Suicide Rates Higher for Patients With Urologic Cancers

COPENHAGEN — Patients with a urologic malignancy, including bladder, kidney, and prostate cancer, are five times more likely to commit suicide than those in the general population, researchers warn. And when they do attempt suicide, they are more likely to be successful.

"All cancers have a higher suicide rate," investigator Mehran Afshar, MBBS, PhD, from St George's Hospital in London, explained in a statement, "which infers a higher level of psychologic distress, but there are disparities between cancers," he pointed out. "This needs to be addressed within our healthcare systems."

For their study, Afshar and his colleagues used data from the Office for National Statistics to identify suicide risk in the United Kingdom from 2001 to 2011. Results were presented during a poster session here at the European Association of Urology 2018 Congress.

In the cohort of patients diagnosed with urologic malignancies, there were 1222 suicide attempts and 162 completed suicides.

The ratio of suicide attempts to completed suicides was lower in patients with a urologic malignancy than that in the general population (1:7 vs 1:25).

"This is important," Afshar observed. "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."

Table. Time From Diagnosis to Suicide Attempt

Cancer Cohort	Days
Kidney	175
Prostate	846
Bladder	1037

Age seems to play a role in the likelihood of a suicide attempt. For patients with kidney cancer, those younger than 50 years were more likely than older patients to make an attempt (P = .01). However, for those with bladder or prostate cancer, older patients were more likely to attempt suicide (P < .01).

Paradoxically, patients with kidney cancer with fewer comorbidities were more likely than those with more comorbidities to attempt suicide (P = .04).

"There are a number of possible reasons why the suicide rate is so high in patients with urologic malignancies," said investigator Antonio Bardoli, MD, from Queen Elizabeth Hospital in Birmingham.

First, the majority of those with urologic cancer who committed suicide were men. In the general population, the suicide rate is at least three times higher in men than in women.

But probably more important, the cancer itself — or in the case of prostate cancer, its treatment — often leads to significant psychosocial distress.

"Cancer such as kidney cancer is very aggressive. Patients have a very short time from diagnosis to the ultimate end of life," Bardoli told Medscape Medical News.

The important thing here is to identify patients — even those with prostate cancer who have a good prognosis — who are not getting the psychiatric support they need.

Disease-specific mortality for prostate cancer is among the lowest of all cancers, but men are increasingly being diagnosed with prostate cancer at a younger age, at least in the United Kingdom, he pointed out.

This means that patients are living for considerable periods of time with possible sexual dysfunction or urinary or fecal incontinence, and these adverse effects could well be a source of serious psychosocial distress, he suggested.

And then there is androgen-deprivation therapy for early-stage prostate cancer, which can send men abruptly into male menopause that can lead to high levels of psychiatric distress, he added.

"The important thing here is to identify patients — even those with prostate cancer who have a good prognosis — who are not getting the psychiatric support they need," Bardoli said.

"We are recommending that uro-oncology services provide greater psychiatric intervention at an earlier stage, and we would like to develop some sort of prognosticator to identify patients at high risk for suicide," so that this "highly vulnerable population" can get help, he said.

Cancer and Stress

This study shows just how distressing cancer can be, said Hendrik Van Poppel, MD, PhD, from the University of Leuven in Belgium.

"It also shows that there may be special factors associated with urologic cancers which make them even more stressful than other cancers," Van Poppel said in a statement.

For every suicide or attempted suicide, "there will be many more patients who find difficulty in coping," he noted, adding that the distress associated with cancer does not stop when a cancer is removed or contained.

"We therefore owe it to patients to ensure that ongoing emotional support and mental health care is fully integrated in cancer care," Van Poppel said.

Afshar, Bardoli, and Van Poppel have disclosed no relevant financial relationships.

European Association of Urology (EAU) 2018 Congress: Poster 68. Presented March 16, 2018.

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