Suicide and Cardiovascular Death Among Patients With Multiple Primary Cancers in the United States

Abstract

BackgroundPrevious studies have demonstrated that patients with a cancer diagnosis have an elevated risk of suicide and cardiovascular death. However, the effects of the diagnosis of multiple primary cancers (MPCs) on the risk of suicide and cardiovascular death remain unclear. This study aimed to identify the risk of suicide and cardiovascular death among patients with MPCs in the United States.MethodsPatients with a single or MPC(s) between 1975 and 2016 were selected from the Surveillance, Epidemiology, and End Results database in a retrospective cohort study. Mortality rates and standardized mortality ratios (SMRs) of suicides and cardiovascular diseases among patients with MPCs were estimated.ResultsOf the 645,818 patients diagnosed with MPCs included in this analysis, 760 and 36,209 deaths from suicides and cardiovascular diseases were observed, respectively. The suicide and cardiovascular-disease mortality rates were 1.89- (95% CI, 1.76–2.02) and 1.65-times (95% CI, 1.63–1.67), respectively, that of the general population. The cumulative mortality rate from both suicides and cardiovascular diseases among patients with MPCs were significantly higher than those of patients with a single primary cancer (Both p < 0.001). In patients with MPCs diagnosed asynchronously, the cumulative incidence rates of suicides and cardiovascular deaths were higher than those diagnosed synchronously. Among all MPCs, cancers of the pancreas and esophagus had the highest SMRs of suicide (5.98 and 5.67, respectively), while acute myeloid leukemia and brain cancer had the highest SMRs of cardiovascular diseases (3.87 and 3.62, respectively). The SMR of suicide was highest within 1 year after diagnosis, while that of cardiovascular diseases was highest 5 years after diagnosis.ConclusionsThis study showed that the mortality rates from suicides and cardiovascular diseases among patients with MPCs were higher than those with a single primary cancer. Therefore, our results underscore the need for psychological assessment and targeted preventive interventions for suicides and cardiovascular diseases among patients with MPCs.

Suicide among Cancer Patients: Current Knowledge and Directions for Observational Research

“…Regarding geography, Su, et al showed that cancer patients living in urban areas were at a lower risk of suicide as compared to their rural counterparts [39]. Suk, et al similarly found that while patients diagnosed with cancer were at an elevated risk of suicide regardless of their urban or rural status, cancer patients living in rural areas had a larger increase in their risk of suicide than patients living in urban areas [8].…”

Trends in the incidence and survival of cancer in individuals aged 55 years and older in the United States, 1975–2019

“…However, based on the conclusion of our analysis, the incidence of multiple primary cancers should be similar to that of single primary cancer. First, the incidence of multiple primary cancer is much lower than that of single primary cancer [ 59 ]. Moreover, the main factors affecting the incidence are early screening and prevention of cancer in society overall.…”

Recommendations for broadening eligibility criteria in esophagus cancer clinical trials: the mortality disparity of esophagus cancer as a first or second primary malignancy

“…Substantial evidence has demonstrated that risks for cardiovascular mortality ( 34 ), suicide ( 35 - 37 ) and mental health disorders ( 38 ) increase sharply after an initial malignancy diagnosis. Su et al conducted a study which revealed that patients with multiple primary cancers had a higher mortality rate from suicides compared to those with a single primary cancer ( 39 ). The risk of cardiovascular mortality within the first month proceeding a cancer diagnosis is doubled compared to individuals without cancer ( 40 ), underlying the acute and significant impact of stress on the cardiovascular health induced by such a diagnosis.…”