Suicide and Accidental Death Among Women with Primary Ovarian Cancer: A
population-based study
Abstract
Objective To determine the relative risk of suicide and accidental death
among patients with ovarian cancer to that of the general population,
and to identify risk factors associated with suicide and accidental
death. Design The surveillance, epidemiology, and end results (SEER)
registry provided ovarian cancer data from 18 registries. Setting
Surveillance, Epidemiology, and End Results database. Population The
study population comprised 149,204 patients. Methods The standardized
mortality ratios (SMRs) were calculated and Fine-Gray models were
fitted, with stratifications on demographic and tumor-related
characteristics. Main outcome measures The standardized mortality
ratios. Results Women with ovarian cancer had a higher risk of suicide
and accidental death than the cancer-free group (SMR=1.86; 95% CI
[1.54-2.25] and SMR=1.54; 95% CI [1.39-1.71]). Subgroup
analysis indicated that only patients with type II epithelial ovarian
cancer (SMR=2.31; 95% CI [1.83-2.91]) had an increased risk of
suicide, and those with type I and type II epithelial ovarian cancer
(SMR=1.65; 95% CI [1.39-1.97] and SMR=1.49; 95% CI
[1.30-1.70]) were at a higher risk of accidental death. Patients
with ovarian cancer who were younger, white, diagnosed with high-grade,
non-metastatic cancer and pelvic exenteration were at a higher risk of
suicide. Additionally, pelvic exenteration increased the risk of suicide
but not the risk of accidental death among these women. Conclusion Women
with ovarian cancer had a higher risk of suicide and accidental death
compared with the general population. Clinicians should identify
high-risk subgroups of ovarian cancer patients for suicide and
accidental death as early as possible, with appropriate prevention
strategies.