Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
Brown School, Washington University in St. Louis, St. Louis, Missouri.
Cancer. 2022 Feb 1;128(3):624-632. doi: 10.1002/cncr.33957. Epub 2021 Oct 25.
Previous studies have described suicidal ideation among survivors of childhood cancer, but small numbers of events limit the understanding of suicide risk. The objectives of this study were to assess whether childhood cancer survivors are at increased risk of suicide in comparison with the general population and to determine risk factors associated with risk in a population-based cohort.
First primary malignancies among individuals aged 0 to 19 years from 1975 to 2016 were identified from Surveillance, Epidemiology, and End Results (SEER) databases. Standardized mortality ratios (SMRs) of suicide were obtained via SEER*Stat software from SEER 9. Fine and Gray proportional hazards models were used to identify suicide-associated factors among childhood cancer patients included in SEER 18.
In all, 96,948 childhood cancer cases and 89 suicides were identified. Across all attained ages, the suicide risk for individuals with a childhood cancer history (11.64 per 100,000 person-years) was similar to the risk for those without a cancer history (SMR, 1.14; 95% confidence interval [CI], 0.91-1.43). However, for survivors alive beyond the age of 28 years (the median age of death by suicide), the suicide risk was significantly elevated (suicides per 100,000 person-years, 22.43; SMR, 1.40; 95% CI, 1.02-1.87). Females (hazard ratio, 0.29; 95% CI, 0.18-0.59; P < .01) had lower risks than males.
These results suggest that long-term childhood cancer survivors may be at increased suicide risk. Male sex is an independent risk factor for suicide. However, the absolute risk of suicide in older survivors is still low at ~1 per 5000 person-years. Future efforts should identify survivorship strategies to mitigate suicide risk.
先前的研究描述了儿童癌症幸存者的自杀意念，但由于事件数量较少，限制了对自杀风险的理解。本研究的目的是评估与普通人群相比，儿童癌症幸存者是否存在更高的自杀风险，并确定基于人群的队列中与风险相关的危险因素。
从监测、流行病学和最终结果（SEER）数据库中确定了 1975 年至 2016 年期间年龄在 0 至 19 岁的个体的首次原发性恶性肿瘤。通过 SEER*Stat 软件从 SEER9 中获得自杀的标准化死亡率比（SMR）。使用 Fine 和 Gray 比例风险模型，在 SEER18 中确定了与儿童癌症患者相关的自杀因素。
共确定了 96948 例儿童癌症病例和 89 例自杀事件。在所有达到的年龄中，有癌症病史的个体（11.64/10 万人年）的自杀风险与无癌症病史的个体（SMR1.14；95%置信区间[CI]，0.91-1.43）相似。然而，对于年龄超过 28 岁（自杀死亡的中位年龄）的幸存者，自杀风险显著升高（每 10 万人年的自杀人数为 22.43；SMR1.40；95%CI，1.02-1.87）。女性（风险比，0.29；95%CI，0.18-0.59；P<.01）的风险低于男性。
这些结果表明，长期的儿童癌症幸存者可能存在更高的自杀风险。男性是自杀的独立危险因素。然而，在年龄较大的幸存者中，自杀的绝对风险仍然很低，约为每 5000 人年 1 例。未来的努力应确定减轻自杀风险的生存策略。
