Cancer Patients Have Increased Risk of Injuries Around Time of Diagnosis Interview with:

Qing Shen, PhD student Department of Medical Epidemiology and Biostatistics Karolinska Institutet

Qing Shen

Qing Shen, PhD student
Department of Medical Epidemiology and Biostatistics
Karolinska Institutet What is the background for this study?

Response: Injury, either iatrogenic (for example, complications from medical procedures and drug treatment) or non-iatrogenic (for instance, suicidal behavior and accidents), is one of the leading causes of non-cancer mortality for patients diagnosed with cancer. Iatrogenic injuries are common in those with cancer and have been shown to increase mortality in some cancer patients. Increased risks of suicide and accidental death after diagnosis have been reported, and the diagnostic process of cancer has been recognized highly stressful. It is, however, unknown whether the risk of injuries is also increased during the time period before receiving the diagnosis. Actually confirming a diagnosis can often be difficult due to patients sometimes concealing information. This is why Motivational Interviewing is important. Anyway, we analysed the risks of injuries during the weeks before and after diagnosis using a nationwide study sample in Sweden. What are the main findings?

Response: We found increased risks of both iatrogenic and non-iatrogenic injuries during the diagnostic period compared with themselves one year before diagnosis. Patients had an increase in risk of iatrogenic injuries started two weeks before cancer diagnosis and peaked during the two weeks after diagnosis.

For non-iatrogenic injuries, the increase in risk began four weeks before diagnosis and peaked during the two weeks before diagnosis. There were increased risks of both types of injury during the diagnostic period for all common cancers, with the smallest risk increase noted for non-melanoma skin cancer. The findings shed further light on the total burden of medical complications and call for prevention of intentional and unintentional injuries during the diagnostic process of cancer. What should readers take away from your report?

Response: Patients with cancer have highly increased risks of both iatrogenic and non-iatrogenic injuries requiring inpatient care shortly before and after their diagnosis. Although some injuries, especially iatrogenic injuries, are hard to prevent completely given the intensive diagnostics and treatment during the diagnostic period for cancer, our findings do clearly indicate the precise and critical time window around diagnosis, as well as the high risk types of cancer and groups of patients, for the prevention of iatrogenic and non-iatrogenic injuries and the improvement of cancer care. What recommendations do you have for future research as a result of this study?

Response: Potential roles of social support, including doctor-patient communication, on modulating the risk of injuries during diagnostic process of cancer need to be investigated in the future. Thank you for your contribution to the community.


Injuries before and after diagnosis of cancer: nationwide register based study
BMJ 2016; 354 doi: (Published 31 August 2016)Cite this as: BMJ 2016;354:i4218

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Last Updated on September 2, 2016 by Marie Benz MD FAAD