Studies show that cancer patients are at high risk for depression and suicide

A day ago, years ago, Dr. Corinna Seliger-Behme met a man with terminal bladder cancer during her training as a neurologist. Before the diagnosis, the man had a stable family and job and no history of mental health problems, recalled Dr. Seliger-Behme. But shortly after learning of his terminal illness, he tried to kill himself with a knife in the bathtub. He spent the last week of his life in a psychiatric ward.

This patient’s situation was extreme, but the psychological burden caused by cancer is significant for many patients. Two studies released Monday quantify the psychological burden of cancer in minute detail, drawing from much larger datasets than previous research. The findings make a compelling case for oncologists to have more conversations with their patients about mental health issues.

“We can probably prevent suicide if we talk about it and if we really start it that early,” says Dr. Seliger-Behme, neurologist at the University of Heidelberg in Germany.

In one of the new reports, she and several colleagues reviewed 28 studies that included more than 22 million cancers patients worldwide. Their analysis showed that the suicide rate in people with cancer was 85 percent higher than in the general population. Predictably, cancers with the best prognosis—including prostate cancer, nonmetastatic melanoma, and testicular cancer—had the lowest suicide rates, while those with the worst prognosis, such as gastric and pancreatic cancer, had the highest suicide rates.

Suicide rates among cancer patients were significantly higher in the United States than in Europe, Asia or Australia, the study found. The authors speculated that high healthcare costs in the United States may have prompted some patients to forgo treatment to avoid bankrupting their families. They also wondered if easier access to firearms in the United States compared to countries in other world regions might have contributed to the higher suicide rates.

In the second new study, Alvina Lai, who studies computer science at University College London, and a colleague created a large database drawn from the medical records of about 460,000 people with 26 different types of cancer diagnosed in the UK between 1998 and 2020.

Five percent of patients were diagnosed with depression after their cancer diagnosis, and the same was true for anxiety. About one percent of the group had self-injured after their diagnosis. Patients with brain tumors, prostate cancer, Hodgkin’s lymphoma, testicular cancer, and melanoma were the most likely to get injured.

The study found that about a quarter of cancer patients suffered from a substance abuse disorder. And psychiatric problems, including substance abuse, increased over time, even years after a diagnosis.

Analysis showed that the single greatest risk factor for developing mental illness was treatment with surgery, radiation, and chemotherapy. The length, intensity, and cumulative side effects of this triple-threat approach to cancer treatment may explain why it triggers depression, anxiety, and even personality disorders in many people.

Chemotherapy alone was also associated with high rates of psychiatric disorders, while “kinase inhibitors” — targeted drugs that often have fewer side effects — had the lowest rates.

The stark data made Dr. Lai wonder if patients are given enough opportunities to weigh the psychological risks of potential treatments. “It would be so useful for newly diagnosed cancer patients to see what the data is telling us and make an informed decision,” said Dr. lay

The study also produced some surprising results. For example, testicular cancer was associated with a higher risk of depression than any other cancer, affecting 98 out of 100 patients.

“That’s a bit counterintuitive — it’s one of the better-prognostic forms of cancer,” said Dr. Alan Valentine, chair of the psychiatric department at MD Anderson Cancer Center in Houston, who was not involved in the study. The finding, he said, underscores how tumultuous a diagnosis can be, even when a tumor doesn’t shorten life.

Because studies assessing mental health are typically based on self-reported questionnaires, the data likely underrepresent reality, noted Wendy Balliet, a clinical psychologist at the Hollings Cancer Center at the Medical University of South Carolina in Charleston. Persistent stigma attached to psychiatric disorders means people may not be open about their inner struggles, said Dr. ballet She also noted that the complexity involved in declaring a death a completed suicide can also mean that the association between cancer and fatal self-harm is underreported.

The results raise the question of how much more advice and support patients could get along the way. “It’s hard for me not to think about the conversations these patients are having with their oncologists,” said Dr. ballet

The studies also draw attention to cancer patients with previously diagnosed psychiatric disorders such as schizophrenia. Previous research has shown that such patients are more likely to die of cancer than patients without these diseases. The study by Dr. Lai found that cancer patients with schizophrenia were more likely to receive palliative care, possibly indicating they were not receiving the treatment they needed early in their diagnosis.

“Cancer is an expensive disease,” said Dr. Valentine by MD Anderson, “and it could be argued that people with serious mental disorders either don’t have access to medical care or are in a health care system that doesn’t have the resources they need.”

Current treatment guidelines suggest screening for depression as part of routine cancer care, noted Dr. Nathalie Moise, professor of medicine at Columbia University’s Vagelos College of Physicians and Surgeons. “I think these results may support the need to also screen for suicide and other risk factors,” she said.

“Normalizing mental health treatment as an integral part of your overall cancer care journey can also go a long way,” she said.

If you are having suicidal thoughts, call or go to the National Suicide Prevention Lifeline at 800-273-8255 (TALK). SpeakingOfSuicide.com/resources for a list of additional resources.

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