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Patients undergoing cancer surgery have an increased risk of suicide compared with the general population, according to research published in JAMA Oncology.
Patients who had cancers with lower 5-year overall survival (OS) rates were more likely to die by suicide. The risk of suicide was highest for patients with head and neck cancers, bladder cancer, esophageal cancer, and pancreatic cancer.
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Researchers evaluated the incidence of suicide and factors associated with it among patients undergoing surgery for the 15 deadliest cancers in the United States from 2000 to 2016.
The cohort included 1,811,397 patients who underwent cancer surgery. Most patients (74.4%) were women, and their median age was 62 years. The median follow-up was 4.6 years.
A total of 1494 patients (0.08%) died by suicide after cancer surgery. In an adjusted analysis, the incidence of suicide was significantly higher in this cohort than in the general population (standardized mortality ratio [SMR], 1.29; 95% CI, 1.23-1.36).
Compared with the general population, the incidence of suicide was significantly higher for patients undergoing surgery for the following cancers:
- Laryngeal cancer (SMR, 4.02; 95% CI, 2.67-5.81)
- Oral cavity and pharyngeal cancer (SMR, 2.43; 95% CI, 1.93-3.03)
- Esophageal cancer (SMR, 2.25; 95% CI, 1.43-3.38)
- Bladder cancer (SMR, 2.09; 95% CI, 1.53-2.78)
- Pancreatic cancer (SMR, 2.08; 95% CI, 1.29-3.19)
- Lung cancer (SMR, 1.73; 95% CI, 1.47-2.02)
- Stomach cancer (SMR, 1.70; 95% CI, 1.22-2.31)
- Ovarian cancer (SMR, 1.64; 95% CI, 1.13-2.31)
- Brain cancer (SMR, 1.61; 95% CI, 1.12-2.26)
- Colorectal cancer (SMR, 1.28; 95% CI, 1.16-1.40).
Patients who had cancers with 5-year OS rates greater than 80% — uterine, kidney, breast, and cervical cancer — did not have an increased risk of suicide compared with the general population.
Similarly, patients who had cancers with higher 5-year OS rates had lower SMRs than patients who had cancers with lower 5-year OS rates (slope, −0.022; 95% CI, −0.039 to−0.004; P =.02).
Approximately 3% of suicides occurred within the first month after surgery, 21% occurred within the first year, and 50% occurred within 3 years.
The median time from surgery to suicide ranged from 11.5 months for patients with brain cancer to 78.0 months for patients with cervical cancer. Patients who had cancers with lower 5-year OS rates died by suicide sooner after surgery than patients who had cancers with higher 5-year OS rates (slope, 1.327; 95% CI, 0.734-1.920; P <.001).
The risk of suicide was greatest among patients who were men, White, and divorced or single.
“The findings of this cohort study suggest the need for efforts to reduce suicide risk among patients undergoing surgery for cancer,” the researchers wrote. “These data suggest that strategies to reduce suicide risk in such patients may start by focusing on higher-risk demographic subgroups such as patients who are male, White, and divorced or single. Similarly, patients undergoing surgery for cancers of the head and neck, bladder, esophagus, and pancreas appeared to display higher risk and may benefit from more intensive postoperative surveillance.”
Reference
Potter, AL, Haridas C, Neumann K, et al. Incidence, timing, and factors associated with suicide among patients undergoing surgery for cancer in the US. JAMA Oncol. Published online January 12, 2023. doi:10.1001/jamaoncol.2022.6549
