Psychological Distress and Suicide Correlated with Long-Life Expectancy in Advanced Cancer Patients

OBJECTIVE Advances in systemic therapy together with better diagnostic and surgical techniques have contributing to survival improvement of many tumor types. Patients with cancer have an increased risk of suicide and the psychological impact of cancer is due the diagnosis itself, side effects of the therapy and cancer-related symptoms. METHOD The purpose of this study is to present the clinical case of an advanced gastrointestinal stromal tumor patient who committed suicide after 6 years of treatment. RESULT A 49-years-old male with a history positive only for an anxiety-depressive disorder was diagnosed with a locally advanced gastrointestinal stromal tumor. After 6 months of neoadjuvant imatinib, with stable disease, the patients decided to undergo surgery, with the subsequent resumption of adjuvant imatinib. Once the patient experienced disease progression, he preferred a surgical approach, even though he was aware that surgery was not the standard treatment and that a second-line systemic therapy was recommended. When the start of a second line therapy was the only possible treatment option, the patient has resigned himself to the idea that he would never be able to heal from cancer. After few months of second-line therapy he died of suicideSIGNIFICANCE OF RESULTS This case report shows that suicidality in cancer patients is a continuum spectrum from wanting to live, through the decreasing will to live, the readiness to die and then actively ending one’s life. Multidisciplinary teams should focus their attention not only on the disease itself but also on the cancer-related long-term psychological distress. Therefore, patient palliative care on psychological aspects should be improved strengthening psycho-social interventions during the entire cancer treatment history, not only at the end of life.