Risk factors for suicide in patients with colorectal cancer: A Surveillance, Epidemiology, and End Results database analysis

Background: Specific risk factors for suicide in patients with colorectal cancer have not been well established. Therefore, we aimed to assess factors associated with increased risk of suicide among patients with colorectal cancer. Methods: This was a retrospective cohort analysis of consecutive patients with colorectal cancer. Patients who survived were compared with patients for whom suicide was registered as their cause of death. Data were extracted from the National Cancer Institute's Surveillance, Epidemiology, and End Results Research Database 2000–2020. Primary outcome was risk factors for suicide. Results: In total, 309,561 patients were included in the analysis; 160,095 (51.7%) were male. Suicide was the cause of death in 1,052 (0.34%). The suicide rate among patients with colorectal cancer decreased over time from 1% between 2000 and 2010 to 0.05% between 2011 and 2020 (P < .001). Male sex (odds ratio, 6.44; P < .001), non-Hispanic ethnicity (odds ratio, 2.84; P = .014), household income between $50,000 and $74,999 (odds ratio, 1.79; P = .008) or <$50,000 (odds ratio, 1.84; P = .030), and metastatic disease (odds ratio, 2.89; P = .001) were independent risk factors for suicide. Colorectal cancer diagnosis in the second half of the study (2011–2020) was associated with lower risk of suicide compared with the first half (odds ratio, 0.338; P < .001). Conclusion: Among patients with colorectal cancer, male patients of non-Hispanic ethnicity and income <$75,000 USD who presented with metastatic disease were at increased risk of suicide. This trend decreased in the last decade, especially compared with the suicide rate among all patients with cancer. On the basis of these findings, we recommend targeted screening of this group of patients with colorectal cancer for suicidality as part of routine oncologic care.