Sweden - Cancer Diagnosis Raises Risk Of Death From Heart Attack, Suicide

Finding out that you have cancer greatly increases the risk of death by heart attack or suicide, according to a new study. That risk is especially big in the first week after getting the bad news.

The notion that stress can spark a heart attack has long been part of folklore. Only in the past decade have scientists connected emotional stress with physiological reactions that can bring on a heart attack. Heart attacks spike after the death of a loved one or a natural disaster, so it makes sense that could happen after a devastating medical diagnosis, too.

Researchers looked at the medical records of 6 million people in Sweden from 1991 to 2006. The country's medical registry made it possible to match death records with cancer diagnoses. Suicide rates among people told they had cancer spiked in the first week after getting the news, with 2.50 suicides per 1,000 person-years of life, compared with 0.18 in people without cancer diagnoses.

The risk of suicide was greatest for people who were diagnosed with esophageal, liver or pancreatic cancer — some of the deadliest forms of cancer. For all patients, suicide risk declined over time. But in the first year after a diagnosis, people with cancer were about three times as likely to commit suicide. The results were published in the New England Journal of Medicine.

Deaths from heart attack also spiked in the first week, almost tripling compared to people without cancer. But the risk dropped more quickly than did suicide risk, and after a year it wasn't significantly higher than for the population in general.

The fact that the risk of death increases immediately after diagnosis shows that it's the diagnosis, not the stresses of cancer treatment, causing the deaths, according to Unnur Valdimarsdottir, head of the Centre of Public Health Sciences at the University of Iceland and a co-author of the study. She and her colleagues had earlier found a sharp increase in deaths after a prostate cancer diagnosis. This study looks at all major cancers, and it found that the risk rose along with the seriousness of the cancer.

"We believe that the shock of the diagnosis and corresponding magnitude of stress is highest during the immediate time window following diagnosis," Valdimarsdottir tells Shots by email. "Other studies on different kinds of stressors, e.g. loss of relative, also indicate a remarkably short induction time between stress onset and cardiovascular outcomes."

Interestingly, people who were already getting psychiatric care or treatment for heart disease were less likely to die, perhaps because their stresses were already getting some attention.

This suggests more support delivered along with a cancer diagnosis could reduce the risk of death. "We do believe that we have identified a critical time window where the resources of health care providers of cancer patients needs to be directed," Valdimarsdottir says. "The important thing is that health care professionals, cancer patients themselves and their significant others are aware of these risks, and remain observant of early signs and symptoms of such serious hazards."

NANCY SHUTE

npr.org