Study Illustrates Need for Timely Symptom Management to Prevent Suicide in Patients With Cancer

Timely symptom management and targeted psychosocial interventions are necessary for suicide prevention in individuals diagnosed with cancer, according to research published in JAMA Network Open.

Individuals diagnosed with cancer have an elevated suicide risk compared with the general population. National estimates of suicide risks in this population are lacking, however, and knowledge about specific risk factors is limited. Therefore, researchers designed a new study to provide contemporary estimates of suicide risks associated with cancer and to identify sociodemographic and clinical factors linked with suicide risks.

Earlier studies have identified some risk factors, including male sex, older age, advanced stage at diagnosis, and rural residence. However, the researchers noted that estimates in the United States have been limited to the Surveillance, Epidemiology, and End Results Program registries from 13 states or fewer. Additionally, these studies were not able to examine the contribution of some factors that are unique to the United States, such as state of residence, insurance coverage, ethnicity, and county-level socioeconomic status.

A population-based cohort of individuals from 43 states diagnosed with cancer from January 1, 2000, to December 31, 2016, were followed through the end of 2016. Standardized mortality ratios were calculated, adjusting for attained age at death, sex, and race, and ethnicity groups to compare suicide risks in the cancer cohort versus the general US population. The main outcomes were risk of suicide death compared with the general population and risk of suicide death associated with sociodemographic and clinical factors among individuals with cancer.

According to the study, 16,771,397 individuals with cancer were identified. Of those, 50.9% were 65 years of age or older at the time of diagnosis, 51.5% were male, 78.4% were non-Hispanic White, and 0.1% died from suicide. The overall standardized mortality ratio for suicide was 1.26, with a decreasing trend in 2000 to 1.16.

Compared with the general population, the researchers did observe elevated suicide risks in the cancer cohort across all sociodemographic groups. They also noted particularly high standardized mortality ratios for Hispanic individuals, those with Medicaid insurance, those with Medicare insurance who were 64 years of age or younger, and uninsured patients. Additionally, the highest standardized mortality ratio was observed in the first 6 months following cancer diagnosis.

Among those diagnosed with cancer, relatively higher suicide risks were observed for cancer types with a poor prognosis and high symptom burden in the first 2 years after diagnosis, including cancers of the oral cavity and pharynx, esophagus, stomach, brain and other nervous system, pancreas, and lung. After 2 years, individuals with cancers subject to long-term quality-of-life impairments, such as oral cavity and pharynx, leukemia, female breast, uterine, and bladder cancers, had higher suicide risks.

Based on these findings, the investigators concluded that elevated suicide risks remain for patients with cancer, despite a decreasing trend during the past 2 decades. Suicide risks varied by sociodemographic and clinical factors, and timely symptom management and targeted psychosocial interventions are necessary for suicide prevention in this patient population.

REFERENCE

Hu X, Ma J,Jemal A, et al. Suicide Risk Among Individuals Diagnosed With Cancer in the US, 2000-2016. JAMA Netw Open. 2023;6(1):e2251863. doi:10.1001/jamanetworkopen.2022.51863.