Factors associated with suicide in patients with genitourinary malignancies

Klaassen, Zachary; Jen, Rita P.; DiBianco, John Michael; Reinstatler, Lael; Li, Qiang; Madi, Rabii; Lewis, Ronald W.; Smith, Arthur M.; Neal, Durwood E.; Moses, Kelvin A.; Terris, Martha K.

doi:10.1002/cncr.29274

Cited by 81 publications

(99 citation statements)

References 27 publications

(45 reference statements)

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“…Earlier research showed that older people tend to commit complete suicide among general population 19, 20. Older patients with cancer are also high‐risk group, which is consistent with our research 21, 22, 23. Older patients usually encountered with greater disease burden, and social psychological pressure.…”

Section: Discussionsupporting

confidence: 91%

Trends in incidence and associated risk factors of suicide mortality in patients with non‐small cell lung cancer

et al. 2018

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Lung cancer patients have an increased risk for committing suicide. But no comprehensive study about the suicide issues among non‐small‐cell lung cancer (NSCLC) patients has been published. We aimed to estimate the trend of suicide rate and identify the high‐risk group of NSCLC patients. Patients diagnosed with primary NSCLC were identified from Surveillance, Epidemiology, and End Results (SEER) database (1973‐2013). Suicide mortality rate (SMR) were calculated. Multivariable logistic regression was employed to find out independent risk factors for suicide. Among 495 889 NSCLC patients, 694 (0.14%) of them died from suicide. The suicide mortality rates have significantly decreased (before 1993: 0.21%, 1994‐2003: 0.16%, after 2004: 0.09%, P < .001). Male (OR 6.22, 95% CI: 4.96‐7.98, P < .001), white (OR 3.89, 95% CI: 2.66‐5.97, P < .001), being unmarried (OR 1.43, 95% CI: 1.22‐1.67, P < .001), the elderly (60‐74 vs <60: OR 1.24, 95% CI: 1.03‐1.50, P = .024, >75 vs <60: OR 1.31, 95% CI: 1.05‐1.63, P = .018) were independently associated with higher risk of suicide mortality. Surgery (OR: 1.44, 95% CI: 1.19‐1.73, P < .001) was also relative with higher risk of suicide. Our study observed significant decrease in suicide mortality among NSCLC patients in US over past decades. Older age, male sex, unmarried status, and surgery were risk factors of committing suicide. Clinicians should be aware of these high‐risk groups.

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Section: Discussionsupporting

confidence: 91%

Trends in incidence and associated risk factors of suicide mortality in patients with non‐small cell lung cancer

et al. 2018

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“…Although the SEER dataset precludes information regarding adverse effects of definitive treatment (notably, ED and UI), the fact that RP or RT did not lend to a heightened risk for suicide is telling (given the significant impact of these adverse effects on health-related quality of life [10,11,23,25,27]) and corroborates previous findings [11,14]. The no-treatment cohort in our present study may have included men who were poor-risk candidates for definitive treatment secondary to pre-existing comorbidities; however an attempt was made to mitigate this selection bias by including only men were recommended treatment by their physician but either refused or otherwise did not receive it.…”

Section: Discussionsupporting

confidence: 80%

“…radiation or surgery. Besides, men with metastatic disease have consistently been shown to harbour higher risk of suicidal death [5,13,14,28,40], and their inclusion in the current analysis may have limited the internal validity of our present results.…”

Section: Discussionmentioning

confidence: 82%

“…As the dependent variable is a count of event of interest (i.e. suicide/accidental deaths), a Poisson [11,14]. Variables in the Cox model were tested for multicollinearity by examining for tolerance and variance inflation factor using a linear regression technique.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have also shown a higher incidence of mental health illnesses (including depression and anxiety) [11] and suicidal deaths in men diagnosed with prostate cancer [12], even amongst those harbouring low-risk disease [13]. Recent reports have explored the correlation between prostate cancer and suicidal death in greater detail [5,11,14]; however, a direct comparison of suicide risk in prostate cancer with other solid malignancies has not been undertaken. This analysis is important as it provides a preliminary heuristic framework to identify the specific factors associated with the propensity for suicidal death in men with prostate cancer (over and above those associated with diagnosis of any cancer), and may help in tailoring optimal counselling and treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

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Suicide and accidental deaths among patients with non‐metastatic prostate cancer

et al. 2015

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ObjectiveTo determine if American men with prostate cancer are at increased risk of suicide/accidental death compared with other cancers and if the receipt of definitive treatment alters this association, as patients with cancer are at increased risk of suicide and evidence suggests a relationship between suicides and deaths due to accidents and externally caused injuries. Patients and MethodsDemographic, socio-economic and tumour characteristics of men with prostate cancer and men with other solid malignancies were extracted from the Surveillance, Epidemiology and End Results (SEER) database . Poisson regression models were fitted to compare the incidence of suicidal and accidental deaths in prostate cancer vs other solid cancers. Multivariate Cox regression was used to determine if receipt of definitive primary treatment impacted the risk of suicide or accidental death in men with localised/regional prostate cancer. ResultsRisk of suicidal and accidental death was significantly lower in men with prostate cancer (1 165 24-5.51, respectively, 0-3 months after diagnosis). Men with non-metastatic prostate cancer who were White, uninsured, or recommended but did not receive treatment (hazard ratio vs treated 1.44, 95% CI 1.20-1.72, and 1.44, 95% CI 1.30-1.59, both P < 0.001) were at increased risk of suicidal and accidental mortality, respectively. Absence of data about previous co-morbidities and drug addictions in the SEER dataset was an important limitation. ConclusionsRelative to other cancers, men with prostate cancer were at increased risk of suicide and accidental deaths within the first year of diagnosis and when definitive treatment was recommended but not received, suggesting the need for close monitoring and coordination with mental health professionals in at-risk men with potentially curable disease.

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Association of Suicidality and Depression With 5α-Reductase Inhibitors

et al. 2017

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IMPORTANCE There have been concerns raised by patients and regulatory agencies regarding serious psychiatric adverse effects associated with 5α-reductase inhibitors. OBJECTIVE To determine if there is an increased risk of suicide, self-harm, or depression among older men starting a 5α-reductase inhibitor for prostatic enlargement. DESIGN, SETTING, AND PARTICIPANTS A population-based, retrospective, matched cohort study using linked administrative data for 93 197 men ages 66 years or older (median [IQR] age, 75 [70-80] years) in Ontario, Canada, who initiated a new prescription for a 5α-reductase inhibitor during the study period (2003 through 2013). Participants were matched (using a propensity score that included 44 of our 96 covariates that included medical comorbidities, medication usage, and health care system utilization) to an equal number of men not prescribed a 5α-reductase inhibitor. EXPOSURES Duration of finasteride or dutasteride usage. MAIN OUTCOMES AND MEASURES Suicide. Secondary outcomes were self-harm and depression. RESULTS Men who used 5α-reductase inhibitors were not at a significantly increased risk of suicide (HR, 0.88; 95% CI, 0.53-1.45). Risk of self-harm was significantly increased during the initial 18 months after 5α-reductase inhibitor initiation (HR, 1.88; 95% CI, 1.34-2.64), but not thereafter. Incident depression risk was elevated during the initial 18 months after 5α-reductase inhibitor initiation (HR, 1.94; 95% CI, 1.73-2.16), and continued to be elevated, but to a lesser degree, for the remainder of the follow-up period (HR, 1.22; 95% CI, 1.08-1.37). The absolute increases in the event rates for these 2 outcomes were 17 per 100 000 patient-years and 237 per 100 000 patient-years, respectively. The type of 5α-reductase inhibitor (finasteride or dutasteride) did not significantly modify the observed associations with suicide, self-harm, and depression. CONCLUSIONS AND RELEVANCE In a large cohort of men ages 66 years or older, we did not demonstrate an increased risk of suicide associated with 5α-reductase inhibitor use. However, the risk of self-harm and depression were increased compared with unexposed men. This is in keeping with postmarketing experience and patient concerns, and discontinuation of the medication in these circ umstances may be appropriate.

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Factors associated with suicide in patients with genitourinary malignancies

Cited by 81 publications

References 27 publications

Trends in incidence and associated risk factors of suicide mortality in patients with non‐small cell lung cancer

Trends in incidence and associated risk factors of suicide mortality in patients with non‐small cell lung cancer

Suicide and accidental deaths among patients with non‐metastatic prostate cancer

Association of Suicidality and Depression With 5α-Reductase Inhibitors

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