Key PointsQuestion
What are the incidence, timing, and factors associated with suicide among patients undergoing cancer operations in the US?
Findings
In this cohort study of 1 811 397 patients who underwent cancer surgery, the incidence of suicide, compared with the general US population, was statistically significantly higher among patients undergoing surgery for 10 of the 15 cancers assessed, with approximately 50% of suicides committed within the first 3 years after surgery. Patients who were male, White, and divorced or single had the greatest risk of suicide.
Meaning
These findings suggest the need to implement suicide screening among patients undergoing cancer operations, especially patients whose demographic and tumor characteristics are associated with the highest suicide risk.
Importance
The risk and timing of suicide among patients who undergo surgery for cancer remain largely unknown, and, to our knowledge, there are currently no organized programs in place to implement regular suicide screening among this patient population.
Objective
To evaluate the incidence, timing, and factors associated with suicide among patients undergoing cancer operations.
Design, Setting, and Participants
This retrospective population-based cohort study used data from the Surveillance, Epidemiology, and End Results Program database to examine the incidence of suicide, compared with the general US population, and timing of suicide among patients undergoing surgery for the 15 deadliest cancers in the US from 2000 to 2016. A Fine-Gray competing risks regression model was used to identify factors associated with an increased risk of suicide among patients in the cohort. Data were analyzed from September 2021 to January 2022.
Exposures
Surgery for cancer.
Main Outcomes and Measures
Incidence, compared with the general US population, timing, and factors associated with suicide after surgery for cancer.
Results
From 2000 to 2016, 1 811 397 patients (74.4% female; median [IQR] age, 62.0 [52.0-72.0] years) met study inclusion criteria. Of these patients, 1494 (0.08%) committed suicide after undergoing surgery for cancer. The incidence of suicide, compared with the general US population, was statistically significantly higher among patients undergoing surgery for cancers of the larynx (standardized mortality ratio [SMR], 4.02; 95% CI, 2.67-5.81), oral cavity and pharynx (SMR, 2.43; 95% CI, 1.93-3.03), esophagus (SMR, 2.25; 95% CI, 1.43-3.38), bladder (SMR, 2.09; 95% CI, 1.53-2.78), pancreas (SMR, 2.08; 95% CI, 1.29-3.19), lung (SMR, 1.73; 95% CI, 1.47-2.02), stomach (SMR, 1.70; 95% CI, 1.22-2.31), ovary (SMR, 1.64; 95% CI, 1.13-2.31), brain (SMR, 1.61; 95% CI, 1.12-2.26), and colon and rectum (SMR, 1.28; 95% CI, 1.16-1.40). Approximately 3%, 21%, and 50% of suicides were committed within the first month, first year, and first 3 years after surgery, respectively. Patients who were male, White, and divorced or single were at greatest risk of suicide.
Conclusions and Relevance
In this cohort study, the incidence of suicide among patients undergoing cancer operations was statistically significantly elevated compared with the general population, highlighting the need for programs to actively implement regular suicide screening among such patients, especially those whose demographic and tumor characteristics are associated with the highest suicide risk.