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One day many years ago, while training in neurology, Dr. Corinna Seliger-Behme met a man with end-stage bladder cancer. Dr. Seliger-Behme recalled that before the diagnosis, the man had a stable family and job and had no history of mental health problems. However, shortly after learning of her terminal illness, she tried to kill herself with a knife in the tub. She spent the last week of her life in the psych ward.

That patient’s condition was extreme, but the psychological distress brought on by cancer is significant to many patients. Two studies published Monday measure the psychological burden of cancer in fine detail, drawing on datasets that are much larger than previous research. The findings make a compelling case for oncologists to discuss more with their patients about their mental health struggles.

A neurologist from the University of Regensburg in Germany, Dr. “Probably, we can prevent suicide if we talk about it and really start it that early,” Seliger-Behme said.

In one of the new reports, he and several colleagues reviewed 28 studies involving more than 22 million cancers. patients Worldwide. Their analysis showed that the suicide rate among people with cancer was 85 percent higher than in the general population. As might be expected, cancers with the best prognosis, including prostate, non-metastatic melanoma, and testicular cancers, had the lowest suicide rates, while those with the worst prognosis, such as stomach and pancreatic cancers, had the highest suicide rates.

The study found that suicide rates among people with cancer were significantly higher in the United States than in Europe, Asia or Australia. The authors suggested that the high cost of healthcare in the United States may cause some patients to discontinue treatment in order not to bankrupt their families. They also wondered whether easier access to firearms could contribute to higher suicide rates in the United States compared to countries in other world regions.

In the second new study, Alvina Lai, an informatics major at University College London, and a colleague created a large database compiled from the health records of nearly 460,000 people with 26 different cancers diagnosed in the UK between 1998 and 2020.

Five percent of patients were diagnosed with depression after being diagnosed with cancer, and the same was true for anxiety. About one percent of the group self-harmed after their diagnosis. Patients with brain tumor, prostate cancer, Hodgkin lymphoma, testicular cancer, and melanoma were more likely to self-harm.

The study found that about a quarter of cancer patients have a substance abuse disorder. And psychiatric problems, including substance abuse, tended to increase over time, even years after diagnosis.

The analysis showed that the biggest single risk factor for developing a mental health condition was treatment that included surgery, radiation and chemotherapy. The length, intensity, and cumulative side effects of this triple threat approach to cancer treatment may explain why it triggers depression, anxiety, and even personality disorders in many people.

Chemotherapy on its own was associated with higher rates of psychiatric disorders, while “kinase inhibitors” – targeted drugs that usually have fewer side effects – had the lowest rates.

Precise data, Dr. It made Lai wonder if patients were given adequate opportunity to weigh the psychological risks of potential treatments. Dr. “It would be very helpful for newly diagnosed cancer patients to see what the data are telling us and make an informed decision,” Lai said.

The research also yielded some surprising findings. For example, testicular cancer had a higher risk of depression than any other type of cancer, affecting 98 of every 100 patients.

D., who was not involved in the study and head of psychiatry at the MD Anderson Cancer Center in Houston. “This is a bit illogical — it’s one of the better prognostic forms of cancer,” said Alan Valentine. He said the finding underscores how turbulent a diagnosis can be, even when a tumor doesn’t shorten life.

Because studies evaluating mental health typically rely on self-report questionnaires, the data are likely underrepresentative of reality, said Wendy Balliet, a clinical psychologist at Hollings Cancer Center at the University of South Carolina Medicine in Charleston. Dr. Persistent stigmatizations against psychiatric disorders mean that people may not be outspoken about their inner struggles, Balliet said. She also noted that the complexity of declaring a death as completed suicide can lead to underreporting of the link between cancer and fatal self-harm, she said.

The results raise questions about how much more counseling and support can be given to patients along the way. Dr. “It’s hard for me not to think about what kind of conversations these patients had with their oncologists,” Balliet said.

Studies are also drawing attention to cancer patients who previously had psychiatric disorders such as schizophrenia. Previous research has found that such patients die from cancer at a higher rate than those who do not have these conditions. Dr. Lai’s study found that cancer patients with schizophrenia are more likely to receive palliative care, potentially indicating they don’t get the treatment they need early in their diagnosis.

MD Anderson’s Dr. “Cancer is an expensive disease,” Valentine said, “and you can argue that people with severe mental disorders either don’t have access to care or are in a healthcare system that doesn’t have the resources they have. need.”

A professor of medicine at Columbia University’s Vagelos College of Physicians and Surgeons, Dr. Nathalie Moise noted that current treatment guidelines recommend screening for depression as part of routine cancer treatment. “I think these findings may support the need to screen for suicide and other risk factors as well,” she said.

“Normalizing mental health treatment as an integral part of your overall cancer care can also go a long way,” he said.

If you have suicidal thoughts, call the National Suicide Prevention Lifeline at 800-273-8255 (TALK) or go to: SpeakingOfSuicide.com/resources For a list of additional resources.