Suicide and accidental deaths among patients with loco-regional prostate cancer

Résumé

textbfINTRODUCTION: Patients with cancer are at increased risk of suicide. Further, evidence suggests a relationship between suicides and deaths due to accidents and externally caused injuries. We sought to determine if American men with prostate cancer (PCa) are at increased risk of suicide/accidental death compared to other cancers, and if the receipt of definitive treatment alters this association. textbfMATERIAL & METHODS: Demographic, socio-economic and tumor characteristics of men with PCa and men with other solid malignancies were extracted from the Surveillance, Epidemiology and End Results (1988-2010). Poisson regression models were fitted to compare the incidence of suicidal and accidental deaths in PCa vs. other solid cancers. Multivariate Cox regression was used to determine if receipt of definitive primary treatment impacted the risk of suicide or accidental death in men with localized/regional PCa. textbfRESULTS: Risk of suicidal and accidental death was significantly lower in men with PCa [1165 (0.2%) and 3,199 (0.6%)] than men with other cancers [2,232 (0.2%) and 4,501 (0.5%) respectively], except within the first year of diagnosis (adjusted relative risk [ARR]=3.98 [95%CI 3.02-5.23] and ARR=4.22 [95%CI 3.24-5.51] respectively, 0-3 months after diagnosis). Men with non-metastatic PCa who were white, uninsured, or recommended but did not receive treatment (HR vs. treated=1.44, 95% CI 1.20-1.72, and 1.44, 95% CI 1.30-1.59, both ptextless0.001) were at increased risk of suicidal and accidental mortality, respectively. Absence of data regarding previous co-morbidities and drug addictions in the SEER dataset was an important limitation. textbfCONCLUSIONS: Relative to other cancers, men with PCa were at increased risk of suicide and accidental deaths within the first year of diagnosis and when definitive treatment was recommended but not received, suggesting the need for close monitoring and coordination with mental health professionals in at-risk men with potentially curable disease. ÉTATS-UNIS HOMME SUICIDE-COMPLÉTÉ CANCER MORTALITÉ ACCIDENT