Male, White, Older Patients With Leukemia at Heightened Risk of Suicide, Study Finds

Patients with leukemia face a higher risk of suicide if they are male, older, white, and if they receive a diagnosis of acute myeloid leukemia (AML), according to new research.

The study, based on an analysis of more than 40 years of data in the Surveillance, Epidemiology, and End Results (SEER) database, was published in the journal Cancer Medicine.​

Cancer has long been linked with an increased risk of suicide, but to date no research has been reported looking at the relationship specifically between leukemia and suicide risk.

In an effort to better understand the situation, corresponding author Jun Lyu, MD, PhD, of the First Affiliated Hospital of Jinan University, in China, and colleagues, searched the SEER database for patients with leukemia diagnosed between 1975 and 2017.

Lyu told The American Journal of Managed Care® that the lack of specific therapies, painful complications of the disease, and treatment-related consequences (eg, hair loss) can all affect patients’ psychological well-being.

“These problems will cause mental stress and psychological problems in patients, which will lead patients to extremes and end their lives,” Lyu said. “Therefore, paying attention to the suicide rate of these special cancer patients and exploring their risk factors is of great significance to preventing their suicide.”

The investigators’ SEER analysis yielded 142,386 patients. Of those, the causes of deaths of 191 patients were listed as “suicide and self-mutilation.” Those figures led to a standardized mortality rate of 2.16.

Next, the investigators performed univariate and multivariate Cox regression analysis to try and isolate factors that appeared to increase risk of suicide. The biggest factors linked with suicide were White race vs Black (HR, 6.80), male sex (HR, 4.41), and age, with the highest risk being found in patients over the age of 80 (HR, 2.94) compared with patients 39 years and younger.

“Despite the similar prevalence rates of male and female leukemia patients, the much higher suicide rate in male leukemia patients may be related to the poor ability of males to withstand psychological pressures and their tendency for self-directed violence,” the authors wrote.

They said the risk associated with age might be due to quality-of-life factors or a poor outlook on life.

In terms of race, their finding that White patients with leukemia more commonly took their own lives compared with their Black counterparts was in line with other research. Lyu and colleagues said this “might be related to differences in the level of knowledge and culture among racial groups, religious beliefs, and economic conditions.”

An AML diagnosis was also a statistically significant risk factor, with an HR of 2.72 vs patients with lymphocytic leukemia. They said this might have to do with prognosis or the rapid progression of the disease.

One factor that did not appear to increase cancer risk was chemotherapy, which Lyu said was a surprise. Chemotherapy is the main course of treatment for patients with leukemia, and thus Lyu and colleagues expected that patients who had undergone treatment would have lower rates of suicide. They did not.

“However, the results of the study showed that there was no difference in suicide rates between the two groups of patients, those who received chemotherapy and those who did not,” Lyu said. “Does this also reflect that current chemotherapy is ineffective for most leukemia patients? Of course, this requires further in-depth research to reach a conclusion.”

In the meantime, Lyu and colleagues said providers must be vigilant in keeping track of patients who might be at heightened risk of suicide. The first step, they concluded, is giving patients with leukemia psychological evaluations.

“Providing psychological treatment to patients with leukemia at risk of depression can help to reduce the risk of suicide, as can the application of active treatment, improving their quality of life, and strengthening communication between family members,” they wrote.

Reference

Yu H, Cai K, Huang Y, Lyu J. Risk factors associated with suicide among leukemia patients: a Surveillance, Epidemiology, and End Results analysis. Cancer Med. Published online October 6, 2020. doi:10.1002/cam4.3502