Suicide Prevention in Cancer Survivorship: A Mixed-Methods Study of Veteran Cancer Survivors

About This Grant

Background: Cancer incidence among Veterans is higher than in the general population; this may be due in part to carcinogenic occupational exposures (e.g., jet fuel, deployment burn pits). As early cancer detection and treatment improve, mortality declines and the number of cancer survivors increases. There are currently an estimated 18 million cancer survivors living in the US, approximately 450,000 of whom receive care through the Veterans Health Administration (VHA). In the general population, cancer survivors are at elevated risk for experiencing suicidal ideation and are more than three times as likely to die by suicide compared to those with no history of cancer. However, there is a dearth of research on suicidal thoughts and behaviors among Veteran cancer survivors, despite the fact that Veterans, overall, are at elevated risk for suicide. Significance/Impact: More than 50,000 Veterans are diagnosed with and treated for cancer in VHA every year, and this number is expected to increase given the recent passage of the PACT Act. Current clinical recommendations from the National Comprehensive Cancer Network suggest that cancer survivors entering survivorship (i.e., the period of time from the end of treatment to the end of life) should be monitored and assessed for psychological distress and mental health disorders, including anxiety and depression. Currently, VHA does not a have a centralized program or guidance to support psychosocial needs of cancer survivors as they transition out of treatment and into survivorship. The transition from active treatment to survivorship may pose significant mental health challenges as cancer survivors adjust to lasting physical and psychosocial effects of cancer and its treatment. Thus, understanding the unique needs of these individuals as they transition is vital to provide whole health care. The proposed project aims to better understand the unique experiences of Veteran cancer survivors who were treated with curative intent and are transitioning into survivorship in order to inform cancer survivorship care and upstream suicide prevention efforts for cancer survivors. This project aligns with the following HSR research priorities: Data Science, Suicide Prevention, Mental Health, Whole Health, and Complex Chronic Disease Management. Innovation: To date, few studies have examined suicidal thoughts and behaviors in Veteran cancer survivors, and none have focused specifically on the transition into the survivorship. The proposed project thus utilizes an exploratory sequential mixed-methods approach to examine the experiences of Veteran cancer survivors receiving care through VHA and identify potential risk and protective factors for suicide in this population. Specific Aims: In a national sample of Veteran cancer survivors who completed VHA cancer treatment with curative intent within the past two years (1) Describe Veteran cancer survivors’ experiences with VHA cancer survivorship care and with suicidal thoughts and behaviors during cancer survivorship, and identify potential risk and protective factors for suicidal ideation (SI) and suicide attempts (SA), as well as suicide prevention opportunities and preferences during the cancer survivorship period; (2a) Estimate the prevalence of post-treatment SI and SA; (2b) Stratify prevalence by demographic and cancer-related factors; (3a) Estimate associations between physical and mental health, and social support, with SI/SA; and (3b) Explore differences in psychosocial factors for those that experience post- treatment SI vs SA. Methodology: Qualitative interviews will be conducted with Veteran cancer survivors who completed treatment with curative intent through VHA within the past two years. Interviews findings will inform development of a national survey of 1,000 Veteran cancer survivors who are within two years of treatment completion. This survey will assess history of SI and SA as well as psychosocial factors which may drive SI/SA. Survey responses will be linked to VHA cancer registry data to examine cancer- and treatment-related risk factors for SI and SA during survivorship. Next Steps/Implementation: The results of this project will be leveraged to inform the integration of upstream suicide prevention within VHA cancer survivorship care.