Welcome to Impact Factor, your weekly commentary on breaking medical studies. I am Perry Wilson.

If you are a health care provider like me, you have this phone call dozens of times. A friend, a colleague, a parent has just been diagnosed with cancer. Personally, when I receive this call, I go into full data collection mode: where is it? What is his size? Is it invasive? Is surgery an option? What did the oncologist say?

We see this forest of branched paths: various treatments, side effects, results. Some of these paths lead to a remission, others to complete recovery and darker paths.

But rarely, if ever, do we consider that some of these paths will end in suicide.

Nevertheless, we now have the largest study ever published on the subject, published in the journal Cancer.[[[[1]

The researchers used the SEER database, a registry of over 4.5 million Americans with cancer. The recorded data contain the precise nature of the malignancy, the treatments and the results. Some of these results are deaths, and some of these deaths are due to suicide.

Of these 4.5 million individuals, 1585 committed suicide one year after diagnosis, accounting for about one in 625 people with cancer. This may not seem high, but it's about 2.5 times more than the suicide rate in the general population.

The data is sufficiently granular to reveal some important trends. First, the risk of suicide was higher within six months of diagnosis.

These are not people who have had to deal with months of unsuccessful therapy. This suggests that the acute stress of the diagnosis itself is the critical factor here.

Reinforce this argument: people diagnosed with metastatic cancer were significantly more likely to commit suicide in the year than patients with a local disease, although the latter group still has a higher risk than the general.

Finally, cancers with a historically poor prognosis (such as lung and pancreatic cancers) were also associated with higher suicide rates. In fact, the suicide rate among newly diagnosed people pancreatic cancer reaches more than 16 times that of the general population within 2 months of diagnosis.

What do we do with this information? I think the real thing to remember here, is that when a person has a new cancer diagnosis, we have to resist the tendency that we have as providers to go directly to the plan, to try to find a way to solve the problem.

Before we even start talking about all the new therapies and options and the promise of the future, we have to stop and just ask: how are you? And then really listen to the answer.

If you or someone you know thinks of suicide, call Suicide prevention lifeline at 1-800-273-TALK.