Christopher Recklitis, PhD, MPH
Adult survivors of childhood cancer have an increased risk for
suicidal thoughts, even decades after their cancer treatments ended,
according to a study led by Dana-Farber Cancer Institute scientists.
The researchers report in the Journal of Clinical Oncology that nearly eight percent of childhood cancer survivors said they have experienced suicidal thoughts, or ideation.
Survivors of brain and central nervous system cancers were most
likely to have had suicidal thoughts. Those who were in poor health or
who had cancer-related pain or treatment-related chronic conditions also
were at greater risk for suicidal thoughts.
The paper is published on the journal's Web site and later will appear in a print edition.
"Our findings underscore the importance of recognizing the connection
between childhood cancer survivors' physical health issues and their
risk for suicidal thoughts, as some of the conditions may be treatable,"
said Christopher Recklitis, PhD, MPH, the study's lead author and a
psychologist and director of research in the Perini Family Survivors' Center at Dana-Farber.
The researchers analyzed data from 9,126 adult survivors of pediatric
cancers who were part of the Childhood Cancer Survivor Study (CCSS), a
multi-institutional study coordinated through St. Jude Children's
Research Hospital in Memphis to track long-term effects of cancer and
The participants were 18 years or older, had been diagnosed with
cancer before the age of 21, and been diagnosed at least five years
prior to participating in the study. The vast majority (8,464, or 92.7
percent) were diagnosed with cancer more than a decade before, and more
than a quarter (2,564, or 28.4 percent) were diagnosed more than 20
The survivors were compared to a non-cancer control group made up of
2,968 of the survivors' nearest-in-age siblings who also participated in
Recklitis and his colleagues found that 7.8 percent of the survivors
reported having suicidal thoughts, compared with 4.5 percent of the
control group. Survivors of brain and central nervous system (CNS)
cancers were the most likely to experience suicidal thoughts (10.6
percent), while survivors of non-Hodgkin lymphoma were ¬the least likely
"Although the vast majority of survivors reported no suicidal
ideation, the significant minority of survivors with thoughts of suicide
is a serious concern," said Recklitis, who is also an assistant
professor of Pediatrics at Harvard Medical School and Children's
The data did not show any link between suicidal thoughts and a
survivor's age or sex, but there was an association with low levels of
education, lower household incomes, and recent unemployment. Those who
had never married or were no longer married were more likely than those
married to report suicidal thoughts.
Among the sibling control group, age was associated with risk for
suicidal thoughts for those ages 18-24 but not other age groups.
Childhood cancer survivors, due to the intensive treatments they
received, are at risk for developing chronic medical problems later in
life. The researchers found that health problems in adulthood were very
strongly associated with the survivors' suicidal thoughts.
For example, 28.8 percent of survivors reporting "poor" overall
health had suicide ideation, compared with only 3.3 percent of survivors
who said their health was "excellent."
Being physically disabled was associated with suicide ideation, as
were the number and severity of chronic medical conditions, and cancer
related pain. Even when depression was accounted for, physical health
problems remained a significant predictor of suicidal thoughts.
The relationship between physical health and suicide ideation,
Recklitis emphasized, has important implications for the clinical care
Because survivors who experience suicidal thoughts often are
diagnosed with chronic medical conditions that require medical care, the
researchers suggest that this group's relatively high use of medical
services provides an opportunity to help identify and address their
"Perhaps more importantly," Recklitis said, the study's results are
"an important reminder to clinicians that cancer survivors who have
significant physical health problems may have significant emotional
problems as well.
"While our health care system and our culture drive us to treat
physical and emotional suffering very differently, clearly we need an
integrated approach to helping survivors with their physical health
problems and the emotional distress that can be associated with them."
In addition to Recklitis, the study's other authors are Lisa Diller,
MD, Xiaochun Li, PhD, and Julie Najita, PhD, Dana-Farber; Leslie
Robison, PhD, St. Jude Children's Research Hospital, Memphis; and Lonnie
Zeltzer, MD, Mattel Children's Hospital at the University of
California, Los Angeles School of Medicine.
The study was supported in part by a grant from the American
Foundation for Suicide Prevention, and the CCSS is supported by grants
from the National Cancer Institute.
Dana-Farber Cancer Institute (www.dana-farber.org)
is a principal teaching affiliate of the Harvard Medical School and is
among the leading cancer research and care centers in the United States.
It is a founding member of the Dana-Farber/Harvard Cancer Center
(DF/HCC), designated a comprehensive cancer center by the National
Cancer Institute. It is the top ranked cancer center in New England,
according to U.S. News & World Report, and one of the
largest recipients among independent hospitals of National Cancer
Institute and National Institutes of Health grant funding.