Suicide Risk among Genitourinary Cancer Patients

For some of us, taking care of our cancer patients involves the physical care. We might recommend surgery for our prostate cancer patients. Or we might order a certain chemotherapy regimen for a woman with ovarian cancer. Of course, we know that their mental health is extremely important, but we tend to focus on our area of expertise.

However, new research published in the journal Cancer (published by the American Cancer Society) stresses the importance of our patients’ mental health, especially in terms of suicide risk.

A group of researchers from the Medical College of Georgia-Georgia Regents University and Vanderbilt University Medical Center report that suicide risk among genitourinary cancer patients “poses a public health dilemma.”

They compared the incidence rates of suicide among genitourinary cancer patients with those of the general U.S. population. Using data from the Surveillance, Epidemiology, and End Results (SEER) database, they looked at information for patients with prostate, bladder, kidney, testis, or penile cancer from 1988 to 2010.

Among 1,239,522 patients with these cancers, 2,268 patients committed suicide.

About 71% of these suicides were committed by prostate cancer patients, followed by 19% for bladder cancer patients and 6% by kidney cancer patients.

The authors also found the following:

• Suicides among prostate cancer patients increased over time, with the highest incidence at least fifteen years following diagnosis.
• More patients with bladder cancer took their lives within the first five years after diagnosis than any other time.
• Kidney cancer patients were more likely to commit suicide during the first five years after diagnosis, but the incidence for this group decreased over time.
• Male sex was strongly associated with higher suicide rates among bladder and kidney cancer patients.
• Patients with prostate, bladder, or testis cancer were more likely to commit suicide as they got older.
• Suicide incidence rates among African-Americans with prostate, bladder, or kidney cancer were lower than those of white patients with these cancers. However, rates were higher for African-American patients with bladder cancer.

Overall, the authors noted that bladder and kidney cancer patients were at the highest risk for suicide.

Many factors can contribute to suicide and ultimately, a person’s decision to end his or her life is a personal one. However, the authors noted that a poor prognosis, financial struggles, depression, and anxiety can all be involved. For example, watchful waiting can bring much anxiety to the prostate cancer patient. And bladder cancer patients may feel they’re becoming a burden to those who care for them.

What can healthcare providers do? Keeping our eyes open for suicidal thoughts among our patients – and getting them help - is the first step. While this may sound obvious, it’s important to know what to look for, how to talk to at-risk patients, and where to refer them if necessary. To that end, the study authors suggested the National Comprehensive Cancer Network (NCCN) for resources and guidelines.

However, we can also talk to our colleagues, especially if we are part of a cancer care team. Other providers might notice changes in patients that we don’t. We can also stay in touch with mental health organizations and learn more about the resources available in our community.

Resources

Cancer

Klaassen, Zachary, MD, et al.

“Factors associated with suicide in patients with genitourinary malignancies”

(Full-text. First published online: February 17, 2015)

http://onlinelibrary.wiley.com/doi/10.1002/cncr.29274/abstract