癌症病人自殺流行病學綜合性論述

Comprehensive interpretations of epidemiology of suicide among cancer patients

癌症多變性的衝擊以及死亡威脅所產生的心理壓力，促使癌症病人有相對較高的自殺風險，但其流行病學、危險因子、自殺的時間點、不同癌症與自殺間的關係、自殺防治並無統一整理論述，因此本文藉由分析整理國、內外癌症病人自殺相關之研究資料，歸納釐清並探討導致癌症病人自殺的可能原因和機制，期望進一步將防治工作推展至臨床工作，降低癌症自殺率。經文獻整理得知在癌症確診後、癌症診斷初期、癌症遠端轉移與預後差、影響生活品質或功能之癌症有較高的自殺風險，且當身體功能障礙、合併憂鬱症與物質濫用者、失去獨立性與自主權、中老年、男性、失業、低收入、未婚、離婚、鰥寡者亦是癌症病人高風險的自殺因子，此外，不安全的就醫環境、不當的醫療評估、未適當培訓管理照護人員，無法辨識潛在的自殺隱憂，因此如何有效評估高危險癌症自殺族群與進行防治工作是照護過程甚為重要的課題。本文結果有助於提高臨床照護過程癌症病人自殺防治的敏感度，於診治過程利用自殺風險篩選工具即早確診病人心理層面的問題，即時提供預防措施，創造安全就醫環境，促進醫護團隊與癌症病人有效溝通。

Psychological stress as the result of the impact of varieties of cancer and death threat leads to a relatively higher risk of suicide completion among cancer patients. Nevertheless, unified and comprehensive interpretations concerning relevant epidemiology, risk factors, time point of suicidal behavior, the relationship between different cancers and suicidal behavior, and suicide prevention remain scarce. With the analysis of previous studies about cancer patients' suicidal behavior, the current study probed into potential reasons and mechanism leading to suicidal behavior among cancer patients, hoping to upgrade relevant preventions to clinical fields and lower the cancer-related suicide rate. The results revealed that upon confirmation of cancers, higher risks of suicide existed in conditions as getting close to the initial diagnosis, metastasis, poor prognosis, or suffering from cancers that affected quality of life and functions. High suicidal factors were also found among cancer patients with physical disabilities, comorbid depression and substance use, loss of independence and decision-making power, middle-aged people, male, unemployed, having low income, single, divorced, widower/widow. Moreover, unsafe medical environments, inappropriate medical assessment, insufficient training of caretakers, and inability to identify potential suicide problems were also major challenges. Therefore, effective assessment of cancer patients with high suicide risk and relevant prevention has been vital in the care process. The results of the current study help enhance the sensitivity to suicide prevention in the clinical process of taking care of cancer patients, with suicide risk screening employed to have a timely confirmation of the patients' psychological issues, to provide prompt prevention measures, to create safe medical environments, and to enhance effective communication between the medical team and cancer patients.