Cancer patients’ refusal of recommended surgery increases risk of suicide

There is an increased rate of suicide attempts among cancer patients who have not undergone recommended surgery, according to a study published September 3 in the journal JAMA Network Open.

Michael L. Chen from Stanford University in California and colleagues used a database of 17 Surveillance, Epidemiology and End Results Program Registries (for the period 2000-2020) to examine whether any specific treatments for malignant neoplasms were associated with suicide mortality. The analysis included 5.16 million patients with a first-time diagnosis of primary cancer.

The researchers found that 0.1 percent of patients committed suicide. Among patients who had not undergone surgery, suicide mortality was highest for cancers of the pancreas, esophagus, lung, or bronchus and stomach.

Standardized mortality rates varied by surgical status, but there was a higher incidence of suicide among patients who refused surgical treatment.

For all stages of cancer, the highest suicide mortality rate was observed among patients who did not undergo surgery but for whom surgery was strongly recommended. Patients with pancreatic cancer had a suicide rate 331 percent higher than in the general population, but this rate varied by treatment modality: patients who did not receive surgical treatment even if surgery was strongly recommended had a 1,011 percent increased risk of suicide.

The observed trend was independent of cancer stage, race, ethnicity, age, and gender, but was significantly related to surgical status.

It is worth noting that no relationship was observed between undergoing radiation or chemotherapy and suicide mortality.

“Even in the group of patients with advanced cancer, suicide mortality was significantly lower among those who underwent surgery, suggesting that differences cannot be explained solely by disease stage or types of treatment administered,” the authors wrote.

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Published: 08.09.2024

Updated: 14.10.2024

Medical author, Medical editor:

Stepan Yuk

Medical expert:

PhD. Olexandr Voznyak