In this episode recorded at the 2026 American Psychosocial Oncology Society (APOS) annual meeting, Daniel C. McFarland, DO, sat down with Kelly Irwin, MD, to address one of the most challenging topics in oncology: suicide risk. The conversation aimed to equip oncologists with the tools and confidence to navigate the emotional complexities of cancer care.

Key Discussion Points:

Understanding the Risk: Patients with cancer experience more than double the risk of completed suicide compared with the general population. The risk is highest during the first month following a diagnosis—a 12-fold increase in some studies—and remains elevated for the first year.
Identifying High-Risk Factors: Beyond a prior suicide attempt (the No.1 risk factor), specific contributors include advanced-stage disease, financial distress, and cancers that impact core identity or physical function, such as head and neck or pancreatic cancers.
The Power of Asking: Both experts emphasized that a clinician asking about suicide does not increase the risk. Irwin advises clinicians to trust their instincts and use a continuum of questioning, starting with general feelings of hopelessness and moving toward specific plans and access to "means" (such as firearms or medication).
The "Don’t Worry Alone" Rule: Irwin urged clinicians never to handle these concerns in isolation. She recommended involving social workers, nurses, and family members, noting that in life-threatening situations, clinician-patient confidentiality (HIPAA) can be "broken" to ensure safety.
Relieving Suffering and Building Connection: The primary goal is to make the "unbearable bearable". Irwin highlighted that even small, non-transactional gestures—like a "thinking of you" message—can significantly decrease suicide risk by reinforcing a patient's sense of belonging and mattering.

Available Resources:

· National Mental Health Hotline: Call or text 988

· Connect with a crisis counselor: Text HOME to 741741

· Samaritans Hotline and Website: (877)870-4673; https://samaritanshope.org/our-services/24-7-helpline/

McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer, in addition to being a psycho-oncology editorial advisory board member for the journal ONCOLOGY®. Irwin is an instructor in psychiatry at Harvard Medical School and a faculty psychiatrist at the Massachusetts General Hospital (MGH) Cancer Center and MGH Schizophrenia Program, where she founded the Cancer Prevention Program.

S1 Ep208: Cancer and Suicide: Identifying Risk Factors and Providing Support