Patients had increased risk of both suicide and death from cardiovascular causes following a diagnosis of cancer vs. those who were cancer-free, a large cohort study conducted in Sweden reported in the New England Journal of Medicine April 5.

“Our findings suggest that a cancer diagnosis constitutes a major stressor, one that immediately affects the risk of critical, fatal outcomes,” the investigators wrote. “We speculate that our findings show only a portion of the range of effects induced by the emotional distress associated with a cancer diagnosis.”

They conducted an historical cohort study from 1991 to 2006 of more than 6 million Swedes to examine whether a diagnosis of cancer was associated with an immediate risk of suicide or death from cardiovascular disease.

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Compared with those who were cancer-free, relative risk of suicide among patients who received a cancer diagnosis was 12.6 during the first week, or 29 patients (incidence rate, 2.50 per 1,000 person-years) and 3.1 during the first year, or 260 patients (incidence rate, 0.60 per 1,000 person-years).

“The incidence rates of suicide were higher among patients with preexisting psychiatric or cardiovascular diseases, regardless of whether a patient had a recent cancer diagnosis. However, the relative risks of suicide after a cancer diagnosis were stronger among patients without these coexisting illnesses than among patients with those illnesses,” they found.

After diagnosis, the relative risk of cardiovascular death was 5.6 during the first week (1,318 patients; incidence rate, 116.80 per 1,000 person-years) and 3.3 during the first 4 weeks (2,641 patients; incidence rate, 65.81 per 1,000 person-years).

There was a highly elevated risk during the first week after diagnosis of all cancers except for skin cancer; risk elevation was strongest for CNS tumors, followed by cancers of the esophagus, liver, or pancreas, and lung cancer.

“The risk elevations decreased rapidly during the first year after diagnosis,” they noted. The hazards were found to be shared equally by men and women.