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

Abstract

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.

Risk factors associated with suicide among kidney cancer patients: A Surveillance, Epidemiology, and End Results analysis

“…Our study showed that the suicide rates of the white race and other races were respectively 2.77 and 1.34 times higher than that of the black race. Furthermore, the black race was proved to be a protective factor of suicide, matching the findings in previous investigations . In terms of the black race, this finding might be explained by religious beliefs, family support, and culture of rejecting suicide .…”

“…In our study, a tendency of increased suicide rate with age was also observed, although without statistical association. As reported in previous studies, suicide risk among cancer patients varied by time after diagnosis, and elevated suicide rates could be found in the initial period after diagnosis . Our findings showed significantly increased suicide rates among kidney cancer patients with the general population in the initial 9 years after diagnosis.…”

“…Increased suicide risks were commonly associated with cancer types of poor prognosis . Recently, some investigations had reported that histologic subtype was not significantly associated with suicide risks among non‐small cell lung cancer patients and colorectal cancer patients . As we know, histologic subtype was a prognostic indicator for kidney cancer survival .…”

“…Conversely, cancer‐directed surgery was associated with increased suicide rate in breast cancer patients, which might be related to the increased adverse psychological impact after mastectomy and the relative body image disturbance . Zhou et al reported that cancer‐directed surgery was a risk factor for committing suicide among patients with non‐small cell lung cancer, probably due to the increased frailty and lack of dignity in the postoperative period . Jayakrishnan and colleagues investigated the association between suicide and surgery.…”

Risk factors associated with suicide among hepatocellular carcinoma patients: A surveillance, epidemiology, and end results analysis

“…In a retrospective study, the predominant patients who committed suicide were whites (12,258, 92.1%), with HR of suicide for black race vs. white race among cancer patients is 0.31 (95% CI: 0.29e0.35, P < 0.0001), which suggested that white race may be significant predictors of suicide in the cancer population. Furthermore, the white race also has been corroborated to be a risk factor of suicide in many previous investigations [55,57]. Regarding the low suicide rate of the non-white ethnicity, the most reasonable explanation of that may be attributed to being impacted by religious beliefs, family support and a culture of refusing suicide [58e60].…”