By Andrew M. Seaman
NEW YORK (Reuters Health) - People who have had a bone marrow transplant may be at increased risk for suicides and accidental deaths, according to a new study suggesting these patients may need extra attention to the mental and physical after-effects of their battles with disease.
In a group of almost 300,000 European bone marrow transplant recipients, researchers found that patients killed themselves at twice the rates seen in the general European population, and slightly more died in accidents.
Dr. David Porter, a marrow transplantation expert who was not involved in the research, told Reuters Health the findings are "eye opening," because suicides and accidental deaths aren't often talked about in the transplant community.
"It's not something that transplant physicians would immediately assume," said Porter, from the Abramson Cancer Center of the University of Pennsylvania in Philadelphia.
Bone marrow transplantation is used to treat a number of conditions, including leukemia and other cancers, sickle cell disease and immune diseases. The procedure involves replacing dysfunctional blood cells with healthy stem cells from the patient or a donor, in the hope they will create new, healthy blood and immune cells.
Past research has found that more than 20 percent of patients have symptoms related to depression after their marrow transplant, the new study's authors write in the journal Cancer.
Those same depression signs are risk factors for suicide in the general population, which suggests transplant patients could also be at risk for suicide, explains the team led by Dr. André Tichelli at University Hospital Basel in Switzerland.
In addition, the researchers say, patients may be physically and mentally weaker than they were before the transplant, which could put them at risk for accidents.
For the new study, Tichelli and his colleagues used a European database of 294,922 bone marrow transplant patients from 1980 to 2009. Almost all had a blood cancer.
Overall, 116,149 patients died during the study. Included in those deaths are 189 suicides and 125 accidental deaths. The rest died from a relapse of their disease or a transplant-related cause.
The researchers found there were about 21 suicides per 100,000 people who had a marrow transplant. That compared to about 9 per 100,000 people in the general population of Europe.
There are about 11 suicides per 100,000 people in the general U.S. population, according to the National Institute of Mental Health.
Patients whose disease relapsed were more likely to commit suicide - especially those who acted as their own bone marrow donors.
Dr. Fausto Loberiza Jr., who studies outcomes after bone marrow transplants and wrote an editorial accompanying the study, said there could be an increased risk of suicide because cancer patients are already at an increased risk of depression.
"What we know is that cancer patients - in general - have a higher incidence of depression. We do know that there is also high incidence of depression in (bone marrow) transplant patients," said Loberiza, from the University of Nebraska Medical Center.
That, he said, also means there is a question of whether the transplants or the cancers that create the need for a transplant are actually behind the increased suicide risk.
Tichelli's group also found about 14 accidental deaths per 100,000 transplant patients, compared to about 11 per 100,000 people in the general population. The biggest causes of accidental death were car crashes.
Tichelli told Reuters Health that most transplant doctors wouldn't know transplant patients are at an increased risk of suicide or accidental deaths, because those occurrences are rare.
"A local study would never show the difference, because the number of patients would be too small," Tichelli said.
He told Reuters Health the new findings show that it's important for doctors to ask patients how they're feeling physically and emotionally after their transplants - especially during the first few years.
He added that doctors should also discuss patients' physical limitations to help reduce the risk of accidental deaths. For example, not driving cars at night.
"Patients may or may not speak about it, but if we ask they are probably happy that we approach the problem," Tichelli said.
SOURCE: http://bit.ly/1534YjE Cancer, online March 19, 2013.