J Pain Symptom Manage. 2025 Jun 6:S0885-3924(25)00670-0. doi: 10.1016/j.jpainsymman.2025.06.001. Online ahead of print.
ABSTRACT
CONTEXT: Despite the heightened risk of suicide in cancer patients, effective tools identifying those at risk remain limited.
OBJECTIVES: 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).
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
PMID:40484358 | DOI:10.1016/j.jpainsymman.2025.06.001
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