A cancer diagnosis can bring on psychological distress, sometimes leading to self-harm or suicide. But two recent studies published in Nature Medicine demonstrate how widespread the risks for depression and suicide are and support the need for oncologists and patients to have honest conversations about mental health struggles.
For the first study, Corinna Seliger-Behme, MD, a neurologist at Heidelberg University in Germany, and colleagues analyzed 28 studies spanning more than 22 million people with cancer around the world. They found that rates of suicide among people with cancer were 85% higher than in the general population. Specifically, they found that people with cancers with better prognoses, including prostate, nonmetastatic melanoma and testicular cancers, had the lowest rates of suicide, while people with cancers with worse prognoses, such as stomach and pancreatic cancer, had the highest rates.
“Probably, we can prevent suicide if we talk about it, and if we really start that early,” Seliger-Behme told The New York Times. Seliger-Behme’s study found that suicide rates among people with cancer in the United States were higher than in Asia, Australia or Europe. This could be due to the high cost of cancer care, which leads some people to skip lifesaving treatment, the authors speculated. Easier access to guns in the United States could also have contributed to higher suicide rates, the study authors wrote.
In the second study, Alvina Lai, who studies informatics at University College London, and a colleague created a database using the health records of about 460,000 people in Britain with 26 different cancers diagnosed between 1998 and 2020 to examine their mental health.
They found that 5% of patients diagnosed with cancer were also diagnosed with depression; the same proportion were diagnosed with anxiety. About 1% of the group admitted to self-harming following their diagnosis. Patients with testicular cancer, brain tumors, prostate cancer, Hodgkin lymphoma and melanoma were most likely to hurt themselves.
The biggest risk factor for developing depression and other psychiatric disorders was treatment involving surgery, radiation and chemotherapy, possibly due to the intensity, length and cumulative side effects associated with these three treatments.
The type of treatment also made a difference. Chemotherapy was linked to high rates of psychiatric disorders, while targeted drugs called kinase inhibitors, which often have fewer side effects, were associated with the lowest rates. This leads researchers to wonder whether patients are sufficiently counseled about the risks, including mental health risks, of potential treatment options.
While current treatment guidelines for cancer care recommend screening for depression, these study findings underscore the importance of screening for suicide risk factors and normalizing mental health treatment as part of overall cancer care.