Veterans with advanced lung cancer face a significantly higher risk of suicide compared to the already high rate among veterans. But this suicide risk is greatly reduced when they receive at least one palliative care visit, according to a new study published in the Annals of the American Thoracic Society.
Palliative care is specialized medical care for patients with severe illness. It aims to relieve physical pain and discomfort and to address psychological issues like anxiety that diminish quality of life for those with life-threatening illnesses.
The new study is based on the data of thousands of veterans with advanced lung cancer enrolled in the U.S. Department of Veterans Affairs (VA) Central Cancer Registry. Of the 20,900 veterans with advanced lung cancer enrolled in the registry, 30 patients committed suicide, a rate more than five times greater than the average among all veterans of a similar age and gender who use VA health care.
However, the data showed that those with lung cancer who had at least one palliative care visit after their diagnosis were 81 percent less likely to die by suicide.
Lead author Donald Sullivan, M.D., M.A, M.C.R., said the psychological impact of a cancer diagnosis — particularly a lung cancer diagnosis — is underappreciated and largely overlooked in the medical community.
“Suicide is a significant national public health problem, especially among lung cancer patients and among veterans,” said Sullivan, an assistant professor of medicine (pulmonary and critical care medicine) in the Oregon Health & Science University (OHSU) School of Medicine.
“As a result, manifestations of this impact like social isolation, depression, anxiety, can go undiagnosed and untreated.”
Sullivan believes this study is the first to investigate the link between palliative care and suicide risk in cancer patients. He said that while several medical societies recommend palliative care for all patients with advanced stage lung cancer, there is often a gap between recommendations and practice.
“There are many barriers to palliative care, and unfortunately, some are related to clinician referrals,” he said. “Not all doctors are aware of the benefits of palliative care.”
Sullivan believes that palliative care should be offered to all patients shortly after receiving a diagnosis of advanced stage lung cancer. The best scenario would be an integrated approach in which patients with serious illness receive palliative care at the same time they receive other treatment therapies like chemotherapy, he said.
He emphasized that clinicians need to be vigilant for additional conditions or disorders, such as comorbid psychological illness, in their patients and to become familiar with local resources.
“For patients and families, it’s important to understand these risks exist and not to be afraid to reach out to your providers for help,” Sullivan said.
“We really can’t afford to wait for more data,” he said.
“I would like to see more efforts to screen and treat comorbid psychological illness among patients with lung cancer for which there is good evidence. I also believe more efforts are needed to integrate palliative care earlier in the lung cancer treatment paradigm.”