By Stephen Ornes
Cancer and Suicide Risk
The best way to approach the unspeakable is to talk about it
By Stephen Ornes
Despite medical advances that have increased life expectancy for most cancer survivors, suicide remains a potent and mysterious menace. Patients often feel uncomfortable sharing suicidal thoughts, which is part of the reason it is difficult for doctors to assess the likelihood that a patient will try to kill himself.
But the risk is substantial, as highlighted by three new studies in the Oct. 10, 2008, Journal of Clinical Oncology (JCO). According to the largest of these studies, cancer survivors—including those who have completed treatment—kill themselves at nearly twice the rate of the general population.
Using three decades of data on nearly 3.6 million patients in the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database, Stephanie Misono, a resident in head and neck surgery at the University of Washington, in Seattle, and her colleagues found that suicide risk varies depending on the type of cancer a person has. People with lung cancer face a suicide risk more than five times that of the general population; other types of cancer that are linked to an elevated suicide risk include stomach and oral cancers. The risk is greatest in the five years after diagnosis. Other high-risk factors include being white, male or unmarried, or having advanced disease at the time of diagnosis.
A second study in the same journal measured the prevalence of suicidal thoughts among cancer survivors. British investigators interviewed 2,924 cancer patients and found that 229 (8 percent) reported feeling that they would be “better off dead” or that they wanted to hurt themselves for several days in the two weeks before the interview. Jane Walker, a cancer researcher with Cancer Research UK, in Edinburgh, who led the study, says she and her colleagues are now studying in more depth what people mean when they report suicidal thoughts.
“People who had these thoughts of being better off dead were likely to have high levels of emotional distress and high levels of pain,” Walker says. “But we know that the main link with suicide is depression.”
Depression and Beyond
Suicide is strongly associated with severe depression: Some studies cite a correlation as high as 90 percent. According to the American Cancer Society, one in four people with cancer suffer from clinical depression, which can be difficult to diagnose and even more of a challenge to treat.
“Addressing underlying depression is important,” says Matthew Miller, an oncologist and epidemiologist at the Harvard School of Public Health in Boston. But everyone who commits suicide is not clinically depressed, he cautions.