How many patients see no other way out? A retrospective study on 8.7 million cancer patients currently published in 'Nature' provides answers.
Cancer is the leading cause of death in the United States and the third leading cause of death worldwide. In the last century, survival was seen as the primary therapeutic goal - sometimes under the acceptance of physical, emotional and financial stress.
Today, most tumor patients do not die directly from tumor-related causes. (Source 1) The results of a large American study emphasize that monitoring mental stress and suicide prevention are immensely important, especially in patients over 50 with neoplasia of the prostate, lungs, colorectum, and bladder, as well as leukemias, lymphomas, and germ cell tumors. (Source 2)
Even if we don't hear about it that often in oncology: Patients who take their own lives are far too frequent. (Source 3) Between 1973 and 2014, 13,311 of 8,651,569 oncological patients committed suicide, corresponding to a suicide rate of 28.6/100,000 person-years. (Source 2) The rates have risen dramatically since the 1970s.
Since the study originates in the USA, we also want to compare American figures: In the USA, suicide is the 10th most frequent cause of death and claimed 45,000 lives each year in the USA alone. (Source 4) Suicides were thus about twice as frequent as homicides. According to figures from the National Institute of Mental Health, the suicide rate in the general population is 13.4/100,000 person-years. (Source 4)
Higher age and male sex are associated with a higher risk. Nevertheless, suicides are the second most frequent cause of death among people between 10 and 34 years of age and the fourth most frequent among 35-54-year-olds. The rate was four times higher for men than for women (21.3 versus 6/100,000).
Statistically, neoplasms of the lungs, head, and neck, testicles, bladder and Hodgkin's lymphoma are associated with the highest risk. In addition, the absolute majority of cancer suicides is male (83%) and white (92%). (Source 2)
Even if one might intuitively assume otherwise, the patients who actually commit suicide are not necessarily those who have been unsuccessful in their therapy. Compared to all other cancer patients, the suicide rate was highest in older, unmarried, white men with localized disease.
For many types of cancer, especially in the first months after diagnosis, the risk is up to 13 times higher than for people from the normal population. (Source 3) However, the authors of the study found tumor entities in which the risk remained elevated for years.
Among those under 50 years of age, hematologic neoplasia and testicular cancer were the most common, while among those over 50 years of age, prostate, lung and colorectal tumors were the most common.
The importance of a potentially fatal diagnosis and the prospect of prolonged treatment and rehabilitation should not be underestimated in their impact on patients and their families. Suicide is often the culmination of excessive stress. As survival rates of cancer patients continue to rise, it will be critical to identify vulnerable patients. (Source 2)
Sources:
1. Zaorsky, N. G. et al. Causes of death among cancer patients. Ann. Oncol. 28, 400-407 (2017).
2. Zaorsky, N. G. et al. Suicide among cancer patients. Nature Communications 10, 207 (2019).
Three.
3. Hughes, G. & MD. The Risk of Suicide in People With Cancer. Very Well Health Available at https://www.verywellhealth.com/the-risk-of-suicide-in-cancer-patients-2248817. (Accessed: 17th January 2019)
4. NIMH " Suicide. Available at: https://www.nimh.nih.gov/health/statistics/suicide.shtml. (Accessed: 16th January 2019)