Changing Trends for Suicidal Death in Patients With Bladder Cancer

A 40+ Year Population-level Analysis

Zachary Klaassen, Hanan Goldberg, Thenappan Chandrasekar, Karan Arora, Rashid K. Sayyid, Robert J. Hamilton, Neil E. Fleshner, Stephen Williams, Christopher J.D. Wallis, Girish S. Kulkarni

    Research output: Contribution to journalArticle

    7 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish (US)
    JournalClinical Genitourinary Cancer
    DOIs
    StateAccepted/In press - Jan 1 2018

    Fingerprint

    Urinary Bladder Neoplasms
    Suicide
    Population
    Odds Ratio
    Cystectomy
    Epidemiology
    Urinary Bladder
    Survival Rate
    Logistic Models
    Databases
    Carcinoma

    Keywords

    • Competing risks
    • Radical cystectomy
    • SEER
    • Suicide
    • Survivorship

    ASJC Scopus subject areas

    • Oncology
    • Urology

    Cite this

    Klaassen, Z., Goldberg, H., Chandrasekar, T., Arora, K., Sayyid, R. K., Hamilton, R. J., ... Kulkarni, G. S. (Accepted/In press). Changing Trends for Suicidal Death in Patients With Bladder Cancer: A 40+ Year Population-level Analysis. Clinical Genitourinary Cancer. https://doi.org/10.1016/j.clgc.2017.12.016

    Changing Trends for Suicidal Death in Patients With Bladder Cancer : A 40+ Year Population-level Analysis. / Klaassen, Zachary; Goldberg, Hanan; Chandrasekar, Thenappan; Arora, Karan; Sayyid, Rashid K.; Hamilton, Robert J.; Fleshner, Neil E.; Williams, Stephen; Wallis, Christopher J.D.; Kulkarni, Girish S.

    In: Clinical Genitourinary Cancer, 01.01.2018.

    Research output: Contribution to journalArticle

    Klaassen, Z, Goldberg, H, Chandrasekar, T, Arora, K, Sayyid, RK, Hamilton, RJ, Fleshner, NE, Williams, S, Wallis, CJD & Kulkarni, GS 2018, 'Changing Trends for Suicidal Death in Patients With Bladder Cancer: A 40+ Year Population-level Analysis', Clinical Genitourinary Cancer. https://doi.org/10.1016/j.clgc.2017.12.016
    Klaassen, Zachary ; Goldberg, Hanan ; Chandrasekar, Thenappan ; Arora, Karan ; Sayyid, Rashid K. ; Hamilton, Robert J. ; Fleshner, Neil E. ; Williams, Stephen ; Wallis, Christopher J.D. ; Kulkarni, Girish S. / Changing Trends for Suicidal Death in Patients With Bladder Cancer : A 40+ Year Population-level Analysis. In: Clinical Genitourinary Cancer. 2018.
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    abstract = "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.",
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    author = "Zachary Klaassen and Hanan Goldberg and Thenappan Chandrasekar and Karan Arora and Sayyid, {Rashid K.} and Hamilton, {Robert J.} and Fleshner, {Neil E.} and Stephen Williams and Wallis, {Christopher J.D.} and Kulkarni, {Girish S.}",
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    T1 - Changing Trends for Suicidal Death in Patients With Bladder Cancer

    T2 - A 40+ Year Population-level Analysis

    AU - Klaassen, Zachary

    AU - Goldberg, Hanan

    AU - Chandrasekar, Thenappan

    AU - Arora, Karan

    AU - Sayyid, Rashid K.

    AU - Hamilton, Robert J.

    AU - Fleshner, Neil E.

    AU - Williams, Stephen

    AU - Wallis, Christopher J.D.

    AU - Kulkarni, Girish S.

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    N2 - 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.

    AB - 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.

    KW - Competing risks

    KW - Radical cystectomy

    KW - SEER

    KW - Suicide

    KW - Survivorship

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