WEDNESDAY, April 4 (HealthDay News) — When people learn they
have cancer, they might face a heightened risk of suicide or a fatal heart
attack in the days and weeks that follow, according to a large new
study.
Using nationwide census and death registry data that covered more than
6 million people over a 15-year period ending in 2006, Swedish researchers
tabulated the suicides and cardiovascular fatalities among people with new
cancer diagnoses and compared them to similar deaths in those without
cancer.
Suicide risk was more than 12 times higher for people with cancer
during the first week after diagnosis and nearly five times higher during
the first three months, they found.
Death from cardiovascular causes — particularly heart attack — was
5.6 times higher in the week after a cancer diagnosis and 3.3 times higher
in the first month.
Hard-to-treat cancers with poor odds for survival, including cancers of
the esophagus, pancreas, liver, lung and central nervous system, were most
common in these types of deaths, the researchers said.
“That the risk increase appeared so quickly after cancer diagnosis and
then decreased in magnitude during the first year after diagnosis really
illustrated the role of the diagnosis itself on these adverse outcomes,”
said study co-author Dr. Katja Fall, a senior lecturer in epidemiology at
the University of Orebro. “It largely argues against [death] from cancer
treatment and progression that presumably take time to accumulate.”
The researchers found a prevalence of 0.18 suicides for cancer-free
people and a prevalence of 0.36 for people with any type of cancer when
they looked at deaths per 1,000 person-years.
Suicide risk decreased as time passed, but it was still about three
times higher during the first year, and remained higher after. For
heart-related death, risk leveled off after a year.
Researchers accounted for other factors that might predispose people to
sudden heart death or suicide, such as seasonal differences and previous
psychiatric illness, or demographic factors such as age or sex. Only
adults aged 30 or older were included.
The study was published in the April 5 New England Journal of
Medicine.
Dr. Len Lichtenfeld, deputy chief medical officer at the American
Cancer Society, noted that because the study took place in Sweden, it’s
not certain how the results apply to the United States. Nevertheless, he
said, “this study is saying we have to be aware that this is a very real
problem.”
“We believe that the words ‘you have cancer’ certainly can be
associated with distress, but we also like to believe with support and
care and love that people will find a way to confront their illness and
move through that process under the best possible circumstances,”
Lichtenfeld added.
“But we can’t always be optimistic that that’s going to happen, and we
have to be sensitive to the warning signals that somebody who has a
history of depression or may be currently depressed could become more
so — we can’t pass that off: ‘Well, they’ve been told they have cancer,
what do you expect?'” he said.
“Patients who have a history of depression need to be counseled and
observed more carefully — by their health professionals, by their family,
by their friends, by their colleagues,” Lichtenfeld said.
Nearly 550,000 cardiovascular deaths occurred during the study, with a
prevalence of 23.1 in people with cancer diagnoses compared with 7.53
among cancer-free people. Heart attacks were the biggest cause, followed
by strokes.
Both experts said that severe emotional stress could provoke physical
changes.
“Psychological stress induces an array of physiological reactions,
including the release of stress hormones such as catecholamines and
corticosteroids that have impact on the cardiovascular system,” Fall said.
Lichtenfeld noted that many U.S. patients are already under treatment
for coronary artery and vascular disease.
“Certainly, if someone starts having increased symptoms of coronary
artery disease, such as angina (chest pain), or decreased ability to walk,
or increased shortness of breath with walking, once again that could be a
medical emergency — not just that someone’s not feeling well because
they’ve been told they have cancer,” he said.
Although cancer treatments and survival rates continue to improve,
study author Fall said it’s impossible to predict whether statistics in
studies like hers might also improve.
“We do observe higher risk increases among patients diagnosed with
cancers of less favorable prognosis,” she noted. “If the prognosis
improves, one could, of course, hope that the risks for adverse
stress-related health outcomes would decrease.”
The study did not measure suicide attempts or serious but nonfatal
heart attacks after a cancer diagnosis.
More information
The U.S. National Cancer Institute describes how it feels to learn
you have cancer.
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