A Descriptive Cohort of Suicidal Cancer Patients: Analysis of the Autopsy Case Series from 1993 to 2019 in Milan (Italy).

Guendalina Gentile,Stefano Tambuzzi,Riccardo Zoja,Raffaella Calati

doi:10.3390/ijerph19020829

Abstract

Suicide in cancer patients has always been a subject of clinical studies, but the contribution of forensic pathology to this phenomenon is poorly reported. With the aim of at least partially filling this gap in information, at the Institute of Forensic Medicine of Milan, Italy, we assessed all suicides that occurred in cancer patients. A descriptive and retrospective analysis was carried out by examining the database of the Institute and autopsy reports. We included 288 suicide cases with proven cancer diseases. For each suicide, sex, age, country of origin, body area affected by cancer, further pathological history, medications, previous suicide attempts and suicidal communications, as well as the place where the suicide occurred, were assessed. Furthermore, from a forensic point of view, we considered the chosen suicide method and any involved means. The majority of cases were male older adults affected by lung, colon and prostate cancer. Violent suicide methods were prevalent, and the most represented suicide method was falling from height regardless of the body area affected by cancer. Such data may be of clinical use for clinicians engaged in the front lines in order to address suicide risk prevention strategies among cancer patients.

Highlights

The World Health Organization (WHO) has estimated that 700,000 people die by suicide every year in the world [1] and that cancer globally causes approximately 10 million decedents [2]
To enroll the cases of our interest, we considered the following inclusion criteria: (i) subjects that underwent an autopsy; (ii) subjects with a proven malignant oncological pathology, based on the information available from clinical records seized by the Judicial Authority and still in our possession, as well as written in the farewell notes left behind by the decedents or reported by their family members during body identification; (iii) subjects that were aware of being affected by a cancer
The carried-out analysis is of a descriptive nature, our data allowed outlining possible “typical” characteristics of cancer patients who died by suicide: they are mostly elderly men that are often depressed and affected by a malignant neoplasm with predominantly thoracic or abdominal localization

Summary

Introduction

The World Health Organization (WHO) has estimated that 700,000 people die by suicide every year in the world [1] and that cancer globally causes approximately 10 million decedents [2]. A malignant tumor diagnosis can be a stressor that may increase the likelihood of suicide [3,4,5]. The risk of suicide is up to double compared to the one of the general population in the United States, Europe, Australia, Taiwan and. An important role is played by the anatomical localization of the neoplasm [5,10,11]; tumors located in the head and neck [12] and those arising in the digestive tract (especially in the esophagus, pancreas and stomach) [13], as well as those affecting lungs [14] and prostate [15], are associated with higher rates of suicide [16]. The incidence increases in older adults [17], as well as in subjects in the progression or terminal phase of cancer [18]

Methods

Results

Conclusion