“I Want to Die” — The Link Between Cancer and Suicide

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“The thought of suicide is a great consolation: by means of it one gets through many a dark night.” ― Friedrich Nietzsche

Receiving a cancer diagnosis is devastating. Suddenly, without warning, the world as you knew it comes to an end, and you’re faced with a vast and terrifying unknown. Shock, fear, anger and depression are common reactions, and they can persist for quite some time. Eventually, though, most people adjust and become more able to cope with what the diagnosis means for them and their lives.

Not surprisingly, however, some people who are newly diagnosed with cancer don’t adjust and cannot cope. For these people, the reality of living with a life-limiting illness and all that implies is too overwhelming to bear. Feeling that they are out of options or that life is simply too difficult to go on, they choose suicide far more often than many of us — both lay persons and physicians — realize. According to Dr Lynn Eldridge, 6 percent of people newly diagnosed with cancer seriously contemplate suicide. And the risk of a person completing suicide during the first three months after a cancer diagnosis is 13 times higher than in the population as a whole. Further, according to a study from the American Thoracic Society, the numbers may be even higher than that. Their analysis found that patients with cancer, regardless of where in their illness trajectory they were, had a 60 percent higher rate of suicide than the rest of the population. People with lung cancer were 420 times more likely to die by their own hand.

Even long after patients are in remission or even “cured,” the risk of suicide persists. According to Dr. Christopher Recklitis, Ph.D., Associate Professor of Pediatrics at Dana-Farber Cancer Institute and Harvard Medical School, long-term cancer survivors also have more suicidal thoughts and a greater risk of completed suicide than the population as a whole. This is especially true of adults who survived childhood cancers, which often have significant, treatment-related late effects.

Who Is at Risk?

Obviously, living with a debilitating illness can be profoundly distressing. And for some individuals, particularly those whose cancer is advanced, the idea of suicide may make perfect sense. In some cases, it may be a very rational choice. Why go through the physical pain and emotional suffering of cancer treatment if there is no hope that you can return to any semblance of your former self? Why not end your life while you still have all your faculties and are relatively free from suffering and pain? Why not spare your loved ones the anguish of seeing you waste away?

Thankfully, these are questions that I have not had to answer — at least not yet. But if I am someday faced with a diagnosis of advanced cancer, I’m sure I will ask them. And I’m not at all certain what my answer will be.

But the truth is that not every cancer patient who thinks about or completes suicide has advanced cancer. As Dr. Eldridge points out, many patients choose suicide while in the early stages of their disease, when they are still feeling relatively well. These are the people who are most likely overwhelmed by their diagnosis and acting out of fear of what the future will hold. Additionally, there may be other physical and psychosocial factors in play. For example, cancer patients are at a higher risk of suicide if they are over the age of 65, are unmarried or are unable to work. A very poor prognosis, uncontrolled physical pain or preexisting mental illness also increase suicide risk.

How Can We Help?

The choice of whether or not to continue living with a debilitating illness is a very personal one. As an individual, I support personal autonomy and the right to die on one’s own terms, and I am 100 percent in favor of legal physician-assisted death. But at the same time, I believe each of us can do more to support people with cancer and to help them find meaning when life seems too scary, painful or overwhelming to endure.

What does that mean, exactly? Well, for one thing, it means not running away. Far too many of us turn away in fear when we learn that a friend or a loved one has been diagnosed with cancer. Their disease reminds us of our own vulnerability, so we hide behind platitudes or simply disappear. And if our friend or loved one is expressing suicidal thoughts, we may think that talking with them about how they feel will increase the risk that they will carry them out. But that simply isn’t true. If there is one thing that a desperately frightened person needs from us it is to be listened to and to be heard.

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It’s hard to be with someone who is talking about suicide. And it’s even harder to engage in meaningful discussion about why they may want to die. But if we don’t listen, we can miss important clues about a person’s state of mind and, quite possibly, our only opportunity to step in and help.

If someone you know has cancer and is talking about wanting to end their life, please take them seriously. Listen to them; let them vent; and ask if they have a plan. Are they hoarding pain medication or sleeping pills? Do they have access to a firearm? It is not your job to talk them out of their decision. Again, sometimes the choice to die before the disease becomes too debilitating has been made carefully and after a great deal of thought.

But it is your obligation to let the person know that you are there to support them in any way you can and to seek help for them if they are unable or unwilling to consider it themselves. A palliative care physician or mental health professional can assess whether the person is suffering from depression, anxiety or PTSD — all treatable conditions that can greatly increase suicide risk. They may also be able to help the person process their fears around illness and death, and explore options they may not have thought about, such as hospice and palliative care. If the person lives in a state that allows medical aid in dying, that may be a possibility as well. 

What you should not do is you try to handle the situation alone. Even if you completely understand the person’s desire to end their suffering, that is far too big a burden to bear. Call their physician, family, friends and loved ones and let them know your concerns. Most importantly, if the person has access to lethal means, do not leave them alone.

Perhaps your friend or loved one has made a rational decision to die. That is, ultimately, their right. But it doesn’t need to happen today. 

The National Suicide Prevention Hotline can help you find resources in your local community. Reach out online or call the Lifeline network to speak to someone about your concerns. It’s available 24/7 — 1-800-273-TALK (8255)

About Kathleen

Each month Kathleen Clohessy, R.N., offers a new perspective on living with a terminal illness. Kathleen comes to SevenPonds with 25 years experience as a registered nurse caring for families and children facing life-threatening illness. She began her career in the Pediatric Intensive Care Unit at Nassau County Medical Center in New York. After relocating to California, she spent 15 years as an R.N. and Assistant Nurse Manager at the Pediatric Oncology & Bone Marrow Transplant Unit at Lucille Salter Packard Children’s Hospital at Stanford. She uses her knowledge and expertise to enlighten our readers about the challenges associated with chronic illness and its effects on family relationships.