@article{ref1,
title="Morbidity of curative cancer surgery and suicide risk",
journal="Psycho-oncology",
year="2017",
author="Jayakrishnan, Thejus T. and Sekigami, Yurie and Rajeev, Rahul and Gamblin, T. Clark and Turaga, Kiran K.",
volume="26",
number="11",
pages="1792-1798",
abstract="IMPORTANCE: Curative cancer operations lead to debility and loss of autonomy in a population vulnerable to suicide death. The extent to which operative intervention impacts suicide risk is not well-studied. <br><br>OBJECTIVE: To examine the effects of morbidity of curative cancer surgeries and prognosis of disease on the risk of suicide in patients with solid tumors. <br><br>DESIGN: Retrospective cohort study using Surveillance, Epidemiology and End Results data from 2004 - 2011; Multi-level Systematic Review. SETTING: General U.S. PARTICIPANTS: 482,781 patients diagnosed with malignant neoplasm diagnosed between 2004-2011 who underwent curative cancer surgeries. MAIN OUTCOMES AND MEASURES: Death by suicide or self-inflicted injury. <br><br>RESULTS: Among 482,781 patients that underwent curative cancer surgery, 231 committed suicide (16.58/100 000 person-years [95% CI, 14.54-18.82]). Factors significantly associated with suicide risk included male-sex (incidence rate [IR]-27.62; 95% CI,23.82-31.86) and age >65 years (IR-22.54; 95% CI,18.84-26.76). When stratified by 30-day overall post-operative morbidity, a significantly higher incidence of suicide was found for high morbidity surgeries (IR, 33.30; 95% CI, 26.50-41.33) vs. moderate morbidity (IR, 24.27; 95% CI, 18.92-30.69) and low morbidity (IR, 9.81; 95% CI, 7.90-12.04). Unit increase in morbidity was significantly associated with death by suicide (Odds Ratio [OR], 1.01; 95% CI, 1.00-1.03; P = .02) and decreased suicide specific survival (Hazards Ratio [HR], 1.02; 95% CI 1.00-1.03, P = .01) in prognosis adjusted models. <br><br>CONCLUSIONS: In this sample of cancer patients in the SEER database, patients that undergo high-morbidity surgeries appear most vulnerable to death by suicide. The identification of this high-risk cohort should motivate healthcare providers and particularly surgeons to adopt screening measures during the post-operative follow-up period for these patients.<br><br>This article is protected by copyright. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1057-9249",
doi="10.1002/pon.4221",
url="http://dx.doi.org/10.1002/pon.4221"
}