Introduction
Suicide is the tenth leading cause of death in the US, claiming the lives of more than 48,000 individuals in 20181. It not only represents an individual tragedy but also takes a staggering toll on global public health. The hitherto unknown suicidal deaths may have been classified as death from accidental or unintentional injury23. Both suicide and accidental death are regarded as external causes of death, and they share common risk factors such as physical, social, and emotional dysfunction4. Though the 5-year survival rates of cancer patients have increased over the past decades, the risk of dying from suicide and accidental death for those patients remains elevated over time 5. Epidemiological studies have shown that the rate of death from suicide and unintentional injury in cancer patients was 1.9 5and 1.6 6 times those of the general population, respectively.
Gynaecologic cancers represent a major problem affecting women’s health. Kristy et al. reported that women with gynaecological malignancies were at a higher risk of suicide compared with those diagnosed with non-gynaecological malignancies 7. Among gynaecologic cancers, the patients with ovarian cancer had the highest suicidal rate among patients with gynaecological malignancies 8. It was estimated that approximately 75% of ovarian cancer occurs as an advanced disease 9 because of the lack of effective screening methods and non-specific symptoms 10. This resulted in a high recurrence and mortality rate in ovarian cancer patients. Severe pain, high recurrence rate, intense treatment, and inferior quality of life from the disease itself and adverse effects of treatment often caused serious depression and anxiety among patients with ovarian cancer, which could put them at high risk for suicide and accidental death 11.
Previous studies have shown higher suicide rates in ovarian cancer patients compared with other gynaecological malignancies8, however, a direct comparison of the risk of suicide and accident injury especially among ovarian cancer with the general population has not been undertaken, and there is currently no literature on characteristics, incidence, and risk factors for suicide and accidental death in women with ovarian cancers in details.
As such, to address the current lack of evidence, we conducted a population-based analysis of the suicide and accidental death among patients with ovarian cancer. The objective of this study was to determine the relative risk of suicide and accidental deaths among ovarian cancer patients compared with the general population and to identify demographic and tumour-related characteristics, such as age at diagnosis and histological subtypes, that is associated with a particularly high risk of suicide and accidental deaths among ovarian cancer patients.