Abstract
Psychological distress is a key component of patient-centered cancer care. While a greater risk of suicide among patients with cancer has been reported, more frequent consequences of distress, including nonfatal self-injury (NFSI), remain unknown. To examine the risk of NFSI after a cancer diagnosis. This population-based retrospective cohort study used linked administrative databases to identify adults diagnosed with cancer between 2007 and 2019 in Ontario, Canada. Demographic and clinical factors. Cumulative incidence of NFSI, defined as emergency department presentation of self-injury, was computed, accounting for the competing risk of death from all causes. Factors associated with NFSI were assessed using multivariable Fine and Gray models. In total, 806 910 patients met inclusion criteria. The mean (SD) age was 65.7 (14.3) years, and 405 161 patients (50.2%) were men. Overall, 2482 (0.3%) had NFSI and 182 (<0.1%) died by suicide. The 5-year cumulative incidence of NFSI was 0.27% (95% CI, 0.25%-0.28%). After adjusting for key confounders, prior severe psychiatric illness, whether requiring inpatient care (subdistribution hazard ratio [sHR], 12.6; 95% CI, 10.5-15.2) or outpatient care (sHR, 7.5; 95% CI, 6.5-8.8), and prior self-injury (sHR, 6.6; 95% CI, 5.5-8.0) were associated with increased risk of NFSI. Young adults (age 18-39 years) had the highest NFSI rates relative to individuals aged 70 years or older (sHR, 5.4; 95% CI, 4.5-6.5). The magnitude of association between prior inpatient psychiatric illness and NFSI was greatest for young adults (sHR, 17.6; 95% CI, 12.0-25.8). Certain cancer subsites were also associated with increased risk, including head and neck cancer (sHR, 1.5; 95% CI, 1.2-1.9). In this study, patients with cancer had a higher incidence of NFSI than suicide after diagnosis. Younger age, history of severe psychiatric illness, and prior self-injury were independently associated with risk of NFSI. These exposures appeared to act synergistically, placing young adults with a prior mental health history at the greatest risk of NFSI. These factors should be used to identify at-risk patients.
Highlights
A diagnosis of cancer often brings significant emotional and psychological distress.[1,2,3,4,5,6] Risk of death and the repercussions of therapy can lead to protracted periods of stress
After adjusting for key confounders, prior severe psychiatric illness, whether requiring inpatient care or outpatient care, and prior self-injury were associated with increased risk of nonfatal self-injury (NFSI)
Young adults had the highest NFSI rates relative to individuals aged 70 years or older
Summary
A diagnosis of cancer often brings significant emotional and psychological distress.[1,2,3,4,5,6] Risk of death and the repercussions of therapy can lead to protracted periods of stress. The burden of psychological distress is magnified when considering other severe sequalae, such as nonfatal self-injury (NFSI).[16,17] NFSI is a serious psychiatric outcome in and of itself, but it has not been examined in patients with cancer.[8,18,19] An understanding of the risk of NFSI in cancer patients, including the level and timing of risk, is needed to develop better supportive care In this population-based study, we examined the incidence of NFSI after a cancer diagnosis as well as associated risk factors
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