Suicide in Cancer Patients: Could We Expect
Similar Results in the Commonwealth?
C. Collins, S. Brown DrPH, J. Seals MPH
Kentucky Injury Prevention and Research Center, Department of Epidemiology
University of Kentucky, Lexington, KY
Introduction
Suicide has an estimated global burden of over 800,000 deaths per year
with one person dying every 40 seconds1. In 2006, suicide was listed as the
11th leading cause of death in the United States, taking the lives of 33,289
individuals2. By 2015, suicide had become the tenth leading cause of death with
over 44,000 deaths3. The number of suicides in the United States has continued
to increase throughout the years. Generally, a combination of factors helps
contribute to the overall risk of suicide. Risk factors associated with suicide
include feelings of hopelessness, mental health issues, chronic pain, physical
illness, and the onset of stressful life events4.
In 2012, the World Health Organization estimated a total of 14 million new
cases of cancer with the number expected to rise to about 22 million in the next
two decades5. In 2015, cancer was responsible for 1 in 6 deaths5. Even with a
decline in mortality of certain cancer types, as shown in figures 1 and 2, cancer
is still the second leading cause of death in the United States after heart
disease with 595,930 deaths each year6. Although there have been
improvements in the treatment of cancer and its prognosis, a potentially life
threatening diagnosis such as a cancer diagnosis can take a large toll on a
person. In many cases, a cancer diagnosis can result in physical and
psychological pain for the patient, leaving them feeling hopeless.
Seeing that both physical and psychological stressors are commonly
associated with suicide and suicide ideation within the general population, it is
not surprising that studies have reported a higher risk of suicide in cancer
patients compared to the rest of the population. Numerous international studies
have been conducted reporting an increased rate of suicide among cancer
patients. In the United States, it has been reported that the risk of suicide in
patients with cancer is twice that of the general population; confirming that there
needs to be more emphasis on patients’ overall well being and not just physical
health7.
While many studies on suicide in cancer patients have been conducted
throughout the world, there is still a gap in the literature as few non-site specific
studies have been conducted in the United States. From 1999-2014, the overall
suicide rate for the general population increased from 10.5 to 13.08. The state of
Kentucky had an estimated suicide rate of 16.8, a 24.44% increase compared
to the rest of the nation8. Along with the state’s high suicide rate, the
Commonwealth ranks as the state with the highest cancer rate in the country
and the disease has become the number one leading cause of death in the
state8. Given these numbers, we believe that one could expect cancer patients
in Kentucky to have an increased rate and risk for suicide. The purpose of this
study aims to determine the suicide rates, patterns, and risk factors among
cancer patients in Kentucky.
Methods
In order to determine the risk of suicide, a cross-sectional study will be
conducted. State specific data will be gathered by linking data from the
Kentucky Cancer Registry (KCR) and the Kentucky Violent Death Reporting
System (KY-VDRS).
The KCR has served as the only population-based central cancer
registry for the Commonwealth of Kentucky since 19919. The KY-VDRS is part
of the National Violent Death Reporting System (NVDRS) and began
collecting data on violent deaths in 2005. The KY-VDRS links data from a
variety of networks including law enforcement, coroner’s, medical examiners,
vital statistics, and crime laboratories10. Data will be linked on key variables
including but not limited to decedents name, date of death and date of birth.
Information gathered from the KCR will include data regarding the
cancer type, stage, age, sex, and age at diagnosis and recurrence. Data from
the KY-VDRS will confirm KCR patients’ manner of death as suicide. Suicide
rates will be based on the number of suicides deaths by cancer patients in the
state of Kentucky from the years 2005-2014. Standardized mortality ratios will
be calculated while risk factors will be evaluated using a chi-squared test. Risk
factors will include age at diagnosis, recurrence, number of children (if
applicable), family history, marital status at diagnosis. Location of death will
also be examined to evaluate geographic trends.
Importance
Numerous factors can put a patient at a higher risk for suicide including having aggressive
forms of cancer such as lung cancer, being male, older in age, history or feelings of depression,
and being recently diagnosed with the disease2. It is thought that certain populations may be
more at risk than others including men 65 years or older with aggressive forms of the disease11.
This particular study will focus on those at risk in the state of Kentucky and aim to determine if the
state is at a high enough risk for further research.
The Commonwealth currently has some of the highest suicide and cancer rates in the
country. A study examining the life expectancy in U.S. counties revealed that 8 out of the 10 U.S.
counties showing the greatest declines were located in Eastern Kentucky12. In the Appalachian
region of the state, Kentucky’s cancer mortality rate is reported be 35% higher than the nation
and 18% percent than the Non-Appalachian regions of Kentucky13. The incidence of suicide in the
region is approximately 18% higher than the national rate and only 3% lower than the rest of the
state13. The lack of affordable access to proper care for both mental and physical health,
particularly in the eastern region of the state, could be to blame. Many residents in Eastern
Kentucky either cannot afford health insurance or live too far away from a medical center to seek
help or receive annual check-ups14. It is thought that this might explain the high mortality in the
area as residents could be diagnosed with cancer at a later stage due to lack of screenings.
However, the eastern region might not be solely to blame for these high rates but more so
the environment of the state as a whole. According to the CDC, rural counties in the United States
tend to have higher rates of suicide compared to metropolitan counties15. Kentucky has a total of
120 countries, with 59 of them being rural, 35 metropolitan, and 26 micropolitan. A metropolitan
area contains a population of at least 50,000 or more while micropolitan areas contain less than
50,000 people area is described as an similar to a metropolitan area with over 10,000 residents
but less than 50,000. Given the state’s long and continuing history with the tobacco industry, it is
no surprise that lung cancer is one of the most common forms of cancer diagnosed in the
Commonwealth8. It is possible that with some of the most fatal cancers being the most commonly
diagnosed cancers in the state, along with the physical and psychological distress that comes
with treatment, some patients may choose to end their own life to avoid painful and expensive
treatment for a disease that might not be able to be treated in the end.
Due to these statistics, along with findings from previous international studies, we have
reason to believe that Kentucky could expect significant results from this study. To further this
study, more research is needed and tailored specifically to Kentucky cancer patients. If significant
results and geographic patterns are produced, physicians in Kentucky would be able to utilize the
data to better treat their patients both physically and mentally during the course of their treatment.
If the data were to result in a large number of suicides in cancer patients in a specific region, the
data could be utilized as evidence to help the region gain more funding for better access to
screenings or mental health programs. Healthcare providers should be aware that a serious event
such as a cancer diagnosis can put a person at risk for suicide and they need to continually be
looking for warning signs that their patient might be feeling depressed or suicidal. By identifying
and treating these symptoms, a physician could not only help reduce the risk of suicide in the
patient, but also improve the patient’s overall quality of life.
Disclaimer
This presentation was supported by: GRANT NUMBER 424128 from the: CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC).
It’s contents are solely the responsibility of the author and do not necessarily represent the official views of the CDC.
Produced by the Kentucky Injury Prevention and Research Center, a bona fide agent for the Kentucky Department for Public Health. January
2017. Data source: Kentucky Death Certificate Database, Kentucky Office of Vital Statistics, Cabinet for Health and Family Services. Data
are provisional and subject to change.
For further information, please contact: Cassady Collins: cmco269@g.uky.edu
References
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