Originally published as JCO Early Release 10.1200/JCO.2007.13.8941 on August 11 2008

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Incidence of Suicide in Persons With Cancer

Stephanie Misono, Noel S. Weiss, Jesse R. Fann, Mary Redman, Bevan Yueh

From the Departments of Otolaryngology/Head and Neck Surgery, Epidemiology, Psychiatry and Behavioral Sciences, and Health Services, University of Washington; Public Health Sciences Division, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA; and Department of Otolaryngology, University of Minnesota, Minneapolis, MN

Corresponding author: Stephanie Misono, MD, MPH, 1959 NE Pacific St, Box 356515, Seattle, WA 98195; e-mail: smisono{at}u.washington.edu

Purpose The purpose of this study was to characterize suicide rates among patients with cancer in the United States and identify patient and disease characteristics associated with higher suicide rates. Prior studies, mostly in Europe, have suggested that patients with cancer may be at increased risk for suicide, but large cohort studies comparing patients with cancer with the general population have not been performed in the United States.

Methods Patients in the study were residents of geographic areas served by the Surveillance, Epidemiology, and End Results (SEER) program who were diagnosed with cancer from 1973 to 2002. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. This was a retrospective cohort study of suicide in persons with cancer.

Results Among 3,594,750 SEER registry patients observed for 18,604,308 person-years, 5,838 suicides were identified, for an age-, sex-, and race-adjusted rate of 31.4/100,000 person-years. In contrast, the suicide rate in the general US population was 16.7/100,000 person-years. Higher suicide rates were associated with male sex, white race, and older age at diagnosis. The highest suicide risks were observed in patients with cancers of the lung and bronchus (standardized mortality ratio [SMR] = 5.74; 95% CI, 5.30 to 6.22), stomach (SMR = 4.68; 95% CI, 3.81 to 5.70), oral cavity and pharynx (SMR = 3.66; 95% CI, 3.16 to 4.22), and larynx (SMR = 2.83; 95% CI, 2.31 to 3.44). SMRs were highest in the first 5 years after diagnosis with cancer.

Conclusion Patients with cancer in the United States have nearly twice the incidence of suicide of the general population, and suicide rates vary among patients with cancers of different anatomic sites. Further examination of the psychological experience of patients with cancer, particularly that of patients with certain types of cancer, is warranted.

published online ahead of print at www.jco.org on August 11, 2008

Supported by National Institutes of Health Basic Sciences Training in Otolaryngology Grant No. DC00018 (S.M.) and by Department of Veterans Affairs Health Services Research and Development Service Center of Excellence Grant HFP 83-027 (S.M. and B.Y.).

Presented in part at the Annual Meeting of the American Head and Neck Society, August 17-20, 2006, Chicago, IL.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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