The Assertive Cancer Patient

Stories You Probably Didn't Read in October: II

There were a number of important stories about cancer that were reported by the wire services in October but not widely picked up by magazines and newspapers.

These stories seem to have fallen into a black news hole: Very few of the people I know who are living with cancer or are professionals caring for people with cancer (doctors, nurses, therapists, and so on) saw these stories.

So, here's one more--a report on suicides among cancer patients.

The report itself doesn't surprise me at all. When I learned that my father had been diagnosed with pancreatic cancer at age 53 (almost 30 years ago now), my first thought was that he would kill himself.

My father did not commit suicide, but he was profoundly depressed during the six months from his diagnosis at Christmas in 1976 until he died the following June. According to the research, men with cancer are about five times more likely to kill themselves than women are, and they are more likely than women to do so right after they learn they have cancer.

Also, in my father's case, I just recently learned that depression is a symptom of pancreatic cancer.

Reuters reported on October 18 that researchers at the Ottawa Hospital Regional Cancer Center in Canada had found that cancer patients were two to 2 1/2 times more likely to commit suicide than the general population.

The study, published in the Annals of Oncology, was an analysis of 1.3 million cancer cases in the United States, Reuters reported. It found that 19 of every 1,000 men with cancer and four of every 1,000 women with cancer commit suicide, which equates to 24 suicides per 100,000 cancer patients per year.

Some of the factors that play a role in suicide risk are gender, prognosis, the type of cancer, the stage and prognosis of the disease, race, and the person's family situation; however, the author of the study said that the research did not determine why patients killed themselves.

The lead author, Dr. Wayne Kendal, was quoted by Reuters as saying that oncologists need to realize that cancer patients need support. "Oncology patients are not an island," he said. " ...It's not just treating diseases, it's treating the person--the holistic approach that I wanted to foster."

Let's hope that oncology doctors and nurses out there are listening. I know a few who think that their patients' mental health is none of their concern--they duck their responsibilities by referring patients to mental health professionals, when maybe all that is needed is a little empathy from the doctor.

Needless to say, I avoid doctors with this kind of attitude like the plague. A doctor who lacks empathy can kill you. More on this topic to come.

Read the Reuters report: Cancer patients have higher suicide risk: study

A Tangent
If you have cancer, think of all the (supposedly well-meaning) people who have said to you, "I'd rather commit suicide than go through cancer treatment."

This is a really weird thing to say to someone who IS going through cancer treatment. Is the person trying to suggest that you should commit suicide and just get it over with? Clear out and leave more room on the planet for healthy people?

Probably not. They probably just aren't thinking.

But in any case, I think that they don't know what they are talking about. I think most people cling to life, and most of the people who say they would kill themselves rather than do chemotherapy would probably make a different choice if they did have cancer.

For most of us with cancer, every day is precious. And most of us are surprisingly happy.

One More Thought
November 28--I wrote yesterday that every day is precious and most people living with cancer are surprisingly happy. That is true for me, but it is not the whole story. I have been seriously depressed at times during cancer treatment and occasionally considered suicide.

See Jeanne's Diary, Chapter 7: Depression and Chapter 8: Life on 7 North.

I wrote Jeanne's Diary almost eight years ago, and I haven't had a bad period of depression for a long time now, but I still struggle with anxiety, especially while waiting for test results. It is the not knowing that sets me off--once I have the news, good or bad, I can generally pull myself together and do what I have to do.

How do I feel about suicide? I think suicide is the most personal of decisions. However, if a friend of mine were seriously depressed and considering suicide, I would try to talk them into getting help for the depression and then reconsidering whether or not they wanted to die.

Will I kill myself? No, I don't think so.

I am not afraid of dying of cancer. What's hard for me are the really tough times toward the end of a long series of chemo treatments when I have no energy--either physical or emotional. Then I do wonder if it is worth it to continue. But, so far, I've toughed it out and things have always gotten better. The treatment I'm on now, a combination of four drugs (Herceptin, Avastin, Cytoxan, and Zometa), is pretty easy to tolerate and I'm happy to be alive.

@ Jeanne Sather 2006

Stories You Probably Didn't Read in October: I--UPDATED

There were a number of important stories about cancer, breast cancer in particular, that were reported by the wire services in October but not picked up by magazines and newspapers.

The first of these was a report sent out by Reuters early in October that said that breast cancer survivors--SURVIVORS, not women living with the disease or in treatment--are at higher risk of suicide than other women.

This story seems to have fallen into a black news hole: No one I mentioned it to, including medical oncologists who treat women with breast cancer, therapists, and other women living with cancer, was aware of the report. (CNN was the only mainstream news outlet that I noticed had picked it up.)

I can only guess at the reasons, which would include an editorial reluctance to run a negative story during a month devoted to pink froth and feel-good stories about breast cancer, which is, after all, a pretty devastating disease, but not during October.

Reuters reported on October 6 that breast cancer survivors are 37 percent more likely to commit suicide than are other women. The report also said that the increased risk continues for at least 25 years after diagnosis. Reuters was reporting findings by Dr. Catherine Schairer, from the National Cancer Institute in Rockville, Maryland, and her colleagues that were originally published in the Journal of the National Cancer Institute.

The research was a population study that analysed data for 723,810 breast cancer survivors diagnosed between 1953 and 2001 in the United States and Scandinavia. During follow-up through 2002, a total of 836 women committed suicide, Reuters says.

What the research does not include is the why. Why did these women commit suicide?

I can understand that women might commit suicide at the time they are first diagnosed, or if they are living with a cancer that cannot be cured, but I was surprised to learn that survivors had such an increased risk of suicide.

I've asked several experts for their opinions, and I am also e-mailing the lead author of the study to see what she can add.

Dr. Robert Livingston, a well-known medical oncologist who has been treating women with breast cancer for more than 20 years, says, "I do not have an explanation for it. I have not had a breast cancer survivor who committed suicide (to my knowledge), and very few patients of mine with breast cancer and advanced disease have done so, either."

Actually, this is not surprising, even though Dr. Livingston has cared for a couple of thousand women over the years, according to Reuters the suicide rate for breast cancer survivors was 4.1 per 100,000 women per year.

I think this helps put the news story into perspective: Even though suicide among breast cancer survivors is significantly higher than for women in the general population, and should not be ignored, it is still low.

Dr. Livingston adds that this is in contrast to a number of other malignancies, like cancer
of the pancreas: "Where the incidence of suicide is unquestionably high, and is not all explained by the dire prognosis of the disease (suicidal depression is sometimes a presenting symptom of cancer of the pancreas)."

I also talked to a Seattle therapist who sees a number of patients with life-threatening illnesses, including cancer, and she said the increased suicide rate among breast cancer survivors may be due to their marriages or other relationships breaking up, and also to increased fears about their own mortality that may become overwhelming.

The next piece, of course, is for doctors, cancer survivors, and family members to be aware of this risk, and do what they can to help. More on that soon.

Read the original Reuters story:
Breast cancer survivors have increased suicide risk