Learning that you have a serious disease, such as cancer, is a stressful life event. Some cancer patients struggle with anxiety, depression and may — in the worst-case scenario — even contemplate or commit suicide.
In a recent analysis of more than 3.6 million cancer patients, researchers found a disproportionately high incidence of suicide in patients diagnosed with lung cancer compared to patients with other types of cancer and the suicide rates of the general population.
Dr. Jeffrey L. Port, one of the researchers, says the study was prompted by the observation of a high number of lung cancer patients in his clinic who had significant anxiety and stress. Port is professor of cardiothoracic surgery at Weill Cornell Medical College and associate attending physician of cardiothoracic surgery at New York-Presbyterian Hospital. “[We observed the degree of stress] was sometimes out of proportion to the extent of the disease,” Port says. “These patients have trouble making appointments, sticking to treatment and understanding their prognosis.”
[See: 7 Things You Didn’t Know About Lung Cancer.]
According to the National Cancer Institute, 15 to 25 percent of cancer patients suffer from depression, due to the experience of loss (real or anticipated) and to side effects, such as pain, from the cancer itself or from treatment.
Port’s study found that over a 40-year period the suicide rate was significantly higher in patients with any kind of cancer — about 27.5 suicides per 100,000 person years versus 13 suicides per 100,000 person years in the general population. (Person year is a way of measuring time — specifically, the number of years multiplied by the number of people in the population who were affected). Lung cancer patients, however, were 420 percent more likely to die by suicide. Men with lung cancer have a nine times greater risk of suicide than women, and Asians are at higher risk than other ethnic populations. Being older, widowed and having a hard-to-treat lung cancer were also associated with a higher suicide risk, the study found.
Dr. Gaetane Michaud, a pulmonologist and associate professor of medicine at NYU Langone’s Perlmutter Cancer Center, says she’s not surprised by the results of the study. “Patients [with lung cancer] feel hopeless because their prognosis is poor. Despite decades of progress [in cancer], survival rates in [lung cancer] have not moved. Lung cancer has the highest mortality rate of the common cancers [which also include breast, colorectal and prostate cancers].”
The good news is that this is changing. “We’ve seen a lot of advances in lung cancer,” Michaud says. Immune therapies, for example, are still in their infancy but are showing good possibilities for extending patients’ lives. “I tell patients now that I can’t say with confidence what to expect. Every week there is a new drug, a new line of treatment.”
It’s important for lung cancer patients to know the disease comes in many different stages, Port says, and that it’s curable in the early stage. Part of the problem, he says, is patients don’t understand the difference between early stage lung cancer and advanced lung cancer. Regardless of their diagnosis, they see their disease as a death threat. “Lung cancer has a reputation for having a poor outcome,” Port says. “There are cures and there are better treatment options. These are the areas to focus on.”
[See: What Not to Say to Someone With Lung Cancer.]
Michaud agrees with this thinking. “If [patients are] given no hope, it’s hard [for them] to be hopeful,” she says.
Michaud says cancer patients may turn to suicide because of pain (or the anticipation of pain) and their wish not to be a burden on loved ones. This is an opportunity for cancer care professionals to intervene and have a positive impact. “We can institute palliative care earlier [in the course of the disease],” she says. “Palliative care shows positive outcomes on pain and shortness of breath. Patients have a better quality of life.”
Palliative care, also called comfort care, focuses on managing symptoms, such as pain, fatigue and anxiety, and keeping patients comfortable at all stages of their disease.
“More than 50 percent of [lung cancer] patients have shortness of breath,” Michaud says. “Older studies showed the vast majority of them didn’t get [palliative] care. Now, they are not suffering as much as they used to. We can intervene with respect to depression and anxiety. There are good guidelines [for treating depression and anxiety] from the American College of Chest Physicians. It’s part of lung cancer treatment guidelines to be aggressive in managing pain and symptoms and improving patient experiences. Palliative care is so much more than end-of-life care.”
[See: 7 Innovations in Cancer Therapy.]
Michaud says patients often feel guilty when they have lung cancer. “There’s always a negative view of lung cancer, that smokers do this to themselves,” Michaud says. However, the number of nonsmokers developing lung cancer is rising — with 10 to 15 percent of lung cancer cases occurring in people who have never smoked. “It’s not just a smoker’s disease,” she says.
The psychosocial aspect of palliative care is important. Having a support network, whether it’s family and friends or a formal cancer support group, is helpful. “The psychological burden of lung cancer is real. Support groups for patients and caregivers are still underutilized,” Michaud says. She says we need to treat patients’ loss of autonomy as well as their physical symptoms. “We don’t talk about loss of autonomy very often. Patients are at appointments all the time. They don’t get a say [in their disease]. The loss of autonomy can feel awful.”
The good news is that the rates of suicide are declining in lung cancer patients. However, there is still an opportunity for clinicians to do a better job of understanding the emotional stress of lung cancer, Port says.
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The Link Between Lung Cancer and Suicide Risk originally appeared on usnews.com
