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Abstract
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IMPORTANCE: Curative cancer operations lead to debility and loss of autonomy in a population vulnerable to suicide death. The extent to which operative intervention impacts suicide risk is not well-studied.
OBJECTIVE: To examine the effects of morbidity of curative cancer surgeries and prognosis of disease on the risk of suicide in patients with solid tumors.
DESIGN: Retrospective cohort study using Surveillance, Epidemiology and End Results data from 2004 - 2011; Multi-level Systematic Review. SETTING: General U.S. PARTICIPANTS: 482,781 patients diagnosed with malignant neoplasm diagnosed between 2004-2011 who underwent curative cancer surgeries. MAIN OUTCOMES AND MEASURES: Death by suicide or self-inflicted injury.
RESULTS: Among 482,781 patients that underwent curative cancer surgery, 231 committed suicide (16.58/100 000 person-years [95% CI, 14.54-18.82]). Factors significantly associated with suicide risk included male-sex (incidence rate [IR]-27.62; 95% CI,23.82-31.86) and age >65 years (IR-22.54; 95% CI,18.84-26.76). When stratified by 30-day overall post-operative morbidity, a significantly higher incidence of suicide was found for high morbidity surgeries (IR, 33.30; 95% CI, 26.50-41.33) vs. moderate morbidity (IR, 24.27; 95% CI, 18.92-30.69) and low morbidity (IR, 9.81; 95% CI, 7.90-12.04). Unit increase in morbidity was significantly associated with death by suicide (Odds Ratio [OR], 1.01; 95% CI, 1.00-1.03; P = .02) and decreased suicide specific survival (Hazards Ratio [HR], 1.02; 95% CI 1.00-1.03, P = .01) in prognosis adjusted models.
CONCLUSIONS: In this sample of cancer patients in the SEER database, patients that undergo high-morbidity surgeries appear most vulnerable to death by suicide. The identification of this high-risk cohort should motivate healthcare providers and particularly surgeons to adopt screening measures during the post-operative follow-up period for these patients.
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Language: en |