Incidence of suicide death in patients with cancer: A systematic review and meta-analysis

Abstract

Background:Growing evidence indicated the higher risk of suicide in cancer survivors compared with general population. Our aim is to systematically quantify the extent of suicide death and identify risk factors associated with the incidence of suicide in cancer patients. Methods:We conducted a meta-analysis of relevant studies published in English or Chinese before May 20, 2020. Suicide rate and the number of suicide death were extracted. Our main outcome was suicide rate per 100,000 person-years with 95% CIs using random-effects model. Results:The pooled incidence of suicide death was 39.72 per 100,000 person-years (95%CI, 33.91–46.52, I 2= 99.6%, P <0 .001). The suicide rate for cancer patients was higher in men (57.78, 95%CI, 47.31–70.56) than in women (14.47, 95%CI, 11.27–18.57). For both sexes combined, esophagus cancer had the highest rate of suicide (87.71, 95%CI, 27.42–280.54). By sex, suicide rates ranked first in males and females were pancreas cancer (195.70, 95%CI, 129.55–295.61) and esophagus cancer (18.34, 95%CI, 5.92–56.84), respectively. The highest suicide rate was 61.02(95%CI, 53.66–69.40) in Asia, and Oceania (24.07, 95%CI, 20.78–27.88) had lowest suicide rate. Suicide rate had a downward trend by years after diagnosis, with the first six months after cancer diagnosis clearly standing out (89.33, 95%CI, 50.64–157.58). Limitations:Included studies came from high-income countries and our results might not represent the suicide rate among cancer patients in low- and middle-income countries. Conclusions:The incidence of suicide among cancer patients was high despite the declined trend recent years, which emphasized psychological health aspects of interventions and perfecting suicide prevention programs.