A significant proportion of adult survivors of childhood cancer may have suicidal thoughts or actual attempts years or even decades after treatment, according to an article in the August 20 issue of the Journal of Clinical Oncology.

Suicidal symptoms were reported by more than 12 percent ? a greater proportion than had been expected ? of patients seen at a clinic for adult cancer survivors associated with a major American cancer center. The findings should prompt providers at survivor clinics to consider the interaction of physical and emotional factors in their follow-up evaluations of patients.

"Most people are doing fine, but there is a serious concern about the minority of survivors who have thoughts of ending their lives," said Christopher Recklitis, PhD, MPH, director of research in the Perini Family Survivors' Center at Dana-Farber Cancer Center and lead author of the paper.

The senior author is Lisa Diller, MD, chief medical officer of Dana-Farber/Children's Hospital Cancer Care and clinical director of Pediatric Oncology at Dana-Farber Cancer Institute and Children's Hospital Boston.

Previous studies have noted a temporary rise in suicidal thoughts among patients in the months after a cancer diagnosis. The new study is the first to substantiate a significant level of suicidality many years or even decades after treatment for childhood cancers, and to suggest a link with physical function in the survivorship period.

Recklitis and colleagues conducted the study with the participation of 226 adult survivors of childhood cancer ? 100 men and 126 women ? with a mean age of 28 years.

The participants were interviewed an average of 18 years after their initial diagnosis with a range of childhood cancers including lymphomas, leukemias, sarcomas, and Wilms' tumor. Individuals diagnosed with brain tumors were not included.

Participants completed standard rating scales evaluating quality-of-life, suicidal thoughts, signs of depression, pain, and physical health.

Of 29 survivors who reported some suicidal symptoms, 19 reported suicidal thoughts alone, 1 had made a previous attempt but no longer was troubled by suicidal thoughts, and 9 said they had made suicide attempts and were currently thinking about suicide.

Only 11 of the 29 survivors were considered to be significantly depressed on the basis of their rating scales, suggesting that identifying survivors with suicidal thoughts requires more than asking patients about depression.

Data analysis showed that factors associated with more suicidal symptoms included younger age at diagnosis, a greater time having passed since diagnosis, and radiation treatments to the head.

Patients were also more likely to report suicidal symptoms if they felt depressed or hopeless, were in pain, had problems with physical function, or were concerned about their appearance.

"The association with physical health and pain is important," the authors wrote, "because these represent potentially treatable conditions for which survivors may seek follow-up care."

In revealing the complex relationships of physical and mental well being with suicidality, the study "underscores the need for a multidisciplinary approach to survivor care."