People with cancer are more than four times more likely to commit suicide than people without cancer, according to Penn State College of Medicine researchers.

In a study using data on more than 8 million cancer patients in the United States, the researchers also found that among people with cancer, white males; patients who were diagnosed at a younger age; and patients with lung, head and neck, testicular cancer, and lymphomas were more likely to commit suicide.

Dr. Nicholas Zaorsky, a radiation oncologist at Penn State Cancer Institute, said the study — published today (Jan. 14) in Nature Communications — highlights the importance of a comprehensive approach to treating cancer patients.

“Even though cancer is one of the leading causes of death in the United States, most cancer patients do not die from cancer. The patients usually die of another cause,” Zaorsky said. “There are multiple competing risks for death, and one of them is suicide. Distress and depression can arise from cancer diagnosis, treatment, financial stress, and other causes. Ultimately, distress and depression may lead to suicide. Our goal was to quantify the risk of suicide among cancer patients.”

Zaorsky said that while a lot of progress has been made in treating the cancer itself, not as much work and research has been put into how cancer affects patients mentally and emotionally. The researchers compared the suicide risk of cancer patients versus the general public, and they explored whether certain cancer patients had a higher risk than other patients.

The researchers used data gathered from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. SEER includes data about cancer incidence, survival, treatment, and age and year of diagnosis, and covers 28 percent of the U.S. population. For the study, the researchers used SEER data on more than 8.6 million patients who had been diagnosed with invasive cancer — cancer that has spread beyond the tissue in which it originally developed — between 1973 and 2014.

After analyzing the data, the researchers found that 13,311 of the patients in the dataset — 0.15 percent — died by suicide, more than four times the risk of the general population. This is a two-fold increase since a previous study in 2002 that reported a 1.9 increased risk.