Supportive Care in Cancer

, Volume 27, Issue 2, pp 617–621 | Cite as

Clinical and epidemiological factors associated with suicide in colorectal cancer

  • Thuy T. Pham
  • Asif M. Talukder
  • Nathaniel J. Walsh
  • Andrew G. Lawson
  • Andrew J. Jones
  • Jessica L. BishopEmail author
  • Edward J. Kruse
Original Article



While increased suicidal tendencies among cancer patients have been well documented, this study aims to examine suicide rates and factors associated with suicide specifically in patients with colorectal cancer (CRC).


Patients diagnosed with CRC between the years of 1988–2010 were selected from the Surveillance, Epidemiology, and End Result (SEER) database. Comparisons with the general population were done using the National Center for Disease Control registry.


One thousand three hundred eighty-one suicides among 884,529 patients were identified, with a standardized mortality ratio (SMR) of 1.53 (95% CI, 1.13–1.33) compared to the general population. No statistically significant difference in suicide rate was found with respect to age, marital status, socio-economic status, surgical intervention, histologic subtype, or stage at diagnosis. Within the CRC population, Whites were significantly more likely to commit suicide than non-Whites (OR, 2.28; 95% CI, 1.89–2.75; P < 0.001), and males were significantly more likely than females (OR, 5.635; 95% CI, 4.85–6.54; P < 0.001). Most suicides occurred in patients with distal lesions in the sigmoid/rectosigmoid junction (P < 0.001). SMRs for CRC patients were 4.24 for females (95% CI, 3.69–4.86), 1.35 for males (95% CI, 1.28–1.43), 0.38 for African-Americans (95% CI, 0.28–0.52), 1.77 for Whites (95% CI, 1.68–1.87), and 0.90 for other races (95% CI, 0.72–1.12).


Identification of risk factors associated with suicide among patients with CRC is an important step in developing screening strategies and management of psychosocial stressors. These results could be helpful in formulating a comprehensive suicide risk scoring system for screening all cancer patients.


Colorectal cancer Colon cancer Rectal cancer SEER database Suicide risk 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Siegel RL et al (2017) Colorectal cancer statistics, 2017. CA Cancer J Clin 67:177–193. CrossRefPubMedGoogle Scholar
  2. 2.
    American Cancer Society (2014) Cancer facts & figures 2014. Am Cancer SocGoogle Scholar
  3. 3.
    Turaga KK, Malafa MP, Jacobsen PB, Schell MJ, Sarr MG (2011) Suicide in patients with pancreatic cancer. Cancer 117(3):642–647. CrossRefPubMedGoogle Scholar
  4. 4.
    Greenberg DB (2011) The signal of suicide rates seen from a distance in patients with pancreatic cancer. Cancer 117(3):446–448CrossRefGoogle Scholar
  5. 5.
    Ahn MH, Park S, Lee HB et al (2015) Suicide in cancer patients within the first year of diagnosis. Psycho-Oncology 24(5):601–607CrossRefGoogle Scholar
  6. 6.
    Johnson TV, Garlow SJ, Brawley OW, Master VA (2012) Peak window of suicides occurs within the first month of diagnosis: implications for clinical oncology. Psycho-Oncology 21(4):351–356CrossRefGoogle Scholar
  7. 7.
    Vyssoki B, Gleiss A, Rockett IRH et al (2015) Suicide among 915,303 Austrian cancer patients: who is at risk? J Affect Disord 175:287–291CrossRefGoogle Scholar
  8. 8.
    de la Grandmaison GL, Watier L, Cavard S, Charlier P (2014) Are suicide rates higher in the cancer population? An investigation using forensic autopsy data. Med Hypotheses 82(1):16–19CrossRefGoogle Scholar
  9. 9.
    Smailyte G, Jasilionis D, Kaceniene A, Krilaviciute A, Ambrozaitiene D, Stankuniene V (2013) Suicides among cancer patients in Lithuania: a population-based census-linked study. Cancer Epidemiol 37(5):714–718CrossRefGoogle Scholar
  10. 10.
    Yamauchi T, Inagaki M, Yonemoto N et al (2014) Death by suicide and other externally caused injuries following a cancer diagnosis: the Japan public health center-based prospective study. Psycho-Oncology 23(9):1034–1041CrossRefGoogle Scholar
  11. 11.
    Misono S, Weiss NS, Fann JR, Redman M, Yueh B (2008) Incidence of suicide in persons with cancer. J Clin Oncol 26(29):4731–4738. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Renee Twombly; Decades after cancer, suicide risk remains high, JNCI: Journal of the National Cancer Institute, Volume 98, Issue 19, 4 October 2006, Pages 1356–1358Google Scholar
  13. 13.
    Klaassen Z, Jen RP, DiBianco JM et al (2015) Factors associated with suicide in patients with genitourinary malignancies. Cancer 121(11):1864–1872CrossRefGoogle Scholar
  14. 14.
    Riblet N, Larson R, Watts BV, Holtzheimer P (2014) Reevaluating the role of antidepressants in cancer-related depression: a systematic review and meta-analysis. Gen Hosp Psychiatry 36(5):466–473CrossRefGoogle Scholar
  15. 15.
    Oberaigner W, Sperner-Unterweger B, Fiegl M, Geiger-Gritsch S, Haring C (2014) Increased suicide risk in cancer patients in Tyrol/Austria. Gen Hosp Psychiatry 36(5):483–487CrossRefGoogle Scholar
  16. 16.
    Cole TB, Bowling JM, Patetta MJ, Blazer DG (2014) Risk factors for suicide among older adults with cancer. Aging Ment Health 18(7):854–860 857pCrossRefGoogle Scholar
  17. 17.
    Panczak R, Spoerri A, Zwahlen M, Bopp M, Gutzwiller F, Egger M (2013) Religion and suicide in patients with mental illness or cancer. Suicide Life Threat Behav 43(2):213–222CrossRefGoogle Scholar
  18. 18.
    Erlangsen A, Stenager E, Conwell Y (2015) Physical diseases as predictors of suicide in older adults: a nationwide, register-based cohort study. Soc Psychiatry Psychiatr Epidemiol 50(9):1427–1439CrossRefGoogle Scholar
  19. 19.
    Surveillance Epidemiology and End Results (SEER) program: public-use data (1988–2010). Bethesda, MD, National Cancer Institute, 2016Google Scholar
  20. 20.
    Surveillance Epidemiology and End Results: mortality–all COD, public-use with state, total US (1988–2010), Surveillance, Epidemiology, and End Results (SEER) Program SEER*Stat Database. Bethesda, MD, National Cancer Institute, 2016Google Scholar
  21. 21.
    U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2014 Incidence and Mortality Web-based report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2017Google Scholar
  22. 22.
    Ury HK, Wiggins AD (1985) Another shortcut method for calculating the confidence interval of a Poisson variable (or of a standardized mortality ratio). Am J Epidemiol 122:197–198CrossRefGoogle Scholar
  23. 23.
    Komic A, Taludker A, Walsh N, Jones A, Lawson A, Bateson B, Kruse EJ (2017) Suicide risk in melanoma: what do we know? Am Surg 83(11):435–437Google Scholar
  24. 24.
    Walsh, NJ, Taludker, AM, Lawson, AG, Komic, AX, Bateson, BP, Jones, A, Kruse, EJ Thyroid malignancy and suicide risk: an analysis of epidemiologic and clinical factors. Accepted for print in: World Journal of Endocrine Surgery. 2018Google Scholar
  25. 25.
    Majumdar SR, Fletcher RH, Evans AT (1999) How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol 94(10):3039–3045CrossRefGoogle Scholar
  26. 26.
    Ravasco P, Monteiro-Grillo I, Vidal PM et al (2004) Cancer: disease and nutrition are key determinates in patients’ quality of life. Support Care Cancer 12:246CrossRefGoogle Scholar
  27. 27.
    Miller M, Azrael D, Hemingway D (2004) The epidemiology of case fatality rates for suicide in the northeast. Ann Emerg Med 43:723–730CrossRefGoogle Scholar
  28. 28.
    Rehse B, Pukrop R (2003) Effects of psychosocial interventions on quality of life in adult cancer patients: meta analysis of 37 published controlled outcome studies. Patient Educ Couns 50:179–186CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryMedical College of GeorgiaAugustaUSA
  2. 2.Medical College of GeorgiaAugustaUSA

Personalised recommendations