Factors associated with suicide in patients with genitourinary malignancies

Zachary Klaassen, Rita P. Jen, John M. Dibianco, Lael Reinstatler, Qiang Li, Rabii Madi, Ronald W. Lewis, Arthur M. Smith, Durwood E. Neal, Kelvin A. Moses, Martha K. Terris

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

BACKGROUND Approximately 70% of all suicides in patients aged >60 years are attributed to physical illness, with higher rates noted in patients with cancer. The purpose of the current study was to characterize suicide rates among patients with genitourinary cancers and identify factors associated with suicide in this specific cohort. METHODS Patients with prostate, bladder, kidney, testis, and penile cancer were identified in the Surveillance, Epidemiology, and End Results database (1988-2010). Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were calculated for each anatomic site. Multivariable logistic regression models generated odds ratios (ORs) for the identification of factors associated with suicide for each malignancy. RESULTS There were 2268 suicides identified among 1,239,522 individuals with genitourinary malignancies observed for 7,307,377 person-years. The SMRs for patients with cancer were 1.37 for prostate cancer (95% CI, 0.99-1.86), 2.71 for bladder cancer (95% CI, 2.02-3.62), 1.86 for kidney cancer (95% CI, 1.32-2.62), 1.23 for testis cancer (95% CI, 0.88-1.73), and 0.95 for penile cancer (95% CI, 0.65-1.35). On multivariable analysis, male sex was found to be associated with odds of suicide among patients with bladder cancer (OR, 6.63) and kidney cancer (OR, 4.98). Increasing age was associated with suicide for patients with prostate, bladder, and testis cancer (OR range, 1.03-1.06). Distant disease was associated with suicide in patients with prostate, bladder, and kidney cancer (OR range, 2.82-5.43). Among patients with prostate, bladder, and kidney cancer, African American patients were less likely to commit suicide compared with white individuals (OR range, 0.26-0.46). CONCLUSIONS Suicide in patients with genitourinary malignancies poses a public health dilemma, especially among men, the elderly, and those with aggressive disease. Clinicians should be aware of risk factors for suicide in these patients.

Original languageEnglish (US)
Pages (from-to)1864-1872
Number of pages9
JournalCancer
Volume121
Issue number11
DOIs
StatePublished - Jun 1 2015

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Suicide
Urinary Bladder Neoplasms
Kidney Neoplasms
Neoplasms
Odds Ratio
Confidence Intervals
Prostatic Neoplasms
Testicular Neoplasms
Penile Neoplasms
Logistic Models
Urogenital Neoplasms
Mortality
African Americans
Epidemiology
Public Health
Databases

Keywords

  • Surveillance, Epidemiology, and End Results (SEER)
  • bladder cancer
  • genitourinary malignancies
  • kidney cancer
  • marital status
  • penile cancer
  • prostate cancer
  • race
  • suicide
  • testis cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Factors associated with suicide in patients with genitourinary malignancies. / Klaassen, Zachary; Jen, Rita P.; Dibianco, John M.; Reinstatler, Lael; Li, Qiang; Madi, Rabii; Lewis, Ronald W.; Smith, Arthur M.; Neal, Durwood E.; Moses, Kelvin A.; Terris, Martha K.

In: Cancer, Vol. 121, No. 11, 01.06.2015, p. 1864-1872.

Research output: Contribution to journalArticle

Klaassen, Z, Jen, RP, Dibianco, JM, Reinstatler, L, Li, Q, Madi, R, Lewis, RW, Smith, AM, Neal, DE, Moses, KA & Terris, MK 2015, 'Factors associated with suicide in patients with genitourinary malignancies', Cancer, vol. 121, no. 11, pp. 1864-1872. https://doi.org/10.1002/cncr.29274
Klaassen, Zachary ; Jen, Rita P. ; Dibianco, John M. ; Reinstatler, Lael ; Li, Qiang ; Madi, Rabii ; Lewis, Ronald W. ; Smith, Arthur M. ; Neal, Durwood E. ; Moses, Kelvin A. ; Terris, Martha K. / Factors associated with suicide in patients with genitourinary malignancies. In: Cancer. 2015 ; Vol. 121, No. 11. pp. 1864-1872.
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title = "Factors associated with suicide in patients with genitourinary malignancies",
abstract = "BACKGROUND Approximately 70{\%} of all suicides in patients aged >60 years are attributed to physical illness, with higher rates noted in patients with cancer. The purpose of the current study was to characterize suicide rates among patients with genitourinary cancers and identify factors associated with suicide in this specific cohort. METHODS Patients with prostate, bladder, kidney, testis, and penile cancer were identified in the Surveillance, Epidemiology, and End Results database (1988-2010). Standardized mortality ratios (SMRs) and 95{\%} confidence intervals (95{\%} CIs) were calculated for each anatomic site. Multivariable logistic regression models generated odds ratios (ORs) for the identification of factors associated with suicide for each malignancy. RESULTS There were 2268 suicides identified among 1,239,522 individuals with genitourinary malignancies observed for 7,307,377 person-years. The SMRs for patients with cancer were 1.37 for prostate cancer (95{\%} CI, 0.99-1.86), 2.71 for bladder cancer (95{\%} CI, 2.02-3.62), 1.86 for kidney cancer (95{\%} CI, 1.32-2.62), 1.23 for testis cancer (95{\%} CI, 0.88-1.73), and 0.95 for penile cancer (95{\%} CI, 0.65-1.35). On multivariable analysis, male sex was found to be associated with odds of suicide among patients with bladder cancer (OR, 6.63) and kidney cancer (OR, 4.98). Increasing age was associated with suicide for patients with prostate, bladder, and testis cancer (OR range, 1.03-1.06). Distant disease was associated with suicide in patients with prostate, bladder, and kidney cancer (OR range, 2.82-5.43). Among patients with prostate, bladder, and kidney cancer, African American patients were less likely to commit suicide compared with white individuals (OR range, 0.26-0.46). CONCLUSIONS Suicide in patients with genitourinary malignancies poses a public health dilemma, especially among men, the elderly, and those with aggressive disease. Clinicians should be aware of risk factors for suicide in these patients.",
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T1 - Factors associated with suicide in patients with genitourinary malignancies

AU - Klaassen, Zachary

AU - Jen, Rita P.

AU - Dibianco, John M.

AU - Reinstatler, Lael

AU - Li, Qiang

AU - Madi, Rabii

AU - Lewis, Ronald W.

AU - Smith, Arthur M.

AU - Neal, Durwood E.

AU - Moses, Kelvin A.

AU - Terris, Martha K.

PY - 2015/6/1

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N2 - BACKGROUND Approximately 70% of all suicides in patients aged >60 years are attributed to physical illness, with higher rates noted in patients with cancer. The purpose of the current study was to characterize suicide rates among patients with genitourinary cancers and identify factors associated with suicide in this specific cohort. METHODS Patients with prostate, bladder, kidney, testis, and penile cancer were identified in the Surveillance, Epidemiology, and End Results database (1988-2010). Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were calculated for each anatomic site. Multivariable logistic regression models generated odds ratios (ORs) for the identification of factors associated with suicide for each malignancy. RESULTS There were 2268 suicides identified among 1,239,522 individuals with genitourinary malignancies observed for 7,307,377 person-years. The SMRs for patients with cancer were 1.37 for prostate cancer (95% CI, 0.99-1.86), 2.71 for bladder cancer (95% CI, 2.02-3.62), 1.86 for kidney cancer (95% CI, 1.32-2.62), 1.23 for testis cancer (95% CI, 0.88-1.73), and 0.95 for penile cancer (95% CI, 0.65-1.35). On multivariable analysis, male sex was found to be associated with odds of suicide among patients with bladder cancer (OR, 6.63) and kidney cancer (OR, 4.98). Increasing age was associated with suicide for patients with prostate, bladder, and testis cancer (OR range, 1.03-1.06). Distant disease was associated with suicide in patients with prostate, bladder, and kidney cancer (OR range, 2.82-5.43). Among patients with prostate, bladder, and kidney cancer, African American patients were less likely to commit suicide compared with white individuals (OR range, 0.26-0.46). CONCLUSIONS Suicide in patients with genitourinary malignancies poses a public health dilemma, especially among men, the elderly, and those with aggressive disease. Clinicians should be aware of risk factors for suicide in these patients.

AB - BACKGROUND Approximately 70% of all suicides in patients aged >60 years are attributed to physical illness, with higher rates noted in patients with cancer. The purpose of the current study was to characterize suicide rates among patients with genitourinary cancers and identify factors associated with suicide in this specific cohort. METHODS Patients with prostate, bladder, kidney, testis, and penile cancer were identified in the Surveillance, Epidemiology, and End Results database (1988-2010). Standardized mortality ratios (SMRs) and 95% confidence intervals (95% CIs) were calculated for each anatomic site. Multivariable logistic regression models generated odds ratios (ORs) for the identification of factors associated with suicide for each malignancy. RESULTS There were 2268 suicides identified among 1,239,522 individuals with genitourinary malignancies observed for 7,307,377 person-years. The SMRs for patients with cancer were 1.37 for prostate cancer (95% CI, 0.99-1.86), 2.71 for bladder cancer (95% CI, 2.02-3.62), 1.86 for kidney cancer (95% CI, 1.32-2.62), 1.23 for testis cancer (95% CI, 0.88-1.73), and 0.95 for penile cancer (95% CI, 0.65-1.35). On multivariable analysis, male sex was found to be associated with odds of suicide among patients with bladder cancer (OR, 6.63) and kidney cancer (OR, 4.98). Increasing age was associated with suicide for patients with prostate, bladder, and testis cancer (OR range, 1.03-1.06). Distant disease was associated with suicide in patients with prostate, bladder, and kidney cancer (OR range, 2.82-5.43). Among patients with prostate, bladder, and kidney cancer, African American patients were less likely to commit suicide compared with white individuals (OR range, 0.26-0.46). CONCLUSIONS Suicide in patients with genitourinary malignancies poses a public health dilemma, especially among men, the elderly, and those with aggressive disease. Clinicians should be aware of risk factors for suicide in these patients.

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KW - bladder cancer

KW - genitourinary malignancies

KW - kidney cancer

KW - marital status

KW - penile cancer

KW - prostate cancer

KW - race

KW - suicide

KW - testis cancer

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