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28.11.2016 | Clinical Research | Ausgabe 5/2017

Clinical Orthopaedics and Related Research® 5/2017

What is the Incidence of Suicide in Patients with Bone and Soft Tissue Cancer?

Suicide and Sarcoma

Clinical Orthopaedics and Related Research® > Ausgabe 5/2017
BS Brianna L. Siracuse, BA George Gorgy, MD Jeremy Ruskin, MD Kathleen S. Beebe
Wichtige Hinweise
Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
A comment to this article is available at http://​dx.​doi.​org/​10.​1007/​s11999-016-5209-1.



Patients with cancer in the United States are estimated to have a suicide incidence that is approximately twice that of the general population. Patients with bone and soft tissue cancer often have physical impairments and activity limitations develop that reduce their quality of life, which may put them at high risk for depression, anxiety, and suicidal ideation. To our knowledge, there have been no large studies determining incidence of suicide among patients with bone and soft tissue cancer; this information might allow screening of certain high-risk groups.


To determine (1) the incidence of suicide in patients with bone and soft tissue cancer, (2) whether the incidence of suicide is greater in patients with bone and soft tissue cancer than it is in the general US population, and (3) any demographic and tumor characteristics associated with increased suicide incidence.


A retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER) program was performed. A total of 23,620 patients with primary bone and soft tissue cancer were identified in this database from 1973 and 2013. Patients with a cause of death listed as “suicide and self-inflicted injury” were considered to have committed suicide and suicide incidences were determined for different demographic and tumor characteristics in this subset of patients. Patient data for age, gender, race, marital status, year of diagnosis, primary cancer site, cancer stage, course of treatment, and survival time were collected and analyzed. The incidence of suicide in patients with bone and soft tissue sarcoma was compared with the age-, gender-, and race-adjusted incidence of suicide in the general US population from 1970 to 2013 available from the National Center for Health Statistics through the SEER Program.


The overall suicide incidence in this population was 32 per 100,000 person-years, which was higher than the age-, race-, and gender-adjusted US general population suicide incidence of 13 per 100,000 person-years. When compared with the incidence of suicide in matched subgroups of the general US population, a higher suicide incidence was observed in men (standardized mortality ratio [SMR], 2.49; 95% CI, 1.92–3.22; p < 0.001), patients of white race (SMR, 2.68; 95% CI, 1.94–3.56; p < 0.001), patients 21 to 30 years old (SMR, 4.40; 95% CI, 3.44–5.54; p < 0.001) and 61 to 70 years old (SMR, 3.27; 95% CI, 2.54–4.18; p < 0.001), patients with cancer of the vertebral column (SMR, 2.88; 95% CI, 2.13–3.83; p < 0.001) and pelvic bones (SMR, 2.75; 95% CI, 2.00–3.65; p < 0.001), and patients within the first 5 years of cancer diagnosis (SMR, 10.8; 95% CI, 9.19–12.61; p < 0.001).


With identification of these characteristics that are associated with higher incidence of suicide, physicians should consider screening patients possessing these traits. By identifying at-risk patients, we can hope to reduce the incidence of suicide in this population by providing the treatment that these patients need. Further research must be done to determine how best to screen these patients and to identify the best interventions to reduce suicide incidence.

Level of Evidence

Level III, prognostic study.

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