Changing Trends for Suicidal Death in Patients With Bladder Cancer: A 40+ Year Population-level Analysis

To identify the demographic and clinical factors associated with suicidal death among patients with bladder urothelial carcinoma, patients diagnosed from 1973 to 2013 were identified in the Surveillance, Epidemiology, and End Results database. Using a competing risks model, factors associated with suicidal death included older age, unmarried status, white race, male gender, regional disease, living in the Southeast United States, and not undergoing a radical cystectomy. Background: Previous studies suggest that patients with bladder cancer (BCa) are at increased risk of suicide compared with the general population. The objective of this study is to improve our understanding of patients at high risk for suicidal death and to better characterize patients at risk of delayed suicide years after diagnosis. Patients and Methods: Patients with bladder urothelial carcinoma were identified between 1973 and 2013 using the Surveillance, Epidemiology, and End Results (SEER) database (n = 333,679). Competing risks models were performed to generate hazard ratios (HRs) to identify variables associated with suicidal death. Among patients dying of suicide, logistic regression modelling was used to generate odds ratios (ORs) for factors associated with suicide > 36 months after diagnosis. Results: There were 794 patients (0.24%) that died of suicide, 190,734 patients (57.2%) that died from other causes, and 142,151 patients (42.6%) that were alive. Significant factors associated with suicide included diagnosis between 1973 and 1983 (HR, 2.22), unmarried (HR, 1.74), white race (HR, 2.22), male (HR, 6.91), regional disease (HR, 2.49), living in the Southeast United States (HR, 2.43), and not undergoing a radical cystectomy (HR, 1.42). Older age was associated with suicide, whereas younger age was protective. No radical cystectomy (OR, 0.45), older age (OR, 0.32), unmarried status (OR, 0.65), and regional disease (OR, 0.19) were significantly associated with decreased odds of suicidal death > 36 months after diagnosis. Conclusions: Those at highest risk for suicidal death include male gender, the elderly, white, unmarried, and patients with nonlocalized disease. These patients may benefit from targeted survivorship care plans.