Study Finds Advanced Bladder Cancer Increases Suicide Risk

Zachary Klaassen, MD

A new study has found that older, single white males with advanced bladder cancer have the highest suicide risk among those with other cancers of the male genitals and urinary system.

“The older, white, single male is already at higher risk in the general society for suicide; add on the fact that he has advanced bladder cancer, and this is a high-risk patient,” said Zachary Klaassen, MD, a urology resident at the Medical College of Georgia at Georgia Regents University, the study’s corresponding author. “But this has taught me that we have to look for warning signs in all these patients.”

When compared with the general population, overall suicide risk was 2.7 times higher for bladder cancer patients; rates were 1.86 times higher in kidney cancer patients, 1.27 times higher in prostate cancer, 1.23 times higher in testicular cancer, and 0.96 times higher in penile cancers.

Researchers reviewed the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, or SEER, database from 1988-2010 to find 1.2 million people with genitourinary cancer, examining variables such as age, sex, race, as well as disease and treatment aggressiveness.

They found that bladder cancer patients across the board, whether or not they had surgery or advanced disease, had a higher suicide risk than patients with other genitourinary cancers. Older patients with bladder, prostate, and testis cancer were generally at an increased risk. When looking specifically at the black population, those with bladder cancer also had the highest suicide rates; however, those with bladder, prostate, and kidney cancer had much lower suicide rates than whites in the group. Prostate cancer patients had an increased suicide risk over time, with the highest rate 15 years or more after their diagnosis.

The review identified suicide in these patients as a public health dilemma that needs physician awareness, particularly in patients who are older, male, and have aggressive disease.

“It’s a tough situation. We have to talk more with our patients about how they are feeling even if it’s uncomfortable for us,” said Martha K. Terris, MD, chief of the section of Urology, chief of Urology at the Charlie Norwood Veterans Affairs Medical Center, and the study’s senior author.

The clinicians recognized the challenging road faced by many of these patients during recovery. Those with bladder cancer, for example, often have surgery to both remove their diseased bladder and divert urine to a collection bag at their side. Recovery from this major procedure takes about 3 months; interferes initially with bowel function; can result in ongoing problems such as leakage and infection; and patients need long term, close follow up for signs of metastasis, so it’s also a very expensive cancer to treat.

Monica Smith, the executive director of the Bladder Cancer Advocacy Network (BCAN) says its important for patients to remember that "cancer is not a death sentence though in the debpths of depression, it may seem like it."

"Most bladder cancer patients, even those with urinary diversion, are able to maintain a full and active lifestyle and BCAN can offer support and resources that can help," she added.

The average age of diagnosis of bladder cancer is 73, and about nine out of 10 patients with bladder cancer are over age 55, according to the American Cancer Society. Bladder cancer is more common in men and smokers, with about 74,000 new cases annually in this country and more than a half million survivors. Suicide is the 10th leading cause of death in the United States; cancer is number two, according to the Centers for Disease Control and Prevention.