The Psychological Toll of Cancer 

Cancer diagnosis and treatment can be emotional experiences, eliciting fear, anxiety, hope, optimism, pessimism, loss of self, lowered self-esteem, heightened determination, resignation, and countless other feelings in the thousands of patients impacted by cancer each year.

The rollercoaster of emotions can have a major impact on a patient’s well-being, and upwards of 25% of patients experience despair so profound and prolonged that it qualifies as clinical depression. This rate is much higher than the general population and, on top of the immense psychological toll, puts patients at risk of poor treatment adherence, worsened pain, and inferior outcomes.

It also makes them more likely to die by suicide.

Identifying which cancer patients have an increased risk of suicide could help providers better support patients’ mental health, improve their quality of life, and intervene before death by suicide occurs.

Examining Suicide Rates Among Patients With Cancer

Several studies have analyzed cancer registry data to understand the trends, patterns, and patient populations at risk of suicide. While differences in methodologies and datasets have led to a range of risk estimates, studies have consistently found that suicide deaths—though rare—are significantly more likely to occur in patients with cancer than in the general population.  

An analysis of the Surveillance, Epidemiology, and End Results (SEER) registry found that, between 1973 and 2014, cancer patients in the United States had a more than fourfold higher rate of suicide than the general population. A study that examined a shorter time frame—2000 to 2016—and included data from patients across North America from the Cancer in North America dataset found a 26% higher risk of suicide among cancer patients compared with the general population. And yet another reported an 85% increased risk, based on a meta-analysis of studies conducted around the world. 

Across multiple studies, suicides in cancer patients were found to occur more frequently within the first year after diagnosis and in patients who were male, white, or unmarried. 

Patients with cancer are also more likely to think about suicide or engage in suicidal behaviors, such as injuring themselves or attempting suicide, and the elevated risk of suicidal ideation and behaviors compared with the general population may be higher among women, according to research presented at the 18th AACR Conference on the Science of Cancer Health Disparities. 

While the vast majority of people who have suicidal thoughts or actions do not die by suicide—highlighting the often transient nature of suicidal impulses—these behaviors can indicate that an individual is at risk, providing an opportunity for targeted interventions.

The study, presented by Brandy M. Byrwa-Hill, PhD, of the University of Utah Huntsman Cancer Institute, examined data from 14,644 suicide deaths that occurred in Utah between 1994 and 2022. Of these deaths, 1,015 occurred in individuals who had a history of cancer.

Byrwa-Hill reported that among women who died of suicide, those with cancer had a nearly eightfold higher rate of prior suicidal ideation and behaviors than those without cancer. This contrasted with the findings in men—where a cancer history was associated with an approximately twofold greater rate of prior suicidal ideation and behaviors compared with individuals without cancer.

The finding indicates that women with cancer may be more likely to exhibit early warning signs that could allow clinicians to intervene, Byrwa-Hill explained, but she cautioned that the results were from a limited geographic location that may not be representative of all populations.

The research also showed that psychiatric illness and a history of substance or tobacco use were additional risk factors for suicidal ideation and self-injuring behaviors in both men and women with cancer.

The Association Between Cancer Type and Suicide

The type and stage of cancer a patient is diagnosed with may also be a risk factor for suicide and/or suicidal ideation and behavior—driven, in part, by the cancer’s prognosis. Suicides have been found to occur more frequently among patients with cancers associated with high mortality rates, such as advanced cancers and cancers of the lung, head and neck, esophagus, stomach, brain, and pancreas. Cancers whose symptoms or treatments impair long-term quality of life are also associated with an increased risk of suicide.

Patients with sex-specific cancers face additional challenges that can negatively impact their mental health. Surgeries that remove the breast, uterus, prostate, or testicles may impact a patient’s body image, self-esteem, sexual function, and/or fertility. And hormone therapies commonly used to treat certain sex-specific cancers are associated with side effects that can lower a patient’s quality of life. 

Moreover, patients with these types of cancer may feel less comfortable talking with their providers or support systems about their struggles, given the body sites that are affected and the sensitive nature of common treatment side effects, according to Byrwa-Hill. They may also be less likely to communicate concerning symptoms early on, which can lead to these cancers being diagnosed at later stages where the risk of suicide is higher.

Accordingly, Byrwa-Hill’s analysis revealed that 89% of women with sex-specific cancers (breast, cervical, and uterine cancers) who died of suicide had a documented history of suicidal ideation, suicide attempts, and/or self-harm, compared with 51% of women with other types of cancer. Among men who took their lives, there were no differences in the occurrence of prior self-harm, though there was a modest increase of prior suicidal behavior or attempt in those with sex-specific cancers (prostate and testicular cancers) compared with those with other forms of cancer. 

What Can Be Done to Reduce Suicide Risk?

Suicide is preventable, and identifying the patients at risk is a critical step to ensuring that patients get the help they need. 

“Access to diverse and granular data enables a deeper understanding of the complex factors that influence a patient’s mental health and predisposition to suicide,” said Byrwa-Hill, noting that descriptive data such as those she reported may help identify patients who might need additional monitoring or targeted interventions, such as medications and/or cognitive behavioral therapy.

Ameliorating physical symptoms and distressing treatment side effects are additional steps that can improve patients’ mental health, and reducing patient access to lethal means can mitigate the risk of suicide attempts.

“Being diagnosed with cancer is a major life stressor that can trigger or worsen suicidal behaviors, particularly in individuals who are already vulnerable due to a complex mix of psychological, medical, and social factors. Recognizing red flags and identifying at-risk patients offer a critical opportunity for early intervention,” said Byrwa-Hill.

“While we often speak of cancer patients as courageously fighting to survive,” she added, “it’s also important to acknowledge that suicide is a real and pressing concern within the cancer community.” 

If you are in crisis, please call, text, or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.