The suicide rate in patients with urological cancers — such as prostate, kidney or bladder cancer — is five times higher than in people without cancer, results from a large U.K. survey show. Data also demonstrated that the proportion of completed suicide attempts is higher in cancer patients, especially in those with urological cancers.

The research, “Patients with urological malignancy are 5 times more likely to commit suicide: A large national cohort study,” highlights the need for improved assessment and treatment of mental health needs in cancer care, the authors said. Their work was presented at the 2018 Annual European Association of Urology (EAU) Congress, held in Copenhagen, Denmark.

The scientists conducted the largest U.K. study addressing suicide in patients with cancer. It was also the first analysis of suicidal intent in cancer patients, defined as the proportion of suicides to attempted suicides.

Prior research found that depression affects between 5% and 25% of cancer patients, while a 2014 series of studies from Scotland showed that most cancer patients diagnosed with depression were not receiving treatment.

The latest study examined 2001-11 records from England and Wales. From a total of 980,761 patients (493,234 men, 487,094 women), researchers identified 162 suicides and 1,222 suicide attempts.

Results showed that the general suicide rate was three times higher in cancer patients (30 per 100,000 people) than in the general population (10 per 100,000). In patients with urological cancers, this rate was even higher – 52 per 100,000 in patients with prostate cancer, 48 per 100,000 in bladder cancer, and 36 per 100,000 in kidney cancer.

“We can see from the results of our study that although all cancers have a higher suicide rate, inferring a higher level of psychological distress, there are disparities between cancers. This needs to be addressed within our healthcare systems, and more focus is needed on integrating the robust and specialist assessment and treatment of mental health needs in cancer care,” Mehran Afshar, PhD, the study’s first author, said in a press release.

Previous studies had reported higher suicide rates in cancer patients from other countries, but the present research demonstrates this to be particularly true in urological cancers, Afshar observed.

The data also demonstrated that patients with urological cancers have a higher rate of completed suicides. Compared to the general population, which exhibits an average of 25 suicide attempts for each suicide, prostate cancer is associated with one suicide for every seven attempts. In kidney cancer, this ratio is one suicide for every 10 attempts.

“The cause for the disparity with other cancers may be multifactorial, including the possible social stigma associated with cancer of the urological tract,” the researchers wrote.

“We have shown this ‘intent’ to commit to be far higher in our cancer population, thus confirming a real need to address psychological issues early on in the management of these patients,” Afshar added.

“There are particular issues which are specific to this cancer group — for example, men with prostate cancer undergo treatment which can affect their bladder function, their bowel function, erectile function and libido, can result in symptoms similar to the female menopause, and entirely alter the personality, leading to relationship problems, anxiety, depression, and post-traumatic stress disorder,” Afshar said. 

The scientists also found that the time taken to commit suicide highly depends on the type of urological cancer: 1,037 days from diagnosis for bladder cancer, 846 days for prostate cancer, and only 175 days for kidney cancer.

“This important work shows just how distressing cancer can be, but it also shows that there may be special factors associated with urological cancers which make them even more stressful than other cancers. It looks like urological cancers can affect patients’ sense of self in a way that many cancers don’t,” said Hein van Poppel, adjunct secretary general at the European Association of Urology.

“The work implies that some urological cancers, such as kidney cancer, can lead to fairly immediate distress, whereas the distress associated with prostate and bladder cancer may take a while to hit home — perhaps when patients begin to take up some of the problems associated with returning to normal life,” van Poppel added.

“We also need to put things in context: many patients recover well, and don’t reach the stage of despair or distress which brings them to think of suicide.” However, van Poppel noted the “need to recognise that the figures presented here are for suicides, which means that they are at the ‘sharp end of emotional distress’. For every suicide or attempted suicide, there will be many more patients who find difficulty in coping.”

“We owe it to patients to ensure that ongoing emotional support and mental health care is fully integrated in cancer care,” he said.