Validation of the MASC-20 and Development of a Short Form to Assess Suicide Risk in Cancer Patients

Despite the heightened risk of suicide in cancer patients, effective tools identifying those at risk remain limited.

This study validates the multi-dimensional assessment of suicide risk in chronic illness (MASC-20) for cancer patients and examine the psychometric properties of its short-form (MASC-8).

A total of 298 patients with cancer from four teaching hospitals in South Korea completed an on-site survey, including the MASC-20, the schedule of attitudes toward hastened death-abbreviated version, Attitudes toward end-of-life interventions (e.g., euthanasia, and physician-assisted suicide), and the Hospital Anxiety and Depression scale.

The MASC-20 showed excellent reliability (α=.93), and exploratory structural equation modeling confirmed its four-factor structure (physical distress, psychological distress, social distress and suicidal behavior) with acceptable model fit (CFI=.947, RMSEA=.069). A higher-order factor correlated strongly with psychological (.98) and social distress (.91). The MASC-8 retained good reliability (α=.84) and demonstrated known group validity, differentiating clinical depression/anxiety. It also showed incremental validity, explaining additional variance in desire for hastened death (ΔR²=.10, P<.001). Using a cutoff score of 6, the MASC-8 showed good sensitivity (81.8%) and specificity (73.3%; AUC=.84), performing comparably to the MASC-20.

The MASC-20 is a valid measure of distress and suicidal behavior in patients with cancer. The MASC-8 maintains acceptable psychometric properties, offering a brief yet effective tool for suicide risk assessment in oncology settings.