Suicide and accidental deaths among patients with non-metastatic prostate cancer

Abstract

Objective: To determine if American men with prostate cancer are at increased risk of suicide/accidental death compared with other cancers and if the receipt of definitive treatment alters this association, as patients with cancer are at increased risk of suicide and evidence suggests a relationship between suicides and deaths due to accidents and externally caused injuries.

Patients and methods: Demographic, socio-economic and tumour characteristics of men with prostate cancer and men with other solid malignancies were extracted from the Surveillance, Epidemiology and End Results (SEER) database (1988-2010). Poisson regression models were fitted to compare the incidence of suicidal and accidental deaths in prostate cancer vs other solid cancers. Multivariate Cox regression was used to determine if receipt of definitive primary treatment impacted the risk of suicide or accidental death in men with localised/regional prostate cancer.

Results: Risk of suicidal and accidental death was significantly lower in men with prostate cancer (1 165 [0.2%] and 3 199 [0.6%]) than men with other cancers (2 232 [0.2%] and 4 501 [0.5%], respectively), except within the first year of diagnosis (adjusted relative risk [ARR] 3.98, 95% confidence interval [CI] 3.02-5.23 and ARR 4.22, 95% CI 3.24-5.51, respectively, 0-3 months after diagnosis). Men with non-metastatic prostate cancer who were White, uninsured, or recommended but did not receive treatment (hazard ratio vs treated 1.44, 95% CI 1.20-1.72, and 1.44, 95% CI 1.30-1.59, both P < 0.001) were at increased risk of suicidal and accidental mortality, respectively. Absence of data about previous co-morbidities and drug addictions in the SEER dataset was an important limitation.

Conclusions: Relative to other cancers, men with prostate cancer were at increased risk of suicide and accidental deaths within the first year of diagnosis and when definitive treatment was recommended but not received, suggesting the need for close monitoring and coordination with mental health professionals in at-risk men with potentially curable disease.

Keywords: SEER; accidental death; primary treatment; prostate cancer; suicide.