Getting a cancer diagnosis is a stressful and shocking experience. But is it stressful enough to increase a patient's risk of suicide and heart attack?
That's the question that an international group of researchers from the U.S., Sweden and Iceland set out to answer when they launched the largest study ever to examine the specific effect of cancer diagnosis on suicide risk. Researchers analyzed data gathered between 1979 and 2004 on 342,000 men who were recently told they had prostate cancer. Compared to death rates among a similar group of men without cancer, men who received a cancer diagnosis were 90% more likely to commit suicide in the following year.
Overall, the authors point out, the absolute risk of suicide was small; among the more than 340,000 cases studied, 148 men died of suicide. But the relative risk was still quite large, says study co-author Lorelei Mucci, an epidemiologist at Brigham and Women's Hospital in Boston.
The men who had prostate cancer, particularly those who had advanced disease, were also at a slightly higher risk of dying from a heart attack or another cardiovascular event within the first year. The risk was highest during the first month after diagnosis.
While it's intuitively true that a cancer diagnosis can cause significant psychological stress and heightened anxiety, the findings underscore the importance of addressing these consequences in the doctor's office, along with the patient's physical disease. Previous studies have shown that traumatic events the loss of a loved one, for instance, or a natural disaster such as an earthquake can raise a survivor's risk of a heart event. Although the authors have not directly compared these events to the impact of a cancer diagnosis, they believe the aftermath may be similar. "Any acute stress event, including a cancer diagnosis, would have the same effect," says Mucci.
It is worth noting, however, that Mucci and her colleagues detected the increased suicide and heart risk only in men diagnosed with cancer before the prostate-specific antigen (PSA) test became available in the 1980s. PSA screening allows doctors to pick up tumors at earlier stages, which makes treatment potentially more effective, less invasive and possibly less disfiguring and makes a diagnosis of prostate cancer far less menacing.
Other important developments in prostate cancer diagnosis and treatment also occurred in the 1980s, says Dr. Nicholas Vogelzang, chair and medical director of developmental therapeutics at US Oncology, a cancer-services company. Better biopsy techniques and drug treatments emerged, making castration and use of estrogens, the most common therapies for prostate tumors, almost obsolete. Such advances may have contributed to the drop off in suicides seen in the post-PSA era. "There may be an element here of the treatment for prostate cancer that was causing excess suicide," says Vogelzang.
Although earlier detection made possible by PSA screening may help reduce the psychological trauma of a diagnosis, it is impossible to avoid the blow completely. But there are ways for easing the shock of the news, says Vogelzang. Physicians should be aware of and alerted to any history of depression or mental illness in their cancer patients. And if their patients do need counseling or support, they should be provided these services as part of their overall cancer care. "We think the diagnosis of cancer is a teachable moment, when clinicians need to really be involved in thinking not only, what am I going to do to treat this cancer, but the total person," says Mucci.
Care of the total person involves not just professional help, but support from friends and family. Mucci found that men who were given their diagnosis in the presence of their families were less likely to kill themselves than those who bore the news alone. Having a social support network may not take the cancer away, but it could help ease the anxiety of learning to live with it.