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| Dr. Paul Duberstein |
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| Dr. Fang Fang |
April 5, 2012 — Receiving a diagnosis of cancer can drive some people
to take their own lives. It can also trigger cardiovascular events that
result in death, according to a study published in the April 5 issue of the New England Journal of Medicine.
"Being diagnosed with cancer is a severely stressful life event that
may bring about an immediate and critical health risk," lead author Fang
Fang, MD, PhD, from Karolinska Institutet, Stockholm, Sweden, told Medscape Medical News.
The information "represents an opportunity for healthcare
professionals and close relatives to intervene, for example through
actively monitoring and treating psychological and cardiovascular
symptoms in these newly diagnosed patients," Dr. Fang added.
Paul Duberstein, PhD, professor of psychiatry at the University of
Rochester Medical Center in New York, who was not involved in the study,
agrees.
"These findings underscore the importance of communication between
patients and oncologists, particularly the communication of prognosis
and treatment options," Dr. Duberstein told Medscape Medical News.
Listen to Patients' Emotional Reactions
The study by Fang et al is largely confirmatory, said Dr. Duberstein.
"It is well established that physical illness, including cancer,
increases suicide risk. It is also well established that suicides
typically occur early in the course of the disease or treatment."
In recent years, attention has been focused on the need for patients
to express their emotional concerns and for oncologists to signal that
they are interested in patients' emotional reactions, Dr. Duberstein
noted.
"There is now a burgeoning literature on this topic. The National Cancer Institute commissioned a monograph on communication a few years ago," he said.
There will be dramatic improvements in this aspect of cancer care over the coming decade.
"Every day patients, their family members, and oncologists have
difficult conversations that have significant implications for how
patients and families will manage the emotional consequences of a cancer
diagnosis. In my view, there is much room for progress, but change is
coming. I think that there will be dramatic improvements in this aspect
of cancer care over the coming decade," Dr. Duberstein said.
Increased Risk for Suicide
Dr. Fang and her team conducted a historic cohort study involving
6,073,240 Swedes, and compared the risk for cardiovascular death or
suicide in newly diagnosed cancer patients and people with no cancer
from 1991 to 2006.
They also compared the probability of having a cancer diagnosis
immediately before cardiovascular death or suicide with the probability
of experiencing a cancer diagnosis earlier in time for the same cancer
patient.
For both comparisons, the researchers made sure that any positive
relation between cancer diagnosis and cardiovascular death or suicide
was not due to other factors, such as age, sex, socioeconomic status,
and education level.
They found that during follow-up, there were 13,284 cases of suicide
among cancer-free individuals (incidence rate, 0.18 per 1000
person-years) and 786 suicides among patients with cancer (an incidence
rate, 0.36 per 1000 person-years).
The proportion of patients who committed suicide immediately after
being diagnosed with cancer was small, Dr. Fang said. In the first week
after diagnosis, 29 patients committed suicide (incidence rate, 2.50 per
1000 person-years; relative risk [RR], 12.6; 95% confidence interval
[CI], 8.6 to 17.8).
During the first 12 weeks, patients were 5 times more likely to
commit suicide after their cancer diagnosis than individuals who were
cancer-free (RR, 4.8; 95% CI, 4.0 to 5.8). During this period, 110
cancer patients committed suicide (incidence rate, 0.95 per 1000
person-years).
The relative risk for suicide declined over 12 months, down to 3.1 (95% CI, 2.7 to 3.5).
Patients diagnosed with cancer of the esophagus, liver, or pancreas were the most likely to commit suicide.
Deaths From Cardiovascular Causes
During follow-up, there were 543,144 deaths from cardiovascular
causes among cancer-free individuals (incidence rate, 7.53 per 1000
person-years).
This compares with 48,991 deaths among patients who had received the
diagnosis of any cancer but central nervous system tumors (incidence
rate, 23.10 per 1000 person-years).
As with suicide, cancer patients had the highest risk for death from
cardiovascular causes in their first week after diagnosis. The relative
risk was 5.6 (95% CI, 5.2 to 5.9), compared with cancer-free
individuals, and there were 1318 deaths (incidence rate, 116.80 per 1000
person-years).
The risk for cardiovascular death lessened with time. In the first 4
weeks, patients were 3 times more likely to die from cardiovascular
causes (RR, 3.3; 95% CI, 3.1 to 3.4), and there were 2641 deaths
(incidence rate, 65.81 per 1000 person-years).
This new understanding of the serious consequences of a cancer diagnosis has important implications.
"We believe that this new understanding of the serious consequences
of a cancer diagnosis has important implications for doctors and
relatives of cancer patients," Dr. Fang said. "We hope that our study
will lead to improvements in the care of newly diagnosed cancer patients
and eventually diminish the risk of stress-related disease and death."
The study was supported by the Swedish
Council for Working Life and Social Research and the Swedish Research
Council. Dr. Fang and Dr. Duberstein have disclosed no relevant
financial relationships.
N Engl J Med. 2012;366:1310-1318. Abstract
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