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Suicide Risk Doubles After Cancer Diagnosis

By Amanda Gardner
Although their overall incidence of suicide is still low, cancer patients are more than twice as likely to take their own lives compared to those in the general population.

That's the sobering finding of a new Canadian study published in the Oct. 19 online issue of the Annals of Oncology.

The report's author says doctors, nurses, social workers and other health professionals need to be alert to the possibility for suicide among cancer patients.

"You have to be aware of this in all cancer patients, but there are some particular patterns," said study author Dr. Wayne Kendal, a radiation oncologist at Ottawa Hospital Regional Cancer Center, in Ontario. "The high-risk patient was male with head or neck cancer or myeloma, advanced stage, with little social or cultural support and limited treatment options."

The lower-risk patient was typically female and black, with breast or colorectal cancer, the researchers found.

To characterize who, among cancer patients, might be at higher risk for suicide, Kendal analyzed 1.3 million cancer cases in the United States.

A total of 265 females and 1,307 males committed suicide. "Overall, it's a relatively rare event," Kendal said. "It's a fraction of a percent of each [gender]."

"It's pretty rare," echoed Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "I've practiced cancer medicine for 20 years, and I have had only three suicides."

The rate in the study worked out to be 19 out of every 1,000 male cancer patients and four out of every 1,000 female patients. The overall rate of suicide was about 24 per 100,000 cancer patients per year, or two to two-and-a-half times that of the general U.S. population.

In this population, males committed suicide at four to five times the rate of females, which is consistent with the suicide rate in the overall American population.

"One of the most striking findings was the gender difference, and that is parallel with the general population," Kendal said. It was unclear why such a difference persisted.

The risk of suicide varied according to a number of other factors, including prognosis for the disease, stage of the disease, type of cancer, ethnicity and family situation.

Among the study's other findings:

* Males with lung, liver and brain cancer or leukemia had lower rates of suicide than males with other types of cancer.
* Both genders were more likely to commit suicide if their tumors had already spread at the time of diagnosis.
* The highest suicide rate for men was right after diagnosis while, for women, the rate was relatively constant over time.
* Divorced males and females had a higher risk of suicide than married individuals. Married men had about half the risk and married women about a third lower.
* Blacks had a lower risk of suicide, similar to trends in the general population. The rate of suicide among black males was closer to that of female cancer patients.
* Generally speaking, poor prognosis was associated with a higher suicide risk, although this did not hold true for pancreatic cancer. "This was a surprise," Kendal said.
* Refusing surgery or radiation did not appear as a risk factor, although there was a higher risk of suicide when surgery was discouraged, possibly because of more advanced disease.
* Many of the cancers which were associated with a higher risk (for instance, head and neck cancer) also carried with them significant quality-of-life issues. "Surgery can be deforming and, once the cancer comes back, it's much more difficult," Brooks said. "It's very disfiguring."

When cancer strikes, social support can be key, Brooks said.

"The message I try to tell my patients when you have any type of chronic disease -- and cancer is a chronic disease -- is to try to make sure that they allow the support of the family to help them," Brooks. "I've seen many cases where the husband and wife are divorced, and the ex-wife is there if the man develops cancer. It can be a healing process for both of them."

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