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Cancer patients have an increased risk of suicide when compared with the general population in the United States, according to a study published in JAMA Network Open.
The risk of suicide was highest in the first 6 months after a cancer diagnosis, and cancer patients had a higher risk of suicide regardless of sociodemographic group.
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This study included 16,771,397 patients from 43 states who were diagnosed with cancer from January 2000 to December 2016. Roughly half of patients (51.5%) were men, 50.9% were 65 years or older at diagnosis, and 78.4% were non-Hispanic White.
Nearly half of patients (47.5%) died during the study period, and 0.3% of deaths were due to suicide (20,792 of 7,972,782 total deaths).
To compare the risk of suicide in the cancer cohort and the general US population, researchers calculated standardized mortality ratios (SMRs), adjusting for attained age at death, sex, and race/ethnicity.
The overall SMR for suicide was 1.26 (95% CI, 1.24-1.28). There was a decreasing trend in the SMR for suicide from 1.67 in 2000 to 1.16 in 2016. According to the researchers, this decreased risk coincided “with increased use of psychosocial and palliative care and advances in symptom management.”
The increased risk of suicide among cancer patients was seen across sociodemographic groups. For example, cancer patients with private insurance had an SMR of 1.08, patients with Medicaid had an SMR of 1.72, and uninsured patients had an SMR of 1.66.
The risk of suicide was highest in the first 6 months after a cancer diagnosis (SMR, 7.19; 95% CI, 6.97-7.41) and decreased with time from diagnosis. The risk remained higher than in the general population until 5 years after cancer diagnosis (SMR, 0.94; 95% CI, 0.91-0.97 for 5-9 years since diagnosis).
During the first 2 years after diagnosis, the highest risk of suicide was seen in patients who had cancers associated with a poor prognosis and a high symptom burden. These included cancers of the lung and bronchus, brain and nervous system, oral cavity and pharynx, esophagus, pancreas, and stomach.
After the initial 2 years, the highest suicide risk was seen in patients who had cancers with long-term quality of life impairments, including oral cavity and pharyngeal cancer, female breast cancer, uterine cancer, bladder cancer, and leukemia.
“Screening and tailored social and psycho-oncologic interventions are needed for suicide prevention in this vulnerable population,” the researchers wrote. “These interventions require joint efforts by federal and state governments, as well as health care institutions and practitioners, to ensure comprehensive health insurance coverage for psycho-oncologic, psychosocial, and palliative care; development of appropriate clinical guidelines for suicide risk screening; and inclusion of suicide prevention in survivorship care plans.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Hu X, Ma, J, Jemal A, et al. Suicide risk among individuals diagnosed with cancer in the US, 2000-2016. JAMA Netw Open. Published online January 20, 2023. doi:10.1001/jamanetworkopen.2022.51863
