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Patients with a cancer diagnosis had a significantly greater risk of fatal suicide attempts compared with individuals who did not have diagnosed cancer, according to a study presented at the in Florence, Italy.

The analysis of seven studies and almost 250,000 patients showed that patients with a cancer diagnosis had a 55% greater risk of death by suicide (OR 1.55) compared with controls who didn't have cancer (P=0.002), reported Raffaella Calati, PsyD, PhD, of the University of Montpellier in France, and colleagues.

Two additional studies focusing on suicide death versus death from other causes showed that cancer patients had a 53% greater risk of suicide death than those without cancer (P=0.03). The risk of fatal suicide appeared greatest during the first year after a cancer diagnosis.

But Calati's group in rates of either suicide attempts or suicidal ideation between those who had received a cancer diagnosis and those who had not.

"A number of reviews have been published on the link between suicide, in particular suicidal ideation and suicide death, and cancer," the authors stated in a poster presentation. "A cancer diagnosis constitutes a major stressor that affects the risk of fatal outcomes such as suicide death. The assessment of suicide risk in patients with cancer is crucial."

The meta-analysis included studies in which rates of any form of suicidal thoughts or behavior including death by suicide, suicide attempts, and suicidal ideation were compared between individuals who had received a cancer diagnosis and those who had not. Articles were published from 1983 to 2015 and came from a number of different countries representing North America, Scandinavia, Europe, Asia, and Australia.

Seven of those studies involving 247,978 participants compared outcomes between patients with cancer to case-controls representative of the general population. Two other studies focused on suicidal death versus non-suicidal death from myocardial infarction or motor vehicle accidents and included 23,839 individuals.

Four of the studies evaluated the risk of suicide attempts in a total of 8,147,762 individuals with and without cancer while three studies involved 42,700 individuals where the risk of suicidal ideation was evaluated in those with and without cancer.

Calati told 麻豆传媒 that the current analysis is only the first stage; her group is now analyzing a larger number of pooled studies, and adjusting for confounders in order to get a clearer picture of the association between death by suicide and a cancer diagnosis.

"For example, considering studies evaluating the risk of suicidal ideation after childhood cancer, this group seems to be at increased risk," she said in an email. She also cautioned that the lack of an association between suicide attempts or suicidal ideation and a cancer diagnosis was based on a limited number of studies and this may well have influenced their outcome.

"Clinicians should be aware that independent of the presence of a psychiatric diagnosis when cancer is diagnosed, patients should be screened for suicidal thoughts and behaviors, together with anxiety and depressive symptoms once diagnosed with cancer, particularly during the period immediately after the diagnosis," Calati stated.

Study limitations included lack of data on tumor characteristics and how advanced the disease may have been at diagnosis.

Eric Caine, MD, of the University of Rochester Medical Center in New York, conducted astudy of suicide in and identified eight cases where people had killed themselves because they believed they had cancer, even when they did not.

"The challenge may not yet arise from the full impact of the disease, as many cancers take time to reach that point, but rather from the 'idea' of cancer," Caine wrote in an email to 麻豆传媒.

"For so many persons, this feels hopeless and can be devastating," added Caine, who was not involved in the current study.

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