Patients with Lung Cancer Have Risk of Cancer-Associated Suicide

The number of suicides in patients with cancer is almost two times than that of the general population. However, when compared with breast, prostate and colorectal cancers, lung cancer associated suicide rates are much higher, according to a recent study conducted by researchers at Weill Cornell Medicine, New York Presbyterian Hospital in New York City.

“We wanted to see what the impact of one of life’s most stressful events is on patients,” said Mohamed Rahouma, M.D., a post-doctoral cardiothoracic research fellow and first author on the study. “I think it’s fair to say that most clinicians don’t think about suicide risk in patients with cancer. This study, I hope, will change that by making us more aware of those at greatest risk of suicide so that this catastrophe in the care of our patients doesn’t happen.”

In an interview with CURE, Jeffrey Port, M.D., a thoracic surgeon and senior author on the study, added, “I think we as doctors do a good job with the physical examination and understanding the laboratories and imaging, but we don't necessarily do a thorough emotional or psychosocial evaluation.”

Using the Surveillance, Epidemiology and End Results (SEER) database, researchers studied the suicide deaths in all cancers, as well as in lung, prostate, breast and colorectal cancers individually, over a period of 40 years (1973-2017). For each type, researchers also looked at the suicide trends over time and the time from cancer diagnosis to suicide. To focus on lung cancer, the researchers also recorded demographic, social and tumor-related factors, hoping to get a better idea of who would be at high risk.

Of the 3,640,229 patients with cancer studied, researchers found 6,661 cancer-associated deaths by suicide, which were most notable among patients with lung cancer. Compared to the general population, patients with cancer had a 60 percent higher suicide rate. Patients with lung cancer had a 420 percent higher rate, colorectal cancer was 40 percent higher and breast and prostate cancers were both 20 percent higher.

“There’s no doubt that lung cancer is a serious diagnosis,” Port said. “A patient gets a diagnosis, and then gets a treatment plan that’s pretty extensive and it can include chemotherapy, radiation and even surgery. There’s a lot to handle there. It’s often overwhelming, early on.” This stress can be compounded when there are other medical conditions to consider. Port added, “Many of our patients have extensive comorbidities, the same group of patients that have heart disease from smoking and many of them are older and more frail.”

In addition, patients with lung cancer can also feel a lack of support due to the stigma associated with this disease. “This is considered a disease they brought upon themselves by smoking,” Port said, “there's not as much emotional support or sympathy perhaps, they feel, as other types of cancers.”

Patients with lung cancer also showed the least amount of time between diagnosis and suicide — a median of 7 months. All other types proved far higher — for colorectal cancer the median was 37 months, breast cancer was 52 months and prostate cancer was 56 months.

“What’s striking to me, regardless of the stage of the diagnosis, is that having lung cancer is portrayed with a terminal outcome,” said Port. “If a patient starts asking about numbers and chances of cure, compared to breast and prostate for example, the results are not as favorable.”

Interestingly, the authors noted that there has been an overall trend toward a decrease in suicide over time. This decrease has been more noticeable in patients with lung cancer. Port hopes this trend will continue “as we talk about things like CAT scan screening, liquid biopsy and, potentially, blood tests in the future,” to provide for better screening and earlier diagnosis. “There’s reason to be hopeful,” he said.

The researchers determined that certain factors could indicate a patient with lung cancer would be at high risk for suicide. They included being a man, Asian, widowed, older (70-75 years), someone who refused surgical treatment or had a difficult to treat type of cancer (metastatic, small-cell lung carcinoma histology).

Identifying these high-risk patients is important as it can allow clinicians to provide psychological assessment, support and counseling to reduce the rates of suicide. Port said, “We have to do a better job in assessing those emotional needs. If we can do that, and we can tease out the risk factors, then you can intervene earlier.” Port explained that intervention could be as simple as a referral to a social worker, psychologist or psychiatrist.

“While cancer diagnosis counselling is an established practice, especially if a patient seems depressed, referral for ongoing psychological support and counseling typically does not happen,” Rahouma said. “This represents a lost opportunity to help patients with a devastating diagnosis.”

Port added, “It’s not just about suicide. If you have these higher suicide rates, it must also imply that there’s a higher distress level among all our patients. That’s what’s important here.”