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Cancer can kill long before malignant tumors take their toll, new research shows. A study involving more than 6 million Swedes reveals that the risk of suicide and cardiovascular death increases immediately after a cancer diagnosis.
Within the first week of being told they had cancer, patients were 12.6 times more likely to commit suicide than people of similar backgrounds who were cancer-free. The newly diagnosed patients were also 5.6 times more likely to die from a heart attack or other cardiovascular complication in those first seven days, according to a study published in Thursday's edition of the New England Journal of Medicine.
"One has to assume that it's the psychological impact of that news," said Dr. Ilan Wittstein, a cardiologist at the Johns Hopkins University School of Medicine in Baltimore, who was not involved in the study.
"This is not data that suggests cancer, and the physical stress of the cancer, is what's causing people to die," he said. "These are people getting the news, and within a very short period dying from heart disease — long before treatment ever begins."
The researchers examined the records of 6,073,240 people born in Sweden and linked them to the national Cancer, Causes of Death, and Migration registers. Since each person has a unique identification number, researchers could pick out those who received cancer diagnoses and look up the cause of death.
They found that risk of suicide or cardiovascular death increased in the first few weeks — when stress from the diagnosis would have been highest — but leveled off over several months. After a year, the suicide risk for cancer patients was 80% higher than for cancer-free controls and the risk of cardiovascular death was elevated by 20%.
More serious forms of cancer seemed to correlate with the highest risks of suicide. For example, over the first 12 weeks, suicide risk among lung cancer patients was 12.3 times higher, while for those with skin cancer it was just 1.4 times higher. The same pattern held for cardiovascular death.
The danger in those first few weeks appears higher for younger patients than for older patients. For instance, those under the age of 55 saw their risk of cardiovascular death rise by a factor of 11.9 during the first four weeks after being diagnosed, compared with a 5.2-fold increased risk for those between the ages of 65 and 74.
This may be in part because older patients would be more likely to have preexisting heart conditions and more likely to be on the alert for cardiovascular issues, researchers said.
The psychological impact of a cancer diagnosis may go beyond what the team documented in this study, said senior author Unnur Valdimarsdottir, an epidemiologist at the University of Iceland in Reykjavik. After all, she noted, the researchers counted only deaths, not the unquantified damage from, say, nonlethal heart attacks and unsuccessful suicide attempts.
But the findings still show that, well before a patient's health is compromised by chemotherapy or further affected by the progress of the disease, a cancer diagnosis can have immediate and perhaps deadly consequences. These risks need to be addressed by both medical and mental health professionals, Valdimarsdottir said.
"We're hoping to raise awareness that resources from the healthcare system need to be directed to this time period in a person's life," she said.
Wittstein agreed that the study should put oncologists on notice to watch for symptoms of cardiac stress in their patients. Perhaps patients should start taking aspirin and cholesterol-lowing medication soon after receiving the bad news, he said.
"We need to be much more vigilant about watching people, and maybe even treating them prophylactically," Wittstein said.