Patients who are diagnosed and forced to live with cancer long-term often suffer from mental distress as a result of the traumatic experience that a cancer diagnosis entails. Previous studies have shown that these patients are at a higher risk of both suicide and cardiovascular disease, which, until now, mainly has been interpreted as a result of the emotional strain brought by living with a fatal disease or of the often physically demanding cancer treatment. Recent published data on patients with prostate cancer suggest however that being given the diagnosis may, in itself, lead to a marked increase in the risk of stress-related disease and death.
In this study, published in The New England Journal of Medicine, a group of researchers from Karolinska Institutet and Örebro University, both Sweden, and University of Iceland, has followed over six million Swedes, of which 500,000 were diagnosed with cancer, to investigate whether the risk of suicide and cardiovascular death increases immediately after the cancer diagnosis. The study is based on the Swedish national population and health registries and includes people who were diagnosed with cancer between 1991 and 2006.
No link to previous disease
All in all, only a small proportion of the cancer patients committed suicide immediately after being given the diagnosis. However, compared to those in the study without cancer, cancer patients ran a twelve times higher risk of suicide during the first week after the diagnosis. Similarly, the risk of cardiovascular death was six times higher during the first week and three times higher during the first month. Both the risk of suicide and cardiovascular death then decreased rapidly during the first year after diagnosis. Risk elevation was most pronounced in patients with cancers with a poor prognosis, e.g. lung and pancreatic cancer, and least pronounced in patients with skin cancer.
The fact that the risk elevation was apparent immediately after the diagnosis and that the risk then decreased over time leads the researchers to conclude that the link cannot be explained by the cancer treatment or the emotional or physical suffering related to the progression of the disease in itself. Neither did the researchers identify a link to patients’ previous medical history, as the increased risk was observed both among those who had previously been treated for psychiatric or cardiovascular conditions respectively and in those with no such history.
“Just the tip of the iceberg”
- Most likely, the immediate risk elevation is a result of the extreme emotional stress induced by the cancer diagnosis, says Katja Fall, physician and researcher at the Clinical Epidemiology and Biostatistics Unit at Örebro University Hospital and co-author of the study.
In their paper, the researchers conclude that the evident health risks demonstrated in newly diagnosed cancer patients is most likely just the tip of the iceberg of the mental distress suffered by these patients. The researchers are hoping that these new insights may lead to an increased focus on cancer patients’ mental health and point out that it is important, also for family members, to know that a cancer diagnosis may trigger extreme mental stress which, in a worst-case scenario, may have life-threatening consequences.
- We hope that increased awareness and improved care of these patients may in the long run lead to a reduced risk of stress-related disease and death, says Katja Fall.
Text: Karolinska Institutet och Ingrid Lundegårdh
Photo: Gunilla Sonnebring
Translation: Karolinska Institutet and Charlotta Hambre-Knight