Lung cancer patients have highest risk of suicide: A discussion with Dr. Jeffrey Port

Background:
The suicide rate in cancer patients is 60% higher than the suicide rate among the general United States population. But the suicide rate of lung cancer patients is much higher—an astonishing 420% higher than the suicide rate of other Americans, according to study results presented May 23, 2017 at the American Thoracic Society 2017 International Conference, in Washington, DC.

For more on lung cancer, select the Lung Cancer Resource Center.

For this study, the researchers used a large national database to identify suicide deaths associated with all types of cancers, and in particular those associated with lung, prostate, breast, and colorectal cancers. The findings showed that patients with lung cancer have the highest risk of suicide compared with all other cancer patients. Among lung cancer patients themselves, suicide was highest in males, Asians, widowed, and older patients, those with metastatic disease, and those who refused medical treatment.

In this interview, study co-author Jeffrey L. Port, MD, discusses some of the possible reasons why lung cancer patients have a higher rate of suicide, and how clinicians can try to help reduce this rate.

MDLinx: What prompted this investigation of suicide in cancer patients?

Dr. Port: Many of us who take care of cancer patients—in my case, lung cancer patients—we’ve noticed that they’re often distressed and overwhelmed by their diagnosis. So it prompted us to think about how overwhelmed they really are. Does it impact their treatment? Does it impact their management plan? Do some of them think about taking their life, or ultimately do take their life? We’ve recognized all along how stressful the diagnosis is, so in this study we wanted to collate it and try to document it.

MDLinx: Does your study provide any clue why suicide is highest among lung cancer patients?

Dr. Port: It doesn’t, and the national database that we queried couldn’t give us all the details as to why it would be lung cancer. However, we can speculate that lung cancer tends to be tumor associated with a grave prognosis. Patients often present with advanced disease. There’s often associated guilt because many patients have smoked—85% of our patients have a smoking history, so they believe they’ve brought it upon themselves. Patients tend to present late in life and so they’re older, more frail, and have associated medical co-morbidities that can rule out aggressive therapy. Because of all these things, there’s not necessarily the intensive or highly visible support that we see in other tumor types like breast cancer. For many patients with lung cancer, they often don’t know where to turn for support.

MDLinx: Did your investigation reveal any other unexpected findings?

Dr. Port: The one unexpected finding we can’t overlook is that 50% of the suicides occurred in lung cancer patients with potentially curable disease. So there’s a disconnect where practitioners are not conveying the positive message to patients that, even though it’s lung cancer, there is a group of patients—such as stage one patients with an isolated tumor and no associated spread—who have a very high cure rate. So it’s incumbent on us to fix that.

MDLinx: Another finding is that the suicide rate has been declining over time, so perhaps that positive message is now reaching patients?

Dr. Port: There has been a decrease in the risk of suicide over time. It seemed to plateau around 1993 to 1995, and then it started decreasing in the last 20 years. So we’re doing better, but whether that’s because we’ve gotten the word out that you can be cured of lung cancer, or whether it’s because treatments have actually improved in patients, or whether we’re just being trained better as clinicians to recognize these high-risk patients, we’re not sure. So there’s definitely been a decreasing trend, but the suicide rate is still pretty significant.

The other thing I want to highlight is that although this paper discusses suicide, that’s the tip of the iceberg. Many of our patients are very distressed yet they don’t ultimately take their life, which is obviously the most extreme form of that stress. As a continuation of this paper, I think future work has to focus on those patients who are so distressed that it impacts their ability to navigate their management and their treatment, even though they may potentially have curable disease.

MDLinx: Knowing that these patients are so distressed, what can clinicians do to help them combine their cancer treatment with mental health services or other assistance?

Dr. Port: Cancer doctors and surgeons are well trained in examining our patients and looking for physical ailments. But we’re not as well trained in understanding some of the signals that tell us that these patients need intervention from other health professionals, whether that’s psychiatrists, psychologists, or social workers. This study highlights that even though we’re probably doing a better job based on the trends, there’s also an increasing need to survey our patients and to understand that they may need intervention. Loss of sleep and loss of appetite ultimately require intervention—not simply telling patients that what they’re experiencing is normal. We need to better tease out which of these patients are at high risk for having significant distress and ultimately have the potential for suicide.

About Dr. Port: Jeffrey L. Port, MD, is an attending thoracic surgeon at Weill Cornell Medical Center and a professor of Clinical Cardiothoracic Surgery at Weill Cornell Medical College, in New York, NY. He specializes in lung and esophageal cancers, mediastinal tumors, Barrett’s esophagus, and also in the area of minimally invasive thoracoscopic pulmonary surgery.