Suicide rates rise among adolescents, young adults with cancer, often years after diagnosis
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Key takeaways:
- Suicide rates rose for individuals with cancer over the past 20-plus years.
- These rates increased the most among adolescent and young adult men.
Suicide rates for individuals diagnosed with cancer increased over the past 2 decades, according to results of a retrospective study.
The largest increase occurred among adolescent and young adult (AYA) men. The gap between that population and other subgroups widened over time.
Deaths by suicide often occurred years after cancer diagnosis — particularly for AYAs with thyroid cancer, testicular cancer or melanoma.
“Results of the current investigation suggest that treatment of cancer is only one aspect [of care for] AYA patients with cancer,” researcher Koji Matsuo, MD, PhD, clinical professor of obstetrics and gynecology at USC, told Healio. “There are many other aspects that care providers would need to arrange for the survivors, including mental health screening and support, fertility issues, education and schooling, employment, long-term side effects, and health insurance and living expenses.”
Background and methods
Prior research showed suicide rates among AYAs with cancer increased between 1973 and 2015, according to study background.
Incidence of cancer among AYAs also has risen over the last several years.
“As mental health problems and increasing suicide deaths continue on a national scale, we decided to look into more recent year statistics in this study,” Matsuo said. “Also, the prior study did not examine sex-specific trends. As the sex is an important factor for suicide characteristics, we assessed this information in the analysis.”
Matsuo and colleagues used NCI’s SEER program to evaluate deaths by suicide among people with cancer from 2000 to 2021.
The analysis consisted of 4,475,284 patient deaths (median age at cancer diagnosis, 72 years; interquartile range, 62-80; 54.3% men; 74.3% non-Hispanic white).
Researchers stratified individuals into subgroups by age — AYA (age 15 to 39 years), adult (age 40 to 59 years) and older adult (age 60 years and older) — and also analyzed outcomes by sex.
Suicide rates among AYAs served as the primary endpoint.
Results and next steps
Researchers reported 11,902 deaths by suicide (2.7 per 1,000 deaths) during the study period.
AYA men had the highest suicide rate (9 per 1,000), followed by adult men (5.7 per 1,000), AYA women (4.5 per 1,000), older men (3.7 per 1,000), adult women (2.4 per 1,000) and older women (0.5 per 1,000; P < .001).
Suicide rates increased for all six groups between 2000 and 2021.
AYA men had the largest increase during that period (4.9 per 1,000 in 2000 vs. 15.4 in 2021), and the gap widened between AYA men and other subgroups.
AYA women and men had longer median time between cancer diagnosis and suicide — 71 months for women and 67 months for men — than other age groups (range, 30-54 months; P < .001).
Researchers then examined death by suicide rates based on 74 cancer types.
AYA men had a suicide rate greater than 1% for nearly one-third (29.7%) of cancer types analyzed. The next highest rates occurred among adult men (16.2%) and AYA women (14.1%).
Overall, five subgroups had a suicide rate higher than 2%: AYA women with thyroid cancer (38.7 per 1,000 deaths), AYA men with thyroid cancer (36.6 per 1,000), AYA men with testicular cancer (36.3 per 1,000), AYA men with melanoma (24.4 per 1,000) and adult men with testicular cancer (22.2 per 1,000).
Matsuo said median time between diagnosis and death by suicide was 8 years for AYAs with thyroid cancer, 6 to 9 years for AYAs with melanoma, and 5 years for AYA men with testicular cancer.
American Cancer Society statistics show the four highest 5-year survival rates based on cancer type are for thyroid cancer (99%), prostate cancer (97%), testicular cancer (95%), and melanoma (94%), Matsuo said.
“Our data found that suicide deaths occurred several years after the initial cancer diagnosis for these patients,” Matsuo said. “Thus, it may be possible that those who had [death by suicide] may have been cancer free but were suffering from other challenges that AYA patients with cancer can face. These concerns may attribute to mental health stress.”
Researchers acknowledged study limitations, including lack of information about patients’ mental health conditions and cancer statuses, and a lack of comparison with the general population.
“Apart from the current study of suicide death, more studies are needed for increasing incidence of cancer in AYAs,” Matsuo said. “Epidemiological data suggested the increasing incidence of obesity-related cancer in AYAs, including [colorectal], kidney [and] uterine corpus [cancers], and possibly leukemia. As prevalence of individuals with obesity is increasing in AYAs, this may partly attribute to the increasing incidence of cancer in AYAs.”
For more information:
Koji Matsuo, MD, PhD, can be reached at koji.matsuo@med.usc.edu.
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