番茄社区

Patients with urologic cancers had suicide rates four to five times higher than in the general population, British researchers reported.

Patients with bladder or prostate cancers were about five times more likely to commit suicide as compared with individuals without cancer; the rate was about four times higher among patients with kidney cancer. Patients with non-urologic cancers were three times as likely to commit suicide compared with the general population, as reported at the meeting in Copenhagen.

The data corroborated findings from other countries, showing higher suicide rates among cancer patients, but factors specific to urologic cancers may put those patients at particularly high risk, according to Mehran Afshar, MD, PhD, of St. George's Hospital in London.

"Men with prostate cancer undergo treatment which can affect their bladder function, their bowel function, erectile function and libido, and can result in symptoms similar to female menopause and entirely alter their personality, leading to relationship problems, anxiety, depression and post-traumatic stress disorder," Afshar said in a statement.

The findings are consistent with, though somewhat higher than, the known suicide rate among cancer patients in the United States, said Alan Valentine, MD, a psycho-oncologist at the University of Texas MD Anderson Cancer Center in Houston.

"The known prevalence of suicide for cancer patients across the board is thought to be pretty close to twice that of the American adult population, which is about 10 per 100,000," Valentine told 番茄社区. "The actual rate is probably higher than that; these are the ones that are actually confirmed."

Results of the British study are "not hugely surprising," Valentine added. "Some people would say it's surprising that the known rate is actually that low."

Multiple studies have shown a higher incidence of suicide among patients with cancers than in the general population. However, none of the studies examined whether suicide rates differed by cancer type. Afshar and colleagues performed an analysis that focused on patients with kidney, bladder, or prostate cancers.

Using data from the Office of National Statistics in England, investigators searched for patients with newly diagnosed cancer from April 2001 to January 2011. They identified 980,761 cases comprising the 10 most common types of cancer, including 328,372 patients with urologic malignancies.

For purposes of the study, investigators defined suicide as a completed suicide. The analysis revealed 1,222 suicide attempts and 162 completed suicides.

The suicide rates among all urologic cancer patients (49/100,000) were statistical drivers of the overall suicide rate among patients with cancer. In contrast, patients with non-urologic cancers had a suicide rate of 30/100,000.

The rates for urologic cancer patients were 36/100,000 among those with kidney cancer, 48/100,000 for those with bladder cancer, and 52/100,000 for those with prostate cancer.

In the general population, during the same time period, the suicide rate was 10/100,000.

The study was one of the first to examine suicidal intent in cancer patients, defined as the ratio of completed versus attempted suicides. The ratio for the general population was 1:25. That compared with 1:10 for patients with kidney cancer and 1:7 for patients with bladder or prostate cancers.

"This is important, as we know that people who attempt suicide are at a higher risk of subsequently being successful in completing a suicide," said Afshar. "We have shown this 'intent' to commit suicide 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."

The data also showed substantial variation in the median time from diagnosis to suicide for different types of urologic cancer: 175 days for kidney cancer, 846 days for prostate cancer and 1,037 days for bladder cancer. The observation suggested that some cancer patients are more vulnerable at certain time points, said Afshar.

The National Comprehensive Cancer Network recommends monitoring a patient's emotional distress at every seminal visit or event, but does not currently recommend screening for suicide, said Valentine. At MD Anderson, clinicians use one or more validated questionnaires or scales to assess a patient's level of emotional distress. A certain score on a scale will trigger a visit from a social worker.

MD Anderson and several other major cancer centers are working on comprehensive suicide screening strategies, he added, something that has attracted the interest of the Joint Commission on Accreditation of Healthcare Organizations.

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