Cancer and Suicide Risk

Two new studies have contradicted what we have long believed about cancer and the risk of suicide. In one, German researchers reviewed 28 studies that included more than 22 million cancer patients worldwide. Their conclusion was that the suicide rate for people with cancer was 85% higher than it is for the general population. Not surprisingly, those cancers with the best prognoses had the lowest rates while those with the worst prognoses had the highest.

[The study’s] conclusion was that the suicide rate for people with cancer was 85% higher than it is for the general population.

They also noted that the suicide rates of people with cancer were significantly higher in the United States than in Europe, Asia, or Australia. Their speculation was that our much higher health care costs might have motivated some people to end their lives rather than to bankrupt their families’ futures.

The second study from the United Kingdom examined the records of 460,000 people who had been diagnosed with 26 different kinds of cancer between 1998 and 2020 in Britain. They found that approximately 5% had been diagnosed with depression, another 5% with anxiety, and about 1% had suicided.

They also noted that almost 25% of the cancer patients had substance abuse disorders and that psychiatric issues increased over time. Finally, they noted that the single biggest risk factor for developing depression or anxiety was cancer treatment that included surgery, radiation, and chemotherapy.

I have written and lectured about this issue over the years, and these two studies are different than all the others. Previous research has concluded that the rate of suicide among cancer patients is almost twice as high as that in the general population, but comparable to patients being seen in a general medical (internal medicine) practice.

We have known that suicide rates vary among people with different cancers and are highest in people with cancers of the lung and bronchus, followed by stomach cancers and cancers of the oral cavity and pharynx. Suicide risk among all cancer patients has been highest in the years immediately following diagnosis, but remain elevated for more than 15 years when compared to the general population. Rates that have been quoted as being almost twice as high are bad enough, but the new study which suggests that the number may be as high as 85%, is worse. 

Many studies have found that, in summary, the risk of suicide is greater in more lethal cancers, can be exacerbated by side effects of the disease or treatment, and is inversely related to the strength of the patient’s support system.

It is very important to mention that many cancer patients, at some point, think about suicide. This does not mean that we all seriously think about it. For most people, the thought is as far as it goes.

It is equally important to comment that there is a huge difference between having thoughts like these and real consideration of action. Most people will never act on these thoughts and can honestly deny ever having a plan or imagining leaving their families with this legacy.

For clinicians, this means that we need to carefully listen to our patients and be aware of potentially overwhelming feelings and reactions. Almost everyone is going to think sometimes of death when diagnosed or going through treatment for cancer.

There is always relief in talking about these feelings and feeling heard and understood. For patients, this means that there should never be shame about these thoughts and that we must be brave enough to share them if we are feeling at risk of self-harm. If you or someone you know is talking about ending their life, listen carefully and get some help.