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Cancer-Related Suicides Dip Over Past Two Decades

While the suicide rate has increased overall in the U.S. in the last 2 decades, a new study reported that the rate of cancer-related suicide has decreased during this same time period.

Looking at the 1999-2018 Multiple Cause of Death database, Xuesong Han, PhD, of the American Cancer Society in Atlanta, and colleagues found that the average annual percentage change (AAPC) of age-adjusted cancer-related suicide rates decreased by 2.8%, as compared with a 1.7% increase in suicide rates overall.

The database contains a single underlying cause of deaths and up to 20 contributing causes. Including deaths of people ages 15 and older, the researchers identified 738,743 suicides from 1999-2018, 0.9% of which listed cancer as a contributing cause. Of the cancer-related suicides, the most common diagnoses were lung cancer (18.2%), prostate cancer (15.4%), and colorectal cancer (9.1%).

Commenting on the study, Donald Sullivan, MD, MA, MCR, of Oregon Health & Science University in Portland, who was not involved with the research, said that if these results are confirmed, “it is possible that with more concerted efforts directed at mental health of cancer patients, including an emphasis on depression by oncologic societies — to call for increased screening and treatment — and widespread use of palliative care for the sickest patients, we are improving patients’ mental health and reducing suicides.”

However, Sullivan noted that the attribution of suicide is likely undercounted in most large databases.

“Therefore, this might be a tip of the iceberg phenomenon,” Sullivan said. “Given the very high rates of depression among patients with cancer and how this can affect adherence to treatment and clinical appointments, you could understand how a death from cancer could be impacted by comorbid depression and not counted as a suicide from cancer per se.”

In their data, Han and colleagues also observed the largest declines in cancer-related suicide rates among high-risk populations. Specifically, large decreases were seen in people ages 65 to 84 (AAPC -3.0%), in men (AAPC -3.0%), and those with prostate (AAPC -5.1%), head and neck (AAPC -3.7%), and lung cancer (AAPC -4.7%). In contrast, overall suicide rates significantly increased across most demographic and death subgroups, the researchers noted.

According to Sullivan, the decreases in cancer-related suicide in high-risk populations could be due to use of resources directed at those populations.

“Although, personally, I think the rates of suicide due to cancer are still very troubling and likely undercounted as death certificates are notorious for misclassification as SEER [Surveillance, Epidemiology, and End Results] data among cancer patients shows some conflicting results,” Sullivan said.

Han and colleagues also found that cancer-related suicides with firearms decreased (AAPC -3.7%) and cancer-related suicides with drugs remained low in contrast to overall rates. These findings suggest “distinct impacts of these epidemics and different risk profiles of suicide for cancer patients compared to the general population,” the researchers noted.

Han and colleagues suggested that the evolving role of psycho-oncology, palliative care, and hospice care might have contributed to the decrease in cancer-related suicides seen, but acknowledged that no causal relationship can be established.

Sullivan agreed. “Palliative care does a great job in the mental health space with our patients with serious illness and cancer,” he said. “A pillar of palliative care is treating the psychological and emotional effects of cancer among both patients and their families.” However, he also noted that mental health resources in general are still “very underfunded in medical settings.”

Suicide rates among patients with cancer are still much too high, Sullivan said.

“We need to double-down on efforts to screen, treat, and support our patients with cancer,” he said. “If I were to speak to a room of cancer patients I would say, ‘The psychological effects of a cancer diagnosis and treatment are real, disabling, and common. Please talk to your support persons and doctors and be honest about how you’re doing and feeling. There are resources to help you and your family and they do not have to include any new medications.'”


Han and a co-author have received grant/research support from AstraZeneca.

Sullivan has received funding from the National Institutes of Health and the American Cancer Society.