Introduction

During crucial times when you have to make informed health-related decisions, emotions, stress, and motivation can affect your thought processing and behaviour. Therefore, understanding their impact is crucial for effective intervention and implementation.¹

Cancer clinical trials and the misconceptions around suicide are two important topics that need to be carefully considered and understood.²

What is a cancer clinical trial?

Cancer clinical trials are research studies that test new ways to prevent, detect, diagnose, or treat cancer.³ These trials usually evaluate therapeutic efficiency and are conducted in several stages  to test new treatments:

• Early trial (Phase I) 
• Preliminary trial (Phase II) 
• Comparative trial (Phase III)⁴

Before partaking in a cancer clinical trial, patients sign a non-binding consent form which outlines the benefits and risks associated with joining the trial. Enrolling in a clinical trial allows cancer patients to access new treatments, be closely monitored by healthcare professionals, and contribute to research and future treatments for other patients.³ The availability of these treatments offers patients the hope of a cure.² 

Considerations and risks of cancer clinical trials

Although clinical trials are hailed as a saviour to many therapeutic dilemmas, there are several risks to be aware of. Some of these risks include the potential adverse effects of the new treatment, not receiving the therapy they want due to randomised trials, trial duration, and health insurance-related costs.³

Studies have shown that about 51.6% of patients who chose not to participate in clinical trials reported that they did not directly assess the benefits or risks. Educational level, age, employment, treatment options, insurance, and spiritual-religious beliefs were significantly associated with whether participants assessed the risks and benefits. Participants who felt more informed were more likely to have assessed the risks and benefits at enrollment.⁵ 

Without going over the risks and benefits, patients may rely on misconceptions about cancer clinical trials to make their decisions. Many participants may fear, for the purpose of research, that they may be assigned to less-than-optimal therapy or that their care will be carried out in a sterile, scientific atmosphere that is inhuman and impersonal.² To ensure that patients make informed decisions rather than those based on misconceptions, it is recommended that they consult with a healthcare professional. This will ensure that the patient understands the trial protocols.⁶

The relation between cancer and suicide

Suicide continues to be one of the most controversial topics in our society, surrounded by stigma and silence.⁷ The stigma surrounding suicide negatively influences attempts to prevent it by making it difficult for people to get assistance and for communities to offer sufficient support. 

Addressing the misconceptions about suicide, specifically in cancer patients, will encourage understanding, support, and create a more compassionate and proactive approach to improving suicide prevention.⁸

Common myths about suicide in cancer patients

1. Cancer patients don’t think about suicide because they’re focused on survival
2. Suicidal thoughts are a symptom of cancer
3. Enrolling in a clinical trial gives patients hope for a cure, thus, preventing suicidal thoughts

Addressing and dispelling myths

According to numerous studies, the risk of suicide is at least twice that of the general population and is highest after diagnosis.⁹ Prevalence of suicidal ideation (SI) in cancer patients ranges from 0.7% to 46.3% due to psychological distress.^10,11 Although there’s confusion on whether this distress is due to a desire to escape extreme pain, or the desire to speed up death, evidence shows that cancer patients think about suicide.⁹  

Patients with head and neck cancers have higher depression scores than the general population, even before receiving a cancer diagnosis. This raises the possibility that these patients, who are also dealing with symptoms related to their diagnosis, may have a biological cause that increases their risk of suicide.⁹ 

Patients enrolled in clinical trials do hope for a cure. However, many participants worry that they may receive poorer therapy or that their treatment will not feature the support or care that they need.² These reasons may cause intense psychological distress that outweighs the therapeutic benefits. A cancer diagnosis, along with the risks of participating in a clinical trial, can have a profound psychological effect on patients.²

Role of society in preventing suicide in cancer patients

Finding the best methods to screen for suicidal ideation and assess risk is one of the main issues in suicide prevention. 

Very little information has been collected regarding formal suicide risk assessment in cancer patients.¹² Research shows that 20% of health care providers did not feel adequately prepared to ask about suicidality or to provide support and resources to patients, and they underestimated the patient’s suicide risk.¹²  Physicians and nurses often fail to ask oncology patients about depression. Depressed patients typically only report physical symptoms, minimising their depression and SI.¹² 

80% of suicidal individuals requested improved treatment for their medical symptoms before committing suicide, yet the risk was not identified. Healthcare professionals should be able to identify and evaluate any indications of suicide risk and determine a patient’s lethality.¹²

Another key role that society can play in preventing suicide among cancer patients is providing a supportive and non-judgmental environment. Cancer patients often face significant emotional and psychological challenges as they cope with their diagnosis and treatment.   Feeling isolated, stigmatised, or misunderstood can aggravate these challenges and increase the risk of suicidal thoughts or behaviours.¹³ 

By raising awareness and empathy towards the mental health struggles of cancer patients, society can help create a more compassionate and understanding environment for them. This can involve educating the public about the realities of cancer and mental health, challenging harmful stereotypes or misconceptions, and encouraging open dialogue about these issues.  Providing accessible mental health resources and support services specifically tailored to the needs of cancer patients can also be instrumental in suicide prevention.¹³ 

Therefore, the role of society is to ensure that no cancer patient feels alone or unsupported in their journey. By demonstrating care, empathy, and a willingness to listen and provide assistance, society can play a vital part in helping cancer patients navigate the emotional complexities of their illness and reduce the risk of suicide.¹³

Summary

Cancer clinical trials test new ways to prevent, detect, diagnose, or treat cancer. Patients sign a consent form outlining the benefits and risks of participating. The benefits include accessing new treatments, close monitoring, and contributing to research. Risks include potential adverse effects, not receiving the desired therapy, time commitment, and insurance-related costs. Many patients do not fully assess the risks and benefits, relying on misconceptions about clinical trials. Suicide is a controversial and stigmatised topic, making it difficult for people to get the required help. Research shows that the risk of suicide in cancer patients is at least twice that of the general population, especially after diagnosis. Despite providing hope for a potential cure, enrolling in a clinical trial may not prevent suicidal thoughts. Therefore, providing a supportive and non-judgmental environment is crucial, as cancer patients face significant emotional and psychological challenges. Raising awareness, challenging harmful stereotypes, and providing accessible mental health resources can help create a more compassionate and understanding environment for cancer patients.