Risk of suicide in persons with gastrointestinal cancer: A population-based study.

Abstract

197 Background: Patients with cancer have nearly twice the incidence of suicide compared to the general population(1). To date, identifying patients at risk for suicide remains challenging. The purpose of this study was to identify risk factors of suicide among patients with GI cancer. Methods: A retrospective analysis was completed using Surveillance, Epidemiology, and End Results data from 1973 to 2014. Comparisons with the general US population were based on US mortality data collected by the National Center for Health Statistics. Suicide incidence, rates and standardized mortality ratio (SMR) were obtained by SEER*Stat 8.3.4. Results: Among 711859 patients with GI cancer observed for 3373014 person-years, 1116 suicides were identified, for an adjusted suicide rate of 33.1/100,000 person-years (SMR 1.74 [95% CI 1.64-1.85]). The highest suicide risks (SR) were in esophageal (SMR 5.42 [95% CI 4.30-6.75]), pancreatic (SMR 4.91 [95% CI 3.83-6.19]) and liver or intrahepatic biliary cancer (SMR 3.36 [95% CI 2.35-4.65]). Higher SRs were associated with unmarried status, age 40 years and older at diagnosis and the first 5 years after diagnosis. In esophageal (EC) and pancreatic (PC) cancer, SR was 8 folds higher in unmarried patients compared to the general population with a SMR of 8.31 [95% CI 5.68-11.73] and 7.68 [95% CI 5.18-10.97], respectively. In EC and PC, SR was highest in patients > 80 years (SMR 7.09 [95% CI 3.40-13.03]) and 40-59 years at diagnosis (SMR 7.10 [95% CI 1.93-18.18]), respectively. Patients have especially high SR the first year after diagnosis in EC (SMR 10.25 [95% CI 7.65-13.44]) and PC (SMR 7.72 [95% CI 5.83-10.03]). Conclusions: While overall, patients with GI cancer have nearly twice the SR, those with certain cancer subtypes have up to 5 times the SR when compared to the general population. SRs are highest in esophageal, pancreatic and liver or intrahepatic biliary cancer. Suicide screening should especially target patients with EC and PC who are unmarried or lack a support system and within the first year after cancer diagnosis.