By Mohamed Rahouma, MD, Mohamed Kamel, MD, and Jeffrey L. Port, MD
A cancer diagnosis can be overwhelming, especially if someone has limited social support. Previous international reports have indicated that the distress associated with a cancer diagnosis could lead to a higher suicide rate. This was evident in respiratory and breast cancers in Denmark,1 esophageal, pancreatic, and respiratory cancer patients in Sweden,2 and respiratory and oropharyngeal cancers in Norway.3 We sought to explore suicide rates in lung cancer patients in comparison to the US general population and to the three most prevalent non-skin cancers: breast, prostate, colorectal cancer (CRC).4 The SEER database was used to estimate the suicide incidence and standardized mortality ratio (SMR).
Our study evaluated 3,640,229 cancer patients from the SEER database and identified 6,661 patients who committed suicide over a period of 4 decades (1973–2013). The cancer-associated suicide rate was 27.5/100,000 person-years, nearly twice the suicide rate for the US general population (SMR=1.6). Despite this, many doctors don’t consider suicide a risk in cancer patients or are simply unaware.
The suicide rate among lung cancer patients stood out significantly because it was more than four times higher than the US general population (SMR=4.2). This was followed by CRC and breast cancer patients, with a rate 40 percent higher than average (SMR=1.4). The median time to suicide was shortest in lung cancer patients (7 months) in contrast to 56 months in prostate cancer, 52 months in breast cancer and 37 months in CRC (p <0.001). This may be attributed to several factors: (1) the diagnosis of lung cancer often occurs at late stage and is associated with a rapidly terminal course; (2) some patients have guilt for smoking, which remains the leading cause of lung cancer; and (3) patients are often older with associated risk of medical comorbidities. Among lung cancer patients, the suicide rate was significantly higher in males (SMR =8), older patients (70–75 years; SMR=12), Asians (SMR=13.7), and widowed patients (SMR=11.6).
While CRC, prostate, and breast cancer had nearly stable suicide rates, a noticeable decrease in lung cancer SMR was found over the study period.
The results of the study should stimulate clinicians to introduce measures that address the distress of a cancer diagnosis. A patient’s emotional well-being should be assessed, and if high anxiety is identified— often manifested by sleeplessness, weight loss, and depression—appropriate intervention should be initiated. Patients should be queried as to the extent of their social support structure. Doctors also need to realize that each patient is unique and that individual prognosis can vary, with some patients destined to have a more favorable clinical course than others in their practice. Having a friend or family member, often being available and present is a significant emotional boost for patients.
In conclusion, the cancer-associated suicide rate is nearly twice that of the US general population. Suicide risk is highest among lung cancer patients, particularly older males, and the widowed. It is extremely important to identify these high-risk patients to provide the proper psychological assessment, support, and counseling to reduce these rates. ✦
1. Yousaf U, Christensen M-L, Engholm G, Storm HH. Suicides among Danish cancer patients 1971- 1999. Br J Cancer 2005;92:995–1000. doi:10.1038/ sj.bjc.6602424.
2. Björkenstam C, Edberg A, Ayoubi S, Rosén M ans. Are cancer patients at higher suicide risk than the general population? A nationwide register study in Sweden from 1965 to 1999. Scand J Soc Med 2005;33:208–214.
3. Hem E, Loge JH, Haldorsen T, Ekeberg Ø. Suicide risk in cancer patients from 1960 to 1999. J Clin Oncol 2004;22:4209–4216.
4. Rahouma M, Kamel M, Nasar A, Harrison S, Lee B, Stiles B, et al. Lung Cancer Patients Have The Highest Malignancy-Associated Suicide Rate In USA: A Population Based Analysis. C94 Psychosoc. IMPACTS Respir. Health Crit. Illn., Am Thoracic Soc; 2017, p. A6730–A6730.