Are young cancer patients being let down?
Adolescents and young adults with cancer are committing suicide long after their diagnosis, pointing to unmet needs around survivorship and depression in this vulnerable population, warns expert.
Adolescent and young adult (AYA) cancer survivors, especially males, are more likely than older people to commit suicide, typically several years after their diagnosis, finds a US analysis that underlines their complex needs and the importance of survivorship care.
The authors, led by Koji Matsuo, MD, PhD, Division of Gynecologic Oncology, University of Southern California, Los Angeles, CA, USA, highlight that the number of deaths due to an individual’s cancer itself continues to fall among AYAs, defined as persons aged 15–39 years.
However, those who survive their cancer are at “elevated risk for emotional distress, mental health problems, and suicide.”
An ever-increasing gap
To look at how suicide rates have changed over time in people with cancer, they turned to the SEER Program, run by the National Cancer Institute (NCI), which collects information about cancer cases in the United States.
They examined data on almost 4.5 million deaths from 2000 to 2021, of which 11,902 were due to suicide. Overall, the rate of death due to suicide was 2.7 for every 1000 deaths, or one in 376.
The highest suicide death rate was in AYA men, at 9.0 for every 1000 deaths, followed by 5.7 per 1000 deaths for men aged 40–59 years, and 4.5 per 1000 deaths in women aged 15–39 years.
Worryingly, the rate of suicide deaths among AYA males increased from 4.9 per 1000 deaths in 2000 to 15.4 per 1000 deaths in 2021, resulting in an ever-widening gap between that and other age groups.
In terms of individual cancer diagnoses, the highest rates of death from suicide were seen in AYA men and women with thyroid cancer, followed by AYA men with testicular cancer, and AYA men with a form of melanoma that affects skin cells called melanocytes.
The research was published by JAMA Network Open on November 4.
Long after the initial diagnosis
It is important to note, however, that, among AYA females, the typical interval between the cancer diagnosis and suicide death was 71 months (nearly six years), and was 67 months (just over five and a half years) in AYA males, significantly longer than in older people with cancer.
“That means that suicide occurred in these people many years after their cancer was diagnosed,” highlighted Maria Die-Trill, MD, PhD, a palliative and supportive care specialist at the Psycho-Oncology Unit in Hospital Universitario Gregorio Marañón, Madrid, Spain.
“That’s an issue that needs to be taken into account,” she told Medical News Insider, and speaks to the “need to study survivorship issues in this population” and ensure that long-term care is made available in general, but especially to the vulnerable AYA population.
Die-Trill, who was not involved in the study, pointed out that suicide rates have been increasing in the general population, not just in people with cancer, and that the current study does not any information on the mental health of the people who committed suicide.
Moreover, the age range of 15–39 years is wide, and it is “not the same thing to have cancer when you are 15 and when you’re 38, as it affects you in different ways, because you’re at a different point in your development.”
Unique problems
Beyond those limitations, the results highlight that survivors continue to commit suicide despite that the fact that cancer survival rates are at their highest ever, Die-Trill noted, with approximately 85% of people with the majority of cancer types successfully completing treatment.
“And that’s pretty impressive,” she said, “so it’s really a pity that we don’t take into account other issues that could contribute to altered mental health in this population.”
Die Trill continued: “Adolescence is a time when people struggle to develop their identity, when people find support in their peer and social relationships, and their body is changing; and cancer really disrupts all of these developmental steps in very significant ways.”
“They also experience a greater physical symptom burden, and they have an increased likelihood of more aggressive disease,” than adults with cancer, alongside “unique psychosocial problems that require some very sophisticated clinical management by experts who can really care for this specific population with very specific needs.”
Undetected and untreated
However, she stressed that,“unfortunately depression in the cancer population in general, and specifically in this population, goes untreated or undetected.”
Die Trill pointed to a lack of training among specialists to detect depression in cancer, in addition to which there is an “attitude on the part of staff that it is ‘normal’ for this person to be depressed given the medical condition that he or she has.”
They think: “‘I would be depressed as well,’ so they don’t treat it,” but depression “always needs to be detected, identified, and treated,” she said.
Die Trill believes that people with cancer need to be screened for distress all along their journey, and the current results show “we need interventions that are designed specifically for adolescents and young adults.”
She also noted that previous research indicated that one of the strongest protectors against suicidal thoughts among young people with cancer is the strength of their relationship with their oncologist.
Die Trill said that “speaks to the importance of the doctors having good communication skills and knowing how to empathise with their young patients.”
She noted that the European Society of Medical Oncology (ESMO) has produced a Patient Guide on Survivorship, which focuses on the health and physical, psychological, social, and economic issues that affect people after the end of their primary treatment for cancer. The guide is free and is available in 12 languages.
The study was supported by an institutional grant, the Ensign endowment for Gynecologic Cancer Research (to Matsuo)
One author declares relationships with Merck and UpToDate.
No other relevant financial relationships declared.
Liam Andrew Davenport is a medical reporter with more than 20 years’ experience covering a wide range of specialties and topics in the field.