EAU 2018: Survey Shows Greater Suicide Rate in Patients With Urologic Cancers

Key Points

  • The team found that the all-cancer suicide rate was 30 per 100,000 people. In the urologic cancers, the figures are 36 per 100,000 people in kidney cancer, 48 suicides per 100,000 in bladder cancer, and 52 per 100,000 people in prostate cancer.
  • In the general population, there is an average of 25 suicide attempts for each successful suicide. In kidney cancer, this ratio is one suicide for every 10 attempts. In bladder and prostate cancer, this ratio drops to one suicide for every seven attempts.
  • The time taken to commit suicide also varies substantially: median time to suicide is 175 days from diagnosis for kidney cancer, 846 days for prostate cancer, and 1,037 days for bladder cancer. 

A major UK survey has shown that patients with urologic cancer—such as prostate, bladder, or kidney cancer—are five times more likely to commit suicide than people without cancer. The analysis also shows that patients with cancer generally are around three times more likely to commit suicide than the general population, and that the proportion of attempted suicides which result in a completed or successful suicide was higher in patients with cancer, with a higher proportion still in patients with urologic cancers. These findings were presented at the European Association of Urology (EAU) Conference in Copenhagen.

Severe psychological stress is one of the main side effects of both a diagnosis of cancer and cancer treatment, with depression affecting between 5% and 25% of cancer patients. Many are also affected by post-traumatic stress disorder (PTSD). Previous research has shown that the vast majority of patients with cancer who have symptoms of depression often go untreated. This study shows a substantial increase in suicide attempts and successful suicides in patients with cancer.

This wass the largest UK study to date researching suicide in patients with cancer. The research team, led by Prashant Patel, MBBS, MS, FRCSEd, PhD, FRCSEd (Urol), of the University of Birmingham, retrospectively examined records from the England and Wales Hospital Episode Statistics database from 2001–2011. They linked this with cause of death statistics from the Office of National Statistics.

This is also the first time that a major study has examined suicidal intent in patients with cancer, defined as the ratio of successful suicides to the rate of attempted suicides.

Findings

The research team found that the rate of suicidal intent was far higher (one to seven) in patients with prostate cancer than in the general population (one to 25), which may show a greater determination to commit suicide in cancer patients. “This is important,” said first author Mehran Afshar, PhD, MBBS, MRCP, PGDip(Onc), of St George’s Hospital, London. “We know that people who attempt suicide are at higher risk of subsequently being successful in completing a suicide, and we have shown this ‘intent’ to commit to be far higher in our cancer population, thus confirming a real need to address psychological issues early on in the management of these patients.”

Dr. Afshar continued, “Our data confirms research from other countries that suicide rates are higher in cancer patients, and we show this to be higher particularly in patients with urologic cancers. There are particular issues which are specific to this cancer group—for example, men with prostate cancer undergo treatment which can affect their bladder function, their bowel function, erectile function, and libido; can result in symptoms similar to the female menopause; and entirely alter the personality, leading to relationship problems, anxiety, depression, and post-traumatic stress disorder.”

“We know from a 2014 study by Cancer Research UK that the vast majority of cancer patients who have symptoms of depression go untreated. We can see from the results of our study that although all cancers have a higher suicide rate, inferring a higher level of psychological distress, there are disparities between cancers. This needs to be addressed within our health-care systems, and more focus is needed on integrating the robust and specialist assessment and treatment of mental health needs in cancer care,” Dr. Afshar continued.

The study also showed significant differences between the time to a successful suicide, which means that some cancer patients are more vulnerable in certain periods.

Further Findings

  • The researchers identified a total of 980,761 (493,234 males and 487,094 female) patients with cancer which meant that 13.4 million-person years were included in the final data analysis. The team identified 162 suicides and 1,222 suicide attempts.
  • In the general population, the suicide rate is 10 per 100,000 people. The team found that the all-cancer suicide rate was 30 per 100,000 people. In the urologic cancers, the figures are 36 per 100,000 people in kidney cancer, 48 suicides per 100,000 in bladder cancer, and 52 per 100,000 people in prostate cancer.
  • In the general population, there is an average of 25 suicide attempts for each successful suicide. In kidney cancer, this ratio is one suicide for every 10 attempts. In bladder and prostate cancer, this ratio drops to one suicide for every seven attempts.
  • The time taken to commit suicide also varies substantially: median time to suicide is 175 days from diagnosis for kidney cancer, 846 days for prostate cancer, and 1,037 days for bladder cancer. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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