By Christina Austin-Valere, PhD, LCSW

Today, there are more individuals living with cancer and struggling with increased risk of emotional distress, mood disorders and suicide. Current research has shown that suicide risk among individuals with cancer is twice that of the general population.

According to the American Cancer Society’s (ACS) 2025 annual report, cancer remains a significant public health concern and is the second leading cause of death in the U.S. ACS also projected that approximately 2,000,000 new cancer cases will be diagnosed, excluding non-melanoma skin cancers, and more than 618,000 cancer-related deaths will occur in the U.S. in 2025.

It’s also important to note that suicide is rated as the eleventh leading cause of death overall across all ages in the U.S. Suicide rates reportedly increased approximately 36% between the years 2000–2022. Suicide was responsible for nearly 50,000 deaths in 2023, which is about one death every 11 minutes.  The number of people who experienced suicidal thoughts or attempted suicide is even higher. In 2022, an estimated 12.8 million adults seriously thought about suicide, 3.7 million planned a suicide attempt, and 1.5 million attempted suicide. About 45% of individuals with a behavioral health diagnosis did not seek treatment and many individuals, who died by suicide had either seen a healthcare provider within that week or last month of their lives (Centers for Disease Control and Prevention, 2025).  In this article, we will explore available evidence-based methods in screening, assessing, preventing, intervening and treating patients, who present with suicide risk during their cancer care. Finally, ending with a call to action within our profession to, systematically, integrate evidence-based interventions, treatments and behavioral health resources to aid in the prevention and/or reduction of suicide rates in cancer care.

Risk Factors

A cancer diagnosis brings with it a myriad of biopsychosocial issues creating elevated distress, which can lead to despair, creating an increased suicide risk particularly during the initial period following a cancer diagnosis. From a behavioral health viewpoint, suicide risk includes higher levels of emotional distress, adjustment disorders, anxiety and depression and a substance use disorder, preexisting history of a behavioral health disorder, and/or a previous suicide attempt, which can be recent or lifetime.

Common factors, also noted in the general population, were male sex, white race, age 65 and older, unmarried and single, financial concerns, unemployment, lack of or insufficient housing and lower socioeconomic issues, which were also noted to increase suicide risks.

Patients diagnosed with certain cancer disease sites such as head and neck, pancreas, lung and bronchus tend to have a higher risk than other malignancies. The associated reasons may be severity of the disease, advanced stage at diagnosis, poor prognosis, and symptom burden from treatment. Other cancer specific factors such as time to diagnosis and cancer-related and non-cancer-related pain increased suicide risk in cancer patients. Adult survivors of childhood cancers also had a higher suicide risk related to lifelong pain, poor quality of life, physical disability or disfigurement (Barnes, Johnson, Grove, Srivastava Osazuwa-Peters & Perkins, 2022).

Screening Tools

Cancer centers have changed screening practices in response to current research findings about cancer and increased suicide risk. Practices now include screening all patients undergoing treatment. Hospitals accredited by The Joint Commission (JC) were also required to be compliant with the July 2019 revision of its National Patient Safety Goal (NPSG) on suicide prevention (NPSG, 15.01.01). The national requirement for JC accredited hospitals, including their outpatient departments, was to screen all patients for suicide. The majority of cancer centers initiated systematic policies and protocols for suicide screening in hospital-based outpatient radiation and infusion centers as well as any affiliated freestanding cancer programs. The change meant that there is some uniformity in the evidenced-based tools that are effective and measurable, which providers and practitioners can utilize in this effort including:

• Columbia Suicide Severity Rating Scale (C-SSRS)
• Patient Health Questionnaire -9 (PHQ-9)
• Ask Suicide-Screening Questions (ASQ)
• Computerized Adaptive Screen for Suicidal Youth (CASSY)
• Patient Safety Screener-3 (PSS-3)
• SAD PERSON
• The Beck Scale for Suicide Ideation (BSI) was one of the earlier suicide screening tool that dated back to the 1980s and 1990s in certain cancer centers is also noteworthy.

Intervention and Treatment

In an effort to decrease suicide risk among individuals with cancer, the focus on reducing the emotional distress, addressing mood dysregulation, treating adjustment disorders, such as anxiety and depression, and assessing for a substance use disorder and/or other preexisting behavioral health diagnoses in patients with cancer is critical.

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Acceptance and Commitment Therapy (ACT)
• Mindfulness Based Stress Reduction (MBSR)
• Trauma-based Cognitive Behavioral Therapy (TF-CBT)
• Meaning Centered Psychotherapy (MCP)
• Strengths-Based Therapy (SBT)
• Solution Focused Therapy (FST)
• Integrative Medicines for relaxation (i.e., yoga, massage therapy, meditation, acupuncture)

Call to Action

Let us be consistent in our approach to our patients, families and caregivers in showing compassion and intentionality which address their stressors and give them a space to share their fears, worries and feelings of hopelessness so we can intervene with early support. Suicide is a permanent solution to life’s circumstances and pain that we can address in the short-term with support!

• Continue universal suicide screening of all our patients – from newly-diagnosed to survivors
• Be aware of the specific cancers and timelines in which the risk of suicide is more elevated and intervene accordingly.
• Conduct a comprehensive clinical psychosocial assessment.
• Be inclusive of the physical concerns (i.e., pain, sexual health, disfigurement and other disabilities related to patients’ diagnosis, treatment and symptom burden to name a few).
• Be knowledgeable about triaging for a higher level of care as elevated risk is assessed.
• Routinely provide our patients with emergency behavioral health resources (i.e., 988 Suicide and Crisis Lifeline – https://988lifeline.org/ and other local crisis contacts).
• Connect or refer patients to other needed psychosocial resources.

If you’d like to connect with me on this topic, please email me at Christina.Austin-Valere@northside.com.