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Published in final edited form as: Cancer. 2023 Nov 29;130(4):588–596. doi: 10.1002/cncr.35118

Prognosis and risk of suicide after cancer diagnosis

Connor J Kinslow 1,2, Prashanth Kumar 1, Mark Olfson 3,4, Melanie M Wall 3,4, Petros D Petridis 5, David P Horowitz 1,2, Tony J C Wang 1,2, Lisa A Kachnic 1,2, Simon K Cheng 1,2, Holly G Prigerson 6,7, James B Yu 1,2, Alfred I Neugut 2,8,9
PMCID: PMC13110409  NIHMSID: NIHMS2167087  PMID: 38018695

Abstract

Introduction:

Suicide rates are elevated after cancer diagnosis. Existential distress caused by awareness of one’s impending death is well-described in patients with cancer. The authors hypothesized that suicide risk is associated with cancer prognosis, and the impact of prognosis on suicide risk is greatest for populations with higher baseline suicide risk.

Methods:

The authors identified patients (≥16 years old) with newly diagnosed cancers from 2000 to 2019 in the Surveillance, Epidemiology, and End Results database, representing 27% of US cancers. Multiple primary-standardized mortality ratios (SMR) were used to estimate the relative risk of suicide within 6 months of diagnosis compared to the general US population, adjusted for age, sex, race, and year of follow-up. Suicide rates by 20 most common cancer sites were compared with respective 2-year overall survival rates (i.e., prognosis) using a weighted linear regression model.

Results:

Among 6,754,704 persons diagnosed with cancer, there were 1610 suicide deaths within 6 months of diagnosis, three times higher than the general population (SMR = 3.1; 95% confidence interval, 3.0–3.3). Suicide risk by cancer site was closely associated with overall prognosis (9.5%/percent survival deficit, R2 = 0.88, p < .0001). The association of prognosis with suicide risk became attenuated over time. For men, the risk of suicide increased by 2.8 suicide deaths per 100,000 person-years (p < .0001) versus 0.3 in women (p < .0001). The risk was also higher for persons ≥60 old and for the White (vs. Black) race.

Conclusions:

Poorer prognosis was closely associated with suicide risk early after cancer diagnosis and had a greater effect on populations with higher baseline risks of suicide. This model highlights the need for enhanced psychiatric surveillance and continued research in this patient population.

Keywords: cancer, diagnosis, prognosis, stress-diathesis, suicide, suicide risk

INTRODUCTION

Suicide is an uncommon but catastrophic event that can occur during a patient’s cancer course. The suicide rate for patients with cancer is 31 per 100,000 person-years (65 in males and 12 in females) versus 16.7 in the general US population.1 The risk of suicide is acutely elevated within the first several months after cancer diagnosis and then decreases over time.1–6 Risk factors for cancer-related suicide death include male sex, older age, White race, lower socioeconomic status, diagnosis in a rural area, and metastatic disease.1–7 The risk of suicide is lower in patients who undergo cancer-directed surgery.3

Additionally, the risk of suicide varies greatly by cancer site. For example, the adjusted relative risk of suicide within 6 months of diagnosis ranges from 1.1 for patients with breast cancer to 9.5 for those with pancreas cancer.4 Cancers with poorer prognoses generally have higher suicide rates; a recent US study found that the risk of suicide in surgical patients is proportional to the expected 5-year survival rate.5,6,8 Whether a similar trend exists among nonsurgical patients is unknown. It is important to include a broader picture of suicide risk among people with cancer by including the presumably higher risk individuals with unresectable cancers. Unresectable cancers account for almost half of new cancer diagnoses and carry a poorer prognosis and higher risk of suicide.3

We sought to create a model that would quantify variations in suicide risk across different cancer sites, stages, demographic groups, and times of follow-up. One leading etiologic conceptualization of suicide is the stress-diathesis model, in which a significant life stressor could trigger suicidal behavior in individuals with a predisposition to suicide (Figure 1).9 Eighty percent of suicide deaths occur after a recent life-changing event.8,10 Cancer diagnosis is one of the most dramatic and life-changing events, representing a significant psychosocial stressor.8,11 Existential distress caused by awareness of one’s impending death is well-described in patients with cancer.12 The moment of awareness that death is an inevitability has been described as the “existential slap.”12 Based on these concepts, we hypothesized that cancer prognosis is associated with short-term suicide risk, and the impact of prognosis on suicide risk is greater for populations with higher baseline risks of suicide (i.e., males, elderly, Whites). Using Surveillance, Epidemiology and End Results (SEER) data, we employed a population-level approach to explore the relationship between cancer prognosis and suicide risk after diagnosis in a representative sample of 27% of the US population over the past 20 years, with a focus on the 20 most common cancer types.

FIGURE 1.

FIGURE 1

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The stress-diathesis model of suicide. The stress-diathesis model explains that a significant life stressor could trigger suicidal behavior in a person with a predisposition for suicide. The diathesis includes a heightened emotional response to stress, greater propensity for emotion to influence decisions, impaired learning and problem-solving capacity, or severe psychiatric disorders. The stressor is often a life event, such as a new cancer diagnosis.

MATERIALS AND METHODS Data source

The SEER Program is the National Cancer Institute’s (NCI) authoritative source for cancer incidence and survival.13 It is considered the gold standard for cancer data collection internationally.14 The SEER 17 database is populated with data from population-based cancer registries in 13 states, covering approximately 27% of the US population.13,15–18 The Commission on Cancer of the American College of Surgeons requires the participating cancer registries to collect information on malignancies diagnosed and/or treated at the hospital. Vital status is updated annually and the database routinely undergoes quality-control checks. SEER uses a combination of passive (data linkage) and active (direct contact with patients/physicians) follow-up and maintains a minimum standard of 95% completion. Cause of death is determined from death certificate records. United States mortality data are collected and maintained by the National Center for Health Statistics.

Patient and variable selection

We identified all patients, ages 16 or older, newly diagnosed with any malignant tumor from 2000 to 2019 in the SEER 17 database, excluding patients diagnosed by death certificate or autopsy only.19 Patient information included age, sex, race (White, Black, other), stage (localized, regional, distant), surgery, cancer site, year of diagnosis, and cause of death. The “other” race group includes Asian/Pacific Islanders and American Indian/Native Alaskans. Population-based estimates in the United States cannot be derived for more specific racial or ethnic groups. Primary site surgeries in US cancer registries are defined as “cancer-directed” if the goal of treatment is to modify, control, remove, or destroy cancer tissue.20–25,26 Two-year overall survival rates were determined for each cancer site within the SEER database.

Statistical analysis

To determine the risk of suicide within 6 months following diagnosis, subjects were followed for a maximum of 6 months after diagnosis until death, loss to follow-up, or end of study (December 2019). We calculated multiple primary-standardized mortality ratios (SMR) to determine the number of observed versus expected suicides in the study populations based on suicide rates in a matched general US population within SEER registries, adjusted for age (5-year groups), sex, race, and year of follow-up (1-year groups).16,27,28 We also calculated SMRs by stage of cancer at the time of diagnosis and whether surgery was performed.29 To examine the association between prognosis and suicide, we analyzed suicide rates at the aggregated level of the top 20 most common cancer sites. Specifically, we correlated suicide rates and a general prognosis measure (i.e., 2-year overall survival rate in the same population) for the top 20 most common cancer sites using a weighted linear regression model weighted to the number of person-years at risk. Subgroup analyses were stratified by each population-based variable, including sex, age, and race. Sensitivity analyses included a regression based on site/stage and included all cancer types. Additional analyses explored the association of prognosis on suicide risk at various time periods after diagnosis. Statistical analyses were conducted using SEER*Stat Version 8.3.9 (National Cancer Institute) and RStudio Version 1.4.1106 (RStudio, Inc) software. This study was determined exempt from review by the Columbia University institutional review board. This report follows the STROBE reporting guideline for observational studies.

RESULTS

We identified 9028 suicides among 6,754,704 persons diagnosed with cancer over a 20-year period, 1610 of which occurred during the first 6 months of diagnosis over 2,990,082 person-years of follow-up. The rate of suicide within 6 months of diagnosis for all patients with cancer was 54 per 100,000 person-years, compared to 17 per 100,000 person-years in the matched population (SMR, 3.1 [95% confidence interval (CI), 3.0–3.3]) (Table 1). The suicide SMR was higher in men than in women (3.4 [95% CI, 3.2–3.5] vs. 2.1 [95% CI, 1.8–2.4]) and increased with increasing age. For example, the SMR of suicide was 4.5 (95% CI, 4.0–5.1) for persons ages 75–79 versus 1.9 (95% CI, 1.5–3.4) for ages 50–54. Additionally, the SMR was numerically higher for White than for Black patients (3.1 [95% CI, 2.9–3.2] vs. 2.7 [95% CI, 2.0–3.6]). The SMR was highest for patients with race listed as “other” (5.4 [95% CI, 4.4–6.6]). However, this may have been related to a lower baseline risk, as the absolute rate of suicide was lower than for White patients (45 vs. 59 per 100,000 person-years). Patients with distant disease (SMR, 5.6 [95% CI, 5.2–6.1]) and patients who did not undergo cancer-directed surgery (SMR, 5.2 [95% CI, 4.9–5.5]) had an increased risk of suicide compared with patients with localized disease (SMR, 1.5 [95% CI, 1.4–1.7]) and those who underwent cancer-directed surgeries (SM,R 1.5 [95% CI, 1.4–1.6]).

Table 1.

Demographic and clinical characteristics and suicide rates within 6 months of diagnosis in patients with cancer.

Incidence per 100,000 person-years
Characteristic Persons Suicide rate within 6 months of diagnosis Comparable general population rate SMR (95% CI)
Sex Male 3,408,599 94 28 3.4 (3.2–3.5)
Female 3,346,105 13 6.3 2.1 (1.8–2.4)
Age (years) 16–19 20,922 9.9 9.4 1.1 (0.0–5.9)
20–24 40,040 0 14 0 (0–1.4)
25–29 63,578 10 13 0.7 (0.2–2.2)
30–34 98,037 11 13 0.9 (0.3–2.0)
35–39 147,995 20 13 1.5 (0.8–2.6)
40–44 238,567 14 14 1.0 (0.6–1.6)
45–49 377,858 24 16 1.5 (1.1–2.0)
50–54 568,221 33 18 1.9 (1.5–2.3)
55–59 752,364 33 18 1.9 (1.5–2.2)
60–64 878,000 49 16 3.0 (2.6–3.5)
65–69 942,075 60 15 3.9 (3.5–4.4)
70–74 853,697 66 17 4.0 (3.5–4.5)
75–79 734,020 87 19 4.5 (4.0–5.1)
80–84 552,774 90 22 4.2 (3.6–4.8)
85+ 486,347 89 23 3.8 (3.2–4.5)
Race White 5,574,463 59 19 3.1 (2.9–3.2)
Black 680,330 16 5.9 2.7 (2.0–3.6)
Other 499,911 45 8.3 5.4 (4.4–6.6)
Stage Localized 2,474,666 27 17 1.5 (1.4–1.7)
Regional 1,157,694 47 16 2.9 (2.6–3.3)
Distant 1,361,699 101 18 5.6 (5.2–6.1)
Surgery Yes 3,909,916 23 16 1.5 (1.4–1.6)
No 3,087,272 104 20 5.2 (4.9–5.5)
Overall 6,754,704 54 17 3.1 (3.0–3.3)
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Abbreviations: CI, confidence interval; SMR, standardized mortality ratio.

a.

Mortality rates are derived from the SEER 17 database, 2000–2019, with reference rates calculated from the National Center for Health Statistics. The reference rate is calculated as the number of expected suicides divided by the person-years.

b.

Adjusted for age, sex, race, and year of diagnosis.

Source: Kinslow et al. Cancer. 2024;130(4):588–596. doi:10.1002/cncr.35118

Across the 20 most common cancer sites, there was a strong correlation between the population’s 2-year overall survival rate and suicide risk within 6 months after diagnosis, with an SMR approaching 10 for patients with pancreatic cancer (R2 = 0.88, increased risk of 9.5% per percent survival deficit at 2 years, p < .0001) (Figure 2A, Table 2, Tables S1 and S2). Uniform staging information was only available for cancers diagnosed after 2004. When stratifying each cancer site by stage of diagnosis (i.e., localized, regional, distant), similar results were observed with increased statistical significance (R2 = 0.76, increased risk of 9.2% per percent survival deficit at 2 years, p < .0001) (Figure S1A, Tables S3 and S4). Similar results were also observed when including all cancer sites (Figure S1B) and when including only patients who had microscopic confirmation of disease (Figure S1C).

FIGURE 2.

FIGURE 2

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Prognosis and risk of suicide for the top 20 cancer sites within 6 months of diagnosis (A) and stratified by time since diagnosis (B). SMR indicates standardized mortality ratio. Prognosis is calculated based on 2-year overall survival rates for the top 20 most common cancer sites. Suicide rates within 6 months of diagnosis and after are determined from the SEER 17 database, 2000–2019, with reference rates calculated from the National Center for Health Statistics, adjusted for age, sex, race, and year of follow-up. A linear regression model was used, weighted based on the number of person-years followed for each cancer site.

Table 2.

Suicide rate within 6 months of diagnosis and prognosis for the 20 most common cancer sites.

Incidence per 100,000 person-years
Cancer site Persons Suicide rate within 6 months of diagnosis Comparable general population rate SMR (95% CI) 2-year overall survival rate (%)
Pancreas 179,063 165 17 9.7 (7.8–11.8) 15.7
Lung and bronchus 810,986 126 17 7.4 (6.6–8.1) 29.1
Stomach 108,704 134 18 7.3 (5.5–9.4) 38.7
Miscellaneous 232,092 127 19 6.9 (5.6–8.3) 44.9
Oral cavity and pharynx 163,732 124 22 5.7 (4.6–7.0) 72.2
Myeloid and monocytic leukemia 78,705 80 18 4.4 (2.8–6.6) 45.2
Brain 81,814 74 19 4.0 (2.5–5.9) 36.1
Myeloma 94,934 60 17 3.4 (2.2–5.1) 66.1
Liver 108,537 65 20 3.2 (2.1–4.7) 31.1
Ovary 98,606 19 7 2.9 (1.3–5.7) 63.8
Colon and rectum 634,028 48 17 2.8 (2.3–3.3) 71.8
Non-Hodgkin lymphoma 279,443 48 18 2.6 (2.0–3.4) 73.1
Urinary bladder 273,658 61 25 2.4 (1.9–3.0) 77.8
Kidney and renal pelvis 213,343 43 20 2.2 (1.6–2.9) 77.3
Lymphocytic leukemia 88,005 44 20 2.2 (1.3–3.4) 81.4
Thyroid 182,607 16 12 1.3 (0.7–2.2) 96.7
Breast 1,042,834 9 7 1.3 (0.9–1.7) 92.2
Skin excluding basal and squamous 327,883 24 21 1.1 (0.8–1.5) 90.9
Prostate 971,909 28 27 1.1 (0.9–1.3) 93.4
Corpus and uterus, NOS 213,736 6 7 0.9 (0.3–1.9) 85
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Abbreviations: CI, confidence interval; NOS, not otherwise specified; SMR, standardized mortality ratio.

a.

Mortality rates are derived from the SEER 17 database, 2000–2019, with reference rates calculated from the National Center for Health Statistics, adjusted for age, sex, race, and year of diagnosis. The reference rate is calculated as the number of expected suicides divided by the person-years.

b.

Adjusted for age, sex, race, and year of diagnosis.

c.

Miscellaneous malignancies are listed in Supplemental Table S1.

Source: Kinslow et al. Cancer. 2024;130(4):588–596. doi:10.1002/cncr.35118

The risk of suicide was attenuated as more time elapsed from diagnosis (Figure 2B). The risk of suicide increased by 11% from 0 to 2 months (R2 = 0.87, p < .0001), 7.0% from 3 to 5 months (R2 = 0.70, p < .0001), 3.6% from 6 to 11 months (R2 = 0.58, p < .0001), and 3.0% from 12 to 23 months (R2 = 0.70, p < .0001) per percent survival deficit at 2 years.

Suicide risk was significantly associated with prognosis in men (R2 = 0.84, p < .0001) and women (R2 = 0.54, p < .0001). However, the association of prognosis with suicide risk was greater for men than women: 2.8 suicides per 100,0000 person-years per percent survival deficit in men versus 0.3 in women (Figures 3A and S2A). The impact of prognosis on suicide risk was greater for other demographic groups with higher baseline risks of suicide. For patients ≥60 years old, the risk increased by 1.9 suicide deaths per 100,000 person-years (R2 = 0.80, p < .0001) versus 0.9 (R2 = 0.58, p < .0001) in patients under 60 years (Figures 3B and S2B). The rates of suicide deaths in Whites, Blacks, and other races increased by 1.9 (R2 = 0.81, p < .0001), 0.4 (R2 = 0.32, p = .005), and 1.1 (R2 = 0.43, p < .001), respectively, per 100,000 person-years (Figures 3C and S2C).

FIGURE 3.

FIGURE 3

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Prognosis and risk of suicide after diagnosis for the top 20 cancer sites stratified by sex (A), age (B), and race (C). Prognosis is calculated based on 2-year overall survival rates for the top 20 most common cancer sites. Suicide rates within 6 months of diagnosis are determined from the SEER 17 database, 2000–2019. A linear regression model was used, weighted based on the number of person-years followed for each cancer site.

DISCUSSION

In this pan-cancer study, we found a strong association between prognosis and risk of suicide in the first 6 months after cancer diagnosis. The association of prognosis with suicide risk was attenuated as more time elapsed from the diagnosis. The association of prognosis on suicide risk was greatest among individuals with higher baseline risks of suicide, including male, older adult, and White patients. These data provide evidence consistent with the stress-diathesis model for explaining short-term suicide risk following cancer diagnosis.

Previous studies in the United States and internationally have noted that cancers with poorer prognoses have increased risks of suicide.4,6,8 Potter et al.5 formally evaluated the relationship between expected prognosis after cancer-directed surgery and risk of suicide. To our knowledge, this relationship has not been examined for nonsurgical cancer patients, who have a worse prognosis and increased risk of suicide. Potter et al.5 found that the SMR for suicide approached 3 for surgical patients with the worst prognoses, whereas the SMR approached 10 in our study. Our study further expands on the Potter et al.5 study by including a more recent study period, a broader patient population, and a larger sample size. Additionally, no studies have examined how prognosis differentially impacts different demographic characteristics of patients or the stability of the association over time. These data support a unified theory that attributes variations in cancer-related suicide risks based on cancer site, time from diagnosis, and demographic characteristics, which can be broadly employed for cancer screening in the United States.

Evidence-based strategies are needed to reduce short-term suicide mortality in patients following cancer diagnosis.3,30 Our model should provide a useful framework for clinicians in triaging patients who may need increased surveillance or urgent psychiatric referral. Efforts should be directed toward early screening with a priority given to patients with poorer prognoses and also demographic groups with higher baseline risks of suicide. Additional risk factors should be explored, including psychiatric comorbidity, marital status, religiosity, and access to firearms or other lethal means. Because patients are at highest risk early after their cancer diagnosis, suicide risk screening may be conducted by any provider who interacts with patients early in their cancer course and should not necessarily be deferred to the treating provider. There are several validated tools for suicide risk screening.30 However, predicting suicide may be difficult, as patients with cancer have a low ratio of self-harm events to fatal suicide events compared with those with other physical and psychiatric disorders.6,31 Treating providers may choose to spend additional time with high-risk patients, because the patient-oncologist alliance is protective of suicidal ideation.32 High-risk patients should be referred to a psychiatrist or psychooncologist if available. Modifiable risk factors, such as pain, substance use disorder, and psychiatric illness can be addressed. In addition to pharmacological therapy, cognitive behavioral therapy, problem-solving therapies, and crisis response planning have been shown to reduce suicidal behaviors in randomized controlled trials.30

Completed suicides likely reflect a larger burden of cancer-related psychiatric morbidity. It is estimated that there are approximately 20 suicide nonfatal attempts for each fatal suicide attempt.8 Suicide rates may also be a surrogate measure of more generalized psychiatric distress. Psychosocial distress, including existential distress, is prevalent in 35%–46% of patients with cancer.33,34 The rate of major depressive disorder is 15% in cancer patients versus 4%–10% in the general population.6,35,36 Further-more, depression is equally common in patients living with active cancer and those receiving end-of-life care.35,36 However, 73% of depressed cancer patients do not receive effective psychiatric treatment and only 5% see a mental health professional.36,37 The National Comprehensive Cancer Network and the American Society of Clinical Oncology recommend universal screening for psychiatric conditions and elevated emotional distress in patients with cancer.38,39 Additionally, the American College of Surgeons’ Commission on Cancer requires accredited cancer centers to provide routine distress screening to cancer survivors. However, uptake has been minimal, with only 46%–73% of patients being screened.40,41 Addressing distress and improving management of depression in patients with cancer may improve cancer-related outcomes, including quality of life, medication adherence, post-surgical outcomes, and survival.6,30,36,38,42

Reasons for suicide in patients with cancer may include pain, poor quality of life, existential angst, and psychiatric illness or severe depressive symptoms, but may also stem from a desire or will for self-control.8 It is important to distinguish the wish for self-autonomy from severe depression as the two etiologies may be addressed differently. Common reasons for suicide reported in the palliative care setting include concern about autonomy and independence, refusal to depend on others, functional/physical impairments, uncontrolled pain, awareness of being in the terminal stage, depression, hopelessness regarding their clinical condition, fear of suffering, and feeling of being a burden to others.43 Loss of autonomy is the most common reason for physician-assisted suicides in Washington State (90%), whereas inadequate pain control is less common (23%).44 In a survey of potentially life-shortening end-of-life decisions in Belgium, intensified pain/symptom alleviation and euthanasia/physician-assisted suicide occurred in approximately 40% and 10% of cases, respectively.45 The etiology of suicide in the terminal setting may be distinct from suicides early after diagnosis. However, the fact that suicide rates are highest 1–2 months after diagnosis and decrease thereafter highlights the post-diagnostic period as a particular time of crisis.

Although the risk of suicide correlated strongly with prognosis in our study, cancer of the oral cavity and pharynx was an outlier, with a SMR of 5.75 and a relatively higher 2-year survival rate of 72%. High suicide rates have been reported in patients with head and neck cancer.1,5,46 Explanations include persistent/late effects of treatment, functional and aesthetic compromise, pain, substance use disorder, and financial toxicity.

The impact of prognosis on suicide risk was much greater in men than in women. Gender-based differences in coping with cancer have been described.47 The risks were also greater in White than Black patients. Explanations for decreased suicide rates in African Americans include strong religious beliefs, family bonds, and communalism, but may also be due to misclassification of suicide.8,48–50 Lack of universal health care has been hypothesized as an explanation for the higher rates of cancer-related suicides in the United States compared with other countries, as well as easy access to firearms.8 Financial toxicity may contribute to suicide rates, which is supported by the fact that cancer-related suicides are higher in regions with lower socioeconomic status.7

Our study includes a population-based representative sample of 27% of the United States. A strength of SEER is that it oversamples certain racial and ethnic minorities to improve diverse population representativeness, including the traditionally underserved.

This study has several limitations. The absence of known risk factors for suicide (prior suicide attempts, family history of suicide, major depressive disorder, bipolar disorder, etc.) may confound the observed associations. Cancer-related suicide rates are higher in the United States than internationally, which may limit the generalizability of our findings to other nations. Our study does not capture nonfatal suicide attempts, which are expected to be substantially more common. Suicide deaths may also be under-reported in our study. The α was not adjusted for the large number of comparisons. Last, more granular interview studies should explore the etiology of suicide, because it is important to distinguish between the wish for self-autonomy and severe depression as the precipitating cause.

In conclusion, poorer prognosis is strongly associated with risk of suicide in patients with cancer. The associations attenuate over time and are stronger in populations with higher baseline rates of suicide. These data support the stress-diathesis model to explain suicide risks in patients with cancer and highlights the importance of suicide screening programs to decrease potentially preventable deaths. Physicians may use this model to triage patients who are at the highest risk of suicide for urgent referral and additional interventions. Additional effects of prognosis on psychosocial wellbeing should be explored in future studies, because deaths by suicide represent an important aspect of cancer-related psychosocial morbidity.

Supplementary Material

Supplementary Data 2
Supplementary Table 1
Supplementary Data1

Additional supporting information can be found online in the Supporting Information section at the end of this article.

ACKNOWLEDGMENTS

This work was supported by P30 CA13696 Cancer Center Support Grant (Neugut).

CONFLICT OF INTEREST STATEMENT

Tony J. C. Wang reports personal fees and nonfinancial support from AbbVie, Elekta, Merck, Novocure, and RTOG Foundation; personal fees from Cancer Panels, Doximity, Rutgers, University of Iowa, Wolters Kluwer, and Iylon Precision Oncology; and grants and nonfinancial support from Genentech and Varian. Lisa A. Kachnic reports royalties from UpToDate, participation on the data safety monitoring committee for New Beta Innovation; and contracted research for Varian Medical Systems. Simon K. Cheng reports personal fees and nonfinancial support from AbbVie. James B. Yu reports speaking and consulting fees from RefleXion Medical, Boston Scientific, and Pfizer/Myovant; and is an investor in Modifi Bio. Alfred I. Neugut reports consulting fees from Otsuka, GlaxoSmithKline, Eisai, United Biosource Corp., Value Analytics, and Hospira; grant funding from Otsuka; and membership on the medical advisory board of EHE International. David P. Horowitz reports grant funding from Varian Medical Systems, Inc. The other authors declare no conflicts of interest.

Funding information

National Cancer Institute, Grant/Award Number: P30 CA13696

DATA AVAILABILITY STATEMENT

The Surveillance, Epidemiology, and End Results data set is publicly available on request to the National Cancer Institute. Code is available on specific request to the authors.

REFERENCES

  • 1.Misono S, Weiss NS, Fann JR, Redman M, Yueh B. Incidence of suicide in persons with cancer. J Clin Oncol. 2008;26(29):4731–4738. doi: 10.1200/jco.2007.13.8941 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Fang F, Fall K, Mittleman MA, et al. Suicide and cardiovascular death after a cancer diagnosis. N Engl J Med. 2012;366(14):1310–1318. doi: 10.1056/nejmoa1110307 [DOI] [PubMed] [Google Scholar]
  • 3.Zaorsky NG, Zhang Y, Tuanquin L, Bluethmann SM, Park HS, Chinchilli VM. Suicide among cancer patients. Nat Commun.2019;10(1):207. doi: 10.1038/s41467-018-08170-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Saad AM, Gad MM, Al-Husseini MJ, et al. Suicidal death within a year of a cancer diagnosis: a population-based study. Cancer. 2019;125(6):972–979. doi: 10.1002/cncr.31876 [DOI] [PubMed] [Google Scholar]
  • 5.Potter AL, Haridas C, Neumann K, et al. Incidence, timing, and factors associated with suicide among patients undergoing surgery for cancer in the US. JAMA Oncol. 2023;9(3):308. doi: 10.1001/jamaoncol.2022.6549 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Henson KE, Brock R, Charnock J, Wickramasinghe B, Will O, Pitman A. Risk of suicide after cancer diagnosis in England. JAMA Psychiatr. 2019;76(1):51–60. doi: 10.1001/jamapsychiatry.2018.3181 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Suk R, Hong Y-R, Wasserman RM, et al. Analysis of suicide after cancer diagnosis by US county-level income and rural vs urban designation, 2000–2016. JAMA Netw Open. 2021;4(10):e2129913. doi: 10.1001/jamanetworkopen.2021.29913 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Heinrich M, Hofmann L, Baurecht H, et al. Suicide risk and mortality among patients with cancer. Nat Med. 2022;28(4):852–859. doi: 10.1038/s41591-022-01745-y [DOI] [PubMed] [Google Scholar]
  • 9.Blanco C, Wall MM, Olfson M. A population-level approach to suicide prevention. JAMA. 2021;325(23):2339–2340. doi: 10.1001/jama.2021.6678 [DOI] [PubMed] [Google Scholar]
  • 10.Heikkinen M, Aro H, Lönnqvist J. Recent life events, social support and suicide. Acta Psychiatr Scand Suppl. 1994;377(s377):65–72. doi: 10.1111/j.1600-0447.1994.tb05805.x [DOI] [PubMed] [Google Scholar]
  • 11.Carlson LE, Zelinski EL, Toivonen KI, et al. Prevalence of psychosocial distress in cancer patients across 55 North American cancer centers. J Psychosoc Oncol. 2019;37(1):5–21. doi: 10.1080/07347332.2018.1521490 [DOI] [PubMed] [Google Scholar]
  • 12.Rosa WE, Chochinov HM, Coyle N, Hadler RA, Breitbart WS. Attending to the existential experience in oncology: dignity and meaning amid awareness of death. JCO Global Oncol. 2022(8): e2200038. doi: 10.1200/go.22.00038 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.National Cancer Institute. Overview of the SEER Program. Accessed September 15, 2020. https://seer.cancer.gov/about/overview.html
  • 14.Davis FG, McCarthy BJ, Berger MS. Centralized databases available for describing primary brain tumor incidence, survival, and treatment: Central Brain Tumor Registry of the United States; Surveillance, Epidemiology, and End Results; and National Cancer Data Base. Neuro Oncol. 1999;1(3):205–211. doi: 10.1093/neuonc/1.3.205 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Kinslow CJ, Wang TJC. Incidence of extrameningeal solitary fibrous tumors. Cancer. 2020;126(17):4067. doi: 10.1002/cncr.33057 [DOI] [PubMed] [Google Scholar]
  • 16.Kinslow CJ, Kim A, Sanchez GI, et al. Incidence of anaplastic largecell lymphoma of the breast in the US, 2000 to 2018. JAMA Oncol. 2022;8(9):1354–1356. doi: 10.1001/jamaoncol.2022.2624 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Kinslow CJ, Bruce SS, Rae AI, et al. Solitary-fibrous tumor/hemangiopericytoma of the central nervous system: a population-based study. J Neuro Oncol. 2018;138(1):173–182. doi: 10.1007/s11060-018-2787-7 [DOI] [PubMed] [Google Scholar]
  • 18.Kinslow CJ, May MS, Saqi A, et al. Large-cell neuroendocrine carcinoma of the lung: a population-based study. Clin Lung Cancer. 2020;21(2):e99–e113. doi: 10.1016/j.cllc.2019.07.011 [DOI] [PubMed] [Google Scholar]
  • 19.SEER data, 1975–2019. Surveillance, Epidemiology, and End Results Program. Accessed October 7, 2022–August 30, 2023. https://www.seer.cancer.gov
  • 20.Garton ALA, Kinslow CJ, Rae AI, et al. Extent of resection, molecular signature, and survival in 1p19q-codeleted gliomas. J Neurosurg. 2020;134(5):1357–1367. doi: 10.3171/2020.2.jns192767 [DOI] [PubMed] [Google Scholar]
  • 21.Kinslow CJ, Garton ALA, Rae AI, et al. Extent of resection and survival for oligodendroglioma: a U.S. population-based study. J Neuro Oncol. 2019;144(3):591–601. doi: 10.1007/s11060-019-03261-5 [DOI] [PubMed] [Google Scholar]
  • 22.Kinslow CJ, Rae AI, Kumar P, et al. Risk stratification for management of solitary fibrous tumor/hemangiopericytoma of the central nervous system. Cancers. 2023;15(3):876. doi: 10.3390/cancers15030876 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Boyett D, Kinslow CJ, Bruce SS, et al. Spinal location is prognostic of survival for solitary-fibrous tumor/hemangiopericytoma of the central nervous system. J Neuro Oncol. 2019;143(3):457–464. doi: 10.1007/s11060-019-03177-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Rae AI, Mehta A, Cloney M, et al. Craniotomy and survival for primary central nervous system lymphoma. Neurosurgery. 2019;84(4): 935–944. doi: 10.1093/neuros/nyy096 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Kinslow CJ, Rae AI, Taparra K, et al. MGMT promoter methylation predicts overall survival after chemotherapy for 1p/19q-codeleted gliomas. Clin Cancer Res. 2023;29(21):4399–4407. CCR. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Kinslow CJ, May MS, Kozak M, Pollom EL, Chang DT. Signet ring cell carcinoma of the Ampulla of Vater: outcomes of patients in the United States. HPB. 2020;22:1759–1765. doi: 10.1016/j.hpb.2020.03.024 [DOI] [PubMed] [Google Scholar]
  • 27.Kinslow CJ, DeStephano DM, Rohde CH, et al. Risk of anaplastic large cell lymphoma following postmastectomy implant reconstruction in women with breast cancer and ductal carcinoma in situ. JAMA Netw Open. 2022;5(11):e2243396. doi: 10.1001/jamanetworkopen.2022.43396 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Kinslow CJ, Yu JB, DeStephano DM, et al. Risk of squamous cell carcinoma of the breast following postmastectomy implant reconstruction in women with breast cancer and carcinoma in situ. JAMA Surg. 2023;158(7):769–771. doi: 10.1001/jamasurg.2023.0262 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.May MS, Kinslow CJ, Adams C, et al. Outcomes for localized treatment of large cell neuroendocrine carcinoma of the lung in the United States. Transl Lung Cancer Res. 2021;10(1):71–79. doi: 10.21037/tlcr-20-374 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Bryan CJ, Carpenter KM, Pawlik TM. Evidence-based strategies to reduce suicide mortality among patients with cancer. JAMA Oncol. 2023;9(3):303. doi: 10.1001/jamaoncol.2022.6373 [DOI] [PubMed] [Google Scholar]
  • 31.Singhal A, Ross J, Seminog O, Hawton K, Goldacre MJ. Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage. J R Soc Med. 2014;107(5):194–204. doi: 10.1177/0141076814522033 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Trevino KM, Abbott CH, Fisch MJ, Friedlander RJ, Duberstein PR, Prigerson HG. Patient-oncologist alliance as protection against suicidal ideation in young adults with advanced cancer. Cancer. 2014;120(15):2272–2281. doi: 10.1002/cncr.28740 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology. 2001;10(1):19–28. doi: 10.1002/1099-1611(200101/02)10:1<19::aid-pon501>3.0.co;2-6 [DOI] [PubMed] [Google Scholar]
  • 34.Carlson LE, Zelinski EL, Toivonen KI, et al. Prevalence of psychosocial distress in cancer patients across 55 North American cancer centers. J Psychosoc Oncol. 2019;37(1):5–21. doi: 10.1080/07347332.2018.1521490 [DOI] [PubMed] [Google Scholar]
  • 35.Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–174. doi: 10.1016/s1470-2045(11)70002-x [DOI] [PubMed] [Google Scholar]
  • 36.Pitman A, Suleman S, Hyde N, Hodgkiss A. Depression and anxiety in patients with cancer. BMJ. 2018;361:k1415. doi: 10.1136/bmj.k1415 [DOI] [PubMed] [Google Scholar]
  • 37.Walker J, Hansen CH, Martin P, et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatr. 2014;1(5):343–350. doi: 10.1016/s2215-0366(14)70313-x [DOI] [PubMed] [Google Scholar]
  • 38.Andersen BL, DeRubeis RJ, Berman BS, et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol. 2014;32(15):1605–1619. doi: 10.1200/jco.2013.52.4611 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Riba MB, Donovan KA, Andersen B, et al. Distress management, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2019;17(10):1229–1249. doi: 10.6004/jnccn.2019.0048 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Ercolano E, Hoffman E, Tan H, Pasacreta N, Lazenby M, McCorkle R. Managing psychosocial distress: lessons learned in optimizing screening program implementation. Oncology. 2018;32(10):488–490, 492–483. [PMC free article] [PubMed] [Google Scholar]
  • 41.Zebrack B, Kayser K, Sundstrom L, et al. Psychosocial distress screening implementation in cancer care: an analysis of adherence, responsiveness, and acceptability. J Clin Oncol. 2015;33(10): 1165–1170. doi: 10.1200/jco.2014.57.4020 [DOI] [PubMed] [Google Scholar]
  • 42.Berchuck JE, Meyer CS, Zhang N, et al. Association of mental health treatment with outcomes for US veterans diagnosed with non–small cell lung cancer. JAMA Oncol. 2020;6(7):1055–1062. doi: 10.1001/jamaoncol.2020.1466 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Filiberti A, Ripamonti C, Totis A, et al. Characteristics of terminal cancer patients who committed suicide during a home palliative care program. J Pain Symptom Manag. 2001;22(1):544–553. doi: 10.1016/s0885-3924(01)00295-0 [DOI] [PubMed] [Google Scholar]
  • 44.Loggers ET, Starks H, Shannon-Dudley M, Back AL, Appelbaum FR, Stewart FM. Implementing a death with dignity program at a comprehensive cancer center. N Engl J Med. 2013;368(15): 1417–1424. doi: 10.1056/nejmsa1213398 [DOI] [PubMed] [Google Scholar]
  • 45.Verkissen MN, Houttekier D, Cohen J, Schots R, Chambaere K, Deliens L. End-of-life decision-making across cancer types: results from a nationwide retrospective survey among treating physicians. Br J Cancer. 2018;118(10):1369–1376. doi: 10.1038/s41416-018-0070-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Osazuwa-Peters N, Simpson MC, Zhao L, et al. Suicide risk among cancer survivors: head and neck versus other cancers. Cancer. 2018;124(20):4072–4079. doi: 10.1002/cncr.31675 [DOI] [PubMed] [Google Scholar]
  • 47.Volkers N. In coping with cancer, gender matters. J Natl Cancer Inst. 1999;91(20):1712–1714. doi: 10.1093/jnci/91.20.1712 [DOI] [PubMed] [Google Scholar]
  • 48.Rockett IRH, Samora JB, Coben JH. The Black–White suicide paradox: possible effects of misclassification. Soc Sci Med. 2006; 63(8):2165–2175. doi: 10.1016/j.socscimed.2006.05.017 [DOI] [PubMed] [Google Scholar]
  • 49.Gibbs JT. 8 African-American suicide: a cultural paradox. Suicide Life-Threatening Behav. 1997;27(1):68–79. doi: 10.1111/j.1943-278x.1997.tb00504.x [DOI] [PubMed] [Google Scholar]
  • 50.Utsey SO, Hook JN, Stanard P. A re-examination of cultural factors that mitigate risk and promote resilience in relation to African American suicide: a review of the literature and recommendations for future research. Death Stud. 2007;31(5):399–416. doi: 10.1080/07481180701244553 [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Data 2
NIHMS2167087-supplement-Supplementary_Data_2.xlsx (36.1KB, xlsx)
Supplementary Table 1
NIHMS2167087-supplement-Supplementary_Table_1.docx (16.4KB, docx)
Supplementary Data1
NIHMS2167087-supplement-Supplementary_Data1.pdf (396.7KB, pdf)

Data Availability Statement

The Surveillance, Epidemiology, and End Results data set is publicly available on request to the National Cancer Institute. Code is available on specific request to the authors.

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