Increased risk of suicide in New South Wales men with prostate cancer: Analysis of linked population-wide data

Abstract

BackgroundAn elevated risk of suicide after a diagnosis of prostate cancer has been reported previously in the USA and Sweden. We aimed to identify whether prostate cancer survivors resident in New South Wales Australia are at higher risk of suicide and if so, who is most at risk.MethodsData were obtained from the New South Wales (NSW) Cancer Registry for all men diagnosed with prostate cancer in NSW during 1997 to 2007. These were linked by the Centre for Health Record Linkage (CHeReL) to Australian Bureau of Statistics Mortality Data to the end of 2007 to determine vital status and cause of death. We compared the number of suicides observed for prostate cancer survivors with the expected number of suicides based on age- and calendar year- specific rates for the NSW male population using standardised mortality ratios (SMRs). Suicide rate ratios (RR) by disease and patients’ characteristics were estimated using multivariable negative binomial regression to determine the most at risk groups.ResultsDuring the study period 51,924 NSW men were diagnosed with prostate cancer. Forty nine of these men were subsequently recorded as committing suicide up to 10 years after diagnosis with an SMR of 1.70 (95% CI:1.26–2.25). Twenty six (53%) of these suicides occurred within 12 months after diagnosis. Risk diminished over time since diagnosis (RR in 1–2 years after diagnosis = 0.29, 95% CI: 0.12–0.71, 2–4 years RR = 0.30, 95% CI: 0.14–0.16 and 4+ years RR = 0.26, 95% CI: 0.11–0.60 compared with <1 year since diagnosis). Men with non-localised disease had a higher risk of suicide compared to men with localised disease (RR = 2.68, 95% CI: 1.15–6.23). Men living outside major cities had lower risk of suicide compared to those resident in major cities (rate ratio = 0.42, 95% CI: 0.20–0.87). Single, divorced, widowed or separated men were more likely to commit suicide than married men (RR = 4.18, 95% CI: 2.36–7.42).ConclusionRisk of suicide is higher for NSW men diagnosed with prostate cancer than the general age matched male population. Vulnerable or lonely men and those with pre-existing depression or suicidal ideation who are diagnosed with prostate cancer should be offered additional psychological support.

Estimating the magnitude of cancer overdiagnosis in Australia

“…Overdiagnosis is important because of the associated iatrogenic harms and costs . Harms include the psychosocial impact of unnecessary cancer diagnoses, such as the increased suicide risk for men after being diagnosed with prostate cancer . Cancer treatments such as surgery, radiotherapy, endocrine therapy, and chemotherapy can cause physical harm, but the risks are considered acceptable if diagnosis is appropriate.…”

A prospective study of psychological distress after prostate cancer surgery

“…20 This new study confirms these findings in a well-characterised surgical population closely tracked more than 24 months and further supports the need for life course to be considered in men's risk profiles for poorer survivorship outcomes. $40 001 to $60 000 70 (27) $60 001 to $80 000 48 (19) $80 001 + 40 (15) Unwilling to answer/Don't know 12 (5) Comorbid condition, n (%) Myocardial infarction 21 (7) Heart failure 13 ( Prospective longitudinal studies are now emerging to describe how this distress evolves over time. More than 1.1 million men are diagnosed with prostate cancer each year worldwide, and most of them will be long-term survivors.…”

“…A recent meta‐analysis reported that at diagnosis of prostate cancer and treatment, 15% to 27% of men experience anxiety and 15% to 18% report depression . In addition, men have an increased risk of suicide after prostate cancer by comparison with controls, with the first year after diagnosis a period of heightened risk . It is therefore advised that after the diagnosis of prostate cancer and regularly through treatment and surveillance, men are screened regularly for distress and referred for evidence‐based psychosocial intervention when indicated .…”

“…1 In addition, men have an increased risk of suicide after prostate cancer by comparison with controls, [2][3][4] with the first year after diagnosis a period of heightened risk. 5 It is therefore advised that after the diagnosis of prostate cancer and regularly through treatment and surveillance, men are screened regularly for distress and referred for evidence-based psychosocial intervention when indicated. 6,7 However, while distress screening provides the capability to detect men who are experiencing high distress, 8 a clear understanding of what characteristics predict poorer outcomes not only at diagnosis but also over time would support better targeting of assessment and care planning for these men.…”

Prostate cancer survivorship priorities for men and their partners: Delphi consensus from a nurse specialist cohort

“…Survival is high with 90.6% of men living 10 years after diagnosis (AIHW, ), however many men and their partners experience decrements in quality of life and well‐being. Specifically, the survivorship experience of men with prostate cancer may be accompanied by physical symptoms including urinary, bowel and sexual dysfunction, poor quality of life, increased psychological distress and a heightened risk of suicide (Chambers et al, ; Holland, Watson, & Dunn, ; Smith et al, , ). For partners and carers, psychosocial burden can also be considerable and in several studies partners have reported greater psychological distress than prostate cancer survivors (Cliff & MacDonagh, ; Couper et al, ; Eton, Lepore, & Helgeson, ).…”