Investigating risk of suicide in patients with cancer globally

Researchers in the UCL Division of Psychiatry were funded by the UCL Global Engagement Fund (2023-2024) to establish an international research network to investigate risk of suicide in LMICs

This is to balance the preponderance of studies investigating this issue that analyse data from high income countries, as seen in this systematic review (Heinrich et al 2022).

The studies in this review analysed data from Europe, Australia, the US, Japan, South Korea and Taiwan. Consequently, we know little about the points in the cancer journey at which suicide risk is elevated in people with cancer in other regions. We know from 2019 data that 77% of global suicides occurred in Lower and Middle Income Countries (LMICs) and that the global suicide rate is approximately 11 per 100,000 population. We need to do more research to understand modifiable risk factors for suicide in LMIC settings, as a foundation for intervention development.

Team members

The project lead is Dr Alexandra Pitman, Clinical Professor in Psychiatry, UCL Division of Psychiatry; co-lead of the UCL Special Interest Group in Self-harm and Suicide   

Our collaborators are:

  • Dr Neethu Mohan, Public Health Executive, State Health Agency, India; Affiliate Researcher, The GRID Council, India
  • Dr Mareike Ernst, Assistant Professor, University of Klagenfurt
  • Dr Justin Yang, Research Fellow, UCL Division of Psychiatry

Events

On Wednesday 22 May 2024 we held a free webinar, funded by the UCL Global Engagement Fund, and co-hosted in London (at UCL by Dr Alexandra Pitman) and India (at The GRID Council by Dr Neethu Mohan) for researchers analysing cancer/mortality data in South Asian countries. We had advertised the webinar to researchers / clinicians / public health professionals interested in investigating suicide risk in patients with cancer, explaining that the webinar was aimed at those interested in networking with others working on the analysis of linked cancer registry data to mortality data in order to share ideas and generate collaborations.

In the webinar we heard an introduction from Dr Neethu Mohan describing the evidence gap in relation to analyses of suicide risk in patients with cancer in low- and middle-income countries. Dr Alexandra Pitman then summarised a recent systematic review on this topic (Heinrich et al 2022), which had reported an elevated risk of suicide in patients with cancer, particularly in patients with late stage / advanced cancer, those with tumours with a poor prognosis, and in the first year after diagnosis.

We then heard a presentation from Dr Katherine Thackray (née Henson) from the National Disease Registration Service (NDRS) at NHS England, and lead author of an analysis of English cancer registry data linked to mortality data investigating the risk of suicide in patients with cancer (Henson et al 2019). She set out the steps involved in the method and key sources of bias to consider in sensitivity analyses. We also heard a presentation from Dr Justin Yang, UCL, describing the code used for these analyses, which he presented in Stata, R, and Python, also providing access to the code.

The webinar was recorded and discussions focussed on barriers to linkage of routine cancer registry data to mortality data, queries about code and suggestions regarding collaborations. 

Watch the 22 May webinar via this link. Zoom login required - use this passcode to watch: Ct6geT.4

A blog written by UCL MSc student, Shruti Menon, about the webinar is here: Investigating the risk of suicide in patients with cancer: webinar co-hosted by the UCL Institute of Mental Health (IoMH) and the GRID Council (India)

We have created a set of slides that local clinical academic teams can use in their educational/teaching programmes – you can download them here.

Slides from the presentations:

  1. Dr Neethu Mohan and Dr Alexandra Pitman
  2. Dr Katherine Thackray (née Henson)
  3. Dr Justin Yang

 

  • Stata
  • R: The below html link contains the annotated R code and output. The output should be readable in any modern browser and shows some commentary, code (with further explanation), and tabular outputs. This R code has been written by Dr Justin Yang to be highly adaptable for lower-resource settings. You will need to copy and paste this link into your browser:  file:///C:/Users/rejumtt/AppData/Local/Microsoft/Windows/INetCache/Content.Outlook/Y1M48RLU/ncras.html 
  • Python: click on the words 'Python Code' throughout this page to reveal the code for the relevant step in the analysis.
  • A tutorial on using the code, developed by Dr Justin Yang, is available here: https://yangjustinc.github.io/2024-ncras

Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, Bonaventure A, Valkov M, Johnson CJ, Estève J, Ogunbiyi OJ, Azevedo E Silva G, Chen WQ, Eser S, Engholm G, Stiller CA, Monnereau A, Woods RR, Visser O, Lim GH, Aitken J, Weir HK, Coleman MP; CONCORD Working Group. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018 Mar 17;391(10125):1023-1075. doi: 10.1016/S0140-6736(17)33326-3

Ernst M, Schwinn T, Hirschmiller J, Cleare S, Robb KA, Brähler E, Zwerenz R, Wiltink J, O'Connor RC, Beutel ME. To what extent are psychological variables considered in the study of risk and protective factors for suicidal thoughts and behaviours in individuals with cancer? A systematic review of 70 years of research. Clin Psychol Rev. 2024 Apr;109:102413. doi: 10.1016/j.cpr.2024.102413. Epub 2024 Mar 11. PMID: 38518584

Fang F, Fall K, Mittleman MA, Sparén P, Ye W, Adami HO, Valdimarsdóttir U. Suicide and cardiovascular death after a cancer diagnosis. N Engl J Med. 2012 Apr 5;366(14):1310-8. doi: 10.1056/NEJMoa1110307.  https://www.nejm.org/doi/full/10.1056/NEJMoa1110307

Grobman B, Mansur A, Babalola D, Srinivasan AP, Antonio JM, Lu CY. Suicide among Cancer Patients: Current Knowledge and Directions for Observational Research. J Clin Med. 2023 Oct 16;12(20):6563. doi: 10.3390/jcm12206563. 

Heinrich M, Hofmann L, Baurecht H, Kreuzer PM, Knüttel H, Leitzmann MF, Seliger C. Suicide risk and mortality among patients with cancer. Nat Med. 2022 Apr;28(4):852-859. doi: 10.1038/s41591-022-01745-y. Epub 2022 Mar 28. https://www.nature.com/articles/s41591-022-01745-y

Henson KE, Brock R, Charnock J, Wickramasinghe B, Will O, Pitman A. Risk of Suicide After Cancer Diagnosis in England. JAMA Psychiatry. 2019 Jan 1;76(1):51-60. doi: 10.1001/jamapsychiatry.2018.3181

McFarland DC, Walsh L, Napolitano S, Morita J, Jaiswal R. Suicide in Patients With Cancer: Identifying the Risk Factors. Oncology (Williston Park). 2019 Jun 19;33(6):221-6. PMID: 31219606.

Osazuwa-Peters N, Simpson MC, Zhao L, Boakye EA, Olomukoro SI, Deshields T, Loux TM, Varvares MA, Schootman M. Suicide risk among cancer survivors: Head and neck versus other cancers. Cancer. 2018 Oct 15;124(20):4072-4079. doi: 10.1002/cncr.31675. 

Pitman A, Suleman S, Hyde N, Hodgkiss A (2018) BMJ Clinical Updates: Depression and anxiety in patients with cancer BMJ 361:k1415 doi: 10.1136/bmj.k1415  https://www.bmj.com/content/361/bmj.k1415

Pitman A, Suleman S, Hyde N, Hodgkiss A (2018) BMJ 10 Minute Consultation Exploring low mood in a person with cancer BMJ;361:k1488 doi: 10.1136/bmj.k1488   https://www.bmj.com/content/361/bmj.k1488 (with 2018 BMJ podcast – Dr Alexandra Pitman and Dr Andrew Hodgkiss interviewed by BMJ Editor Dr Kate Adlington:  https://soundcloud.com/bmjpodcasts/the-complexities-of-depression-in-cancer )

Wang SM, Chang JC, Weng SC, Yeh MK, Lee CS. Risk of suicide within 1 year of cancer diagnosis. Int J Cancer. 2018 May 15;142(10):1986-1993. doi: 10.1002/ijc.31224. Epub 2018 Jan 3. PMID: 29250783.

Zaorsky NG, Zhang Y, Tuanquin L, Bluethmann SM, Park HS, Chinchilli VM. Suicide among cancer patients. Nat Commun. 2019 Jan 14;10(1):207. doi: 10.1038/s41467-018-08170-1. 

If you would like further information please contact:  Professor Alexandra Pitman, UCL Division of Psychiatry