[Suicidal crisis in oncology: assessment and care]

Patients with advanced cancer often experience with physical impairment and loss of autonomy sometimes preceding inexorable death. It is that can emerge Suicidal ideation occasionally associated with suicidal attempt can arise in this particular context but also following the initial diagnostic talk and during all the stages of the disease. The risk is often considered twice higher in this patients'group compared to the general population and increases with advanced stages of the disease. Among patients with cancer, suicidal crisis can be expressed as part of a request for euthanasia, physician-assisted suicide and para suicide behaviors. Clues can help the clinician to identify early these vulnerable patients. Therefore, suicidal situations can emerge in the particular context of physical impairment, poor quality of life and poor control of physical symptoms (such as pain, tumoral localization in particular lung, head and neck, pancreas). The association of hopelessness and helplessness and a loss of control of the situation are strongly correlated with the expression of suicidal ideations. The presence of a confusional or psychomotor disinhibition with hallucinations, irrational thoughts and the absence of a libidinal object of investment have also to be taken into account. This suicidal crisis can be considered as a way for the patient to escape an intolerable situation (uncontrolled pain or other symptoms) and maintain self-control and decisional autonomy. Management of suicidal crisis in patients with cancer includes careful attention and legitimization of the patient's distress without inducing any guilt. Appropriate control of physical symptoms is warranted including screening and treating any mood disorder or any organic mental disorder. Treating associated anxiety and making sure that the patient's safety is under control are essential. Last but not the least, involving the whole treatment team is key in preventing transformation of the suicidal crisis into institutional crisis.