What your doctor says -- not what he does -- could kill you.
The diagnosis of cancer often leads to agonizing distress for most people. A new study in the April 5, 2012 issue of The New England Journal of Medicine shows that a surprising number of cancer patients die not of cancer, but of a heart attack or suicide triggered by the diagnosis.
Previous studies had found an increase in suicide and death from cardiovascular disease (heart attack and stroke) in cancer patients, but it was unclear whether or not this was related to the difficulty of living with the debilitating disease and from coping with the sometimes unbearable side effects of cancer treatments. Alternatively, people may succumb to the stress brought on simply by learning that they have the life-threatening disease. A study of 6 million Swedes, by Dr. Fang and colleagues at the Karolinska Institute in Stockholm, has suggested it may be the diagnosis itself that kills through heart attack or suicide.
The numbers show that the chances of dying of heart attack or stroke in the first week after the diagnosis increases 5.6 times above that in the cancer-free population. The incidence of suicide increases 4.8 times above normal in the first week. This suggests it is the diagnosis itself, not the side effects of the treatments or the debilitation of the disease, that contributes to these deaths within the first seven days of learning the bad news.
Both risks of death by cardiovascular disease and suicide remain elevated in people three months to one year after learning they have cancer. Beyond one year the death rate from these causes declines but remains slightly elevated. The declining death rate from both suicide and heart attack with longer times after the diagnosis likely reflect both coming to accept the situation, which reduces stress over time, but also the inevitable fact that one can only die once, so that the most vulnerable to suicide or stress-induced cardiovascular illness will have succumbed sooner rather than later.
The increased risk of death by both causes was similar for both men and women, but the type of cancer patients suffered had a major effect on whether people died of suicide and cardiovascular disease. A diagnosis of brain cancer sharply increased the risk of death by cardiovascular disease in the first week after cancer diagnosis to 26.9 times above normal, but a skin cancer diagnosis only increased the risk by 1.2 times normal. Death by suicide was highest after a diagnosis of esophageal, liver or pancreatic cancer, followed by lung cancer and brain tumors, with skin cancer related to the smallest increase in suicide of 1.4 above rates in the normal population. The age of the patient had little effect on the incidence of suicide, but age greatly increased the incidence of death by cardiovascular diseases, as would be expected.
These findings are significant for several reasons. They suggest that how we think about our health does affect our health. Friends, family, doctors, and spiritual counselors may be in a position to provide life-saving support if they can, through compassion and companionship, alleviate some of the overwhelming stress that a cancer diagnosis brings in the first week or months after learning the news. Many families are touched by cancer or other serious illness, so most of us, unfortunately, will have an opportunity to use this new knowledge to help someone.
Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.
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