A major UK survey has shown that patients with urological cancer such as prostate, bladder or kidney cancer are five times more likely to commit suicide than people without cancer.

The analysis also shows that cancer patients generally are around three times more likely to commit suicide than the general population and that the proportion of attempted suicides which result in a completed or successful suicide was higher in cancer patients, with a higher proportion still in patients with urological cancers.

Severe psychological stress is one of the main side-effects of both a diagnosis of cancer and cancer treatment, with depression affecting between 5 and 25% of cancer patients: many are also affected by Post-Traumatic Stress Disorder (PTSD).

Previous research has shown that the vast majority of cancer patients who have symptoms of depression often go untreated. This study shows a substantial increase in suicide attempts and successful suicides in cancer patients. The work is presented at the European Association of Urology conference in Copenhagen.

The research team led by Mr. Prashant Patel at the University of Birmingham retrospectively examined the records from the England and Wales Hospital Episode Statistics database, from the period 2001 to 2011. They linked this with the cause of death statistics from the Office of National Statistics.

This is also the first time that a major study has examined suicidal intent in cancer patients – which they defined as the ratio of successful suicides to the rate of attempted suicides. They found that this rate was far higher (1 to 7) in patients with prostate cancer than in the general population (1 to 25), which may show a greater determination to commit suicide in cancer patients.

"This is important" said first author Dr. Mehran Afshar (St George's Hospital, London), "as we know that people who attempt suicide are at higher risk of subsequently being successful in completing a suicide, and 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".

Dr. Afshar continued: Our data confirms research from other countries that suicide rates are higher in cancer patients, and we show this to be higher particularly in patients with urological cancers. 

The study also showed significant differences between the time to a successful suicide, which means that some cancer patients are more vulnerable in certain periods.

Commenting, EAU Adjunct Secretary-General, Prof Hein van Poppel (Leuven) said:"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.

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.

The team noted a limitation of the study: they looked at the general suicide rate, not at the rate of suicides according to age (age-standardized suicide rate), however a comparison to baseline population suicide rates could only be made using crude suicide rates per 100,000 as this is population-level data available.