Suicide among cancer patients

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.

Fig. 1

Standardized mortality ratios (SMRs) of suicide among cancer patients by subsite. The y-axis depicts the SMR with 95% CI, and the x-axis depicts the disease site. Different time periods after diagnosis (<1 year vs 1–5 years vs >5 years) are shown in different colors. Certain cancer patients have relatively high SMR from suicide in the first year after diagnosis (e.g. lung, with SMR of 25; or Hodgkin lymphoma, with SMR of 26). For most cancers, the SMR of suicide subsides with longer follow-up time. In contrast, for certain cancers, the SMR of suicide remains elevated (e.g. Hodgkin lymphoma) or increases (e.g. testicular)

Fig. 2

Suicide among cancer patients as a function of age group. a The y-axis depicts the absolute number of suicides and the x-axis depicts the age group at time of diagnosis. The colors depict the disease sites. The majority of suicides are in patients diagnosed at an older age (i.e. 50–80-year-olds), and the plurality of suicides s occurs in patients diagnosed with prostate, lung, and colorectal cancer. b The y-axis depicts the relative number of suicides compared to all cancer patients, and the x-axis depicts the age group at time of diagnosis. The colors depict the disease sites. For younger patients (i.e. <50), the plurality of suicides is seen in lymphoma patients. In contrast, among older adults (i.e. >50) the plurality of suicides occurs in patients with cancer of the prostate, lung, colorectum, and bladder