|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
Journal of Clinical Oncology, Vol 25, No 6 (February 20), 2007: pp. 731-732 © 2007 American Society of Clinical Oncology. DOI: 10.1200/JCO.2006.09.7394
Suicide Among Survivors of Childhood CancerCentre for Childhood Cancer Survivor Studies, Department of Public Health and Epidemiology, University of Birmingham, Birmingham, United Kingdom
Division of Epidemiology and Clinical Research, University of Minnesota, Minneapolis, MN
Department of Cancer Epidemiology, Lund University, Lund, Sweden
Oncology-Hematology Section, Department of Pediatrics, University Hospital, Lund, Sweden To the Editor: We read with considerable interest "Suicidal Ideation and Attempts in Adult Survivors of Childhood Cancer" recently published in the Journal of Clinical Oncology.1 The authors are to be congratulated on addressing an important issue relating to adult survivors of childhood cancer. In the article the authors reported, "Several epidemiologic studies indicate that the risk of suicide is elevated in cancer patients compared with the general population." However, on reading the references cited in support of this statement, it becomes clear that the studies are almost entirely concerned with suicide after cancer is diagnosed in mature adulthood as the studies were principally based on cancer registry incident cases, which overwhelmingly comprise cancers diagnosed in individuals older than 50 years. Unfortunately the authors do not report the evidence which has accumulated from large-scale studies carried out exclusively among survivors of cancer diagnosed in childhood or adolescence. A considerable amount of such evidence has accrued and it is presented in Table 1. Table 1 is restricted to the larger studies previously published as they have particular advantages discussed in detail elsewhere.2 In particular, the statistical power to detect evidence of excess risks relating to uncommon specific causes of death is greatest in such larger studies. We have arranged the studies in the Table based on the total number of deaths (from all causes) reported. The expected number of suicides reported in Table 1 are obtained from the appropriate underlying general populations adjusted for age, sex, and calendar period of follow-up.
Inspection of the accumulated evidence in the Table indicates that if there is an increase in suicide after the generality of childhood cancers, then it is likely to be small. Indeed, most previous large-scale studies suggest the risk of suicides in survivors does not exceed the risk observed in the appropriately matched general populations. The purpose of this short note is not to criticize the publication that prompted it, but to complement the information in that publication with an attempt at a comprehensive synthesis of evidence from the more informative previous studies of mortality among survivors of childhood and adolescent cancer. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The authors indicated no potential conflicts of interest.
REFERENCES
1. Recklitis CJ, Lockwood RA, Rothwell MA, et al: Suicidal ideation and attempts in adult survivors of childhood cancer. J Clin Oncol 24:3852-3857, 2006 2. Hawkins MM, Robison LL: Importance of clinical and epidemiological research in defining the long-term clinical care of pediatric cancer survivors. Pediatr Blood Cancer 46:174-178, 2006[CrossRef][Medline] 3. Mertens AC, Yasui Y, Neglia JP, et al: Late mortality experience in five-year survivors of childhood and adolescent cancer: The Childhood Cancer Survivor Study. J Clin Oncol 19:3163-3172, 2001 4. Möller TR, Garwicz S, Barlow L, et al: Decreasing late mortality among five-year survivors of cancer in childhood and adolescence: A population-based study in the Nordic countries. J Clin Oncol 19:3173-3181, 2001 5. Robertson CM, Hawkins MM, Kingston JE: Late deaths and survival after childhood cancer: Implications for cure. BMJ 309:162-166, 1994 6. Hawkins MM, Kingston JE, Kinnier Wilson LM: Late deaths after treatment for childhood cancer. Arch Dis Child 65:1356-1363, 1990 7. Hudson MM, Jones D, Boyett J, et al: Late mortality of long-term survivors of childhood cancer. J Clin Oncol 15:2205-2213, 1997 8. Cardous-Ubbink MC, Heinen RC, Langeveld NE, et al: Long-term cause-specific mortality among five-year survivors of childhood cancer. Pediatr Blood Cancer 42:563-573, 2004[CrossRef][Medline]
Related Reply
Related Article
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2007 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
