Teenagers and Young Adults Diagnosed With Cancer Are at Increased Risk of Suicide
Teenagers and young adults are at increased risk of suicide after being diagnosed with cancer, according to a study published today in Annals of Oncology. A study of nearly 8 million Swedes aged 15 and over found that among the 12,669 young people diagnosed with cancer between the ages of 15 and 30, there was a 60% increased risk of suicide or attempted suicide. The risk was highest during the first year immediately after diagnosis, when suicidal behavior was 1.5-fold higher among the patients with cancer compared with the cancer-free group.
Among the patients with cancer, there were 22 suicides vs 14 expected suicides and 136 attempts at suicide vs 80 expected attempts—an extra 64 instances of suicidal behavior among the 12,669 patients who were studied.
“As far as we are aware, this is the first study to look at suicidal behavior following a cancer diagnosis in adolescents and young adults,” said study author Donghao Lu, from the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm. “Given that young people are still developing their coping strategies for stress, they may be more affected than adults when facing major adversity such as a cancer diagnosis. Although the absolute risk of suicidal behavior is modest among cancer patients, it emphasizes the need to support and carefully monitor these vulnerable young people.”
Study Details
Researchers from Sweden, Iceland, and the United States used Swedish census, medical, and other records to follow 7,860,629 Swedes aged 15 and over between 1987 and 2009. They took account of psychiatric history and they also looked more closely at the difference in suicidal behavior in women who had been diagnosed with cervical cancer or a precursor to cervical cancer (the equivalent of cervical intraepithelial neoplasia grade 3 [CIN3]).
During an average of 17.4 years of follow-up, there were 105,868 cases of suicidal behavior among the nearly 8 million people. Among the 12,669 patients with cancer, more men than women (16 vs 6) killed themselves (completed suicide), whereas more women than men (82 vs 54) made an unsuccessful suicide attempt.
Although the incidence of suicide attempts was higher among people both with and without a cancer diagnosis if they had a history of mental illness, a diagnosis of cancer did not seem to make a statistically significant difference to the suicide risk between these two groups. The researchers suggested that this might be due to ongoing treatment for psychiatric problems, such as antidepressants, which might help to prevent suicidal behavior.
Despite Better Prognosis, Increased Risk Among Women With Cervical Cancer
An increased risk of suicidal behavior was seen after diagnoses for most cancers, except for thyroid and testicular cancer and melanoma, which may reflect the better prognosis for these cancers in this age group.
However, this reasoning did not hold for cervical cancer. Even though the vast majority of patients diagnosed with this disease between the ages of 20 to 29 could expect to survive for more than 5 years, there was a threefold increased risk of suicidal behavior, rising to a nearly sixfold increased risk in the first year after diagnosis. Women diagnosed with CIN3 had a 2.5-fold increased risk of suicidal behavior compared to women without a diagnosis of CIN3 and who were cancer-free.
“We don’t know why this might be and it needs to be explored further,” said Dr. Lu. “A potential reason might be related to the effects of treatment, such as menopausal symptoms and lymphedema, which might contribute to emotional distress. But this does not appear to explain entirely the increased risk of suicidal behavior in our study since only one of the four observed suicide cases during the first year after diagnosis had gone through surgery.”
Another possibility might be that there are certain individual characteristics or health behaviors that are shared in women with suicidal tendencies and CIN3 or cervical cancer. But the results seem to suggest this does not completely explain the increased risk, as there is a contrasting pattern of increased risk between women diagnosed with cervical cancer or with CIN3. The peak of suicidal behavior occurs in the year immediately after a cancer diagnosis and then declines, but the increased risk is constant after a diagnosis of CIN3.
Findings Underscore Importance of Psychosocial Care
“Only a small proportion of patients committed suicide or attempted suicide immediately after being diagnosed with cancer. But suicide behaviors can be seen as manifestations of the extreme emotional stress induced by the cancer diagnosis. We believe that the evident risk of suicidal behavior is likely to represent just the tip of the iceberg of mental suffering in these young cancer patients,” said Dr. Lu.
The study findings emphasize the need for mental care to be included in the clinical care of these patients, especially those with preexisting psychiatric conditions or a poor prognosis. According to the authors, this task should be a collaboration among all parties involved in the care of the patient, including medical and psychological professionals, family members, and social workers.
The researchers are currently carrying out further research to identify what factors might play a role in severe stress reactions to a cancer diagnosis, who might be at high risk, and what could be done to reduce the risk.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
