Suicide And Violent Deaths In Survivors Of Cancer In Childhood, Adolescence And Young Adulthooda National Cohort Study
INTERNATIONAL JOURNAL OF CANCER(2017)
摘要
Suicide risk in adult cancer patients is found to be elevated, but limited information exists regarding risks of suicide and non-suicidal violent deaths when diagnosed with cancer in young age. We investigate suicide and violent deaths in a national cohort including individuals diagnosed with cancer before age 25. Through the linkage of different national registries (Cancer Registry of Norway, Norwegian Causes of Death Registry and the National Registry) a cohort of all live births in Norway during 1965-1985 was defined and followed up through 2008. Individuals diagnosed with cancer before age 25 and the cancer-free references were compared using an extended Cox proportional hazard regression model. The cohort comprised 1,218,013 individuals, including 5,440 diagnosed with cancer before age 25. We identified 24 suicides and 14 non-suicidal violent deaths in the cancer group. The hazard ratio (HR) of suicide in the cancer group was 2.5 (95% confidence interval (CI) 1.7-3.8), and was increased both when diagnosed with cancer in childhood (0-14 years of age); HR=2.3 (95% CI: 1.2-4.6), and during adolescence/young adulthood (15-24 years); HR=2.6 (95% CI: 1.5-4.2). Survivors of bone/soft tissue sarcomas, CNS tumors and testicular cancer were at particular risk. The risk of non-suicidal violent death was not increased in the cancer survivors (HR=1.0; 95% CI: 0.6-1.7). Although based on small numbers and the absolute risk of suicide being low, these are novel findings with important implications for establishing adequate follow-up including suicide prevention strategies for young cancer survivors.What's new? The onset of cancer at a young age profoundly affects psychological health and potentially increases the risk of death by suicide. Little is known, however, about the extent of suicidal behavior exhibited by childhood, adolescent and young adult cancer survivors. Using national registry data, the authors of the present study examined suicides and violent deaths in cancer patients diagnosed before age 25, finding that suicide risk is increased more than two-fold for cancer survivors diagnosed before age 15 and for those diagnosed during adolescence/young adulthood (15-24 years). Suicide screening and prevention efforts may be necessary components of follow-up care in these patient populations.
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关键词
childhood cancer, adolescent and young adult cancer, cohort studies, suicide, violent deaths
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