Suicide risk after cancer diagnosis

A population wide study covering 20 years of data from England has confirmed that people diagnosed with cancer are at increased risk of suicide – 20% overall – compared to the general population, with some cancer diagnoses (such as mesothelioma, pancreatic, lung, esophageal, and stomach cancers) associated with a higher relative risk.

The study found that the elevated risk was highest during the first six months following diagnosis including a risk of suicide within one week of diagnosis.

The researchers comment: “The shock of a cancer diagnosis and the losses inherent to it may be processed as a psychological threat. In some cases this shock can give rise to psychological symptoms diagnosable as depression or anxiety. The prevalence of major depression in patients with cancers is 15%, exceeding the 2% reported for the general population. However, as diagnostic criteria for depression rely on at least 2 weeks of pervasive low mood, patients who attempt suicide within a week of a cancer diagnosis may have been depressed for some time or enacting a catastrophic reaction to a negative life event. Specific cancers may present insidiously with depressed mood and certain treatments for cancer can also cause depression through their direct neuropsychiatric effects. Awareness of the potential for such biological effects, impulsive catastrophic reactions to diagnosis, and incident or worsening depression are starting points for early identification of suicidal distress.

“Suggested responses include addressing the underdiagnosis and undertreatment of depression and anxiety in patients with cancer, improving access to integrated psychological support for all patients with cancers, addressing modifiable risk factors, and restricting access to the means of lethal overdose.”

Jurisdictions with legalised assisted suicide such as Oregon fail to respond appropriately to this increased risk of suicide following a cancer diagnosis by affirming the decision to commit suicide and actively providing the means to do so. It has been established that depression in those requesting assisted suicide in Oregon is overlooked by doctors willing to prescribe lethal substances to them.

In Victoria the re-elected Andrews Labor government is funding an advice line which will facilitate access to assisted suicide. Under its assisted suicide scheme, which is scheduled to be fully operational by 19 June 2019, a person given a cancer diagnosis could be dead by ingesting a legally prescribed lethal substance with two weeks with the authorisation of the secretary of the Department of Health.