[癌症患者的自杀死亡率]

[Suicide mortality among cancer patients].

作者信息

Crocetti Emanuele, Buzzoni Carlotta, Caldarella Adele, Intrieri Teresa, Manneschi Gianfranco, Sacchettini Claudio, Paci Eugenio, Miccinesi Guido

机构信息

Istituto per lo studio e la prevenzione oncologica (ISPO), Firenze, Italy.

出版信息

Epidemiol Prev. 2012 Mar-Apr;36(2):83-7.

PMID:22706357

Abstract

OBJECTIVE

to evaluate the excess risk in the deaths due to suicide in a huge case-series of cancer patients and in particular in a group with recent diagnosis.

DESIGN

observational cohort.

SETTING AND PARTICIPANTS

population-based study based on 136,105 patients of the cancer registry of Tuscany Region, incident during 1985-2005, 42,321 of whom diagnosed during 2000-2005.

MAIN OUTCOME MEASURES

standardised mortality ratio (SMR) of suicide by sex, age, prognosis, time since diagnosis and period of incidence.

RESULTS

deaths due to suicide were 0.2% of all the deaths observed in the cohort of patients. Overall cases, 1985-2005, showed a SMR of 1.47 (p<0.05), it was higher than expected for men (SMR =1.50), for subjects older that 54 years, especially for cancers with poor prognosis (SMR=2.27), particularly during the first year after diagnosis (SMR=2.87) but also in the following years. Cases diagnosed in 2000-2005 had a SMR=1.19 (n.s.), confirmed the high risk for the age 55-64 years (SMR=2.27), for cancers with worse prognosis (SMR=3.23) and during the first year after diagnosis (SMR=2.64). Trend analysis showed that the excess in the risk of suicide death among cancer patients decreased over time (p=0.042).

CONCLUSION

although suicide is not one of the major cause of death among cancer patients, we confirmed that those patients had a higher risk than the general population. SMR higher than expected were documented for the age 55-64 years, for cancers with poor prognosis and during the first year after diagnosis. Trend analysis shows that excess in the risk of suicide death among cancer patients is decreasing over time. This may be due, among other possible explanations, to the relevant development of the palliative care system in the area based both on hospices and on home care. Although suicide deaths are rather rare, their prevention among cancer patients is still a priority, due to its likely depressive etiology and to the effects on the family and on the health system.

摘要

目的

评估在大量癌症患者病例系列中，尤其是近期确诊的患者群体中，自杀死亡的额外风险。

设计

观察性队列研究。

设置与参与者

基于托斯卡纳地区癌症登记处的136,105名患者开展的基于人群的研究，这些患者于1985年至2005年发病，其中42,321名在2000年至2005年期间确诊。

主要观察指标

按性别、年龄、预后、确诊时间和发病时期划分的自杀标准化死亡比（SMR）。

结果

自杀死亡占该患者队列中所有观察到的死亡人数的0.2%。总体病例（1985 - 2005年）的SMR为1.47（p<0.05），男性（SMR = 1.50）、54岁以上的受试者、尤其是预后较差的癌症患者（SMR = 2.27）的SMR高于预期，特别是在确诊后的第一年（SMR = 2.87），但在随后几年也是如此。2000 - 2005年确诊的病例SMR = 1.19（无统计学意义），证实了55 - 64岁年龄段（SMR = 2.27）、预后较差的癌症患者（SMR = 3.23）以及确诊后第一年（SMR = 2.64）的高风险。趋势分析表明，癌症患者自杀死亡风险的额外增加随时间下降（p = 0.042）。

结论

尽管自杀并非癌症患者的主要死因之一，但我们证实这些患者的风险高于一般人群。记录显示，55 - 64岁年龄段、预后较差的癌症患者以及确诊后第一年的SMR高于预期。趋势分析表明，癌症患者自杀死亡风险的额外增加随时间下降。这可能是由于该地区基于临终关怀和家庭护理的姑息治疗系统的相关发展等多种可能原因。尽管自杀死亡相当罕见，但由于其可能的抑郁病因以及对家庭和卫生系统的影响，在癌症患者中预防自杀仍然是一个优先事项。