The bond between young adult cancer patients and their physicians appears to be a critically important factor in preventing thoughts of suicide, new research from Weill Cornell suggests.
Cancer patients have a suicide rate that is twice that of the general population. Young adult patients with advanced disease may be at even higher risk, said Dr. Holly Prigerson, the study's senior author who was recruited to Weill Cornell as the Irving Sherwood Wright Professor in Geriatrics.
Researchers interviewed 93 patients ages 20-40 with incurable, recurrent, or metastatic cancer about their mental health and their relationships with their oncologists. The results were published May 28 in Cancer.
"What was most astounding in this paper was that when we controlled for all the usual confounding factors that might explain away the relationship, the perceived bond with their oncologist was the most important element predicting patients' degree of suicidal ideation,"or thoughts of suicide, Dr. Prigerson said.
Working with lead author Dr. Kelly Trevino, the investigators then compared the effect of a strong perceived bond between young cancer patients and their oncologists with a number of other interventions that also might affect thoughts of suicide, including psychotherapy, palliative care, antidepressants and treatments for pain.
"None of those things mattered as much as their perceived bond with their oncologist,"Dr. Prigerson said.
Dr. Prigerson described the patient-oncologist bond as a "therapeutic alliance,"a term used in psychotherapy to reflect the patient's perception that the doctor "has their back, sees them as a whole person, and will work collaboratively with them toward shared goals of care.”
However, oncologists, who are already charged with treating patients with serious, potentially life-limiting illnesses, may view emotional caregiving as the responsibility of a psychologist or a patient's family, she said.
"We are not saying oncologists need to become psychotherapists, but we are saying that they should acknowledge their role in shaping how the patient feels and copes with having cancer,"Dr. Prigerson said.
"Rational or not, many patients are concerned that their oncologist will abandon them if they fail to respond to treatment and their illness progresses,"she said. She suggested that even "emotional check-ins"like letting patients know that they should feel comfortable asking questions, or that failing treatment is not their fault, go a long way toward establishing a strong therapeutic alliance.