title: Suicide in lung cancer: who is at risk?
abstract: BACKGROUND
  Suicide rates among patients with lung cancer are higher than the general population. This study aims to identify patient and disease characteristics associated with suicide in patients with lung cancer.
  
  
  METHODS
  We conducted an analysis of subjects with primary lung cancer diagnosed between 1973 and 2008 recorded in the Surveillance, Epidemiology and End Results database.
  
  
  RESULTS
  From 871,230 people diagnosed with lung cancer, 1,184 cases of suicide were identified. The rate of suicide did not change considerably over time, with 8.83 compared with 7.17 suicides per 10,000 person-years in 1973 to 1979 and 2000 to 2009, respectively. The standardized mortality ratio (SMR) of the entire cohort was 4.95, with an SMR of 13.4 within 3 months of a cancer diagnosis. Despite most subgroups having a higher SMR than the general population, a wide variation in suicide risk was seen among different subgroups, including histologic type (SMR 1.58 vs 7.28 in bronchoalveolar and small cell carcinoma, respectively). The highest SMRs were found in patients with the following characteristics: male, older age, higher-grade tumor, and metastatic disease, and in patients who did not receive or refused treatment. Despite the higher SMR among patients with metastatic disease, &gt; 50% of suicides occurred in those with locoregional and potentially curable disease.
  
  
  CONCLUSIONS
  Patients with lung cancer have a higher risk for suicide compared with the general US population, especially within 3 months of diagnosis. Despite the higher SMR among patients with a poorer prognosis, a concerning proportion of suicides occurs in potentially curable patients, highlighting the need for effective screening strategies to avoid this preventable cause of death.
authors.affiliation: Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia. Electronic address: damien.urban@petermac.org.
authors.forename: Damien
authors.initials: D
authors.lastname: Urban
authors.affiliation: Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Aparna
authors.initials: A
authors.lastname: Rao
authors.affiliation: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Mathias
authors.initials: M
authors.lastname: Bressel
authors.affiliation: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Dina
authors.initials: D
authors.lastname: Neiger
authors.affiliation: Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Solomon
authors.affiliation: Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Mileshkin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013405:Suicide / Q000706:statistics & numerical data*