The Risk of Suicide in Cancer Patients

Though we don't often hear about it, suicide in cancer patients is far too common.  And though we might expect suicide to be more common in someone for whom treatment has failed, that's not the case.

When Is Suicide Most Common in Cancer Patients?

According to a 2019 study, suicide is most common in the first 3 months after someone is diagnosed with cancer.  With an overall risk twice that of the general population, this risk can be as much as 13 times the average suicide risk in those newly diagnosed with cancer. Suicidal ideation—defined by the CDC as "thinking about, considering, or planning for suicide”—occurs in almost 6% of people with cancer. Again it's important to note that suicide in cancer patients often occurs in the first year after diagnosis, and even when treatment is working, or someone is in full remission from their cancer. When should you be concerned, is there anything you can do to help prevent suicide, and when and how should seek immediate help?

If you or a loved one have made an attempt at suicide, dial 911 immediately. If you believe a loved one has made an attempt, and while awaiting emergency responders, gather any medications present. Ask your loved one about any medications taken, the use of alcohol, and any medical conditions that the emergency response team should be aware of.

If you just need to talk to someone right now, but you or your loved one are safe and not suicidal, call the National Suicide Prevention Hotline at 988.

If you are having suicidal thoughts, it is very important to talk to someone you trust. Don't be afraid to accept professional help. A diagnosis of cancer can seem overwhelming, but people are available to help you through each step. Don't try to be a hero and do this alone. There is a tendency to "reward" people with cancer for being "courageous." But nobody has to suffer in pain—either physical or emotional. Sometimes the courageous act is asking for appropriate help with one's physical and emotional pain.

Who Is at Risk?

A diagnosis of cancer can be devastating, even if the cancer is early stage and largely curable. For this reason, anyone who has been given the diagnosis of cancer is at risk. It is important to emphasize that the risk is highest soon after diagnosis, before treatment has even begun and when symptoms may be mild. If someone you love appears suicidal, even if the reason seems insignificant to you, take them seriously. The majority of people who kill themselves have a treatable mental health condition.

Risk factors for suicide in people with cancer include:

• Age: People with cancer over the age of 65 are more likely to commit suicide than those under age 65. Suicide rates are the highest in men over the age of 80. An exception is that women with ovarian cancer are more at risk if they are younger than older.
• Sex: Men with cancer are much more likely to commit suicide than women with cancer.
• Timing: The first year after diagnosis is the period of greatest risk. A large study in Sweden found that the relative risk of suicide was almost 13 times higher than those without cancer during the first week after diagnosis, dropping to 3.3 times more likely during the first year. Another recent study found that half of the suicides in cancer patients occurred in the first two years following diagnosis.
• Cancer type: Suicide is more common among people with lung, prostate, pancreatic, esophageal, stomach, and head and neck cancers (such as pharyngeal (throat) cancer and laryngeal (voice box) cancer). One study found that male patients with pancreatic cancer had a suicide risk 11 times that of the general population. A Korean study found that suicide in women occurred most commonly in those with lung cancer. A 2017 study by the American Thoracic Society found that of all cancers, those with lung cancer have the highest risk of suicide. In that study, the risk of suicide for all cancers combined was 60% higher than for those without cancer. Among those with lung cancer, the risk was 420% higher than average.
• Race: Suicide rates appear to be higher in non-Hispanic whites than in other races.
• Poor prognosis: People who have a cancer that carries a poor prognosis (lower life expectancy) are more likely to consider suicide than those with earlier stages of the disease. Metastatic disease (cancer that has spread to other regions of the body) is associated with a higher risk of suicide.
• Pain: Pain that is inadequately controlled is associated with a higher risk. Thankfully, most cancer pain can be controlled, and many cancer centers now offer palliative care teams to help address the symptoms of cancer and its treatments.
• Depression and anxiety: It was found that people who experience depression, anxiety, or post traumatic stress syndrome in addition to cancer have significantly more suicidal thoughts than those who don't experience these symptoms.
• Inability to work: Suicidal thoughts were six times more common in people who were unable to perform the duties required by their job.
• Spirituality: In a few studies, people who stated they had "no religion" experienced significantly more suicidal thoughts than those who attended religious services.
• Social factors: People who weren't married were more likely to attempt suicide than those who were married. Suicide was also more likely in people without a high school education.

General Risk Factors

Although many factors that can increase someone's risk for suicide have been identified, some common ones to consider include:

• A family history of suicide, depression, or mental illness
• Previous suicide attempts
• Having a plan as to how they would commit suicide
• Access to firearms
• A sense of hopelessness

When Should You Be Concerned?

Knowing the statistics, if you have a loved one with cancer it is crucial to be aware of the warning signs of suicide. Yet these signs and symptoms can be more difficult to interpret in the setting of cancer. For example, giving things away that are important can be a warning side of suicide, but it can also be normal, even a healthy sign that someone is accepting their impending death in the setting of advanced cancer.

Warning Signs

• Having a plan about how they would commit suicide.
• Giving away things of importance.
• Engaging in risky behavior, such as driving too fast or skipping needed medications.
• Suddenly acting happy or calm after a period of appearing down and depressed.

Trust your gut. If your intuition is sending off warning signals—even if none of the other warning signs are present—listen to your inner voice and seek help for your loved one.

Prevention

Is there anything you can do to lower the risk of suicide in a loved one? It's true that sometimes people commit suicide no matter what you may do to try and prevent it. But sometimes there are things you can do that may lower the risk a bit.

• Be aware: Know the warning signs.
• Listen: Allow your loved one to vent. Many people who attempt suicide are feeling overwhelmed. Just talking may lift some of the burden. Avoid offering quick solutions, and instead, listen to your loved one's concerns.
• Don't judge: You may not understand why your loved one feels so desperate. Their problem may not seem insurmountable to you, but it may feel that way to them. Listen empathically.
• Express your love: Even if your loved one feels your love, it helps to hear it as well. One of the great fears people with cancer carry is that of being a burden to others. Remind your loved one of the joy they bring to your life, even with a diagnosis of cancer.
• Ask: You may be afraid to bring up suicidal thoughts for fear that it may put an idea in your loved one's head. That's not true. In fact, not asking could be construed as a lack of interest on your part. Three important questions to ask that might indicate a level of one's suicidal risk include: Do they know how they would commit suicide? Do they have the supplies available (for example, a supply of sleeping pills) and do they know when they would do it?
• Share: If you have concerns, it's important that you ask for help from other loved ones and friends. Your loved one may ask you not to talk to others, but this is something you shouldn't have to carry alone.
• Seek professional help: If your loved one is feeling hopeless about treatment or experiencing pain, a palliative care specialist may be able to offer assistance. Their oncologist or primary physician may be able to recommend a psychiatrist or psychologist to help manage the emotional pain that has led to thoughts of suicide.
• Make sure weapons are out of reach: Preferably remove any weapons from the home if possible.
• Don't leave them alone: Make sure you, or someone else you trust, stays with your loved one while they are feeling hopeless or until appropriate mental health professionals can assess your loved one.

When Should You Seek Help?

If your loved one has made an attempt, call 911. If you are concerned and want immediate help, the National Suicide Prevention Hotline is a good place to begin. Dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor.