Incidence and risk factors of suicide among patients with pancreatic cancer: A population-based analysis from 2000 to 2018

Yifei Ma; Jun Lyu; Bao Yang; Tianao Yan; Qingyong Ma; Zheng Wu; Zheng Wang; Hairong He

doi:10.3389/fonc.2022.972908

Incidence and risk factors of suicide among patients with pancreatic cancer: A population-based analysis from 2000 to 2018

Front Oncol. 2022 Aug 19:12:972908. doi: 10.3389/fonc.2022.972908. eCollection 2022.

Authors

Yifei Ma^{1

2}, Jun Lyu³, Bao Yang^{1

2}, Tianao Yan^{1

2}, Qingyong Ma¹, Zheng Wu¹, Zheng Wang^{1

2}, Hairong He⁴

Affiliations

¹ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
² Department of Surgical Intensive Care Unit, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
³ Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
⁴ Department of Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Abstract

Background: The rate of suicide within one year after diagnosis in pancreatic cancer patients are high, but suicide studies based on the current large-scale data are still a vacancy. Our study aimed to determine, compared to the general population, the standardized mortality ratios (SMRs) of suicide and risk factors associated with pancreatic cancer patients committing suicide to provide clues for prevention.

Methods: We collected 199,604 patients diagnosed with pancreatic cancer between 2000 and 2018 from the SEER database. Multivariate logistic regression and multivariate Cox regression were applied to determine the risk factors independently affecting the suicide outcome of pancreatic cancer patients.

Results: A total of 180 suicide deaths were observed in the cohort, yielding an overall suicide rate of 88.05 per 100,000 person-years and an SMR of 6.43. In multivariate analyses, males (HR: 12.798, 95% CI: 7.471-21.923), unmarried (HR: 1.826, 95% CI: 1.205-2.767), and divorced, separated or widowed (HR: 1.779, 95% CI: 1.230-2.572) were found associated with a higher risk of suicide. While race black (HR: 0.250, 95% CI: 0.110-0.567), diagnosed with pancreatic neuroendocrine tumor (HR: 0.487, 95% CI: 0.276-0.859), received chemotherapy (HR: 0.456, 95% CI: 0.323-0.646), and received surgical procedures (HR: 0.553, 95% CI: 0.342-0.895) were indicated might protective factors.

Conclusions: The 199,604 pancreatic cancer patients diagnosed between 2000 and 2018 had an overall suicide rate of 88.05 per 100,000 person-years and an SMR of 6.43 compared to the U.S. general population. Male, white, unmarried, and diagnosed with pancreatic adenocarcinoma patients were associated with a higher risk of suicide, while cancer-directed surgery and chemotherapy might indicate protective factors. The screening and prevention process should be enhanced for pancreatic cancer patients with adverse risk factors. Moreover, it is reasonable to assume that timely cancer-directed treatment might help reduce the subsequent suicide risk of pancreatic cancer patients.

Keywords: SMRs; pancreatic cancer; risk factors; suicide; the SEER database.