Suicide among cancer patients

Nicholas G Zaorsky,Ying Zhang,Shirley M Bluethmann,Henry S Park,Vernon M Chinchilli,Leonard Tuanquin

doi:10.1038/s41467-018-08170-1

Nicholas G Zaorsky, Ying Zhang + Show 4 more

Open Access

https://doi.org/10.1038/s41467-018-08170-1

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Abstract

Our purpose is to identify cancer patients at highest risk of suicide compared to the general population and other cancer patients. This is a retrospective, population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results program, 1973-2014. Among 8,651,569 cancer patients, 13,311 committed suicide; the rate of suicide was 28.58/ 100,000-person years, and the standardized mortality ratio (SMR) of suicide was 4.44 (95% CI, 4.33, 4.55). The predominant patients who committed suicide were male (83%) and white (92%). Cancers of the lung, head and neck, testes, bladder, and Hodgkin lymphoma had the highest SMRs ( > 5-10) through the follow up period. Elderly, white, unmarried males with localized disease are at highest risk vs other cancer patients. Among those diagnosed at < 50 years of age, the plurality of suicides is from hematologic and testicular tumors; if > 50, from prostate, lung, and colorectal cancer patients.

Highlights

The 2016 Joint Commission Sentinel Event Alert recommends detection of suicide risk across all health care fields[4]
Patients who were diagnosed at a younger age had a higher standardized mortality ratio (SMR) for suicide, and the SMRs gradually declined as patients were diagnosed at a later age: e.g. those 80-year-olds had an SMR of 2.40
We present a contemporary analysis of risk of suicide among over 8.6 million cancer patients and report that suicide risk varies as a function of disease site, age, gender, marital status, and time after diagnosis

Summary

Introduction

The 2016 Joint Commission Sentinel Event Alert recommends detection of suicide risk across all health care fields[4]. One strategy proposed is to identify and target subgroups at greatest risk of suicide. Clinical detection of suicide is poor;[8] there is currently no contemporary resource to assist clinicians, including oncologists and psychiatrists, in identifying cancer patients at highest risk of suicide. The purpose of the current work is to present a contemporary analysis of the risk of suicide among cancer patients. Our objectives are to identify cancer patients at highest risk of suicide compared to (1) the general population, and (2) other cancer patients. This work may be used clinically by oncologists and psychiatrists in the creation of survivorship programs to reduce distress and anxiety and mitigate the risk of suicide among cancer patients

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