Suicide Among Adult Cancer Survivors, 2000-2019

PURPOSE/OBJECTIVE(S) Cancer patients are at elevated risk of suicide due to additional disease-specific factors relating to cancer and its treatments. Given that cancer survivorship in the United States continues to improve, evaluating the risk and identifying factors associated with suicide among cancer survivors is warranted. MATERIALS/METHODS This population-based study examined the National Center for Health Statistics Multiple-Cause Mortality data for adult cancer survivors aged ≥ 20 with suicide and self-inflicted injury as the underlying cause and malignant neoplasm as a contributing cause of death. Associations with death by suicide were assessed with multivariable logistic regression for demographic and comorbid factors, and univariate logistic regression for anatomic site of cancer stratified by sex. Trends in suicide rates of non-cancer and cancer survivors were assessed with Pearson's correlation coefficient. RESULTS Among 12,180,902 adult cancer survivors, 6,254 (0.051%) deaths were by suicide. Male sex, White race, being not married, and having a high school education or higher, were associated with increased odds of suicide. Cancer survivors with a documented history of substance use disorder (OR [95% CI], 0.35 [0.31-0.39], P < .001) or chronic medical condition (0.36 [0.34-0.39], P < .001) had decreased odds, while history of depressive disorder had significantly increased odds of suicide (97.44 [90.61-104.78], P < .001), compared to those without the respective comorbidity. Survivors of head and neck, female breast, or genitourinary cancers had increased likelihood of death by suicide compared to those of thoracic sites (Table). Over the study period, the suicide rate of those without a history of cancer increased (r = 0.95, P < .0005) while the overall suicide rate of cancer survivors decreased (r = -0.60, P = 0.005). Specifically, suicide rates decreased for thoracic, gastrointestinal, genitourinary, and head and neck cancers, with the largest decline in multiple, metastatic, not otherwise specified sites (r = -0.67, P = 0.001). CONCLUSION Among adult cancer survivors, suicide risk varies with sociodemographic status, comorbid conditions, and anatomic cancer site. Although the suicide rate of cancer survivors has declined overall, further research is needed to develop interventions in high-risk cancer patients, particularly those with a history of depression, to mitigate suicide risk and improve survivorship care.