Childhood cancer survival linked to suicidality

A "significant proportion" of survivors of childhood cancers have suicidal thoughts or have actually attempted suicide many years after treatment, a survey shows. Cancer survivors with pain and physical changes are particularly vulnerable.

The survey of 226 adult survivors of childhood found that 29 - nearly 13 percent - reported "suicidality." Nineteen reported suicidal thoughts alone; one had attempted suicide in the past but wasn't currently having suicidal thoughts; and nine reported both current suicidal ideation and past attempts.

"Although the vast majority of survivors reported no suicidality, the significant minority of survivors with thoughts of ending their lives is a serious concern," write Dr. Christopher J. Recklitis from Dana-Farber Cancer Institute and Boston-based colleagues in the Journal of Clinical Oncology.

Previous studies have shown a temporary rise in suicidal thoughts among cancer patients in the months after receiving a diagnosis of cancer. The new survey is the first to show a significant level of suicidal thoughts many years or even decades after treatment for childhood cancers, the investigators say.

The men and women surveyed were an average of 28 years old and had survived a range of childhood cancers including lymphomas, leukemias, sarcomas, and Wilms' tumor, but not brain tumors, and were interviewed an average of 18 years after their initial diagnosis.

Identified risk factors for suicidal symptoms in cancer survivors included pain, poor physical function and changes in appearance.

"The association with physical health and pain is important," write the authors, "because these represent potentially treatable conditions for which survivors may seek follow up care."

Also, only 11 of the 29 with suicidal thoughts and behaviors were significantly depressed by standard measures, suggesting that doctors need to do more than just ask cancer survivors about depression to identify those who may be suicidal.

SOURCE: Journal of Clinical Oncology, August 20, 2006.