181 Background: Suicide rate is among cancer survivors double that of the general United States population, and risk is significantly greater among males than females. Meanwhile, being married confers survival advantage across the cancer continuum, with males benefitting more than females. This study was aimed at determining whether marital status mitigated the risk of suicide among male cancer patients with advanced stage disease. Methods: Male patients with stage IV cancer of nine common cancer sites (prostate, lung/bronchus, colon/rectum, urinary bladder, melanoma of the skin, kidney/renal pelvis, non-Hodgkin lymphoma, head and neck cancer, liver/intrahepatic bile duct) diagnosed from 2007-2015 from the Surveillance, Epidemiology, and End Results 18 database were included. A multivariate competing risks proportional hazards model determined the impact of marital status on suicide while controlling for covariates (age, county-level poverty percentage, insurance status, race/ethnicity, cancer site). This model yielded adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Results: There were 228,627 male patients included, with 330 patients committing suicide. The cohort was predominantly non-Hispanic white (71%), married/partnered (57%), and had an average age of 65 years. In the model including all nine cancer sites, divorced/separated (aHR = 1.92, 95% CI 1.40, 2.62), never married (aHR = 1.98, 95% CI 1.48, 2.66), and widowed patients (aHR = 1.50, 95% CI 1.01, 2.24) were more likely than married/partnered patients to commit suicide. Conclusions: Married cancer survivors with advance stage disease are less likely to die by suicide, highlighting the value of supportive care in cancer survivorship. Unmarried patients with advanced stage disease are candidates for surveillance to mitigate suicide risk.
The Impact of Post-Diagnosis Depression on Survival and Healthcare Costs for Patients Diagnosed with Late-Stage Cancer in the United States
