Lung cancer diagnosis increases suicide risk by 420%

Mohamed Rahouma
Jeffrey Port

Patients with lung cancer appeared more than four times as likely to commit suicide as individuals in the general population, according to study results presented at the American Thoracic Society International Conference.

A lung cancer diagnosis increased suicide risk far more than other cancer types, results showed.

“We wanted to see what the impact of one of life’s most stressful events is on patients,” Mohamed Rahouma, MD, postdoctoral cardiothoracic research fellow at Weill Cornell Medical College/NewYork-Presbyterian Hospital, said in a press release. “Most clinicians do not think about suicide risk in [patients with cancer]. This study, I hope, will change that by making us more aware of those at greatest risk [for] suicide so that this catastrophe in the care of our patients does not happen.”

The researchers pooled data from 3.6 million patients included in the SEER database. The patients had malignancies other than skin cancer.

The investigators assessed the suicide death rate for all cancer types combined, as well as lung, prostate, breast and colorectal cancers individually.

Rahouma and colleagues identified 6,661 suicides associated with cancer diagnoses during a 40-year-period. Patients with any type of cancer had a 60% higher suicide rate than the general population.

When researchers assessed suicide risk among the four most common cancer types individually, they determined lung cancer was associated with a 420% increase in suicide risk compared with the general population. Other malignancies with the greatest effect on suicide risk included colorectal cancer (42% increase), breast cancer (20% increase) and prostate cancer (20% increase).

“[Although] cancer diagnosis counseling is an established practice, especially if a patient seems depressed, referral for ongoing psychological support and counseling typically does not happen,” Rahouma said. “This represents a lost opportunity to help patients with a devastating diagnosis.”

HemOnc Today spoke with Rahouma and Jeffrey Port, MD, professor of clinical cardiothoracic surgery at Weill Cornell Medicine and NewYork-Presbyterian Hospital, about these findings and their potential implications.

Question: What prompted this study?

Port: We noticed many of our patients are overwhelmed by the diagnosis of cancer in general, and lung cancer specifically. We wondered how it manifests itself, and we chose the endpoint of suicide because this is the most sensationalized endpoint. It was clear to us that patients in general were distressed and had a lot of anxiety over their diagnosis. We wanted to know how this affected their clinical course and disease management. We could measure suicide.

Q: How did you conduct the study?

Port: We used the SEER database to analyze data that spanned a 40-year time period. We used the standard mortality ratio (SMR) to measure the suicide rate.

Q: What did you find?

Port: Not surprisingly, when we looked at all patients, the general cancer population demonstrated an increase in suicide risk. It was most pronounced in patients with lung cancer because of the severity of the type of cancer. The suicide rate appeared significantly elevated in patients with cancer compared with the general population (27.5 per 100,000 people vs. 13 per 100,000 people). Patients with lung cancer had the highest rate (SMR = 4.2). Even though the rate was higher among patients with more advanced disease, the suicide rate was still high among those considered to have curable, early-stage disease.

Rahouma: Of note, we observed a decrease in the suicide rate over time, so this means we are doing a better job introducing these patients to interventions early on. The trend does appear to be improving, even though it is statistically significantly higher compared with the general population.

Q: What are the clinical implications of these findings?

Port: The data clearly tell us that we need to do a better job as physicians explaining to patients that these are not death sentences, and that they can manage the disease and ultimately get through this. When we looked at our results, we looked at specific risk factors. We saw males had a specific higher suicide rate. The potential explanation for this is that males are not able to share their emotions or are not willing to seek professional help. Widowed, older and frailer patients also were at higher risk for suicide. If clinicians identify these factors upfront, it is incumbent upon us to potentially introduce options for emotional support.

Q: Did any of your findings surprise you?

Port: Yes. Clinicians always talk about giving practical advice to our patients, such as bringing a loved one with them to the visit and making sure someone is with them to take notes during the office visit. Often, we see patients in front of us who are so distressed that they cannot focus on what we are telling them or ask appropriate questions. Most times, we have patients who call or send us an email later and want to discuss what we just discussed in the office. I realized these patients are physically present but do not fully have the capacity to understand the consultation. For me, it is surprising to see that the suicide rate can be this much higher, but it is not surprising to see how distressed or anxious they are. It also is important to mention that it is incumbent upon us to discuss the severity of disease. Often our patients do not know how severe their disease is. They hear the words ‘lung cancer’ and they automatically assume the worst. [Many don’t realize] that, if they have early-stage disease, it can be cured.

Q: What is next for research?

Port: We are going to try to create a program through which we conduct a psychosocial measurement of patients’ stress and anxiety, then assess whether interventions can reduce those feelings.

Q: Is there anything else that you would like to mention?

Port: Many physicians need to be reminded that we have to focus not only on patients’ physical well-being, but also their mental well-being. – by Jennifer Southall

Reference:

Rahouma M, et al. Abstract 8321. Presented at: The American Thoracic Society International Conference; May 19-24, 2017; Washington, D.C.

For more information:

Jeffrey L. Port, MD, can be reached at Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 E. 68th St., Suite M404, New York, NY 10065; email: jlp2002@med.cornell.edu.

Mohamed Rahouma, MD, can be reached at Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 E. 68th St., Suite M404, New York, NY 10065; email: mhmdrahouma@gmail.com.

Disclosures: Port and Rahouma report no relevant financial disclosures.

Mohamed Rahouma
Jeffrey Port

Patients with lung cancer appeared more than four times as likely to commit suicide as individuals in the general population, according to study results presented at the American Thoracic Society International Conference.

A lung cancer diagnosis increased suicide risk far more than other cancer types, results showed.

“We wanted to see what the impact of one of life’s most stressful events is on patients,” Mohamed Rahouma, MD, postdoctoral cardiothoracic research fellow at Weill Cornell Medical College/NewYork-Presbyterian Hospital, said in a press release. “Most clinicians do not think about suicide risk in [patients with cancer]. This study, I hope, will change that by making us more aware of those at greatest risk [for] suicide so that this catastrophe in the care of our patients does not happen.”

The researchers pooled data from 3.6 million patients included in the SEER database. The patients had malignancies other than skin cancer.

The investigators assessed the suicide death rate for all cancer types combined, as well as lung, prostate, breast and colorectal cancers individually.

Rahouma and colleagues identified 6,661 suicides associated with cancer diagnoses during a 40-year-period. Patients with any type of cancer had a 60% higher suicide rate than the general population.

When researchers assessed suicide risk among the four most common cancer types individually, they determined lung cancer was associated with a 420% increase in suicide risk compared with the general population. Other malignancies with the greatest effect on suicide risk included colorectal cancer (42% increase), breast cancer (20% increase) and prostate cancer (20% increase).

“[Although] cancer diagnosis counseling is an established practice, especially if a patient seems depressed, referral for ongoing psychological support and counseling typically does not happen,” Rahouma said. “This represents a lost opportunity to help patients with a devastating diagnosis.”

HemOnc Today spoke with Rahouma and Jeffrey Port, MD, professor of clinical cardiothoracic surgery at Weill Cornell Medicine and NewYork-Presbyterian Hospital, about these findings and their potential implications.

Question: What prompted this study?

Port: We noticed many of our patients are overwhelmed by the diagnosis of cancer in general, and lung cancer specifically. We wondered how it manifests itself, and we chose the endpoint of suicide because this is the most sensationalized endpoint. It was clear to us that patients in general were distressed and had a lot of anxiety over their diagnosis. We wanted to know how this affected their clinical course and disease management. We could measure suicide.

PAGE BREAK

Q: How did you conduct the study?

Port: We used the SEER database to analyze data that spanned a 40-year time period. We used the standard mortality ratio (SMR) to measure the suicide rate.

Q: What did you find?

Port: Not surprisingly, when we looked at all patients, the general cancer population demonstrated an increase in suicide risk. It was most pronounced in patients with lung cancer because of the severity of the type of cancer. The suicide rate appeared significantly elevated in patients with cancer compared with the general population (27.5 per 100,000 people vs. 13 per 100,000 people). Patients with lung cancer had the highest rate (SMR = 4.2). Even though the rate was higher among patients with more advanced disease, the suicide rate was still high among those considered to have curable, early-stage disease.

Rahouma: Of note, we observed a decrease in the suicide rate over time, so this means we are doing a better job introducing these patients to interventions early on. The trend does appear to be improving, even though it is statistically significantly higher compared with the general population.

Q: What are the clinical implications of these findings?

Port: The data clearly tell us that we need to do a better job as physicians explaining to patients that these are not death sentences, and that they can manage the disease and ultimately get through this. When we looked at our results, we looked at specific risk factors. We saw males had a specific higher suicide rate. The potential explanation for this is that males are not able to share their emotions or are not willing to seek professional help. Widowed, older and frailer patients also were at higher risk for suicide. If clinicians identify these factors upfront, it is incumbent upon us to potentially introduce options for emotional support.

Q: Did any of your findings surprise you?

Port: Yes. Clinicians always talk about giving practical advice to our patients, such as bringing a loved one with them to the visit and making sure someone is with them to take notes during the office visit. Often, we see patients in front of us who are so distressed that they cannot focus on what we are telling them or ask appropriate questions. Most times, we have patients who call or send us an email later and want to discuss what we just discussed in the office. I realized these patients are physically present but do not fully have the capacity to understand the consultation. For me, it is surprising to see that the suicide rate can be this much higher, but it is not surprising to see how distressed or anxious they are. It also is important to mention that it is incumbent upon us to discuss the severity of disease. Often our patients do not know how severe their disease is. They hear the words ‘lung cancer’ and they automatically assume the worst. [Many don’t realize] that, if they have early-stage disease, it can be cured.

PAGE BREAK

Q: What is next for research?

Port: We are going to try to create a program through which we conduct a psychosocial measurement of patients’ stress and anxiety, then assess whether interventions can reduce those feelings.

Q: Is there anything else that you would like to mention?

Port: Many physicians need to be reminded that we have to focus not only on patients’ physical well-being, but also their mental well-being. – by Jennifer Southall

Reference:

Rahouma M, et al. Abstract 8321. Presented at: The American Thoracic Society International Conference; May 19-24, 2017; Washington, D.C.

For more information:

Jeffrey L. Port, MD, can be reached at Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 E. 68th St., Suite M404, New York, NY 10065; email: jlp2002@med.cornell.edu.

Mohamed Rahouma, MD, can be reached at Weill Cornell Medicine, NewYork-Presbyterian Hospital, 525 E. 68th St., Suite M404, New York, NY 10065; email: mhmdrahouma@gmail.com.

Disclosures: Port and Rahouma report no relevant financial disclosures.