1356NEWS Journal of the National Cancer Institute, Vol. 98, No. 19, October 4, 2006
NEWS
Decades After Cancer, Suicide Risk Remains High
After seemingly successful treatment,the price of surviving cancer for some people is so high that the risk of attempt-ing suicide, succeeding at it, or havingsuicidal thoughts remains elevated for decades, according to two new studies.This research demonstrates that men-tal health counseling, along with physi-cal care, is a must for some, if not all,long-term survivors, say the authors.And this
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nding is true for both child-hood and adult survivors.“We are only just beginning to ac-knowledge that we have this huge popu-lation of people who are long-termsurvivors and whose treatment and illnessmay have had consequences on their cur-rent functioning,” said Julia H. Rowland,Ph.D., director of the of
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ce of cancer sur-vivorship at the National Cancer Institute.One study, published August 20 inthe
Journal of Clinical Oncology
, indi-cated that 12% of 266 adult survivors of childhood cancer reported thoughts of suicide or suicide attempts some 20-plusyears after treatment.The other, reported in this issue of theJournal (
see
p. 1416), found a 50% in-creased rate of suicide among 375,000- plus American women treated for breastcancer compared with the general population. This study, believed to be thelargest population-based investigation todate of long-term suicide risk after can-cer treatment, also looked at 345,000women in four Scandinavian countriesand found that their risk was alsoelevated, an increase that varied from25% to 53%.Several studies have tracked suicide or suicidal thoughts in cancer patients shortlyafter treatment, but these provide a newglimpse into how some cancer patientscontinue to have dif
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culty coping manyyears after treatment, Rowland says.She calls the
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ndings “very provoca-tive” and says that more follow-up will be “very important” to explain thisemerging picture of persistent risk of sui-cide in cancer survivors. At this point, thestudies raise as many questions as theyanswer, she says. For example, the studyof breast cancer survivors accesses ahuge database but does not include inter-views that would shed light on a motiva-tion for suicide. By contrast, the
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ndingsin the child-hood cancer survivor studywere based on personal ac-counts but werelimited to onecenter thattreated referredsurvivors whomay have cometo the clinic precisely be-cause they were having issues, she said.Still, Rowland admits that theessence of these early
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ndings surprisedher. “I just don’t know how to frame theissue yet.”
The Problems Are “Never Over”
The childhood cancer study is onlynow possible given increasing success intreating these cancers, the authors say.“Most people are doing
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ne, but there isa serious concern about the minority of survivors who have thoughts of endingtheir lives,” said lead author Christopher Recklitis, Ph.D., a psychologist anddirector of research in the Perini FamilySurvivors’ Center at the Dana-Farber Cancer Institute in New York.Recklitis and his colleagues evaluateda group of 226 adult survivors of childhood cancer who came to their center for scheduled visits. The partici- pants had a mean age of 28 years andwere interviewed an average of 18 yearsafter their initial diagnosis for a rangeof cancers, including leukemia, lym- phoma, sarcoma, and Wilm’s tumor.The researchers asked the survivorsabout their physical health, quality of life, suicidal thoughts, signs of depres-sion, and pain; they found that 29 survi-vors reported suicidal symptoms. Eventhough only 11 of these patients wereconsidered substantially depressed,many of the participants conveyedfeelings of hopelessness, Recklitis said.Many reported problems with paincontrol and physical function, as wellas concern about their appearance.The researchers found that factorsassociated with suicidal symptoms in-cluded younger age at diagnosis, a lon-ger time since diagnosis, and radiationtreatments to the head — an older treat-ment for leukemia that sometimes pro-duced growth retardation and physicaldis
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gurement, impairment in memoryand cognitive functions, and increasedrisk of second cancers.These issues can be especiallytricky for young adults to handle,Recklitis said. “Life presents us withdifferent tasks at different points in life,and these developmental transitionsare when different issues of the pastcatch them up.“These survivors often tell me their problems are never over,” he said.“Patients in their early 20s complain of chronic pain, as well as possible infertil-ity, heart problems, cognitive disabilities,and a whole host of troubles even their grandparents haven’t yet faced. They areour success stories, but when you aretalking about long-term survival fromchildhood cancer, you are talking aboutthe burden of late medical effects.”Recklitis said that the study points tothe need to closely integrate long-termoncology care with mental health care.“Everyone has this on his to-do list, butmany can’t
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gure out how to overcometraditional barriers, such as a fragmentedmental health care and insurance system,”he said. “In this study we show why it isso important that they move forward.”
Few Suicides, Yet Twice the Risk
As for most children currently treatedfor cancer, most women treated for breast cancer can expect to live for many years — the current 10-year relativesurvival for breast cancer in Americais 78%. Most research suggests thatsuicide risk declines several yearsafter diagnosis for most cancers, butseveral small studies in Canada andScandinavia have turned up an increasedrisk of suicide in breast cancer survi-vors despite equally rosy long-term
Julia H. Rowland
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