Major study shows x5 greater suicide rate in patients with urological cancers

March 15, 2018

A major UK survey has shown that patients with urological cancer such as prostate, bladder or kidney cancer are five times more likely to commit suicide than people without cancer. The analysis also shows that cancer patients generally are around three times more likely to commit suicide than the general population, and that the proportion of attempted suicides which result in a completed or successful suicide was higher in cancer patients, with a higher proportion still in patients with urological cancers.

Severe psychological stress is one of the main side-effects of both a diagnosis of cancer and cancer treatment, with depression affecting between 5 and 25% of cancer patients1, 2: many are also affected by Post-Traumatic Stress Disorder (PTSD)3. Previous research has shown that the vast majority of cancer patients who have symptoms of depression often go untreated2. This study shows a substantial increase in suicide attempts and successful suicides in cancer patients. The work is presented at the European Association of Urology conference in Copenhagen.

This is the largest UK study looking at suicide in cancer patients (see below). The research team led by Mr Prashant Patel at the University of Birmingham retrospectively examined the records from the England and Wales Hospital Episode Statistics database, from the period 2001 to 2011. They linked this with cause of death statistics from the Office of National Statistics.

This is also the first time that a major study has examined suicidal intent in cancer patients - which they defined as the ratio of successful suicides to the rate of attempted suicides. They found that this rate was far higher (1 to 7) in patients with prostate cancer than in the general population (1 to 25), which may show a greater determination to commit suicide in cancer patients. "This is important" said first author Dr Mehran Afshar (St George's Hospital, London), "as we know that people who attempt suicide are at higher risk of subsequently being successful in completing a suicide, and we have shown this 'intent' to commit to be far higher in our cancer population, thus confirming a real need to address psychological issues early on in the management of these patients".

Dr Afshar continued: "Our data confirms research from other countries that suicide rates are higher in cancer patients, and we show this to be higher particularly in patients with urological cancers. There are particular issues which are specific to this cancer group - for example, men with prostate cancer undergo treatment which can affect their bladder function, their bowel function, erectile function and libido, can result in symptoms similar to the female menopause, and entirely alter the personality, leading to relationship problems, anxiety, depression and post-traumatic stress disorder.

We know from a 2014 study2 by Cancer Research UK that the vast majority of cancer patients who have symptoms of depression go untreated. We can see from the results of our study that although all cancers have a higher suicide rate, inferring a higher level of psychological distress, there are disparities between cancers. This needs to be addressed within our healthcare systems, and more focus is needed on integrating the robust and specialist assessment and treatment of mental health needs in cancer care".

The study also showed significant differences between the time to a successful suicide, which means that some cancer patients are more vulnerable in certain periods.

The numbersCommenting, EAU Adjunct Secretary General, Prof Hein van Poppel (Leuven) said: "This important work shows just how distressing cancer can be, but it also shows that there may be special factors associated with urological cancers which make them even more stressful than other cancers. It looks like urological cancers can affect patients' sense of self in a way that many cancers don't.

The work implies that some urological cancers, such as kidney cancer, can lead to fairly immediate distress, whereas the distress associated with prostate and bladder cancer may take a while to hit home - perhaps when patients begin to take up some of the problems associated with returning to normal life.

We also need to put things in context: many patients recover well, and don't reach the stage of despair or distress which brings them to think of suicide. Nevertheless, this is a real problem. We need to recognise that the figures presented here are for suicides, which means that they are at the 'sharp end of emotional distress'. For every suicide or attempted suicide, there will be many more patients who find difficulty in coping.

This distress does not stop when the cancer is removed or contained, and we owe it to patients to ensure that ongoing emotional support and mental health care is fully integrated in cancer care".

(Professor van Poppel was not involved in this work. He is a specialist in urological cancers).

The team noted a limitation of the study: they looked at the general suicide rate, not at the rate of suicides according to age (age-standardised suicide rate), however a comparison to baseline population suicide rates could only be made using crude suicide rates per 100,000 as this is population level data available.
There was no specific funding for this research.

3 Cancer patients and PTSD, see

European Association of Urology

Related Prostate Cancer Articles from Brightsurf:

Low risk of cancer spread on active surveillance for early prostate cancer
Men undergoing active surveillance for prostate cancer have very low rates - one percent or less - of cancer spread (metastases) or death from prostate cancer, according to a recent study published in the Journal of Urology®, an Official Journal of the American Urological Association (AUA).

ESMO 2020: Breast cancer drug set to transform prostate cancer treatment
A drug used to treat breast and ovarian cancer can extend the lives of some men with prostate cancer and should become a new standard treatment for the disease, concludes a major trial which is set to change clinical practice.

Major trial shows breast cancer drug can hit prostate cancer Achilles heel
A drug already licensed for the treatment of breast and ovarian cancers is more effective than targeted hormone therapy at keeping cancer in check in some men with advanced prostate cancer, a major clinical trial reports.

The Lancet: Prostate cancer study finds molecular imaging could transform management of patients with aggressive cancer
Results from a randomised controlled trial involving 300 prostate cancer patients find that a molecular imaging technique is more accurate than conventional medical imaging and recommends the scans be introduced into routine clinical practice.

Common genetic defect in prostate cancer inspires path to new anti-cancer drugs
Researchers found that, in prostate cancer, a mutation leading to the loss of one allele of a tumor suppressor gene known as PPP2R2A is enough to worsen a tumor caused by other mutations.

First prostate cancer therapy to target genes delays cancer progression
For the first time, prostate cancer has been treated based on the genetic makeup of the cancer, resulting in delayed disease progression, delayed time to pain progression, and potentially extending lives in patients with advanced, metastatic prostate cancer, reports a large phase 3 trial.

Men taking medications for enlarged prostate face delays in prostate cancer diagnosis
University of California San Diego School of Medicine researchers report that men treated with medications for benign prostatic hyperplasia (enlarged prostate) experienced a two-year delay in diagnosis of their prostate cancer and were twice as likely to have advanced disease upon diagnosis.

CNIO researchers confirm links between aggressive prostate cancer and hereditary breast cancer
The study has potential implications for families with members suffering from these types of tumours who are at an increased risk of developing cancer.

Distinguishing fatal prostate cancer from 'manageable' cancer now possible
Scientists at the University of York have found a way of distinguishing between fatal prostate cancer and manageable cancer, which could reduce unnecessary surgeries and radiotherapy.

Researchers find prostate cancer drug byproduct can fuel cancer cells
A genetic anomaly in certain men with prostate cancer may impact their response to common drugs used to treat the disease, according to new research at Cleveland Clinic.

Read More: Prostate Cancer News and Prostate Cancer Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to