Annals of Oncology Advance Access originally published online on October 19, 2006
Annals of Oncology 2007 18(2):381-387; doi:10.1093/annonc/mdl385
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© 2006 European Society for Medical Oncology
oncology practice |
Suicide and cancer: a gender-comparative study
Division of Radiation Oncology, The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
* Correspondence to: Dr W. S. Kendal, Division of Radiation Oncology, The Ottawa Hospital Regional Cancer Center, 503 Smyth Road, Ottawa, Ontario, K1H 1C4 Canada. Tel: +1-613-737-7700; Fax: +1-613-247-3511; E-mail: wkendal{at}ottawahospital.on.ca
Background: Persons with cancer commit suicide more frequently than those without, and males generally commit suicide more frequently than females. A population-based analysis of cancer patients was carried out here, comparing suicide risk between the genders, to elucidate the features specific to each gender.
Patients and methods: A total of 1.3 million cancer cases from the Surveillance, Epidemiology, and End Results program were analyzed. Cox proportional hazards models were fitted to personal, tumor-related, and social variates.
Results: A total of 265 female and 1307 male suicides were enumerated, reflecting 0.04% and 0.19% from each gender, and providing an overall hazard ratio for male suicide of 6.2 [95% confidence interval (CI) 5.4–7.1]. Females with colorectal (P = 0.01) and cervical (P < 0.0001) cancers showed decreased suicide rates. Males with head and neck cancers (P < 0.0001) and myeloma (P = 0.02) had increased rates, whereas rates were decreased in males with lung cancer (P = 0.01), liver (P = 0.01), brain tumors (P = 0.04), and leukemia (P = 0.007). The hazard ratio associated for male suicide with distant metastasis was 2.84 (95% CI 2.49–3.24); for married status, 0.46 (95% CI 0.39–0.54); and for African-American ancestry, 0.24 (95% CI 0.17–0.34)—comparable ratios were seen here for female suicides. In head and neck cancers, with both genders analyzed together, the suicide hazard was increased if surgery was contraindicated (3.0, 95% CI 1.3–6.8), but not if refused.
Conclusions: The high-risk patient was male, with head and neck cancer or myeloma, advanced disease, little social or cultural support, and limited treatment options. Oncologists and allied health professionals should be aware of the potential for suicide in cancer patients and their associated risk factors.
Key words: cancer, gender, suicide
Received for publication June 7, 2006. Revision received August 24, 2006. Accepted for publication September 11, 2006.
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