Temporal trends of suicide among cancer patients: A SEER database analysis from 2000 to 2021.

Abstract

12115 Background: Cancer is a known cause of morbidity and mortality, with over 2 million new diagnoses and 600,000 deaths projected in 2024. Some of the most common cancers have shown an increased incidence, including breast and prostate cancer. There is an increasing mortality trend towards younger populations, with colorectal cancer becoming the leading and second most common cause of cancer death in men and women younger than 50 years respectively. An estimated 20-25% of cancer patients suffer from depression, which alongside specific cancer diagnoses and demographic factors translates to increased suicidality. Here we attempt to elucidate the relationship between specific cancer diagnoses and suicide. Methods: We conducted a population-based cohort study of suicide/self-inflicted injury deaths among cancer patients using the National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) over the period 2000 through 2021. The SEER data is comprised of 22 different registries across the United States (US) which captures approximately 47.9% of the US population. We applied simple linear regression with total suicides as response variable and year as predictor variable to estimate the rate of change of the annual number of suicides among cancer patients. Subgroup analysis included sex, age group, household income, and the primary site of cancer. Results are reported as counts and percentage and the rates of change are reported as regression slope and 95% confidence interval (β, 95% CI). Results: A total of 16,156 suicide mortalities were identified of which 13,520 (83.7%) were male and 2,636 (16.3%) were female. The total number of suicides rose approximately ten-fold from 123 in 2000 to 1,211 in 2021 corresponding to β = 54.6 / year (95% CI 50.6 – 58.7). Male suicides rose from 107 in 2000 to 1,017 in 2021 (β = 44.6 / year (95% CI 41.7 – 47.5)) while Female suicides rose from 16 in 2000 to 194 in 2021 (β = 10.0 / year (95% CI 8.6 – 11.5)). The most common primary cancer sites were prostate 3,624 (22.4%), lung and bronchus 1,699 (10.5%), urinary bladder 1,108 (6.9%), and breast 977 (6.0%). Prostate cancer suicides increased from 16 in 2000 to 283 in 2021 (β = 14.0 / year (95% CI 12.9 - 15.1)). Lung cancer suicides rose from 36 in 2000 to 122 in 2021 (β = 2.6 / year (95% CI 12.9 - 15.1)). Breast cancer suicides rose from 4 in 2000 to 80 in 2021 (β = 4.0 / year (95% CI 3.3 – 4.7)). The distribution of ages among suicides was 14.0% for under 50 years old, 19.3% between 50 and 59, 27.8% between 60 and 69, 26.5% between 70 and 79 and 12.5% for 80 years old or greater, with each age group demonstrating significant increase in annual suicides over the period analyzed. Conclusions: A significant and increasing trend of suicide is observed across various cancers. Almost half (47.1%) of suicide attempts were among patients between 50 and 69 years. Males committed suicide more often than females, an exacerbation of the trend seen in the general population.