Vitals - Suicide risk spikes in week after cancer diagnosis, study finds

By Linda Carroll

The risk of suicide spikes in the weeks immediately following a cancer diagnosis, a new study shows. Patients were almost 13 times?more likely to commit suicide in the first week after learning they had cancer than they were prior to the diagnosis. Twelve weeks?after the diagnosis they were still nearly 5 times as likely to commit suicide as they had been before,?according to the study published today in the New England Journal of Medicine.

The risk dropped after that, but in the year following the diagnosis it still remained 3 times higher ?than it was for people without a cancer diagnosis, an international team of researchers reported.

The study also found that the risk of death from heart attack or stroke also climbed - to almost six-fold ?- after a cancer diagnosis. That elevated risk?falls in line with other recent research showing that severe stressors, like losing a loved one, can pump up the risk of death from heart attack and stroke, said study co-author Dr. Murray Mittleman, an associate professor of medicine at the Harvard Medical School and an associate professor of epidemiology at the Harvard School of Public Health.

The researchers hope that the new study will alert family members and health professionals of the heightened risk of dire outcomes after patients learn they have cancer.

?Our study primarily points to the severe stress experienced by newly diagnosed cancer patients," said the study?s lead author, Dr. Fang Fang, a researcher in the department of medical epidemiology and biostatistics at the Karolinska Institute in Stockholm.??We believe it is important that cancer patients, families and caregivers are aware of the stress-related health risks after a cancer diagnosis.?

Psychologist Anne Coscarelli agreed.

?This study ought to bring to people?s attention that cancer is an extremely stressful diagnosis and that it?s important to address the psychological and psychosocial needs of patients and their families when a diagnosis is made,? said Coscarelli, a clinical professor in the department of psychology at the University of California, Los Angeles and director of the Simms/Mann-UCLA Center for Integrative Oncology at UCLA?s Jonsson Comprehensive Cancer Center.

More research might help doctors find a better way to deliver the bad news, Fang said.

In the meantime, doctors should do their best to figure out which patients might be most at risk, Coscarelli said.

While suicide might be of concern in patients with a pre-existing mental health issue, ?you can?t use just that one single criteria to assess by,? Coscarelli said. ?One thing I frequently tell doctors is that you can?t assess the risk unless you spend time understanding other stressors in a patient?s life. Those other stressors might be exacerbated by this.? A patient might be going through a divorce or have some other family-related problems. One?s ability to tolerate stress becomes reduced when you add in multiple stressors. ?

Young people tend to be more distressed by a cancer diagnosis, Coscarelli said. ?They may be in the midst of career issues or have problems with financial security,? she explained. ?They might have young children at home so now they?re worrying not just about themselves, but also about the children.?

Patients should be encouraged to join support groups, Coscarelli said. ?I think many people do not think they want to participate in a support group because they think it will be more difficult to be around others with cancer. But sometimes they find it?s helpful to be with others who are going through the same processes and they can talk about things they wouldn?t otherwise be able to.?

To learn whether a diagnosis upped the risk of suicide and death from heart attack or stroke, Fang and her colleagues pored through data on 6,073,240 Swedes who were aged 30 or older. They identified 534,154 patients who were given a diagnosis of cancer, including 95,787 with prostate cancer, 74,977 with breast cancer and 62,619 with colorectal cancer.

The researchers found a striking increase in the risk of suicide after comparing the recently diagnosed to those who had no cancer diagnosis. And that was even after accounting for factors such as gender, relationship status (cohabiting or not), socioeconomic status and educational level.

Overall, there were 786 suicides among the patients diagnosed with cancer, including 29 people who killed themselves in the first week after learning they had the disease.

There were 48,991 deaths due to heart attack or stroke among patients who received a cancer diagnosis. The highest risk was in the first week after diagnosis.

Ultimately, the new study should be a heads up to everyone around a person getting a cancer diagnosis, Mittleman said.

"Friends and family members need to realize how devastating it is to receive this kind of news and that they need to be there for the person,? Mittleman said. ?And the message to the medical team is to be thoughtful about how the news is delivered and to make sure that there is some sort of social support in place.??

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