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

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.