HARVARD GAZETTE ARCHIVES
Childhood cancer survivors consider suicide
Thoughts, actions persist many years after treatment
By William J. Cromie
Harvard News Office
Adults who survive childhood cancers are more likely to think about and attempt suicide than the general public. That's the conclusion of the first study to substantiate a significant level of suicidal symptoms many years, even decades, after treatment for childhood cancers, including leukemia and lymphoma.
Suicidal thoughts and acts were reported by one of every 13 survivors, a much higher number than had been expected by researchers at the Dana-Farber Cancer Institute, an affiliate of Harvard Medical School in Boston.
"Most of the people are doing fine, but there is a serious concern about a significant minority of survivors who have thought about and attempted to end their lives," notes Christopher Recklitis, a Harvard Medical School psychologist.
As Recklitis and his colleagues expected, pain and failing physical health are the major reasons that push these people into thinking about taking their lives. Loss of physical functions and pain topped the list of risk factors even when depression, a well-known suicide trigger, was taken into account.
"This finding has important implications for developing programs to identify those cancer survivors at risk for [suicide] because it implies that screening for depression alone may not be adequate," the researchers comment in the Aug. 30 issue of the Journal for Clinical Oncology.
Ten suicide attempts
Childhood cancer survivors often receive intensive treatments, many of which can interfere with physical and mental development. They also represent a group who may be at risk for emotional distress, notes Recklitis, who is director of research at Dana-Farber's Perini Cancer Survivors' Center.
Previous studies at that center uncovered rates of attempted and successful suicide much higher than those among people who did not have childhood cancers. This led to the latest investigation, which tracked 226 adult survivors, 100 men and 126 women, ages 18 to 64.
An average of 18 years after being diagnosed with cancer, those in the study answered questionnaires about their present thoughts and past suicide attempts. A third of them had been treated for leukemia (several types of cancer involving blood cells), a third for lymphoma (cancers of lymph tissues), and a third for solid tumors such as Wilm's tumor, a type of kidney cancer.
Twenty-nine of these people (about 13 percent) admitted to thinking about killing themselves. Ten of them (about 4 percent) actually attempted suicide, and nine of these survivors still have thoughts about taking their own lives.
This compares with surveys of the general population that found about 3 percent of people have suicidal thoughts and less than 1 (0.6) percent actually attempt it. So about four times as many childhood cancer survivors think about killing themselves, and almost seven times as many actually try to do so, compared with people who were not treated for cancer when they were young.
The researchers note that the people in their study were chosen from those who had sought care for medical effects experienced later in life, so that their rates of suicide symptoms may not represent all of childhood cancer survivors. If the latter were included, the rates of suicidal behavior might be lower.
Nevertheless, they say, "This study demonstrated suicidal symptoms are meaningfully related to cancer treatments and postcancer health, even many years after completion of treatment." The risk factors involved include the same ones that likely affect all cancer patients and everyone else - pain, poor health, depression, and feelings of hopelessness. For cancer patients, the younger they were at the time of diagnosis and the more time that has passed, the higher the risk. "Younger children may be more vulnerable to the toxic effects of drug and radiation treatments and their long-term effect," Recklitis says.
The other researchers in the study include Rebecca Lockwood, Monica Rothwell, and Lisa Diller, who is senior author of the report and chief medical officer of Dana-Farber/Children's Hospital Cancer Care. The researchers point out that radiation treatment of the head was once used more frequently and in larger doses than is the case today. Such radiation can retard growth and lead to disfigurement, learning and memory impairment, and increased risk of second cancers.
At the time participants in this study were treated, radiation to the head was widely used in treating leukemia. Today, fewer patients undergo such treatment.
"The association of suicide risk with physical health and pain is important because these represent potentially treatable conditions for which survivors may seek follow-up care," the researchers conclude. Those who come into contact with the survivors should be aware of both the physical and emotional factors that impact their health. Different specialists can independently assess different factors that contribute to a patient's well-being, but, Recklitis notes, "only by integrating their findings can they develop an accurate understanding of a survivor's health and quality of life."