Suicide Risk in Digestive Cancer Patients: A Systematic Review of Sociodemographic, Psychological, and Clinical Predictors
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Data Sources and Search Strategy
2.2. Data Collection Process
3. Results
3.1. Findings
3.2. Study Characteristics
Participant Characteristics and Variables
4. Discussion
4.1. Is Suicide a Failure of Mental Adaptation to Cancer?
4.2. Emotional Distress and Depression
4.3. Physical Suffering and Symptom Burden
4.4. Existential and Spiritual Distress
4.4.1. Social and Practical Stressors
4.4.2. Financial Burden
4.4.3. Employment and Career
4.4.4. Sociodemographic and Clinical Factors Related to Suicide
4.5. Gender Differences in Suicide Risk
4.6. Marital Status and Social Support
4.7. Geriatric Psycho-Oncology
4.8. Esophageal Cancer
4.9. Hepatocellular Carcinoma
4.10. Pancreatic Cancer
4.11. Gastric Cancer
4.12. Colorectal Cancer
5. Conclusions
5.1. Limitations
5.2. Implications
5.3. Future Directions
5.3.1. Clinical Practice Recommendations
5.3.2. Research Prospects
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Database | Search Strategies |
---|---|
PubMed | Query box: (“suicide” [Mesh] AND (“digestive cancer” [Mesh] OR “esophageal cancer” [Mesh] OR “gastric cancer” [Mesh] OR “pancreatic cancer” [Mesh] OR “colorectal cancer”). In Embase, we used the search term (exp suicide) AND (digestive cancer system OR esophageal cancer OR gastric cancer OR pancreatic cancer OR colorectal cancer OR liver cancer) Refined by the following: Language: English; 2011–2024 |
PsycINFO | (exp suicide/OR “death” and “dying”) AND (exp “digestive cancer tract”/OR “esophageal cancer”/OR “gastric cancer”/OR “pancreatic cancer”/OR “colorectal cancer” OR “liver cancer”) Refined by the following: Language: English; 2011–2024 |
EMBASE | (exp suicide) AND (digestive cancer system OR esophageal cancer OR gastric cancer OR pancreatic cancer OR colorectal cancer OR “liver cancer”) Refined by the following: Language: English; 2011–2024 |
CINAHL | ((MH “suicide”) OR (MM “death and dying”)) AND ((MH “digestive cancer system”) OR (MM “esophageal cancer”) OR (MM “gastric cancer” OR “pancreas cancer”/OR “colorectal cancer” OR “liver cancer”)) Refined by the following: Language: English; 2011–2024 |
Web of Science | (TOPIC: (“suicide”) OR Title: (“death” and “dying”) AND (TOPIC: (“mortality”) OR TOPIC: (“digestive system cancer”) OR TOPIC: (“survival rate”) OR TOPIC: (“premature mortality”) OR TOPIC (“esophageal cancer”) OR TOPIC (“gastric cancer”) OR TOPIC (“pancreas cancer”)/OR TOPIC (“colorectal cancer”) OR TOPIC (“liver cancer”) Refined by the following: Language: English; 2011–2024 |
Author/Year/ | Country | General Study Aim | No. of Suicides/No. of Patients | Time Period | Cancer Localization | Sociodemographic Risk Factors | Psychological Factors | Clinical Factors | Factors Related to Suicide | SMR (Standardized Mortality Ratio) | Link |
---|---|---|---|---|---|---|---|---|---|---|---|
Ma et al. 2022 [29] | USA | To determine the standardized mortality ratio (SMR) of suicide and risk factors associated with suicide in patients with pancreatic cancer, compared with the general population, to provide evidence for prevention. | 180/199,604 | 2000–2018 | Pancreatic cancer | Male gender, unmarried, white ethnicity | - | Pancreatic neuroendocrine tumors (pNETs) have a lower suicide risk. | PDAC patients have a higher risk of suicide. No treatment (radiotherapy, chemotherapy, surgery) increases suicide risk. | SMR: 7.06 for males | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9437642/ (accessed on 2 August 2024), |
Chen et al. 2021a [30] | USA | To determine the suicide rate and SMRs in patients with liver cancer, in comparison to the U.S. general population, and to identify any relevant risk factors for suicide, using data from the SEER database. | 70/102,567 | 1975–2016 | Hepatocellular cancer | Male gender, older individuals (63–105 years), unmarried, white individuals | - | Higher suicide rates in patients with shorter survival, especially <2 months. Advanced cancer stage associated with higher suicide rates. | Higher suicide rates in the first five years after diagnosis: <2 months SMR = 26.78. | SMR = 26.78 for <2 months | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538389/ (accessed on 25 August 2024) |
Chen et al. 2021 b [31] | USA | To evaluate suicide rates and SMRs relative to the U.S. general population and identify underlying causes of suicide using the SEER database. | 161/69,773 | 1975–2016 | Esophageal cancer | Male gender, older age, unmarried, white ethnicity | - | Grade III tumors associated with higher suicide rates. No surgery or chemotherapy increases suicide rates. | Patients with esophageal cancer had significantly higher suicide rates, particularly within the first five years after diagnosis:
| SMR = 216.79 for <2 months | https://pubmed.ncbi.nlm.nih.gov/34548616/ (accessed on 28 August 2024) |
Henson et al. 2019 [32] | England | To calculate the suicide risk in cancer patients in England, and to identify potential risk factors involved in needs-based psychological assessment. | Liver cancer: 10/51,800, pancreatic cancer: 33/121,207, esophageal cancer: 57/122,132, stomach cancer: 59/128,965, colorectal cancer: 349/578,270 | 1995–2015 | Esophagus, stomach, pancreatic, liver, and colorectal cancers | Male gender, white ethnicity cancer patients aged 60+ | - | Pancreatic cancer has a 3.89-fold increase in suicide risk. | Suicide risk is highest in the first 6 months after diagnosis. The risk rises for the first 3 years, and declines thereafter. | SMR for pancreatic cancer = 3.89 | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583458/ (accessed on 2 September 2014) |
Anderson et al. 2018 [33] | USA | To investigate the suicide rate in various subgroups, such as the site of cancer, stage of cancer, time since diagnosis, and various patient characteristics. | Esophageal cancer: 88/43,912, colon cancer: 311/318,861, rectum and rectosigmoid junction: 185/134,913, liver and intrahepatic bile duct: 47/81,684, pancreas: 93/119,194, stomach: 81/76,313, other digestive organs: 76/81,415 | 2000–2014 | Esophageal, pancreatic, gastric, rectum and rectosigmoid junction, pancreas, liver, and intrahepatic bile duct cancers | Older age (80+ years), male gender, white ethnicity cancer patients, unmarried | - | Pancreatic cancer and esophageal cancer show the highest suicide risk. | Highest suicide risk in the first 5 years of diagnosis for all cancers. Metastatic-stage cancer patients have the highest SMR (4.60). | SMR for pancreatic cancer = 5.28 | https://pubmed.ncbi.nlm.nih.gov/29956393/ (accessed on 18 September 2024) |
Dulskas et al. 2018 [34] | Lithuania | To estimate the suicide risk in patients diagnosed with colorectal cancer in Lithuania. | 67/19, 409 | 1998–2012 | Colorectal cancer | Female gender, aged 60+ | - | Stage IV cancer patients have a fourfold increased risk of suicide. | Suicide risk is highest in the first 3 months after cancer diagnosis (SMR = 4.00). | SMR = 4.00 for Stage IV | https://pubmed.ncbi.nlm.nih.gov/30617411/ (accessed on 8 October 2024) |
Samawi et al. 2017 [35] | USA | To examine the incidence and predictors of suicide in patients diagnosed with a form of colorectal cancer (colon cancer or rectal cancer). | Rectal cancer: 337/187,996, colon cancer: 611/443,368 | 1973–2009 | Colorectal cancer | Male, white race (was a predictor of suicide in the colon cancer cohort) Older age was an independent predictor of suicide in both colon cancer and rectal cancer | - | Metastatic disease and lack of primary resection predict suicide risk. | Suicide risk is higher in individuals with older age, male sex, white race, and metastatic disease. | SMR = 2.3 for metastatic disease | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736490/ (accessed on 24 October 2024) |
Sugawara et al. 2016 [36] | USA | To investigate suicide rates in patients diagnosed with gastric cancer and to identify relevant factors that can increase the suicide risk. | 68/65,535 | 1998–2011 | Gastric cancer | Male gender, older age, white race, unmarried individuals | - | Advanced cancer (Stage IV) and metastatic disease significantly increase suicide risk. | Suicide risk is highest within the first 3–6 months after diagnosis. Non-treatment (surgery, chemotherapy, radiotherapy) predicts a higher suicide risk. | White race (SMR = 3.23) Unmarried status (SMR = 2.01) Distant-stage disease (SMR = 2.90). | https://pubmed.ncbi.nlm.nih.gov/27307574/ (accessed on 3 November 2024) |
Turaga et al. 2011 [37] | USA | To determine suicide rates in patients diagnosed with pancreatic cancer using population-based data, which were used to identify patient, disease, and treatment characteristics associated with suicide. | 30/36,221 | 1995–2005 | Pancreatic cancer | Male gender, age ≥ 60 years, unmarried | Surgery is associated with increased suicide risk, especially postoperatively. | Suicide risk in male pancreatic cancer patients is nearly 11 times higher than the general population. Surgery increases suicide risk in the early postoperative period. | SMR for males = 11.00 | https://pubmed.ncbi.nlm.nih.gov/20824626/ (accessed on 8 November 2024) | |
Larsson et al. 2024 [38] | Sweden | To investigate the prevalence of suicide in a national cohort of patients with newly diagnosed colorectal cancer compared with a matched control group, to determine whether patients with colorectal cancer have an increased incidence of suicide. | 24/64,866 | 1997–2006 (colorectal cancer) 2008–2017 (colon cancer) | Colorectal cancer | Male gender, unmarried patients | - | Surgery significantly increases suicide risk. Non-surgical patients have a higher suicide risk. | Suicide risk is highest in the first year following diagnosis (SMR = 1.86). Non-operated patients have a higher suicide risk (SMR = 7.03). | SMR for non-operated patients = 7.03 | https://pubmed.ncbi.nlm.nih.gov/38831481/ (accessed on 24 December 2024) |
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Lazar, D.E.; Hanganu, B.; Postolica, R.; Buhas, C.L.; Paparau, C.; Ioan, B.G. Suicide Risk in Digestive Cancer Patients: A Systematic Review of Sociodemographic, Psychological, and Clinical Predictors. Cancers 2025, 17, 1427. https://doi.org/10.3390/cancers17091427
Lazar DE, Hanganu B, Postolica R, Buhas CL, Paparau C, Ioan BG. Suicide Risk in Digestive Cancer Patients: A Systematic Review of Sociodemographic, Psychological, and Clinical Predictors. Cancers. 2025; 17(9):1427. https://doi.org/10.3390/cancers17091427
Chicago/Turabian StyleLazar, Diana Elena, Bianca Hanganu, Roxana Postolica, Camelia Liana Buhas, Cristian Paparau, and Beatrice Gabriela Ioan. 2025. "Suicide Risk in Digestive Cancer Patients: A Systematic Review of Sociodemographic, Psychological, and Clinical Predictors" Cancers 17, no. 9: 1427. https://doi.org/10.3390/cancers17091427
APA StyleLazar, D. E., Hanganu, B., Postolica, R., Buhas, C. L., Paparau, C., & Ioan, B. G. (2025). Suicide Risk in Digestive Cancer Patients: A Systematic Review of Sociodemographic, Psychological, and Clinical Predictors. Cancers, 17(9), 1427. https://doi.org/10.3390/cancers17091427