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Prashant Kapoor, MD, FACP


Psychiatric Disorders, Self-Harm, and Patients With Cancer, Including Myeloma

By: Celeste L. Dixon
Posted: Wednesday, June 22, 2022

More than 7,000 patients with multiple myeloma were among those considered in a far-ranging study of the cumulative burden of psychiatric disorders in patients with cancer, for whom depression was found to be the most common such disorder. Chang and Lai, both of University College London in the United Kingdom, focused especially on two risks in patients with cancer: self-harm after incident psychiatric disorder diagnosis and unnatural deaths after self-harm. Their cohort included 459,542 individuals with 26 types of cancer, diagnosed between 1998 and 2020.

The investigators found the cumulative burdens for psychiatric disorders varied widely among patients with different cancer types. For depression, for example, they reported the cumulative burden per 100 patients with testicular cancer was highest (98.05) and lowest (2.4) for patients with prostate cancer. The comparable figure for patients with multiple myeloma was 8.5, the 17th lowest of the 26 types.

The other four psychiatric conditions the pair of investigators examined were anxiety, bipolar and personality disorders, as well as schizophrenia. “All mental illnesses were associated with an increased risk of subsequent self-harm, [with] highest risk observed within 12 months of the mental illness diagnosis,” they wrote. “Patients who harmed themselves were 6.8 times more likely to die of unnatural causes compared with controls within 12 months of self-harm (hazard ratio [HR] = 6.8). The risk of unnatural death after 12 months was markedly lower (HR = 2.0).”

The study authors also found that overall, patients with cancer who received chemotherapy, radiotherapy, and surgery had the highest cumulative burden of psychiatric disorders compared with those treated with kinase inhibitors, who had the lowest burden. They also proposed that depression in older versus younger patients with cancer may be more likely to be missed, unless and until a self-harm attempt is made. And patients with multiple myeloma certainly trend older: The mean and median ages at diagnosis are 70 and 73 years, respectively.

Disclosure: The study authors reported no conflicts of interest.

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