Factors associated with suicide among patients with lung cancer in the United States: A retrospective cohort study based on surveillance, epidemiology, and end results (SEER) data

Background There are significantly higher suicide rates among patients with lung cancer vs. the general population, as well as individuals with other cancer types. This study was conducted to determine the factors associated with suicide among patients with lung cancer. Methods A total of 1,007,088 lung cancer patients diagnosed between 2000 and 2020 from the Surveillance, Epidemiology, and End Results (SEER) database were selected for the study. Chi-square and t-test were used for descriptive analysis  of categorical and continuous variables, respectively. Kaplan-Meier plot, log-rank test, and Cox proportional hazard test were used for survival analysis. The study cohort after the exclusions consisted of 843,750 participants. Results Among 843,750 lung cancer patients included in this study, suicide was the cause of death in 1,014 (0.12%) patients. The overall mean survival in subjects who committed suicide was 26 months. Higher suicide rates were observed in  the elderly, male sex, White race, distant lung cancer, and patients dwelling in metropolitan areas. After adjusting, patients with distant-stage lung cancer had a 1.6 times higher hazard of suicide compared to stage localized cancer patients with a hazard ratio of 1.59 (1.32, 1.90, p < 0.001). Conclusion A lung cancer diagnosis is associated with a higher risk of suicide compared to the general population and patients with other cancer types. We suggest that screening for distress, using the National Comprehensive Cancer Network  (NCCN) distress screening tool, and depression at regular intervals in patients with lung cancer is imperative to mitigate the non-cancer loss of life.