Faculty Collaboration Database

Morbidity of curative cancer surgery and suicide risk. Psychooncology 2017 Nov;26(11):1792-1798

Date

07/17/2016

Pubmed ID

27421798

DOI

10.1002/pon.4221

Scopus ID

2-s2.0-84992468350 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

IMPORTANCE: Curative cancer operations lead to debility and loss of autonomy in a population vulnerable to suicide death. The extent to which operative intervention impacts suicide risk is not well studied.

OBJECTIVE: To examine the effects of morbidity of curative cancer surgeries and prognosis of disease on the risk of suicide in patients with solid tumors.

DESIGN: Retrospective cohort study using Surveillance, Epidemiology, and End Results data from 2004 to 2011; multilevel systematic review.

SETTING: General US population.

PARTICIPANTS: Participants were 482 781 patients diagnosed with malignant neoplasm between 2004 and 2011 who underwent curative cancer surgeries.

MAIN OUTCOMES AND MEASURES: Death by suicide or self-inflicted injury.

RESULTS: Among 482 781 patients that underwent curative cancer surgery, 231 committed suicide (16.58/100 000 person-years [95% confidence interval, CI, 14.54-18.82]). Factors significantly associated with suicide risk included male sex (incidence rate [IR], 27.62; 95% CI, 23.82-31.86) and age >65 years (IR, 22.54; 95% CI, 18.84-26.76). When stratified by 30-day overall postoperative morbidity, a significantly higher incidence of suicide was found for high-morbidity surgeries (IR, 33.30; 95% CI, 26.50-41.33) vs moderate morbidity (IR, 24.27; 95% CI, 18.92-30.69) and low morbidity (IR, 9.81; 95% CI, 7.90-12.04). Unit increase in morbidity was significantly associated with death by suicide (odds ratio, 1.01; 95% CI, 1.00-1.03; P = .02) and decreased suicide-specific survival (hazards ratio, 1.02; 95% CI, 1.00-1.03, P = .01) in prognosis-adjusted models.

CONCLUSIONS: In this sample of cancer patients in the Surveillance, Epidemiology, and End Results database, patients that undergo high-morbidity surgeries appear most vulnerable to death by suicide. The identification of this high-risk cohort should motivate health care providers and particularly surgeons to adopt screening measures during the postoperative follow-up period for these patients.

Author List

Jayakrishnan TT, Sekigami Y, Rajeev R, Gamblin TC, Turaga KK

Author

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age Factors
Aged
Databases, Factual
Female
Humans
Incidence
Male
Middle Aged
Morbidity
Multivariate Analysis
Neoplasms
Population Surveillance
Prognosis
Retrospective Studies
Risk Factors
Sex Factors
Suicide
Time Factors