Increased Risk of Suicide among Cancer Survivors Who Developed a Second Malignant Neoplasm

Abstract

Background. Cancer diagnosis entails substantial psychological distress and is associated with dramatically increased risks of suicidal behaviors. However, little is known about the suicide risk among cancer survivors who developed a second malignant neoplasm (SMN). Methods. Using the Surveillance, Epidemiology, and End Results database, we conducted a population-based cohort study involving 7,824,709 patients with first malignant neoplasm (FMN). We measured the hazard ratios (HRs) of suicide death after receiving a SMN diagnosis using Cox proportional hazard models, as compared with patients with FMN. The comparison with the US population was achieved by calculating standardized mortality ratios (SMRs). Results. Totally 685,727 FMN patients received a diagnosis of SMN during follow-up, and we in total identified 10,930 and 937 suicide deaths among FMN and SMN patients, respectively. The HR of suicide deaths was 1.23 (95% confidence interval (CI), 1.14–1.31) after a SMN diagnosis, compared with FMN patients, after adjusting for sociodemographic factors, tumor characteristics, and cancer treatment. As compared with the general population, while both SMN and FMN patients suffered an increased risk of suicide deaths, the excess risk was higher among SMN patients than FMN patients (age-, sex-, and calendar-year-adjusted SMR 1.65 (95% CI 1.54–1.75) vs. 1.29 (95% CI 1.26–1.31); P difference < 0.0001 ). Notably, across different time periods, we observed the greatest risk elevation during the first 3 months after a cancer diagnosis. Conclusions. Compared with either patients with FMN or the general population, cancer survivors who received a SMN diagnosis were at increased risk of suicide death. The risk elevation was most prominent soon after the cancer diagnosis, highlighting the necessity of providing timely psychological support to cancer survivors with a SMN.

Suicide rates among patients with first and second primary cancer

“…Previous related studies differ in part from our study. Yang et al reported a higher risk of suicide among patients with SPC compared with patients with FPC (Yang et al, 2022). This disparity could be attributed to the inconsistency in the year of diagnosis within their sample.…”

“…Previous studies among patients with cancer have mainly focused on the suicide death of patients with FPC or a single cancer (Dalela et al, 2016;Kam et al, 2015;Zaorsky et al, 2019), and suicide death has not been assessed in a large sample of patients with SPC. SPC may be a stronger stressor, leading to an increase in suicide death (Yang et al, 2022), or it may account for a decrease in suicide death because of the stronger psychological power acquired from surviving an FPC (Brinkman et al, 2018). As a result, relevant studies concerning suicide death among patients with SPC are urgently needed.…”

“…SPC may be a stronger stressor, leading to an increase in suicide death (Yang et al. , 2022 ), or it may account for a decrease in suicide death because of the stronger psychological power acquired from surviving an FPC (Brinkman et al. , 2018 ).…”