July 24, 2019
3 min read

Childhood cancer survivors at higher risk for suicide, death from risky behavior

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Childhood cancer survivors appeared more likely than the general population to die by suicide or from causes related to risky health behaviors, according to results of a retrospective study published in Cancer.

“Because suicides and injuries are among the leading causes of death in young people worldwide, and because psychiatric morbidities appear to be overrepresented among [those who had cancer during childhood], there is a genuine need to evaluate whether [these individuals] are at an elevated risk [for] suicide or other risky health behavior-related deaths,” Liisa M. Korhonen, MD, of the pediatric research center at Children’s Hospital, part of Helsinki University Hospital in Finland, and colleagues wrote.

A prior study conducted in Denmark showed female cancer survivors are at significantly higher risk for anxiety, depression, personality disorders, neurotic disorders and psychotic disorders compared with their female siblings who never had cancer.

Another study conducted in Sweden showed cancer survivors consume alcohol and participate in binge drinking more frequently than the general population.

In this study, Korhonen and colleagues used national registries to identify 29,285 people from Denmark, Finland or Sweden who had been diagnosed with cancer prior to age 20 years. Researchers also evaluated a population-based cohort (n = 146,282) matched for age, sex and country.

Investigators used national registries to evaluate causes of death, specifically looking for suicides, accidental deaths, violent deaths, and deaths due to alcohol or drug abuse.

Median follow-up was 9.4 years (range, 0-42) for childhood cancer survivors and 18.1 years (range, 0-42) for the comparison cohort.

Median age at the end of follow-up was 19 years (range, birth to 59.1) for those diagnosed with cancer, and 27.4 years (range, birth to 58.8) for the comparison cohort.

By the end of follow-up, 32.5% of those diagnosed with cancer and 1.3% of the comparison cohort had died. Cancer was determined to be the cause of death for 90.3% of those diagnosed with a childhood malignancy and 10.3% for those included in the comparison cohort.

Results showed childhood cancer survivors were at increased risk for death due to risky health behavior (RR = 1.25; 95% CI, 1.06-1.47). The risk appeared similarly elevated between males and females.

Cause-specific analyses revealed significant elevations in risk for death by alcohol poisoning (RR = 2.83; 95% CI, 1.28-6.27) or suicide (RR = 1.37; 95% CI, 1.02-1.83) among childhood cancer survivors.

Other causes of death with elevated but not statistically significant risks among the childhood cancer group included accidental poisoning other than alcohol (RR = 1.46; 95% CI, 0.91-2.32), drowning (RR = 1.29; 95% CI, 0.55-3.05), transport accident (RR = 1.11; 95% CI, 0.81-1.52) or other type of accident (RR = 1.19; 95% CI, 0.71-1.98).


When researchers stratified results by cancer type, they observed a significantly elevated risk for risky health behavior-related death only among those who had been treated for central nervous system tumors (RR = 1.49; 95% CI, 1.08-2.05).

Risk for death due to risky health behavior also appeared significantly higher among those who had been diagnosed with cancer between the ages of 5 and 9 years (RR = 1.5; 95% CI, 1.01-2.24) or 15 and 19 years (RR = 1.31; 95% CI, 1.03-1.67), as well as those who attained the age of 30 to 39 years (RR = 1.5; 95% CI, 1.07-2.09).

“Although the majority of patients do not resort to suicide or die of risky health behavior, a small percentage of patients appears to have excess mortality from suicide and violent, accidental, or alcohol-related and drug-related deaths, with patients with central nervous system tumors being a particularly vulnerable group,” Korhonen and colleagues wrote. “These findings [emphasize] that psychosocial screening and support should be included in the long-term follow-up care of [individuals diagnosed with cancer during childhood].” – by John DeRosier


Disclosures: Grants from NordForsk and Vare Childhood Cancer Foundation supported this study. The authors report no relevant financial disclosures.