Suicide Risk May Increase After Cancer Diagnosis, With Disparities Evident Across Socioeconomic Factors

Patients with cancer and cancer survivors had a significantly higher suicide risk, particularly if they lived in the lowest-income counties and in rural areas of the United States, study results demonstrated.

Researchers also found that a patient’s suicide risk was highest within the first year after a cancer diagnosis, although this risk remained high in patients who lived in the lowest-income counties even after 10 or more years after the diagnosis.

“It is known that suicide mortality is higher in those with (a) cancer diagnosis than the general population, but our findings show it is greater in those living in low-income or rural areas,” said Ryan Suk, who holds a Ph.D. in health economics, is an assistant professor in the department of management, policy and community health at University of Texas Health Science Center at Houston School of Public Health, in an interview with CURE®. “Also, it has been studied that the suicide risk is the highest within one year after cancer diagnosis and declines over time, but we discovered that those living in the lowest-income area (had) significantly prolonged risk, almost two-fold risk of the general population even after 10 years or more following diagnosis, while those living in other areas did not show the difference when comparing with the general population.”

CURE® also spoke with Meagan L. Dwyer, who holds a Ph.D. in clinical psychology, is director of onco-psychology and associate professor in the department of psychiatry and behavioral sciences at University of Kansas Medical Center in Kansas City, about this topic. Although she was not associated with this study, she thinks its findings highlight important facts about this patient population.

“The study highlights an important and often overlooked risk for those diagnosed with cancer, as well as socioeconomic factors that may limit patients’ access to mental health care,” she said.

Evidence of Disparities

In the study published in JAMA Network Open, Suk and colleagues reviewed data from 5,365,782 patients (51% men; 72% White; 50% older than 65 years) with cancer from 635 counties in the United States. Of these patients, 6,357 died of suicide. The suicide risk was significantly higher in people with cancer who lived in the lowest-income counties compared with those who lived in the highest-income counties. This increased risk was also observed in patients who lived in rural counties compared with urban counties.

“Our study doesn’t assess the reasons for the outcomes, and we can only discuss them based on the other literature,” Suk noted. “We discuss that the previous studies reported a lack of mental health service providers in these areas compared with high-income or urban counties. Comprehensive cancer survivorship care may be significantly lacking in less affluent and rural areas.”

Dwyer added that patients from lower-income and rural settings may lack access to mental health care, “including cost, transportation and reliable internet connections for telehealth, as well as facing stigma of seeking this form of support,” she said.

The suicide risk was highest within the first year after a cancer diagnosis regardless of what county (rural versus urban, low versus high income) a patient lived in.

“The initial year after diagnosis is a time of enormous change in a patient’s life,” Dwyer said. “They may have to stop working. They will be undergoing often physically debilitating treatments that increase pain and side effects and decrease their ability to function independently. They have to rely more on others, from their medical teams to their family, friends and community. All of these changes can alter a patient’s sense of identity and value. We know from the psychological research that hopelessness, isolation, pain and sense of burdening others can increase risk for suicide, and all of these are often inherent in the life of someone with cancer.”

The risk in patients who lived in the lowest-income counties remained significantly high after 10 or more years after receiving a cancer diagnosis.

Potential Implications

Results from this study may help patients on both a personal level and policy level.

“Assessing how neighborhood-level contextual social factors are associated with suicide among those with (a) cancer diagnosis would help us identify modifiable risk factors for the policy or programmatic intervention implications,” Suk said.

Dwyer mentioned that some actions can be taken to potentially reduce the risk for suicide in patients.

“There are a range of options available in many areas including both in-person and telehealth individual therapy as well as support groups,” she mentioned. “Many disease-specific organizations, such as (the) Leukemia & Lymphoma Society, offer to connect patients to other patient mentors or various supports. Medications may also be a useful tool for patients dealing with depression and cancer. I encourage any patient or caregiver who is concerned to talk very openly with their oncology team about their difficulties. The medical teams can often work to get patients connected to resources and can then check-in to make sure the patient is improving.”

She added that she wants to change the reputation often associated with seeking mental health, especially during times it’s needed most.

“It is my hope that we continue to break down stigma and see that mental health care is health care,” Dwyer concluded. “Getting support when one is depressed should be no different than seeing a physician for an infection or injury.”

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