T. Pham1, A. Talukder1, N. Walsh1, A. Lawson1, A. Jones1, E. J. Kruse1 1Medical College Of Georgia,Surgery,Augusta, GA, USA
Introduction: Increased suicidal tendencies among cancer patients have been well documented. To date, there has been no specific examination of suicide rates and factors associated with suicide in colorectal cancer. The aim of this study is to examine suicide incidence and associated factors in colorectal cancer patients from 1973 to 2013.
Methods: The Surveillance, Epidemiology, and End Results (SEER) Database of the National Cancer Institute was queried to identify patients with colorectal cancer. The study included mortality and demographic data from 1973 to 2013. Comparison data with the general United States population was derived from the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control using the Web-based Injury Statistics Query and Reporting System (WISQARS). Standardized mortality ratios (SMRs) and their 95% confidence intervals (95% CIs) were calculated, and multivariable logistic regression models generated odds ratios (ORs) for the identification of factors associated with suicide in colorectal malignancy.
Results: Overall, 1347 suicides among 884,529 patients were identified. Of the patients committing suicide, almost half, 1158 (84%), were over 80 years old. There was no statistically significant difference in suicide rate with respect to age, marital status, median household income, surgical intervention, or histologic subtype. Whites were significantly more likely to commit suicide than non-whites ( OR 2.28, 95% CI 1.89-2.75 P< 0.001), and males were significantly more likely than females (OR 5.635, 95% CI 4.85-6.54, P <0.001). Most suicides occurred in patients with distal lesions in either the sigmoid or rectosigmoid junction (P<0.001). Stage at diagnosis did not have a statistically significant relationship to suicide. SMRs for patients with colorectal cancer were 4.24 for females (95% CI, 3.69- 4.86), 1.35 for males (95% CI, 1.28- 1.43), 0.38 for African-Americans (95% CI, 0.28- 0.52), 1.77 for Whites (95% CI, 1.68- 1.87), and 0.90 for other races (95% CI, 0.72- 1.12).
Conclusion: Identification of evidence-based risk factors associated with suicide among patients with colorectal cancer is an important step in the development of screening strategies and management of psychosocial stressors. Race and gender appear to influence suicide rates in patients with colorectal cancer. Females with colorectal cancer demonstrated approximately four times the suicide rate of the gender-matched population. These results, coupled with further studies and analyses, could be used to formulate a comprehensive suicide risk factor scoring system for screening all cancer patients.
