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Cancer survivors at risk for suicidal thoughts, attempts

August 21, 2006

Survivors with pain, physical changes may be burdened by thoughts of suicide many years after treatment

BOSTON-A survey of adult survivors of childhood cancers found that more than one out of eight reported having suicidal thoughts or previous attempts to take their lives many years after they were treated, say scientists at Dana-Farber Cancer Institute.

The suicidal symptoms were reported by more than 12 percent -- a greater proportion than had been expected - of patients seen at a clinic providing care for adult cancer survivors, the researchers write in the August 20 issue of the Journal of Clinical Oncology. The findings should prompt providers at survivor clinics to consider the interaction of physical and emotional factors in their follow-up evaluations of patients, they said.

"Most people are doing fine, but there is a serious concern about the minority of survivors who have thoughts of ending their lives," said Christopher Recklitis, PhD, MPH, a psychologist and director of research in the Perini Family Survivors' Center at Dana-Farber. He is lead author of the paper.

The senior author is Lisa Diller, MD, chief medical officer of Dana-Farber/Children's Hospital Cancer Care and clinical director of Pediatric Oncology at Dana-Farber Cancer Institute and Children's Hospital Boston.

Previous studies have noted a temporary rise in suicidal thoughts among patients in the months after a cancer diagnosis. The new study is the first to substantiate a significant level of suicidality many years or even decades after treatment for childhood cancers, and to suggest a link with physical functioning in the survivorship period

Recklitis and colleagues conducted the study with the participation of 226 adult survivors of childhood cancer - 100 men and 126 women - with a mean age of 28.

The participants were interview an average of 18 years after their initial diagnosis with a range of childhood cancers including lymphomas, leukemias, sarcomas, and Wilms' tumor. Individuals diagnosed with brain tumors were not included in the group.

The study participants completed standard rating scales evaluating quality-of-life, suicidal thoughts, signs of depression, pain, and physical health. All together 29 survivors reported some suicidal symptoms.

Nineteen patients reported suicidal thoughts alone, one had made a previous attempt but no longer was troubled by suicidal thoughts, and nine participants said they had made suicide attempts and were currently thinking about suicide. Only 11 of these 29 survivors were considered to be significantly depressed on the basis of their rating scales, suggesting that identifying survivors with suicidal thoughts requires more than asking patients about depression.

Data analysis showed that factors associated with more suicidal symptoms included younger age at diagnosis, a greater time having passed since diagnosis, and radiation treatments to the head. The latter form of treatment - used less frequently and in smaller doses today - can cause growth retardation and physical disfigurement, impairments in memory and cognitive functions, and increased risk of second cancers.

Patients were also more likely to report suicidal symptoms if they felt depressed or hopeless, were in pain, had problems with physical function, or were concerned about their appearance.

"The association with physical health and pain is important," the authors wrote, "because these represent potentially treatable conditions for which survivors may seek follow-up care."

In revealing the complex relationships of physical and mental well being with suicidality, the study "underscores the need for a multidisciplinary approach to survivor care."

With the growth of survivors' clinics across the country, it is important to improve psychological screening methods "that aren't intrusive, but get us to this important information," said Recklitis, who is also a clinical instructor in psychology at Harvard Medical School.

Dana-Farber Cancer Institute