall suicide rate among other veterans who use VA health care after adjustment for age, sex and year (37.5 per 100,000 patient-years).
Palliative care visits occurred for 20% of patients (n = 6) who died of suicide compared with 57% who died of other causes. Palliative care appeared associated with an 82% reduced likelihood of suicide (OR = 0.18; 95% CI, 0.07-0.46).
Although several groups recommend palliative care for patients with advanced lung cancer, Sullivan noted that this does not always translate into practice.
“There are many barriers to palliative care and, unfortunately, some are related to clinician referrals,” Sullivan said. “Not all doctors are aware of the benefits of palliative care. I think the VA is doing a better job than other health care systems, but there is still room for improvement. The risk [for] suicide is underappreciated among cancer patients, especially those with advanced-stage disease. This study shows another potential benefit of palliative care among [patients with lung cancer].” – by Andy Polhamus
Sullivan D, et al. Abstract 8371. Presented at: American Thoracic Society Annual Meeting; May 18-23, 2018; San Diego.
Disclosures: Sullivan reports no relevant financial disclosures. One author reports providing expert testimony for Keating Jones Hughes.