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Pancreatic Cancer and Suicide
Abstract & Commentary
By William B. Ershler, MD
Synopsis: Using the SEER database, data for patients with adenocarcinoma of the pancreas diagnosed in 1995-2005 were analyzed for the occurrence of suicide. As expected, the rates were higher than those reported for the general population, but among men, particularly those who were recovering from surgery, the mortality rate from suicide was 10 times greater than that of the general population. Care providers should be aware of this heightened risk and intervene as possible.
Source: Turaga KK, et al. Suicide in patients with pancreatic cancer. Cancer 2011;117:642-647.
Clinical depression is highly associated with pancreatic cancer, occurring somewhere between 33% to 76% of cases,1,2 and clinicians are aware of the suicide risk in such patients. Yet, the magnitude of this risk has yet to be clearly established. To address this, Turaga and colleagues 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.
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 U.S. population aged 65-74 years was 12.5 per 100,000 person-years, with a Standardized Mortality Ratio of 10.8 (95% confidence interval [CI], 9.2-12.7). Greater suicide rates were noted in males (odds ratio [OR] 13.5; 95% CI, 3.2-56.9; P < 0.001) and, among males, in patients undergoing an operative intervention (OR 2.5; 95% CI, 1.0-6.5; P = 0.05). Married men had a lower risk of committing suicide (OR 0.3; 95% CI, 0.1-0.6; P = 0.002). 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.
Suicide is a feared consequence of severe depression and its occurrence has been associated with the diagnosis and treatment of cancer.3,4 Depression, including severe depression, is common in patients with pancreatic cancer, more so than other malignancies.5,6 Whereas the incidence of suicide among patients with cancer approaches twice that of the general population,7,8 the current study using the large SEER database found the incidence to be more than 10 times greater than in the general population. The risk was higher for men and for those who underwent an operative intervention, with the highest rates occurring within 2 months of the operative procedure.
Why pancreatic cancer is distinctly associated with depression, more so than other malignancies, is unclear. There has been speculation that its roots relate to certain metabolic, hormonal, or biochemical features of the disease, but there is also a pervasive negativity felt throughout the community concerning this disease and this might heighten the sense of doom associated with the diagnosis.
The authors point out that the heightened risk for suicide in the few months after surgery previously had not been reported. If this finding is confirmed it may be of considerable clinical importance. Surgeons and other care providers who attend patients during this vulnerable period should be alerted to the possibility of overwhelming despair or other manifestation of severe depression and be prepared to provide appropriate psychological intervention as possible. Furthermore, acknowledging the high prevalence of depression among patients with pancreatic cancer (76% in one study9), medical/radiation oncologists should have a low threshold for treating depression aggressively in this setting.
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2. Green AI, Austin CP. Psychopathology of pancreatic cancer. A psychobiologic probe. Psychosomatics 1993;34:208-221.
3. Misono S, et al. Incidence of suicide in persons with cancer. J Clin Oncol 2008;26:4731-4738.
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5. Jacobsson L, Ottosson JO. Initial mental disorders in carcinoma of pancreas and stomach. Acta Psychiatr Scand Suppl 1971;221:120-127.
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8. Yousaf U, et al. Suicides among Danish cancer patients 1971-1999. Br J Cancer 2005;92:995-1000.
9. Fras I, et al. Comparison of psychiatric symptoms in carcinoma of the pancreas with those in some other intra-abdominal neoplasms. Am J Psychiatry 1967;123:1553-1562.