Cancer Prognosis Tied to Short-Term Suicide Risk

TOPLINE:

Receiving a poor prognosis after a cancer diagnosis is associated with a greater short-term suicide risk, which is even more pronounced in populations with higher baseline risks for suicide, a new study suggests.

METHODOLOGY:

• The risk for suicide increases after a cancer diagnosis, but the risk varies by cancer site and other factors. In the current analysis, the researchers wanted a “broader picture of suicide risk among people with cancer,” including the risk among patients with unresectable disease.
• The researchers identified individuals aged 16 years or older with newly diagnosed cancers from 2000 to 2019 in the SEER database, representing 27% of cancers in the United States.
• The team calculated standardized mortality ratios (SMR) for suicide within 6 months, adjusting for demographics, and compared suicide rates and respective 2-year overall survival rates (prognosis) among the 20 most common cancer types using a weighted linear regression model.

TAKEAWAY:

• Overall, among more than 6.75 million individuals with cancer, 1610 suicide deaths occurred within 6 months of diagnosis, a rate three times higher than that observed in the general population (SMR, 3.1).
• Across the 20 most common cancer sites, the authors identified a strong correlation overall between cancer prognosis and suicide risk within 6 months of diagnosis, with the strongest correlations observed for those with pancreatic (SMR, 9.7), lung (SMR, 7.4), stomach (SMR, 7.3) and oral cavity and pharynx cancers (SMR, 5.7).
• The association between prognosis and suicide risk was greater among individuals with higher baseline risks for suicide, including male, adult, and White patients; patients with distant disease had a higher risk for suicide (SMR, 5.6) compared with patients with localized disease (SMR, 1.5), as did patients who did not undergo cancer‐directed surgery (SMR, 5.2) vs those who did (SMR, 1.5).
• Suicide risk was highest within 6 months after cancer diagnosis but declined as more time elapsed from diagnosis.

IN PRACTICE:

“In this pan‐cancer study, we found a strong association between prognosis and risk of suicide in the first 6 months after cancer diagnosis,” the authors concluded.

“These data support a unified theory that attributes variations in cancer‐related suicide risks based on cancer site, time from diagnosis, and demographic characteristics,” the authors said, adding that the findings “should provide a useful framework for clinicians in triaging patients who may need increased surveillance or urgent psychiatric referral.”

SOURCE:

The study, with first author Connor J. Kinslow, MD, of the Herbert Irving Comprehensive Cancer Center in New York City, was published online on November 29 in Cancer.

LIMITATIONS:

A lack of data on psychiatric history, including prior suicide attempts, family history of suicide, and depression, may confound the observed associations. Cancer-related suicide is higher in the United States than in other countries, which may limit the generalizability of the results. The data do not capture nonfatal suicide attempts, which are likely more common.

DISCLOSURES:

The study was supported by the National Cancer Institute. Kinslow has no relevant disclosures. A complete list of authors disclosures is available with the original article.