Summaries of three studies being published online August 11, 2008 in the Journal of Clinical Oncology showing people with cancer are more likely to commit suicide or contemplate taking their own lives, compared to the general population
Overview of an editorial examining the implications for the oncology community
Quote for attribution from the American Society of Clinical Oncology’s president, Dr. Richard Schilsky
Links to additional information from ASCO’s Cancer.Net and other cancer groups
Cancer patients nearly twice as likely as the U.S. general population to commit suicide
This study by researchers at the University of Washington compared suicide rates among people diagnosed with cancer in the U.S. from 1973 to 2002 (using data from the Surveillance, Epidemiology, and End Results Program) with those in the general U.S. population (using data from CDC’s National Center for Health Statistics). Researchers found that the rate of suicide among cancer patients was 31.4 per 100,000 person-years, versus 16.7 per 100,000 person-years in the general population.
Higher suicide rates were associated with male gender, white race, and older age at diagnosis. The highest suicide risks were observed in patients with lung, stomach, oral/pharyngeal and larynx cancers. The risk of suicide was greatest within the first five years of cancer diagnosis but remained elevated up to 15 years following diagnosis. The study did not address potential reasons for elevated suicide rates among cancer patients overall or among people with specific cancer types.
Misono S, et al. University of Washington, Seattle, WA.
Older Americans with cancer are more than twice as likely to commit suicide as those without cancer
This study by researchers at the Harvard School of Public Health and Harvard Medical School compared 128 New Jersey residents age 65 and older who committed suicide between 1994 and 2002 with 1,280 living controls in the same age group, and found that suicide risk was 2.3 times greater among people with cancer than among those without cancer—even after adjusting for age, sex, race, medical and psychiatric illnesses, and use of prescription medications. This was the first population-based study to examine the relative risk of suicide associated with medical conditions among older Americans while controlling for other medical and psychiatric illnesses.
Cancer patients who committed suicide were more likely to have advanced metastatic disease, and two-thirds of them committed suicide with a firearm. They also found that most of the patients who committed suicide had visited a physician in the month before their death, and 25 percent were seen within a week of their suicide.
Miller M, et al. Harvard School of Public Health and Harvard Medical School, Boston, MA.
UK study finds cancer patients also more likely to have suicidal thoughts
This study by researchers at University of Edinburgh reports data from survey that evaluated current cancer patients’ state of mind toward suicide, examining whether patients reported thoughts of being “better off dead” or of “hurting themselves in some way” in the previous two weeks. Researchers questioned 2,924 people being treated as outpatients at the Regional Cancer Centre in Edinburgh, Scotland. Nearly 8 percent of participants said these thoughts persisted over at least several days during this period. Researchers compared this to a similar survey of the general population in Australia, finding that only 2.6 percent of respondents reported having such thoughts.
The authors found that suicidal thoughts were associated with having substantial emotional distress or pain and not with cancer severity. They concluded that better management of these symptoms can improve patients’ quality of life and may also reduce suicide risk.
Walker J, et al. University of Edinburgh, Edinburgh, Scotland.
More attention is needed to suicidal thoughts and actions among people with cancer
In an editorial by Timothy Quill, MD, professor of medicine, psychiatry and medical humanities at the University of Rochester Medical Center, Dr. Quill explains that the majority of previous research on this topic focused only on terminally ill patients, while these studies provide detailed information on broader populations such as patients likely to be long-term survivors and those for whom cancer is a chronic illness.
Dr. Quill suggests that thoughts about death and suicide may be common among terminally ill cancer patients and that suicide is more than likely underreported. He urges physicians to proactively engage patients in open conversations about their emotional health. Quill states: “It is important to ask about suicidal thoughts regularly, especially when disease is worsening, symptoms are increasing, or the patient is entering a more serious phase of illness…Creating an environment where these issues can be openly explored without being judged is critical.”
Quill T. University of Rochester Medical Center, Rochester, NY.
ASCO Perspective
Richard L. Schilsky, MD, ASCO President
“As oncologists, we treat people with life-threatening disease on a daily basis. While we play a vital role in providing needed medical treatment, it’s equally important to know our patients’ state of mind. These studies underscore the mental as well as physical challenges facing cancer patients. As a community we need to talk more openly with our patients about their mental health and link them to psychosocial services when needed.”
The Journal of Clinical Oncology is the semi-monthly peer-reviewed journal of the American Society of Clinical Oncology (ASCO), the world’s leading professional society representing physicians who treat people with cancer.
ATTRIBUTION TO THE JOURNAL OF CLINICAL ONCOLOGY IS REQUESTED IN ALL NEWS COVERAGE.
