Patient Reported Outcomes/Quality of Life

PV QA 4 - Poster Viewing Q&A 4

TU_43_3742 - Incidence of Suicide after Cancer Treatment with Radiation, 2004-2014

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Incidence of Suicide after Cancer Treatment with Radiation, 2004-2014
F. Chino1, G. Suneja2, and J. P. Chino3; 1Duke University, Durham, NC, 2Department of Radiation Oncology, Duke University School of Medicine, Durham, NC, 3Duke University Medical Center, Durham, NC

Purpose/Objective(s): Overall suicide rate in the United States has increased steadily since 1999. Patients with cancer have a known increase risk of suicide, however the specific rates and risks for the modern radiation patient population are unknown.

Materials/Methods: All cancer patients known to be treated with radiation (RT), diagnosed from 2004-2014 were compiled from the Surveillance, Epidemiology, and End Results (SEER) Database. The 2 and 5 year suicide rates were calculated from suicide deaths documented in SEER, with the overall 2014 US suicide rate from the CDC used for national comparison. Logistic regression were used to test for associations between clinical and sociodemographic variables and death by suicide. All statistical comparisons were two tailed; a p-value of <0.05 was considered significant.

Results: In the study period, 1,176,914 cancer patients were treated with RT (27% of the SEER cancer cohort of 4,376,790). Median follow up was 4.3 years encompassing 4,283,057 person-years (PY) for the RT cohort and 4.2 years/14,446,584 PY for the full SEER cohort. 962 cancer patients in the RT cohort (22.5 per 100,000 PY) and 4,136 cancer patients in the full SEER cohort (28.6 per 100,000 PY) died due to suicide. Compared to a national rate of 13.0, the standardized mortality ratio was 1.7 in the RT cohort and 2.2 in the full SEER cohort. 2-year suicide rates for the RT and full SEER cohorts were 0.055% (95% CI 0.055-0.056) and 0.069% (95%CI 0.066-0.072) respectively, and 5-year rates were 0.109 (95% CI 0.100-0.117) and 0.131 (95%CI 0.131-0.144) respectively. Specifically for the RT cohort: 38.5% of total suicides occurred within 1 year and 54.5% within 2 years. There appeared to be a spike in suicide 5 years following the cancer diagnosis with the proportional rate increasing 3-fold immediately prior to this landmark (0.00003 to 0.00009) and decreasing to baseline afterwards (0.00005). On multivariate regression analysis, male sex (HR 4.29, 95% CI 2.66-6.91), H&N cancer (HR 2.04, 95% CI 1.13-3.72), and stage IV disease at diagnosis (HR 1.85, 95% CI 1.18-2.89) were associated with increased risk of suicide. Marriage had a negative association with suicide (HR 0.61, 95% CI 0.43-0.87), as did black race (HR 0.27, 95% CI 0.15-0.48) and Hispanic ethnicity (HR 0.31, 95% CI 0.15-0.64). In a targeted assessment of the highest risk RT patients, white single males with H&N cancers had a 0.302% (95% CI 0.171-0.432) rate of suicide at 2 years and 0.432% (95% CI 0.257-0.607) at 5 years.

Conclusion: Cancer patients treated with RT are at an increased risk of suicide when compared with the general US population however at a comparatively lower risk than cancer patients overall. Most suicides in RT patients occurred within the first 2 years although there was a peak in suicide 5 years after diagnosis. White, single males with H&N cancer have the highest rates of suicide with approximately 1 out of 250 dying due to suicide by 5 years after diagnosis.

Author Disclosure: F. Chino: Employee; Central Regional Hospital. G. Suneja: Employee; UNC. Honoraria; NCCN. HIV and Cancer Panel Co-Chair; NCCN. Committee Chair; Radiation Oncology Institute Research. J.P. Chino: Partner; Duke University Cancer Center. Stock; NanoScint. Co-Founder/Owner; NanoScint.

Fumiko Chino, MD

Duke University Medical Center

Duke University Medical Center: Resident: Employee

Indiana Oncology Society: Travel Expenses

Fumiko Chino, MD is a cancer researcher at the Duke Cancer Institute, where she is currently serving as Chief Resident in Radiation Oncology. She graduated medical school at Duke School of Medicine where she was inducted to the Alpha Omega Alpha Honor Society. Her research is focused on the financial toxicity of cancer care, health care disparities and access, patient reported outcomes, shared decision making, survivorship and end-of-life care. Her work has been published in JAMA Oncology, Cancer, the American Journal of Managed Care, and the International Journal of Radiation Oncology * Biology * Physics and her commentary on heath care reform and cancer care has been featured in JAMA Oncology and The Conversation. Her work has been covered by national news media outlets including Forbes, NPR and U.S. News and World Report. She has received research support from the Radiation Oncology Institute.


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TU_43_3742 - Incidence of Suicide after Cancer Treatment with Radiation, 2004-2014

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