New research shows that a diagnosis of cancer significantly increases an individual's risk of dying by suicide. The findings highlight the importance of psychological support at the time of cancer diagnosis.
Patients diagnosed with any form of cancer had a 55% increased risk for suicide death compared to those without cancer and a 53% increased risk compared with those who died from causes other than suicide.
Lead researcher Raffaella Calati, PhD, Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, and University of Montpellier, France, told Medscape Medical News that regardless of previous psychiatric diagnoses, cancer patients should be assessed for suicidal behaviors and should be "strictly" followed, a practice that "is not so common now."
She noted that the findings strengthen the case for providing psychological support at the time of cancer diagnosis, both for patients and their families.
"Our message is also that we should develop specific psychotherapeutic treatments for these kinds of patients," she added.
The study was presented here at the European Psychiatric Association (EPA) 2017 Congress.
55% Increased Risk
Dr Calati said it would be interesting to investigate which psychotherapeutic interventions would work best for patients with a cancer diagnosis. She noted there is little research into cancer and suicide risk and the potential benefit of psychotherapy.
The investigators conducted a meta-analysis to examine the association between cancer and suicidal behaviors, including suicidal death (SD), suicide attempt (SA), and suicidal ideation (SI). A systematic search of the PubMed, PsychINFO, and Cochrane Library databases for studies published before September 2016 yielded 4882 studies, of which 104 studies met the inclusion criteria. Of these, 15 high-quality studies were included in the meta-analysis.
In seven case-control studies that included 247,978 participants and that compared suicide death with living control individuals, the investigators found that any type of cancer was associated with an increased risk for SD, at an odds ratio of 1.55 (P = .0002).
In a comparison of suicide death with other deaths in two studies that included 23,839 individuals, the researchers found that having cancer was associated with an increased risk for suicide death, with an odds ratio of 1.53 (P = .03).
However, the researchers were not able to identify a difference in the risk for SA (in four studies with 8,147,762 participants) or for suicidal ideation (two studies, 37,879 participants) between cancer patients and control persons.
The lack of association between a cancer diagnosis, SA, and SI was likely due to the small number of available studies that examined this association, and therefore a potential link cannot be ruled out, said Dr Catali.
Important Clinical Message
Commenting on the findings for Medscape Medical News, Julian Beezhold, MD, FRCPsych, consultant in emergency psychiatry, Hellesdon Hospital, Norwich, United Kingdom, and secretary general of the EPA, said the research "adds to the awareness of comorbidity between physical and mental illness.
"The study brings together a substantial body of research relating to cancer and suicide. In particular, it alerts clinicians to the importance of considering the psychological well-being of people living with a cancer diagnosis," he said.
Dr Calati and colleagues are continuing their research and have expanded the number studies included in the meta-analysis to 36. She noted that the strength of the associations may change, because in the current analysis, the researchers were not able to control for covariates.
It is possible that controlling for covariates may result in a lower risk for suicidality in cancer patients, she said. However, early indications are that the risk for SD is in fact higher.
No funding or relevant financial relationships have been disclosed.