Risk factors for suicide in individuals with cancer: an integrative literature review

Mendes, Marcos Vinicius de Carvalho; Santos, Solange Laurentino dos; Ceballos, Albanita Gomes da Costa de; Furtado, Betise Mery Alencar Sousa Macau; Bonfim, Cristine Vieira do

doi:10.1590/0034-7167-2019-0889

Marcos Vinicius de Carvalho Mendes

Universidade Federal de Pernambuco. Recife, Pernambuco, Brazil.

https://orcid.org/0000-0003-2841-9869

Solange Laurentino dos Santos

Universidade Federal de Pernambuco. Recife, Pernambuco, Brazil.

https://orcid.org/0000-0002-6405-3959

Albanita Gomes da Costa de Ceballos

Universidade Federal de Pernambuco. Recife, Pernambuco, Brazil.

https://orcid.org/0000-0002-8658-9981

Betise Mery Alencar Sousa Macau Furtado

Universidade de Pernambuco. Recife, Pernambuco, Brazil.

https://orcid.org/0000-0001-6344-8257

Cristine Vieira do Bonfim

Universidade Federal de Pernambuco. Recife, Pernambuco, Brazil.

https://orcid.org/0000-0002-4495-9673

Corresponding author: Marcos Vinicius de Carvalho Mendes. E-mail: marcosvcmendes@gmail.com

EDITOR IN CHIEF: Dulce Barbosa

ASSOCIATE EDITOR: Marcos Brandão

Databases	Search structure
Scielo	(cancer) OR (neoplasm) AND (suicide) OR (suicídio)
MEDLINE	(("cancer" [Mesh] AND "suicide" [tiab])) AND surgery
LILACS	(mh: neoplasms OR tw: cancer) AND (mh: suicídio* OR tw: suicídio* OR tw: parassuicídio*))
CINAHL	TI (neoplasm* OR cancer*) AND (("suicide")
Scopus	(TITLE (neoplasm* OR cancer)) AND OR (TITLE (suicide)

Author/Year	Country/Type of study/ Sample	Objective	Level of evidence
Oberaigner, Sperner-Unterweger, Fiegl et al. (2014)⁽²⁴24 Oberaigner W, Sperner-Unterweger B, Fiegl M, Geiger-Gritsch S, Haring C. Increased suicide risk in cancer patients in Tyrol/Austria. Gen Hosp Psychiatry. 2014;36(5):483-7. https://doi.org/10.1016/j.genhosppsych.2014.05.017 https://doi.org/10.1016/j.genhosppsych.2... ⁾	Austria/Cohort (n=231)	To investigate the risk of suicide in cancer patients compared to the general population.	2B
Ahn, Lee, Ramsey et al. (2015)⁽¹⁴14 Ahn MH, Park S, Lee HB, Ramsey CM, Na R, Kim SO, et al. Suicide in cancer patients within the first year of diagnosis. Psychooncol. 2015;24(5):601-7. https://doi.org/10.1002/pon.3705 https://doi.org/10.1002/pon.3705... ⁾	South Korea/Case-control (n cases=373/n controls=746)	To determine suicide risk factors in the first year of cancer diagnosis.	3B
Klaassen, Jen, DiBianco et al. (2015)⁽²⁵25 Klaassen Z, Jen RP, DiBianco JM, Reinstatler L, Li Q, Madi R, et al. Factors associated with suicide in patients with genitourinary malignancies. Cancer. 2015;121(11):1864-72. https://doi.org/10.1002/cncr.29274 https://doi.org/10.1002/cncr.29274... ⁾	USA/Cohort (n=794)	To identify factors associated with suicide in patients with genitourinary neoplasms.	2B
Sugawara, Kunieda (2016)⁽²⁶26 Sugawara A, Kunieda E. Suicide in patients with gastric cancer: a population-based study. Jpn J Clin Oncol. 2016;46(9):850-5. https://doi.org/10.1093/jjco/hyw075 https://doi.org/10.1093/jjco/hyw075... ⁾	USA/Cohort (n=23,620)	To identify factors associated with increased risk of suicide in cancer patients.	2B
Jayakrishnan, Sekigami, Rajeev et al. (2017)⁽²⁷27 Jayakrishnan TT, Sekigami Y, Rajeev R, Gamblin TC, Turaga KK. Morbidity of curative cancer surgery and suicide risk. Psychooncol. 2017;26(11):1792-8. https://doi.org/10.1002/pon.4221 https://doi.org/10.1002/pon.4221... ⁾	USA/Cohort (n=631,364)	To analyze the risk of suicide in patients with solid cancer.	2B
Siracuse, Gorgy, Ruskin et al. (2017)⁽²⁸28 Siracuse BL, Gorgy G, Ruskin J, Beebe KS. What is the incidence of suicide in patients with bone and soft tissue cancer? Clin Orthop Relat Res. 2017;475(5):1439-45. https://doi.org/10.1007/s11999-016-5171-y https://doi.org/10.1007/s11999-016-5171-... ⁾	USA/Cohort (n=23,620)	To determine the incidence of suicide in patients with bone and soft tissue cancer.	3B
Samawi, Shaheen, Tang et al. (2017)⁽²⁹29 Samawi HH, Shaheen AA, Tang PA, Heng DYC, Cheung WY, Vickers MM. Risk and predictors of suicide in colorectal cancer patients: a surveillance, epidemiology, and end results analysis. Curr Oncol. 2017;24(6):513-7. https://doi.org/10.3747/co.24.3713 https://doi.org/10.3747/co.24.3713... ⁾	USA/Cohort (n=1,005,825)	To identify predictors of suicide in patients with colon cancer vs. rectal cancer.	2B
Zendron, Zequi, Guimarães, Lourenço (2018)⁽³⁰30 Zendron M, Zequi S, Guimarães G, Lourenço M. Assessment of suicidal behavior and factors associated with a diagnosis of prostate cancer. Clinics. 2018;73(9):1-4. https://doi.org/10.6061/clinics/2018/e441 https://doi.org/10.6061/clinics/2018/e44... ⁾	Brasil/Cohort (n=144)	To determine the risk of suicide in patients diagnosed with prostate cancer.	2B
Klaassen, Goldberg, Chandrasekar et al. (2018)⁽³¹31 Klaassen Z, Goldberg H, Chandrasekar T, Arora K, Sayyid RK, Hamilton RJ, et al. Changing trends for suicidal death in patients with bladder cancer: a 40+ year population-level analysis. Clin Genitourin Cancer. 2018;16(3):206-12. https://doi.org/10.1016/j.clgc.2017.12.016 https://doi.org/10.1016/j.clgc.2017.12.0... ⁾	USA/Cohort (n=915,303)	To characterize patients at risk of suicide after bladder cancer diagnosis.	2B
Gaitanidis, Alevizakos, Pitiakoudis et al. (2018)⁽³²32 Gaitanidis A, Alevizakos M, Pitiakoudis M, Wiggins D. Trends in incidence and associated risk factors of suicide mortality among breast cancer patients. Psychooncol. 2018;27(5):1450-6. https://doi.org/10.1002/pon.4570 https://doi.org/10.1002/pon.4570... ⁾	USA/Cohort (n=19,409)	To identify relevant risk factors among breast cancer patients.	2B
Wash, Talukder, Lawson et al. (2018)⁽³³33 Walsh NJ, Talukder AM, Lawson AG, Komic AX, Bateson BP, Jones AJ, et al. Thyroid malignancy and suicide risk: an analysis of epidemiologic and clinical factors. World J Endocr Surg. 2018;10(2):99-102. https://doi.org/10.5005/jp-journals-10002-1227 https://doi.org/10.5005/jp-journals-1000... ⁾	USA/Cohort (n=168,339)	To examine the associated factors in patients with thyroid cancer.	2B
Zhou, Xian, Zhang et al. (2018)⁽³⁴34 Zhou H, Xian W, Zhang Y, Chen G, Zhao S, Chen X, et al. Trends in incidence and associated risk factors of suicide mortality in patients with non-small cell lung cancer. Cancer Med. 2018;7(8):4146-55. https://doi.org/10.1002/cam4.1656 https://doi.org/10.1002/cam4.1656... ⁾	USA/Cohort (n=5,440)	To estimate suicide rate trend in patients with lung cancer.	2B
Yang, He, Chen et al. (2019)⁽³⁵35 Yang J, He G, Chen S, Pan Z, Zhang J, Li Y, et al. Incidence and risk factors for suicide death in male patients with genital-system cancer in the United States. Eur J Surg Oncol. 2019;45(10):1969-76. https://doi.org/10.1016/j.ejso.2019.03.022 https://doi.org/10.1016/j.ejso.2019.03.0... ⁾	USA/Cohort (n=90,911)	To identify risk factors for suicide death in male patients with cancer of the genital system.	2B
Guo, Zheng, Zhu et al. (2019)⁽³⁶36 Guo C, Zheng W, Zhu W, Yu S, Ding Y, Wu Q, et al. Risk factors associated with suicide among kidney cancer patients: a surveillance, epidemiology, and end results analysis. Cancer Med. 2019;8(11):5386-96. https://doi.org/10.1002/cam4.2400 https://doi.org/10.1002/cam4.2400... ⁾	USA/Cohort (n=171,819)	To identify the possible risk factors associated with suicide in kidney cancer.	2B
Zaorsky, Zhang, Tuanquin et al. (2019)⁽³⁷37 Zaorsky NG, Zhang Y, Tuanquin L, Bluethmann SM, Park HS, Chinchilli VM. Suicide among cancer patients. Nat Commun. 2019;10(1):207. https://doi.org/10.1038/s41467-018-08170-1 https://doi.org/10.1038/s41467-018-08170... ⁾	USA/Cohort (n=856,293)	To identify cancer patients at higher risk for suicide compared to the general population.	2B
Saad, Gad, Al-Husseini et al. (2019)⁽³⁸38 Saad AM, Gad MM, Al-Husseini MJ, AlKhayat MA, Rachid A, Alfaar AS, et al. Suicidal death within a year of a cancer diagnosis: a population-based study. Cancer. 2019;125(6):972-9. https://doi.org/10.1002/cncr.31876 https://doi.org/10.1002/cncr.31876... ⁾	USA/Cohort (n=4,671,989)	To examine the risk of suicide within a year after a cancer diagnosis.	2B
Dulsas, Patasius, Kaceniene et al. (2019)⁽³⁹39 Dulskas A, Patasius A, Kaceniene A, Urbonas V, Smailyte G. Suicide risk among colorectal cancer patients in Lithuania. Int J Colorectal Dis. 2019;34(3):555-8. https://doi.org/10.1007/s00384-018-03228-4 https://doi.org/10.1007/s00384-018-03228... ⁾	USA/Cohort (n=19,409)	To estimate the risk of suicide among patients with colorectal cancer.	2B
Henson, Brock, Charnock et al. (2019)⁽⁴⁰40 Henson KE, Brock R, Charnock J, Wickramasinghe B, Will O, Pitman A. risk of suicide after cancer diagnosis in England. JAMA Psychiatr. 2019;76(1):51-60. https://doi.org/10.1001/jamapsychiatry.2018.3181 https://doi.org/10.1001/jamapsychiatry.2... ⁾	England/Cohort (n=4,722,099)	To quantify the risk of suicide in cancer patients.	2B

Reference	Study cancer type	Outcome
²⁴24 Oberaigner W, Sperner-Unterweger B, Fiegl M, Geiger-Gritsch S, Haring C. Increased suicide risk in cancer patients in Tyrol/Austria. Gen Hosp Psychiatry. 2014;36(5):483-7. https://doi.org/10.1016/j.genhosppsych.2014.05.017 https://doi.org/10.1016/j.genhosppsych.2...	All cancers	1. All cancers, except non-melanoma skin cancers, were a risk factor for suicide. 2. Depression and advanced stage of cancer was associated with increased risk of suicide. 3. Suicide was higher during the first six months after diagnosis.
¹⁴14 Ahn MH, Park S, Lee HB, Ramsey CM, Na R, Kim SO, et al. Suicide in cancer patients within the first year of diagnosis. Psychooncol. 2015;24(5):601-7. https://doi.org/10.1002/pon.3705 https://doi.org/10.1002/pon.3705...	All cancers	1. Biliary pancreatic cancer, lung cancer and stomach cancer have more risk of suicide than other types of cancer. 2. Metastatic stage was more frequent associated with suicide risk in the first year of diagnosis.
²⁵25 Klaassen Z, Jen RP, DiBianco JM, Reinstatler L, Li Q, Madi R, et al. Factors associated with suicide in patients with genitourinary malignancies. Cancer. 2015;121(11):1864-72. https://doi.org/10.1002/cncr.29274 https://doi.org/10.1002/cncr.29274...	Male genitourinary cancers: prostate, bladder, kidney, testis and penis	1. The genitourinary cancers studied had a significantly statistical risk for suicide. 2.Males, over 60 years old, single, white, metastatic disease and non-committing to surgery were risk factors for suicide. 3. Pain, penis mutilation and erectile dysfunction were risk factors for suicide in individuals with cancer.
²⁶26 Sugawara A, Kunieda E. Suicide in patients with gastric cancer: a population-based study. Jpn J Clin Oncol. 2016;46(9):850-5. https://doi.org/10.1093/jjco/hyw075 https://doi.org/10.1093/jjco/hyw075...	Stomach cancer	1. Individuals with stomach cancer have a four-fold higher risk of suicide compared to the general population. 2. The risk of suicide is higher in the first three months after diagnosis. 3. Male, white, single and metastatic disease are significantly associated with increased risk of suicide.
²⁷27 Jayakrishnan TT, Sekigami Y, Rajeev R, Gamblin TC, Turaga KK. Morbidity of curative cancer surgery and suicide risk. Psychooncol. 2017;26(11):1792-8. https://doi.org/10.1002/pon.4221 https://doi.org/10.1002/pon.4221...	All cancers except leukemia	1. Individuals undergoing advanced stage cancer surgery, males and age older than 65 years were factors significantly associated with suicide risk. 2. The time of greatest involvement of suicide was in the first month.
²⁸28 Siracuse BL, Gorgy G, Ruskin J, Beebe KS. What is the incidence of suicide in patients with bone and soft tissue cancer? Clin Orthop Relat Res. 2017;475(5):1439-45. https://doi.org/10.1007/s11999-016-5171-y https://doi.org/10.1007/s11999-016-5171-...	Soft tissue sarcoma	1. Bone and soft tissue cancer are associated with suicide risk, especially those of the spine and pelvic bones. 2. Males, white and older than 60 years were risk factors for suicide. 3. The risk of suicide was present in the first five years of diagnosis and mutilation and loss of functionality increased the risk for suicide.
²⁹29 Samawi HH, Shaheen AA, Tang PA, Heng DYC, Cheung WY, Vickers MM. Risk and predictors of suicide in colorectal cancer patients: a surveillance, epidemiology, and end results analysis. Curr Oncol. 2017;24(6):513-7. https://doi.org/10.3747/co.24.3713 https://doi.org/10.3747/co.24.3713...	Colorectal cancer	1. Colon cancer is a risk factor for suicide. 2. Males, older than 60 years, white, metastatic disease and not having undergone surgical procedure were predictors of suicide.
³⁰30 Zendron M, Zequi S, Guimarães G, Lourenço M. Assessment of suicidal behavior and factors associated with a diagnosis of prostate cancer. Clinics. 2018;73(9):1-4. https://doi.org/10.6061/clinics/2018/e441 https://doi.org/10.6061/clinics/2018/e44...	Prostrate cancer	1. Prostate cancer was a suicide risk factor. 2. The risk of suicide was associated with anxiety, depression, singles and living alone.
³¹31 Klaassen Z, Goldberg H, Chandrasekar T, Arora K, Sayyid RK, Hamilton RJ, et al. Changing trends for suicidal death in patients with bladder cancer: a 40+ year population-level analysis. Clin Genitourin Cancer. 2018;16(3):206-12. https://doi.org/10.1016/j.clgc.2017.12.016 https://doi.org/10.1016/j.clgc.2017.12.0...	Bladder cancer	1. Bladder cancer was a risk factor for suicide. 2. Males, white, single, older than 60 years, non-metastatic disease and not submitted to surgical procedure were risk factors for suicide.
³²32 Gaitanidis A, Alevizakos M, Pitiakoudis M, Wiggins D. Trends in incidence and associated risk factors of suicide mortality among breast cancer patients. Psychooncol. 2018;27(5):1450-6. https://doi.org/10.1002/pon.4570 https://doi.org/10.1002/pon.4570...	Breast cancer	1. Breast cancer was a risk factor for suicide. 2. Males, age under 60 years, white and black and single were risk factors for suicide. 3. Until the second year after cancer diagnosis, there was a significant association with suicide.
³³33 Walsh NJ, Talukder AM, Lawson AG, Komic AX, Bateson BP, Jones AJ, et al. Thyroid malignancy and suicide risk: an analysis of epidemiologic and clinical factors. World J Endocr Surg. 2018;10(2):99-102. https://doi.org/10.5005/jp-journals-10002-1227 https://doi.org/10.5005/jp-journals-1000...	Thyroid cancer	1. Males and white were risk factors for suicide in thyroid cancer.
³⁴34 Zhou H, Xian W, Zhang Y, Chen G, Zhao S, Chen X, et al. Trends in incidence and associated risk factors of suicide mortality in patients with non-small cell lung cancer. Cancer Med. 2018;7(8):4146-55. https://doi.org/10.1002/cam4.1656 https://doi.org/10.1002/cam4.1656...	Lung cancer	1. Individuals with lung cancer are at risk for suicide. 2. Males, white, single and age over 60 years were risk factors for suicide.
³⁵35 Yang J, He G, Chen S, Pan Z, Zhang J, Li Y, et al. Incidence and risk factors for suicide death in male patients with genital-system cancer in the United States. Eur J Surg Oncol. 2019;45(10):1969-76. https://doi.org/10.1016/j.ejso.2019.03.022 https://doi.org/10.1016/j.ejso.2019.03.0...	All cancers for males	1. Cancer diagnosis is associated with increased risk of suicide. 2. Over 60 years of age, single, white and not having undergone surgical procedure were a risk for suicide. 3.The first year after diagnosis has an increased risk of suicide.
³⁶36 Guo C, Zheng W, Zhu W, Yu S, Ding Y, Wu Q, et al. Risk factors associated with suicide among kidney cancer patients: a surveillance, epidemiology, and end results analysis. Cancer Med. 2019;8(11):5386-96. https://doi.org/10.1002/cam4.2400 https://doi.org/10.1002/cam4.2400...	Kidney cancer	1. Kidney cancer was a risk factor for suicide. 2. Male, single, white color, advanced disease and not having surgery were risk factors for suicide. 3. Pain increased risk of suicide in individuals with kidney cancer.
³⁷37 Zaorsky NG, Zhang Y, Tuanquin L, Bluethmann SM, Park HS, Chinchilli VM. Suicide among cancer patients. Nat Commun. 2019;10(1):207. https://doi.org/10.1038/s41467-018-08170-1 https://doi.org/10.1038/s41467-018-08170...	All cancers	1. Lung, head and neck, testicle, bladder, and lymphoma cancers were at higher risk for suicide compared to other cancers. 2. Males, white, age over 60 years and local disease were risk factors for suicide.
³⁸38 Saad AM, Gad MM, Al-Husseini MJ, AlKhayat MA, Rachid A, Alfaar AS, et al. Suicidal death within a year of a cancer diagnosis: a population-based study. Cancer. 2019;125(6):972-9. https://doi.org/10.1002/cncr.31876 https://doi.org/10.1002/cncr.31876...	All cancers	1. Pancreatic, lung and colorectal cancer presented a higher risk for suicide. 2. The first year after diagnosis was at higher risk for suicide.
³⁹39 Dulskas A, Patasius A, Kaceniene A, Urbonas V, Smailyte G. Suicide risk among colorectal cancer patients in Lithuania. Int J Colorectal Dis. 2019;34(3):555-8. https://doi.org/10.1007/s00384-018-03228-4 https://doi.org/10.1007/s00384-018-03228...	Colorectal cancer	1. Colorectal cancer was a risk factor for suicide. 2. Females, age older than 60 years and advanced stage of cancer were risk factors for suicide. 3. Colostomy increased the risk of suicide in individuals with colorectal cancer.
⁴⁰40 Henson KE, Brock R, Charnock J, Wickramasinghe B, Will O, Pitman A. risk of suicide after cancer diagnosis in England. JAMA Psychiatr. 2019;76(1):51-60. https://doi.org/10.1001/jamapsychiatry.2018.3181 https://doi.org/10.1001/jamapsychiatry.2...	All cancers	1. Cancer diagnosis carries a risk of psychological distress. 2. Individuals with mesothelioma have a higher risk compared to other cancers for suicide. 3. Pancreatic, esophagus, lung and stomach cancer posed a risk to suicide. 4. The first six months after diagnosis presented a higher risk for suicide.

[1] Corresponding author: Marcos Vinicius de Carvalho Mendes. E-mail: marcosvcmendes@gmail.com

Brasil

Brasil

Risk factors for suicide in individuals with cancer: an integrative literature review

Factores de riesgo de suicidio en individuos con cáncer: una revisión integradora de la literatura

ABSTRACT

Objective:

Method:

Results:

Conclusion: