Suicide in patients with pancreatic cancer.
BACKGROUND
Depression is highly prevalent in patients with pancreatic cancer and can result in fatal outcomes from suicides. The authors report suicide rates among patients with pancreatic cancer in the United States and identify factors associated with greater suicide rates.


METHODS
The current study reviewed data in the SEER database for patients diagnosed with pancreatic adenocarcinoma from 1995-2005. Logistic regression models were used to perform multivariate modeling for factors associated with suicide, while Kaplan-Meier analysis was used to assess factors affecting survival.


RESULTS
Among 36,221 patients followed for 22,145 person-years, the suicide rate was 135.4 per 100,000 person-years. The corresponding rate in the US population aged 65-74 years was 12.5 per 100,000 person-years, with a Standardized Mortality Ratio (SMR) of 10.8 (95% CI, 9.2-12.7). Greater suicide rates were noted in males (Odds Ratio (OR) 13.5 [95% CI, 3.2-56.9, P < .001]) and, among males, in patients undergoing an operative intervention (OR 2.5 [95% CI, 1.0-6.5, P = .05]). Married men had a lesser risk of committing suicide (OR 0.3 [95% CI, 0.1-0.6, P = .002]). Median survival among patients undergoing operative intervention was 2 months for those who committed suicide compared with 10 months for those who did not commit suicide.


CONCLUSIONS
Male patients with pancreatic adenocarcinoma have a risk of suicide nearly 11 times that of the general population. Patients who undergo an operative intervention are more likely to commit suicide, generally in the early postoperative period.
Turaga
Kiran K
KK
Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA. kturaga@gmail.com
Malafa
Mokenge P
MP
Jacobsen
Paul B
PB
Schell
Michael J
MJ
Sarr
Michael G
MG
D000230:Adenocarcinoma / Q000401:mortality / Q000523:psychology* / Q000601:surgery; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000523:psychology* / Q000601:surgery; D018426:SEER Program; D012737:Sex Factors; D012847:Single Person; D013405:Suicide / Q000706:statistics & numerical data*
Lancet. 1999 Oct 16;354(9187):1331-6
10533861
Br J Cancer. 1998 Apr;77(7):1194-6
9569062
Am J Public Health. 2000 Dec;90(12):1885-91
11111261
J Natl Cancer Inst. 2006 Oct 4;98(19):1416-9
17018788
Acta Psychiatr Scand Suppl. 1971;221:120-7
5286323
J Pain Symptom Manage. 1988 Fall;3(4):194-8
3057080
Psychol Med. 2006 May;36(5):575-86
16420727
Soc Psychiatry Psychiatr Epidemiol. 2010 May;45(5):513-21
19618093
Am J Psychiatry. 1986 Aug;143(8):982-6
3524279
Am J Epidemiol. 1979 Jan;109(1):59-65
433917
Am J Public Health. 2007 Dec;97(12):2193-8
17971541
Support Care Cancer. 2001 Jul;9(5):344-9
11497387
Br J Psychiatry. 1982 Sep;141:227-32
6182940
Br J Cancer. 2005 Mar 28;92(6):995-1000
15756279
J Natl Cancer Inst Monogr. 2004;(32):57-71
15263042
J Clin Oncol. 2007 Jun 10;25(17):2397-405
17557953
Cancer. 1992 Mar 15;69(6):1507-12
1540887
Am J Psychiatry. 1967 Jun;123(12):1553-62
4381627
Biol Psychiatry. 2003 Aug 1;54(3):269-82
12893103
Br J Psychiatry. 1998 Jan;172:35-7
9534829
Am J Epidemiol. 1989 Nov;130(5):1024-32
2683747
J Clin Oncol. 2008 Oct 10;26(29):4731-8
18695257
Scand J Public Health. 2005;33(3):208-14
16040462
J Clin Epidemiol. 1989;42(7):611-6
2760653
J Clin Oncol. 2004 Oct 15;22(20):4209-16
15483032
Am J Psychiatry. 2000 Dec;157(12):1925-32
11097952
Psychosom Med. 2003 Sep-Oct;65(5):884-8
14508036
Psychosomatics. 1993 May-Jun;34(3):208-21
8493302
Eur J Cancer. 2003 Oct;39(15):2223-8
14522382
Psychol Med. 1991 Nov;21(4):979-84
1780410
Semin Oncol. 1996 Apr;23(2):229-40
8623059
J Chronic Dis. 1982 Feb;35(2):89-100
7056839