Suicide Risk Rises for Cancer Patients, Especially Advanced Stage

By Judith GrochReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. Oct 19, 2006

Physicians and other health-care professionals are urged to be aware of the potential suicide risk for cancer patients and to offer support to high-risk patients and their families.

Be aware that the suicide risk for male cancer patients far exceeds that of female patients.

OTTAWA, Ontario, Oct. 19 -- Cancer patients in the U.S. are more than twice as likely to commit suicide as the general population, with the rate for men nearly five times that for women.

The composite picture for suicide risk was that of a white man, with a new diagnosis of either head-and-neck cancer or myeloma, widowed, with widely disseminated and perhaps high-grade disease, limited treatment options, or maybe a history of other cancers.

So revealed an analysis of 1.3 million U.S. cancer cases diagnosed from 1973 to 2001 and recorded in the Surveillance, Epidemiology, and End Results (SEER) registry, Wayne Kendal, M.D., of the Ottawa Hospital Regional Cancer Center here. reported online in the Oct. 19 issue of Annals of Oncology.

The analysis found that 19 of every 1,000 male cancer patients and four of every 1,000 female patients took their own lives.

This amounted to 265 women and 1,307 men, reflecting 0.04% for women and 0.19% for men, he said. The overall hazard ratio (HR) for male suicide was 6.2 (95% confidence interval 5.4-7.1).

At around 24 suicides per 100,000 cancer patients a year, the rate was two to 2.5 times that of the general American population (10.6 per 100,000 per year, including the cancer population), This almost fivefold greater rate for men parallels the male-female ratio for suicide in the general population, Dr. Kendal added.

However, the smaller number of women in this cohort and the resulting lower statistical power could account for the findings, Dr. Kendal said. It is also possible that women, as in the general population, were less likely to react with self-directed violence.

The risk of suicide varied according to gender, prognosis, disease stage, type of cancer, ethnicity, and family status, Dr. Kendal said. Of all the risks, not surprisingly, advanced-stage cancer was a major suicide risk factor, with a higher risk for men even with intermediate-stage disease, Dr. Kendal added.

Analyzed according to sex, the women fared better. The suicide rates were similar for most cancer sites, except for colorectal (P = 0.01) and cervical cancer; depression played a role in many of the suicides in this study.

Using the SEER data, Dr. Kendal said, it was not possible to differentiate between suicides associated with affective illness or substance abuse and those motivated by a desire for relief from terminal illness or the avoidance of being a burden to others.

This high-risk picture, he said, might be associated with substance abuse, poor quality of life, or psychological issues in the context of poor family and cultural support, as well as a poor cancer prognosis, he added.

In contrast, for decreased risk, one might envision a woman of African-American heritage, with colorectal or cervical cancer, localized disease, and living with her spouse.

In the general population, mental illness and substance abuse figure prominently as high risk factors, noted Dr. Kendal. However, in this study, it was not possible to differentiate, on the basis of the SEER data, between suicides associated with affective illness or substance abuse and those motivated by the desire for relief from terminal illness or the avoidance of being a burden to others.

To help people cope with their cancer, Dr. Kendal concluded, oncologists and allied health-care workers should be alert to the risk of suicide in cancer patients, particularly those with high-risk factors such as poor social support, substance abuse, and a history of mental health problems.
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