People with mental illnesses are more likely to die and self-harm if they get cancer

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Patients with cancer who are diagnosed with a psychiatric disorder were more likely to die and were at greater risk of self-harm compared with other cancer patients, according to a UK study of nearly half a million people's health records. Depression was the most common psychiatric disorder among cancer patients, the authors say. In a second study, German scientists found that patients with cancer were nearly twice as likely to die by suicide than the general population. They re-analysed the data from 62 previous studies of cancer and suicide, including a total of more than 46 million patients. In the case of the cancers with the worst prognoses, suicide rates were even higher, at 3.5 times the general population, the authors say. identifying mental illness and suicidal intentions in cancer patients could help prioritise those most at risk, the authors conclude.

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From: Springer Nature

Mental health and suicide risk among adults with cancer examined

Patients with cancer who are diagnosed with a psychiatric disorder had a higher incidence of mortality and are at greater risk of self-harm compared with other patients with cancer, according to a paper published in Nature Medicine. A second paper finds that patients with cancer have a nearly 2-fold greater risk of dying by suicide than the general population. These findings are based on the largest population-based analyses of the total burden of mental illness and self-harm events across major adult cancers thus far.

Despite progress in cancer therapy and prognosis in recent decades, patients with cancer are persistently at a high suicide risk. However, the impact of mental health on suicide and survival outcomes in cancer remains unclear, largely due to a lack of studies with sufficient sample sizes to demonstrate such effects.

Alvina Lai and Wai Hoong Chang analyzed population-based data from two large electronic health record databases covering a period of almost 23 years to examine instances of psychiatric disorders and self-harm across 26 cancer types (among 459,542 people 18 years of age and up). The authors found that depression is the most common psychiatric disorder in patients with cancer and that the highest cumulative burden of psychiatric disorders is associated with receiving chemotherapy, radiotherapy, surgery and alkylating agents (used in certain cancer treatments), and with testicular cancer. Psychiatric disorders (such as depression, anxiety disorders, schizophrenia, bipolar disorders and personality disorders) were associated with an increased risk of mortality of any kind and increased risk of self-harm within 12 months of a mental illness diagnosis.

In a separate study, Corinna Seliger and colleagues performed a systematic review and meta-analysis of 62 studies involving more than 46 million patients to determine the overall suicide mortality of patients with cancer. They found that these patients have a risk of dying by suicide nearly 2-fold greater than that of the general population, with a 3.5-fold greater suicide mortality seen in patients with cancers known to have a poor prognosis, including cancers of the liver, stomach and head.

The findings could help to inform collaborative cancer-psychiatric care initiatives by prioritizing patients who are most at risk and identifying early signs of suicidal intentions, and reducing short- and long-term risk of suicide.

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Research Springer Nature, Web page Paper 2: The URL will go live after the embargo ends

Journal/
conference: Nature Medicine

Research:Paper

Organisation/s: University College London, UK, University Hospital Heidelberg, Germany

Funder: Paper 1 (Mortality and self-harm among mentally ill cancer patients): A.G.L. is supported by funding from the Wellcome Trust (204841/Z/16/Z), National Institute for Health Research University College London Hospitals Biomedical Research Centre (BRC714/HI/RW/101440), National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre (19RX02) and Academy of Medical Sciences (SBF006\1084). Paper 2 (Suicide rates in cancer patients): The authors received no specific funding for this work.

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