Zachary Klaassen1, Hanan Goldberg2, Thenappan Chandrasekar2, Karan Arora3, Rashid K Sayyid2, Robert J Hamilton2, Neil E Fleshner2, Stephen B Williams4, Christopher J D Wallis2, Girish S Kulkarni5. 1. Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: zklaassen19@gmail.com. 2. Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 3. St George's University School of Medicine, St George's, Grenada, West Indies. 4. Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX. 5. Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Previous studies suggest that patients with bladder cancer (BCa) are at increased risk of suicide compared with the general population. The objective of this study is to improve our understanding of patients at high risk for suicidal death and to better characterize patients at risk of delayed suicide years after diagnosis. PATIENTS AND METHODS: Patients with bladder urothelial carcinoma were identified between 1973 and 2013 using the Surveillance, Epidemiology, and End Results (SEER) database (n = 333,679). Competing risks models were performed to generate hazard ratios (HRs) to identify variables associated with suicidal death. Among patients dying of suicide, logistic regression modelling was used to generate odds ratios (ORs) for factors associated with suicide > 36 months after diagnosis. RESULTS: There were 794 patients (0.24%) that died of suicide, 190,734 patients (57.2%) that died from other causes, and 142,151 patients (42.6%) that were alive. Significant factors associated with suicide included diagnosis between 1973 and 1983 (HR, 2.22), unmarried (HR, 1.74), white race (HR, 2.22), male (HR, 6.91), regional disease (HR, 2.49), living in the Southeast United States (HR, 2.43), and not undergoing a radical cystectomy (HR, 1.42). Older age was associated with suicide, whereas younger age was protective. No radical cystectomy (OR, 0.45), older age (OR, 0.32), unmarried status (OR, 0.65), and regional disease (OR, 0.19) were significantly associated with decreased odds of suicidal death > 36 months after diagnosis. CONCLUSIONS: Those at highest risk for suicidal death include male gender, the elderly, white, unmarried, and patients with nonlocalized disease. These patients may benefit from targeted survivorship care plans.
BACKGROUND: Previous studies suggest that patients with bladder cancer (BCa) are at increased risk of suicide compared with the general population. The objective of this study is to improve our understanding of patients at high risk for suicidal death and to better characterize patients at risk of delayed suicide years after diagnosis. PATIENTS AND METHODS: Patients with bladder urothelial carcinoma were identified between 1973 and 2013 using the Surveillance, Epidemiology, and End Results (SEER) database (n = 333,679). Competing risks models were performed to generate hazard ratios (HRs) to identify variables associated with suicidal death. Among patients dying of suicide, logistic regression modelling was used to generate odds ratios (ORs) for factors associated with suicide > 36 months after diagnosis. RESULTS: There were 794 patients (0.24%) that died of suicide, 190,734 patients (57.2%) that died from other causes, and 142,151 patients (42.6%) that were alive. Significant factors associated with suicide included diagnosis between 1973 and 1983 (HR, 2.22), unmarried (HR, 1.74), white race (HR, 2.22), male (HR, 6.91), regional disease (HR, 2.49), living in the Southeast United States (HR, 2.43), and not undergoing a radical cystectomy (HR, 1.42). Older age was associated with suicide, whereas younger age was protective. No radical cystectomy (OR, 0.45), older age (OR, 0.32), unmarried status (OR, 0.65), and regional disease (OR, 0.19) were significantly associated with decreased odds of suicidal death > 36 months after diagnosis. CONCLUSIONS: Those at highest risk for suicidal death include male gender, the elderly, white, unmarried, and patients with nonlocalized disease. These patients may benefit from targeted survivorship care plans.
Authors: Christopher W Noel; Yue Jennifer Du; Elif Baran; David Forner; Zain Husain; Kevin M Higgins; Irene Karam; Kelvin K W Chan; Julie Hallet; Frances Wright; Natalie G Coburn; Antoine Eskander; Lesley Gotlib Conn Journal: JAMA Otolaryngol Head Neck Surg Date: 2022-04-01 Impact factor: 8.961
Authors: Rashid K Sayyid; Christopher J D Wallis; Kyle Dymanus; Usama Jazzar; Hanan Goldberg; Stephen B Williams; Zachary Klaassen Journal: Ann Transl Med Date: 2020-03
Authors: Christopher W Noel; Antoine Eskander; Rinku Sutradhar; Alyson Mahar; Simone N Vigod; Elie Isenberg-Grzeda; James Bolton; Julie Deleemans; Wing C Chan; Ravleen Vasdev; Victoria Zuk; Barbara Haas; Stephanie Mason; Natalie G Coburn; Julie Hallet Journal: JAMA Netw Open Date: 2021-09-01