Some individuals who undergo surgery for cancer may be more likely to die by suicide than the general population, suggests a report in JAMA Oncology. The highest rates of death by suicide were among patients who underwent surgery for cancers of the head and neck, bladder, esophagus, and pancreas.
“Regular psychosocial distress screening of patients during preoperative evaluation and postoperative recovery and efforts to increase psychosocial support for these patients during postoperative recovery may represent possible strategies to reduce suicide risk among patients undergoing cancer operations,” wrote senior author Chi-Fu Jeffrey Yang, M.D., of Massachusetts General Hospital and colleagues.
Yang and colleagues analyzed data on cancer patients collected between 2000 and 2016 as part of the Surveillance, Epidemiology, and End Results (SEER) Program. The researchers compared the incidence of death by suicide among patients who underwent surgery for one of 15 solid-organ cancers in the United States with the incidence among the general population.
The study included 1,811,397 patients who underwent cancer surgery. During a median follow-up of 4.6 years, 1,494 of these patients (0.08%) died by suicide after surgery—a rate of death by suicide that was 1.29 times higher than the general population, when adjusted for age, sex, race, and calendar year of death. Among individual cancer types, 10 of the 15 assessed were associated with elevated suicide risk: brain, bladder, colon and rectum, esophagus, larynx, lung, oral cavity and pharynx, ovary, pancreas, and stomach.
The incidence of death by suicide was highest among patients who had undergone surgery for cancers of larynx (4.02 times higher than the general population), followed by cancers of the oral cavity and pharynx (2.43 times higher) and esophagus (2.25 times higher).
Approximately 3%, 21%, and 50% of deaths by suicide took place within the first month, first year, and first three years after surgery, respectively. Patients who were male, White, and divorced or single were at greatest risk of death by suicide.
“The findings of this study suggest that suicide is an important risk following cancer surgery and highlight the importance of improving access to support groups and implementing regular screening for distress during the postoperative period,” the authors wrote. “While screening for distress is recommended for all patients with cancer by major medical professional societies and is mandated by the American College of Surgeons Commission on Cancer, overall adherence to these recommendations has been shown to be low.”
For related information, see the Psychiatric News article “The Role of C-L Psychiatrists in Assessing Suicide.”
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