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Original Research: Lung Cancer |

Suicide in Lung CancerSuicide in Lung Cancer: Who Is at Risk?: Who Is at Risk?

Damien Urban, MBBS, BMedSc; Aparna Rao, MBBS; Mathias Bressel, MSc; Dina Neiger, PhD; Benjamin Solomon, MBBS, PhD; Linda Mileshkin, MBBS, MD, MBioeth
Author and Funding Information

From the Department of Medical Oncology (Drs Urban, Rao, Solomon, and Mileshkin), and the Centre for Biostatistics and Clinical Trials (Mr Bressel and Dr Neiger), Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.

Correspondence to: Damien Urban, MBBS, BMedSc, Department of Medical Oncology, Peter MacCallum Cancer Centre, 10 St. Andrews Place, East Melbourne, VIC, 3002, Australia; e-mail: damien.urban@petermac.org


Drs Urban and Rao contributed equally as joint first authors.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(4):1245-1252. doi:10.1378/chest.12-2986
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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, > 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.

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