Cancer Diagnosis, Treatment Linked to Suicide Risk

A diagnosis of cancer, along with its attendant treatments, can have a disastrous impact on mental health—and two recent studies provide a comprehensive picture of the psychologic burden across tumor types and treatment regimens.

The reports, which pull data from millions of patient records, draw attention to the elevated risk of suicide among people with cancer and help identify those in need of psychiatric care.

“Cancer care has come a long way in terms of screening patients for mental health issues,” says Daniel McFarland, DO, a medical oncologist and psychiatrist at Lenox Hill Hospital's Northwell Health Cancer Institute in New York, NY, who was not involved in the research. “But it's still nascent,” he says—and as these papers underscore, clinicians “could do better.”

In one report, neuro-oncologist Corinna Seliger-Behme, MD, of University Hospital Heidelberg in Germany, and her colleagues reviewed 28 international studies that included more than 22 million patients. Their meta-analysis showed that the chance of dying by suicide was 85% higher for people with cancer compared with the general population (Nat Med 2022;28:852–9).

Cancers associated with poor prognoses—including gastric, pancreatic, and brain—had some of the highest suicide rates, the researchers found. Disease stage and time since diagnosis also impacted risk, as did geography, with U.S. patients most likely to commit suicide, presumably owing to financial hardships linked to health care costs, access to firearms, or other societal factors.

The second study considered incident rates of psychiatric disorders among nearly 460,000 patients in England with 26 different cancers between 1998 and 2020 (Nat Med 2022;28:860–70). Based on their medical records, about 5% of them developed clinical depression after being diagnosed with cancer; more than 1% intentionally hurt themselves.

Again, cancer type mattered, although the most-deadly cancers were not always the most likely to prompt psychologic distress. For example, men with testicular cancer—a commonly curable disease—bore the highest risk of depression, with 98% of patients affected. Study author Alvina Lai, PhD, from University College London, UK, suspects that many of these patients are burdened by stigma, stress, and fear of recurrence, emphasizing that “the journey for a cancer survivor doesn't end at the point of remission.”

Additionally, Lai and co-author Wai Hoong Chang, MSc, found treatment effects on the risk of a psychiatric disorder: Receiving all three treatment modalities—surgery, radiation, and chemotherapy—dramatically increased a person's chance of mental illness compared with one or two treatment types. Furthermore, targeted therapies with more favorable tolerability profiles—kinase inhibitors or hormonal agents, for example—tended to trigger fewer psychiatric problems than some other drug types.

The findings, says Lai, highlight the importance of presenting patients with the full list and likelihood of potential side effects of various treatments, both physical and mental, “so that they can make informed decisions by weighing benefits against harm.”

Kelly Irwin, MD, MPH, a psychiatrist at Massachusetts General Hospital Cancer Center in Boston who isn't tied to the research, hopes that the reports—by “confirming a lot of what we knew already but with higher quality evidence”—will prompt oncologists to place a greater emphasis on psychiatric screening.

Given that, as Lai and Chang's study found, depression increases a cancer patient's risk of self-harm more than 40-fold, “we need to specifically integrate assessments of mental health history and cancer history if we're really going to meaningfully think about decreasing suicide in this population,” Irwin says.

Madeline Li, MD, PhD, a psychiatrist at Princess Margaret Cancer Centre in Toronto, Canada, who isn't connected to the research, agrees. “Studies like these tell us where we need to put psychosocial resources,” she says. “We have to take this knowledge and move toward action and prevention.” –Elie Dolgin