ANN ARBOR, MI — Patients diagnosed with cancer are at an increased risk of adverse mental health outcomes, including suicidal behavior. That is especially of concern to the VA because suicide rates among veterans are 50% greater than for non-veteran U.S. adults.
A study which is part of the 2021 American Society of Clinical Oncology (ASCO) annual meeting emphasized the importance of understanding associations between cancer and suicide risk among veterans receiving VA healthcare from the VHA.1
A research team from the Ann Arbor, MI, VAMC, the Philadelphia VAMC and Duke University in Durham, NC, sought to assess associations between new cancer diagnoses and suicide among veterans receiving care from the VHA care. The goal was to identify high-risk diagnostic subgroups and risk periods.
To do that, researchers used a cohort study design, identifying 4.9 million veterans with VHA use in 2011 and either 2012 or 2013 and without a VHA cancer diagnosis in 2011. They then looked at incident cancer diagnoses, assessed between first VHA use in 2012-2013, grouping them by subtype and stage using VHA Oncology raw data. Information from the VA/DoD Mortality Data Repository identified the date and cause of death for those veterans.
The study calculated crude suicide rates following a new cancer diagnoses for 240,410 veterans from 2012 to 2018. Mortality rates were assessed up to 84 months following diagnosis. On average, however, veteran VHA users were followed for 6.0 years after their first VHA use in 2012-2013 and 2.7 years following a new cancer diagnosis.
Results indicated that a new cancer diagnosis corresponded to a 43% (Adjusted Hazard Ratio [AHR] = 1.43, 95% CI: 1.29, 1.58) higher suicide risk, adjusting for covariates.
Researchers report that the cancer subtype associated with the highest suicide risk was esophageal cancer (AHR = 5.93, 95% CI: 4.05, 10.51). Other significant subtypes included: head and neck (AHR = 3.44, 95% CI: 2.65, 4.46) and lung cancer (AHR = 2.28, 95% CI: 1.79, 2.90).
Researchers advised that cancer stages 3 (AHR = 2.29, 95% CI: 1.75, 3.01) and 4 (AHR = 3.45, 95% CI: 2.75, 4.34) at diagnosis were also positively associated with suicide risk. They found that suicide rates were highest in the first three months following a diagnosis (Rate = 128.3 per 100,000 person-years, 95% CI: 100.4, 161.6) but remained elevated through the first year.
“Among veteran VHA users, suicide risk was elevated following a new cancer diagnosis and was especially high in the initial three months,” the authors concluded. “Additional screening and suicide prevention efforts may be warranted for VHA veterans newly diagnosed with cancer, particularly among those diagnosed with esophageal, head and neck, or lung cancer or at stages 3 or 4.”
- KR, Szymanski BR, Kelley MJ, Katz I, et. Al. . (June 4-8, 2021) Suicide risk following a new cancer diagnosis among veterans in Veterans Health Administration care. ASCO 2021 annual meeting. Virtual. https://meetinglibrary.asco.org/record/200371/abstract