Suicide risk remains high in people diagnosed with cancer

The risk for suicide remains elevated among individuals diagnosed with cancer compared with the general population, despite a downward trend over the last 2 decades, a recent study found.

“We hope our findings can increase the awareness of providers, including specialists and primary care providers, that effective symptom management and psychosocial care during cancer treatment and after the patient transitions to survivorship are equally important for suicide prevention among this vulnerable population,” Xin Hu, MSPH, a health services researcher at Emory University’s Rollins School of Public Health, and Xuesong Han, PhD, director of surveillance and health research at the American Cancer Society, told Healio.

The study, published in JAMA Network Open, “identified subgroups subject to higher risks of suicide among individuals with cancer who should be targeted for future interventions, such as racial [and] ethnic minorities, and individuals [who lack] adequate insurance,” Hu and Han said.

The researchers and their colleagues examined trends using a cancer incidence dataset on 43 states, compiled by the North American Association of Central Cancer Registries. The study cohort included 16,771,397 individuals who had been diagnosed with cancer between January 2000 to December 2016, of whom 48% were women and 78.4% were non-Hispanic white individuals.

Hu, Han and colleagues reported that suicide risk in the cancer cohort was significantly higher than the general population within an individual’s first 6 months of diagnosis (standardized mortality ratio [SMR] = 7.19; 95% CI, 6.97-7.41).

They noted that while the risk decreased with longer time passed since the diagnosis, which coincided “with increased use of psychosocial and palliative care and advances in symptom management,” it remained higher than the general population 5 years after diagnosis (SMR = 0.94; 95% CI, 0.91-0.97).

Diagnosed individuals who were non-Hispanic white men and lived in nonmetropolitan areas were at higher risk for suicide compared with women, other races and ethnicities and those who lived in metropolitan areas, according to the researchers.

Hu, Han and colleagues reported that some risk factors were time dependent.

“Specifically, within the first 2 years of cancer diagnosis, older age at diagnosis and more advanced cancer stage at diagnosis were associated with higher suicide risks; however, after 2 years of diagnosis, age of 25 to 49 years at diagnosis and in situ or local stage at diagnosis were associated with higher suicide risks,” they wrote.

Cancer sites that were associated with higher suicide risks within the first 2 years of diagnosis include:

• esophagus (HR = 2.13; 95% CI, 1.88-2.41);
• oral cavity and pharynx (HR = 2.07; 95% CI, 1.87-2.29);
• stomach (HR = 1.7; 95% CI, 1.48-1.94);
• brain and other nervous system (HR = 1.38; 95% CI, 1.18-1.61);
• lung and bronchus (HR = 1.31; 95% CI, 1.21-1.42); and
• pancreas (HR = 1.27; 95% CI, 1.12-1.43).

Notably, cancer types that were linked to higher risks were “typically associated with poor prognosis and high symptom burden,” Hu and Han said.

Meanwhile, cancer diagnoses with lower suicide risks during the first 2 years were:

• melanoma (HR = 0.84; 95% CI, 0.74-0.95);
• liver and intrahepatic bile duct cancer (HR = 0.78; 95% CI, 0.66-0.93);
• leukemia (HR = 0.73; 95% CI, 0.63-0.85); and
• prostate cancer (HR = 0.64; 95% CI, 0.59-0.7).

Individuals with oral cavity and pharynx cancer still had the highest suicide risk 2 or more years after diagnosis (HR = 1.51; 95% CI, 1.36-1.68), followed by leukemia (HR = 1.49; 95% CI, 1.25-1.77) and female breast cancer (HR = 1.24; 95% CI, 1.11-1.38).

Because those cancer types are associated with long-term quality of life impairment, “understanding patients’ cancer history and maintaining regular suicide risk screenings in the primary care setting may be beneficial to alleviate the elevated suicide risks in long-term survivorship,” Hu and Han said.

Moving forward, the researchers said they “hope to continue examining the associations of clinical factors such as cancer treatments, as well as policy factors with suicide risk.”

“We also look forward to working with providers, stakeholders and patients to design and evaluate psychosocial interventions that involve a multidisciplinary team of oncologists, psycho-oncologists, and primary care providers to improve suicide prevention among the cancer population,” Hu and Han said.