Risk Factors

High suicide risk in young people with cancer warrants surveillance

Adolescents and young adults (AYA) with cancer are 34 times more likely than the general population to die by suicide or self-inflicted injury, an Australia study has shown.

While the risk is highest in the first 12 months after a cancer diagnosis, an elevated risk persists for at least five years, a team from the Peter MacCallum Cancer Centre, Melbourne, found.

The investigators said routine surveillance for psychological concerns was clearly an imperative on the basis of their findings.

The study involved a retrospective analysis of more than 500,000 15–39 year olds with cancer during 1975–2016 from the US Surveillance, Epidemiology, and End Results database.

Published in Cancer Medicine, it found elevated standardised mortality ratios (SMRs) were particularly high in females (SMR 43.5), single relationship status (SMR 50.6), and those with metastatic disease (SMR 45.2).

Specific cancer types were also associated with higher risk – leukaemia (SMR 65.3), central nervous system and associated tumours (SMR 67.6), and soft tissue sarcoma (SMR 79.3).

The study found suicide/non-accidental injury deaths overall were particularly high in the first 12 months following a cancer diagnosis (SMR 72.8) then decreased over time but remained above background population risk even beyond 5 years (SMR 28.1).

“For individuals diagnosed with cancer at a younger age (15–29 years), risk appeared to remain elevated in a sustained fashion over time, whereas the highest risk of death by suicide occurred in the first year following a cancer diagnosis for older individuals aged 30–39 years,” the study authors said.

“This may be of relevance to specialist oncology health-care providers involved in follow-up and survivorship care of patients diagnosed with cancer during the AYA period, as well as primary care providers.”

Patients with Hodgkin’s lymphoma and prostate cancer demonstrated sustained elevation of risk, and patients with testicular cancer demonstrated increasing risk over time.

When comparing AYA cancer patients who died due to suicide/self-inflicted injury and other AYA cancer patients, the study found males, white ethnicity, never married, distant disease or those with one tumour were risk factors.

The authors said that while AYA accounts for a small proportion of annual cancer cases, the complexity of this subgroup places them at a disproportionately high risk of premature death and negative long-term health outcomes.

As well, a focus on non-malignant causes of morbidity and mortality was important given overall survival rates were otherwise high for most major tumour types.

“Consequently, monitoring of suicide risk, developing suicide prevention strategies, and tailoring psychosocial interventions addressing the mental health in AYA cancer patients are required across both oncology and primary care settings.”

“This raises complexities given an individual primary care physician’s exposure to AYA cancer may be limited, and thus also highlights the importance of initiatives aimed to empower patients and families to prompt concerns.”

Senior investigator Dr Jeremy Lewin, Medical Director of ONTrac at Peter Mac Victorian Adolescent and Young Adult Service, told the limbic the large numbers of patients in the SEER dataset could not be reproduced in Australia.

“Nevertheless I think the findings are likely to be quite similar for an Australian population and particularly relevant when looking at a younger population – individuals aged 15-25 which is the traditional AYA age range in Australia.”

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