In the Journals

Suicide risk significantly higher within 1 year of cancer diagnosis

The risk for suicide among patients with cancer rises significantly in the first year after diagnosis compared with the general population, according to a retrospective study published in Cancer.

The highest increases in risk for suicide occurred among patients diagnosed with pancreatic cancer or lung cancer.

However, results did not show a significant increase in risk among patients diagnosed with breast cancer or prostate cancer.

“It’s important that mental health care becomes an integral part of cancer care as this study shows that for some patients with cancer, it’s the emotional aspect of the disease that will lead to fatality,” Hesham M. Hamoda, MD, MPH, attending psychiatrist in the department of psychiatry at Boston Children’s Hospital and assistant professor in psychiatry at Harvard Medical School, told HemOnc Today. “It’s also important that mental health care be imbedded within oncology teams and support be provided early after the diagnosis. Our study reveals that risk for suicide is the highest in the first few months. If we wait for people to be screened and referred to mental health services lives can be lost in the process.”

Researchers used the SEER database to analyze 4,671,989 patients with cancer diagnosed between 2000 and 2014 to evaluate how many died by suicide within the first year after diagnosis, whether any specific types of cancers correlated to a higher rate of suicide, and whether the rate of suicide was higher among those with cancer than the general population.

Results showed that 1,585 of the patients committed suicide within the first year after diagnosis. These data represented a significant increase compared with the general population, with a 2.52 (95% CI, 2.39-2.64) observed/expected (O/E) ratio and excess risk of 2.51 per 10,000 person-years.

Of the 1,585 patients, 1,062 died by suicide within the first 6 months of diagnosis. Men died by suicide within the first year (n = 1,379; O/E, 2.66; 95% CI, 2.52-2.8) at a much higher rate than women (n = 206; O/E, 1.86; 95% CI, 1.61-2.13). However, the suicide risk became higher among women (O/E, 3.4) than men (O/E, 2.68) in the group of patients aged 84 years or older.

“We did find that the majority of suicides in this sample where in males. This is not different than the general population,” Hamoda said. “According to the American Association for Suicide Prevention, in 2017 men died by suicide 3.54-times more often than women. We know that women are, in general, more likely to seek mental health care compared with men, but this study didn’t look at that.”

The highest increases in the O/E ratio came after a diagnosis of pancreatic cancer (8.01; 95% CI, 6.29-10.06) and lung cancer (6.05; 95% CI, 5.42-6.72). Researchers also observed a significant increase after a colorectal cancer diagnosis (2.08; 95% CI, 1.74-2.47).

The risk for suicide did not increase significantly after a breast cancer or prostate cancer diagnosis.

Researchers wrote that the most likely reasons for suicide included anxiety and depression among patients. For example, patients with a smoking history tend to feel guilt after a cancer diagnosis, and patients with head and neck cancers may experience disfigurement as a result of the treatment. Anxiety over medical costs is also likely to play a role, researchers wrote.

Limitations to the study included its retrospective nature and a lack of data in the SEER database on rates of anxiety and depression after cancer diagnosis.

“Awareness among providers to screen for suicide risk and refer to mental health services is important for mitigating such risk and saving lives, especially within the first 6 months after diagnosis,” Ahmad Samir Alfaar, MD, MBBCh, MSc, researcher at Charité Hospital of University of Berlin, said in a press release. “Moreover, family members and caregivers must be trained to provide psychological support for their ill relatives.” – by John DeRosier

For more information:

Hesham M. Hamoda, MD, MPH, can be reached at Boston Children’s Hospital, Department of Psychiatry. 300 Longwood Ave., Fegan, 8th Floor Boston, Massachusetts 02115, email: hesham.hamoda@childrens.harvard.edu.

Disclosures: The authors report no relevant financial disclosures.

The risk for suicide among patients with cancer rises significantly in the first year after diagnosis compared with the general population, according to a retrospective study published in Cancer.

The highest increases in risk for suicide occurred among patients diagnosed with pancreatic cancer or lung cancer.

However, results did not show a significant increase in risk among patients diagnosed with breast cancer or prostate cancer.

“It’s important that mental health care becomes an integral part of cancer care as this study shows that for some patients with cancer, it’s the emotional aspect of the disease that will lead to fatality,” Hesham M. Hamoda, MD, MPH, attending psychiatrist in the department of psychiatry at Boston Children’s Hospital and assistant professor in psychiatry at Harvard Medical School, told HemOnc Today. “It’s also important that mental health care be imbedded within oncology teams and support be provided early after the diagnosis. Our study reveals that risk for suicide is the highest in the first few months. If we wait for people to be screened and referred to mental health services lives can be lost in the process.”

Researchers used the SEER database to analyze 4,671,989 patients with cancer diagnosed between 2000 and 2014 to evaluate how many died by suicide within the first year after diagnosis, whether any specific types of cancers correlated to a higher rate of suicide, and whether the rate of suicide was higher among those with cancer than the general population.

Results showed that 1,585 of the patients committed suicide within the first year after diagnosis. These data represented a significant increase compared with the general population, with a 2.52 (95% CI, 2.39-2.64) observed/expected (O/E) ratio and excess risk of 2.51 per 10,000 person-years.

Of the 1,585 patients, 1,062 died by suicide within the first 6 months of diagnosis. Men died by suicide within the first year (n = 1,379; O/E, 2.66; 95% CI, 2.52-2.8) at a much higher rate than women (n = 206; O/E, 1.86; 95% CI, 1.61-2.13). However, the suicide risk became higher among women (O/E, 3.4) than men (O/E, 2.68) in the group of patients aged 84 years or older.

“We did find that the majority of suicides in this sample where in males. This is not different than the general population,” Hamoda said. “According to the American Association for Suicide Prevention, in 2017 men died by suicide 3.54-times more often than women. We know that women are, in general, more likely to seek mental health care compared with men, but this study didn’t look at that.”

The highest increases in the O/E ratio came after a diagnosis of pancreatic cancer (8.01; 95% CI, 6.29-10.06) and lung cancer (6.05; 95% CI, 5.42-6.72). Researchers also observed a significant increase after a colorectal cancer diagnosis (2.08; 95% CI, 1.74-2.47).

The risk for suicide did not increase significantly after a breast cancer or prostate cancer diagnosis.

Researchers wrote that the most likely reasons for suicide included anxiety and depression among patients. For example, patients with a smoking history tend to feel guilt after a cancer diagnosis, and patients with head and neck cancers may experience disfigurement as a result of the treatment. Anxiety over medical costs is also likely to play a role, researchers wrote.

Limitations to the study included its retrospective nature and a lack of data in the SEER database on rates of anxiety and depression after cancer diagnosis.

“Awareness among providers to screen for suicide risk and refer to mental health services is important for mitigating such risk and saving lives, especially within the first 6 months after diagnosis,” Ahmad Samir Alfaar, MD, MBBCh, MSc, researcher at Charité Hospital of University of Berlin, said in a press release. “Moreover, family members and caregivers must be trained to provide psychological support for their ill relatives.” – by John DeRosier

For more information:

Hesham M. Hamoda, MD, MPH, can be reached at Boston Children’s Hospital, Department of Psychiatry. 300 Longwood Ave., Fegan, 8th Floor Boston, Massachusetts 02115, email: hesham.hamoda@childrens.harvard.edu.

Disclosures: The authors report no relevant financial disclosures.