Trends in incidence and associated risk factors of suicide mortality in patients with non-small cell lung cancer

Dynamic prediction of lung cancer suicide risk based on meteorological factors and clinical characteristics：A landmarking analysis approach

Suicide is a severe public health issue globally. Accurately identifying high-risk lung cancer patients for suicidal behavior and taking timely intervention measures has become a focus of current research. This study intended to construct dynamic prediction models for identifying suicide risk among lung cancer patients. Patients were sourced from the Surveillance, Epidemiology, and End Results database, while meteorological data was acquired from the Centers for Disease Control and Prevention. This cohort comprised 455, 708 eligible lung cancer patients from January 1979 to December 2011. A Cox proportional hazard regression model based on landmarking approach was employed to explore the impact of meteorological factors and clinical characteristics on suicide among lung cancer patients, and to build dynamic prediction models for the suicide risk of these patients. Additionally, subgroup analyses were conducted by age and sex. The model's performance was evaluated using the C-index, Brier score, area under curve (AUC) and calibration plot. During the study period, there were 666 deaths by suicide among lung cancer patients. Multivariable Cox results from the dynamic prediction model indicated that age, marital status, race, sex, primary site, stage, monthly average daily sunlight, and monthly average temperature were significant predictors of suicide. The dynamic prediction model demonstrated well consistency and discrimination capabilities. Subgroup analyses revealed that the association of monthly average daily sunlight and monthly average temperature with suicide remained significant among female and younger lung cancer patients. The dynamic prediction model can effectively incorporate covariates with time-varying to predict lung cancer patients' suicide death. The results of this study have significant implications for assessing lung cancer individuals' suicide risk.

Development and validation of a nomogram for predicting suicide risk and prognostic factors in bladder cancer patients following diagnosis: A population-based retrospective study

This study sought to identify independent risk factors associated with suicide following a diagnosis of bladder cancer and to develop a predictive model with the potential to contribute to suicide rate reduction. Harnessing data from the Surveillance, Epidemiology, and End Results (SEER) database, we identified bladder cancer patients diagnosed between 2004 and 2015, randomly assigning them to training and validation cohorts. The Cox proportional hazard model was employed to identify relevant predictors, leading to the construction of prediction nomogram models. Validation of prognostic nomograms involved assessing the consistency index (C-index), receiver operating characteristic (ROC) curve, and calibration curve. A total of 109,961 eligible bladder cancer patients were enrolled, randomly divided into training and validation sets. Multivariate Cox regression analysis revealed that sex, marital status, tumor local status (T Stage), and lymph node metastatic conditions (N Stage) were independent predictors for suicide in bladder cancer patients. Evaluation of the nomogram's accuracy through the C-index and ROC curve demonstrated acceptable performance in both training and validation sets. Moreover, the calibration plot indicated moderate accuracy of the nomogram in both datasets. Overall, this study successfully identified risk factors for suicide among bladder cancer patients and developed a nomogram, offering individualized diagnosis, intervention, and risk assessment to mitigate the risk of suicide in this patient population.

Suicide among Cancer Patients: Current Knowledge and Directions for Observational Research

Cancer is a major public health concern associated with an increased risk of psychosocial distress and suicide. The reasons for this increased risk are still being characterized. The purpose of this study is to highlight existing observational studies on cancer-related suicides in the United States and identify gaps for future research. This work helps inform clinical and policy decision-making on suicide prevention interventions and ongoing research on the detection and quantification of suicide risk among cancer patients. We identified 73 peer-reviewed studies (2010-2022) that examined the intersection of cancer and suicide using searches of PubMed and Embase. Overall, the reviewed studies showed that cancer patients have an elevated risk of suicide when compared to the general population. In general, the risk was higher among White, male, and older cancer patients, as well as among patients living in rural areas and with lower socioeconomic status. Future studies should further investigate the psychosocial aspects of receiving a diagnosis of cancer on patients' mental health as well as the impact of new treatments and their availability on suicide risk and disparities among cancer patients to better inform policies.

Suicide in Later Life in Uruguay: A Suicide Note Analysis

Suicide is a significant public health challenge worldwide, with inconsistent behavioral patterns. This study examined the psychological processes underlying 191 suicide notes left by older adults in Uruguay, a country doubling global and regional suicide rates, with the highest prevalence among those aged 60+. Uruguay highlights in the region as a high-income country. Through content analysis with an inter-judge strategy, the notes revealed that loneliness, loss of interest, and loss of meaning for life, were prevalent. Financial hardship was not a primary reason for suicide. Social connectedness was highlighted as a factor for reducing suicide risk in older adults, particularly those with ill health and physical impairment. The study sheds light on the need to expand social services aimed at reducing loneliness and the need to combat ageism and social prejudice towards suicide in Uruguay, providing valuable insights into suicide prevention strategies for older adults in diverse social settings.

Higher risk of cardiovascular mortality than cancer mortality among long-term cancer survivors

Background

Previous studies focused more on the short-term risk of cardiovascular (CV) death due to traumatic psychological stress after a cancer diagnosis and the acute cardiotoxicity of anticancer treatments than on the long-term risk of CV death.

Methods

Time trends in the proportions of CV death (P_CV), cancer death (P_CA), and other causes in deaths from all causes were used to show preliminary relationships among the three causes of death in 4,806,064 patients with cancer from the Surveillance, Epidemiology, and End Results (SEER) program. Competing mortality risk curves were used to investigate when the cumulative CV mortality rate (CMR_CV) began to outweigh the cumulative cancer mortality rate (CMR_CA) for patients with cancer who survived for more than 10 years. Multivariable competing risk models were further used to investigate the potential factors associated with CV death.

Results

For patients with cancer at all sites, the P_CV increased from 22.8% in the 5th year after diagnosis to 31.0% in the 10th year and 35.7% in the 20th year, while the P_CA decreased from 57.7% in the 5th year after diagnosis to 41.2 and 29.9% in the 10th year and 20th year, respectively. The P_CV outweighed the P_CA (34.6% vs. 34.1%) since the 15th year for patients with cancer at all sites, as early as the 9th year for patients with colorectal cancer (37.5% vs. 33.2%) and as late as the 22nd year for patients with breast cancer (33.5% vs. 30.6%). The CMR_CV outweighed the CMR_CA since the 25th year from diagnosis. Multivariate competing risk models showed that an increased risk of CV death was independently associated with older age at diagnosis [hazard ratio and 95% confidence intervals [HR (95%CI)] of 43.39 (21.33, 88.28) for ≥ 80 vs. ≤ 30 years] and local metastasis [1.07 (1.04, 1.10)] and a decreased risk among women [0.82 (0.76, 0.88)], surgery [0.90 (0.87, 0.94)], and chemotherapy [0.85 (0.81, 0.90)] among patients with cancer who survived for more than 10 years. Further analyses of patients with cancer who survived for more than 20 years and sensitivity analyses by cancer at all sites showed similar results.

Conclusion

CV death gradually outweighs cancer death as survival time increases for most patients with cancer. Both the cardio-oncologist and cardio-oncology care should be involved to reduce CV deaths in long-term cancer survivors.

Role of exosomes in non-small cell lung cancer and EGFR-mutated lung cancer

As an important mediator of information transfer between cells, exosomes play a unique role in regulating tumor growth, supporting vascular proliferation, tumor invasion, and metastasis. Exosomes are widely present in various body fluids, and therefore they can be used as a potential tool for non-invasive liquid biopsy. The present study reviews the role of exosomes in liquid biopsy, tumor microenvironment formation, and epithelial-mesenchymal transition in non-small cell lung cancer (NSCLC). By targeting epidermal growth factor receptor (EGFR) therapy as a first-line treatment for patients with NSCLC, this study also briefly describes the occurrence of EGRF+ exosomes and the role of exosomes and their contents in non-invasive detection and potential therapeutic targets in EGFR-mutated lung cancer.

Suicide risk after head and neck cancer diagnosis in Taiwan: A retrospective cohort study

BACKGROUND

The diagnosis of head and neck cancer (HNC) may lead to exhaustion and depression. Therefore, the suicide risk of patients with HNC is high. This study aimed to understand the suicide risk of patients with HNC in Taiwan compared with patients with other-cancer and general population during the period from 2010 to 2019.

METHODS

A total of 74,495 patients with HNC were compared against the other two cohort consisting 148,878 patients with other-cancer and 595,512 individual without cancer by age, sex, and index year from the Taiwan National Health Insurance Research Database. The multivariate Cox proportional hazard regression analysis was performed to estimate the risk of all-cause or suicide mortality.

RESULTS

Compared to the non-cancer group, the all-cause mortality risk of the HNC group (the adjusted hazard ratio (aHR), 7.72; 95 % confidence interval (CI), 7.60-7.83) is lower than that of the other-cancer group (aHR, 8.87; 95 % CI, 8.77-8.98). However, the suicide mortality risk compared with non-cancer group in the HNC group (aHR, 3.89; 95 % CI, 3.46-4.37) is much higher than other-cancer group (aHR, 1.86; 95 % CI, 1.64-2.10). HNC only has the seventh highest all-cause mortality risk, but HNC has the second highest suicide mortality risk. Men always have a higher suicide mortality risk than women. Middle-aged patients (age 50-60 years) have the highest suicide mortality risk, whereas younger patients (age < 40 years) have the lowest suicide mortality risk.

LIMITATIONS

In this study, some factors and information needed were limited to the existing database; thus, preventing recall bias was difficult.

CONCLUSIONS

This study indicates that patients with HNC did not have a higher risk of all-cause mortality than patients with other cancers. However, the risk of suicide mortality in patients with HNC was higher than that of patients without cancer and patients with other cancers in Taiwan.

Suicide risk among female breast cancer survivors: A population-based study

Background

Breast cancer is the most common cancer type for females and has the highest relative number of suicide cases among female-specific cancers. This study aimed to demonstrate suicide rates and changing trends and to identify risk factors for suicide among female breast cancer survivors.

Methods

Data were derived from the surveillance, epidemiology, and end results database for women diagnosed with breast cancer from 2000 to 2017. Mortality rate and standardized mortality ratios (SMRs) were calculated to describe the incidence rate and trend of suicide among female breast cancer survivors. Gray's test and cumulative incidence function (CIF) curves were used to assess difference of cumulative suicide incidence in subgroups. Multivariate Fine-Gray competing risk model was used to identify risk factors for individual survivors and nomogram model was used to estimate the probability of suicide.

Result

There were 414 suicide cases among 638,547 female breast cancer survivors observed for 5,079,194 person-years, and the suicide rate and SMRs gradually increased with the year of diagnosis. Female breast cancer survivors had a higher risk of suicide than the general population (SMR = 1.19; 95% CI (1.08-1.31)). Based on the result of Fine-Gray competing risk models, age group (50-70 vs <50: HR=0.65, 95% CI:0.52-0.80; >70 vs <50: HR=0.22, 95% CI:0.15-0.32), race/ethnicity (black vs white: HR= 0.20, 95% CI: 0.11-0.36; other race vs white: HR= 0.67, 95% CI: 0.46-0.97), marital status (separated vs married: HR= 1.50, 95% CI: 1.16-1.94; single vs married: HR= 1.70, 95% CI: 1.31-2.20), stage (distant vs regional: HR= 0.30, 95% CI: 0.14-0.63), radiotherapy (Yes vs No/Unknown: HR= 0.62, 95% CI: 0.49-0.77), and molecular subtypes (HER-2 vs Luminal B (HR= 2.53, 95% CI: 1.10-5.82), TNBC vs Luminal B (HR= 2.11, 95% CI: 1.01-4.42)) were independent predictors of suicide among female breast cancer patients. A nomogram was constructed to predict the suicide probability for individual survivors with a C-index of 0.62 (95%CI: 0.59-0.66).

Conclusion

Female breast cancer survivors with younger age (less than 50 years old), white race, unmarried status, regional stage, HER-2 or TNBC subtype, and no radiotherapy performed were more likely to commit suicide. The clinicians and family members should pay more attention to patients with high risk factors of suicide to decrease the mortality rate.

Analysis of suicide risk in adult US patients with squamous cell carcinoma: a retrospective study based on the Surveillance, Epidemiology and End Results database

OBJECTIVES

The purpose of this study was to determine the risk factors for suicide in patients with squamous cell carcinoma (SCC) in the USA.

SETTING

Patients with SCC diagnosed between 1975 and 2017 from the Surveillance, Epidemiology and End Results (SEER) database were selected for this study.

PARTICIPANTS

This study included patients with SCC older than 20 years who were diagnosed between 1975 and 2017.

PRIMARY AND SECONDARY OUTCOME MEASURES

The general population included in data from the US Centers for Disease Control and Prevention were used to calculate the suicide rate and standardised mortality rate (SMR) of SCC patients. Univariate and multivariate Cox regression analyses were used to identify risk factors for suicide in patients with SCC.

RESULTS

There were 415 268 SCC patients registered in the SEER database, among which 1157 cases of suicide were found, comprising a total of 2 289 772 person-years. The suicide rate for patients with SCC was 50.53 per 100 000 person-years, and the SMR was 4.13 (95% CI 3.90 to 4.38). The Cox regression analyses showed that the factors related to a high risk of suicide among patients with SCC included being male (vs female: HR 5.36, 95% CI 4.51 to 6.38, p<0.001), older at the diagnosis (70-79 vs ≤39 years: HR 1.46, 95% CI 1.09 to 2.08, p=0.012; ≥80 vs ≤39 years: HR 1.48, 95% CI 1.05 to 2.08, p=0.025) and white (vs black, HR 2.97, 95% CI 2.20 to 4.02, p<0.001) and surgery (vs not performed: HR 0.65, 95% CI 0.57 to 0.74, p<0.001).

CONCLUSIONS

Compared with the general population, patients with SCC in the USA have a higher risk of suicide. Being male, older at the diagnosis, white and having a higher histological grade are risk factors for suicide in patients.

Incidence, trend and risk factors associated with suicide among patients with malignant intracranial tumors: a surveillance, epidemiology, and end results analysis

BACKGROUND

Cancer patients are associated with an elevated risk of suicide. This study aims to investigate the suicide rates and identify risk factors for suicide among patients with malignant intracranial tumors (MITs).

METHODS

Patients diagnosed with MITs during the years of 1975-2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) program. Suicide rates and standardized mortality ratios (SMR) were calculated. Cox regression analyses were used to identified risk factors for suicide among MIT patients.

RESULTS

Among 115,668 patients with MITs collected from the SEER program, 99 committed suicide. The rate of suicide was 23.02 per 100,000 person-years, and SMR of suicide was 1.90. Diagnosis in recent era (years 2000-2015, SMR = 2.01), male gender (SMR = 1.78), older age (60-79 years, SMR = 3.54), white race (SMR = 1.86), married persons (SMR = 2.31), living in rural areas (SMR = 2.50), history of other malignancy (SMR = 3.81), diagnosis of glioblastoma (SMR = 4.05) and supratentorial location (SMR = 2.45) were associated with an increased incidence of suicide. In addition, the risk of suicide increased significantly within the first year after diagnosis (SMR = 13.04). Multivariate Cox regressions showed that older age, male sex, and supratentorial location were independent risk factors for suicide.

CONCLUSIONS

The suicide mortality among patients with MITs steadily elevated in the past decades. Male sex, older age, and supratentorial location were significantly associated with risk of suicide, especially within the first year following diagnosis. Healthcare providers should early identify and effectively intervene with MIT patients at risk.

Incidence and risk factors of suicide among patients with pancreatic cancer: A population-based analysis from 2000 to 2018

Background

The rate of suicide within one year after diagnosis in pancreatic cancer patients are high, but suicide studies based on the current large-scale data are still a vacancy. Our study aimed to determine, compared to the general population, the standardized mortality ratios (SMRs) of suicide and risk factors associated with pancreatic cancer patients committing suicide to provide clues for prevention.

Methods

We collected 199,604 patients diagnosed with pancreatic cancer between 2000 and 2018 from the SEER database. Multivariate logistic regression and multivariate Cox regression were applied to determine the risk factors independently affecting the suicide outcome of pancreatic cancer patients.

Results

A total of 180 suicide deaths were observed in the cohort, yielding an overall suicide rate of 88.05 per 100,000 person-years and an SMR of 6.43. In multivariate analyses, males (HR: 12.798, 95% CI: 7.471-21.923), unmarried (HR: 1.826, 95% CI: 1.205-2.767), and divorced, separated or widowed (HR: 1.779, 95% CI: 1.230-2.572) were found associated with a higher risk of suicide. While race black (HR: 0.250, 95% CI: 0.110-0.567), diagnosed with pancreatic neuroendocrine tumor (HR: 0.487, 95% CI: 0.276-0.859), received chemotherapy (HR: 0.456, 95% CI: 0.323-0.646), and received surgical procedures (HR: 0.553, 95% CI: 0.342-0.895) were indicated might protective factors.

Conclusions

The 199,604 pancreatic cancer patients diagnosed between 2000 and 2018 had an overall suicide rate of 88.05 per 100,000 person-years and an SMR of 6.43 compared to the U.S. general population. Male, white, unmarried, and diagnosed with pancreatic adenocarcinoma patients were associated with a higher risk of suicide, while cancer-directed surgery and chemotherapy might indicate protective factors. The screening and prevention process should be enhanced for pancreatic cancer patients with adverse risk factors. Moreover, it is reasonable to assume that timely cancer-directed treatment might help reduce the subsequent suicide risk of pancreatic cancer patients.

Incidence and risk factors of suicide in patients with lung cancer: a scoping review

PURPOSE

To explore the high-risk period of the occupation of suicide after diagnosis; and clarify the risk factors of suicidal behaviors (suicidal ideation, suicide attempt, and suicidal death) behind the lung cancer patients during the cancer cure process.

METHODS

This scoping review was conducted through the whole month of April 2021. We extracted data of the suicide mortality after diagnosis and latent risk factors of suicidal behaviors among lung cancer patients where we used to study from the two online databases which are PubMed and Web of Science. Two online databases were searched and written in English without age restriction. To note that the standardized mortality ratio (SMR), person-years, and odds ratio (OR) associated with lung cancer were documented.

RESULTS

Out of 570 records, 23 studies mentioned suicidal behaviors and lung cancer met the included criteria. Eleven (n = 47.8%) of the selected publications reported changes in suicide mortality. None of them reported suicidal ideation or suicide attempt after diagnosis. The individuals with lung cancer have significantly higher rates of suicidal death (SMR, 2.04-13.4) during the first years after diagnosis and decrease over subsequent years (SMR, 0.66-3.17). The median time from cancer diagnosis to suicide death was around 7 months. Across all studies with the 22 studies that examined factors, we extracted the data of the suicidal ideation (n = 3), suicide attempt (n = 1), and suicidal death (n = 18) in individuals. For patients with suicidal ideation, there was a significantly higher incidence in males than in females. Among patients who attempted suicide, the incidence of mental illness is greater than the incidence of physical illness. Factors for suicidal death, including gender (male, 56.3-100%), prognosis tumors (poor, 25.8-66.3%), marital status (widowhood or unmarried, 19-75.7%), and age of patients (> 70 years, 24.5-47%) with lung cancer, play a vital role. Treatment of lung cancer is expected to affect a patient in his/her mental state.

CONCLUSION

Overall, our finding indicates that lung cancer patients have been presented with a higher incidence of suicide death in a specific period, especially the early years after diagnosis. Discovering risk factors for suicide helps prevent potential suicide. It is essential to screen lung cancer patients for suicidal ideation, especially those with high-risk factors. Future prospective studies are necessary to confirm these findings to support care.

Octogenarians may benefit from stage-specific small cell lung cancer treatment

BACKGROUND

Our study investigates treatment profiles in octogenarian patients with small cell lung cancer (SCLC) and assesses each treatment's role in a stage-specific manner.

METHODS

Patient data from individuals with SCLC aged 80 years and older between 1988 and 2015 in the Surveillance, Epidemiology, and End Results Program (SEER) database were extracted. Cancer-specific survival (CSS) between patients with no treatment and different treatment groups were compared by the Kaplan-Meier method, with stratifications by stage. Cox Proportional Hazard model further identified independent prognostic factors.

RESULTS

A total of 7,290 patients were included in this study. Notably, 3,358 (46.1%) patients did not receive active treatment. Compared with the no active treatment group, the CSS of patients who received treatment was significantly improved (median 6 vs. 0 months, P<0.001) and further validated in stage subgroups. Chemotherapy combined with local therapy was associated with the best CSS in regional and distant disease stages, with the hazard ratios (HR) and 95% confidence intervals (CI) being 0.30 (0.26-0.34) and 0.27 (0.25-0.30), respectively. Local therapy only appeared to confer better oncological outcomes (HR =0.33; 95% CI: 0.25-0.42) than chemotherapy only (HR =0.37; 95% CI: 0.29-0.47) in the localized disease stage.

CONCLUSIONS

Although nearly half of octogenarians with SCLC did not receive active treatment in the real clinical setting, these patients may benefit from treatment. Chemotherapy combined with local therapy may provide the best treatment choice in octogenarians with advanced SCLC, while local therapy appears to play a more critical role in treating those with early-stage disease.

Risk factors associated with suicide among esophageal carcinoma patients from 1975 to 2016

Throughout the world, esophageal cancer patients had a greater suicidal risk compared with ordinary people. Thus, we aimed to affirm suicide rates, standardized mortality rates, and underlying suicide-related risk factors of esophageal cancer patients. Patients suffering esophageal cancer were chosen from the Surveillance, Epidemiology, and End Results repository in 1975–2016. Suicide rates as well as standardized mortality rates in the patients were measured. Univariable and multivariable Cox regression had been adopted for establishing the latent suicide risk factors among patients suffering esophageal cancer. On multivariable Cox regression, gender (male vs. female, HR: 6.37), age of diagnosis (70–105 vs. 0–55, HR: 2.69), marital status, race (white race vs. black race, HR: 6.64; American Indian/Alaska Native, Asian/Pacific Islander vs. black race, HR: 8.60), histologic Grade (Grade III vs. Grade I, HR: 2.36), no surgery performed (no/unknown vs. yes, HR: 2.01), no chemotherapy performed were independent risk factors related to suicide in patients suffering esophageal cancer. Male sex, the older age, unmarried state, non-black race, histologic Grade III, no surgery performed, no chemotherapy performed were strongly related to suicide in patients suffering esophageal cancer.

Prediction of risk of suicide death among lung cancer patients after the cancer diagnosis

BACKGROUND

Patients diagnosed with lung cancer have a higher suicide rate than the general population and other cancer patients. The aim of this study was to develop and validate a prediction model for the individual risk for suicide after the diagnosis of lung cancer.

METHODS

Patients diagnosed with lung cancer between 2007 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and validation cohorts. Cox proportional hazard models were used to identify relevant predictors and construct prediction models. Additionally, graphic visualization methods were used to predict the risk for suicide within 5 years after the diagnosis of lung cancer. We used bootstrapping for the internal validation, Harrell's C-index for the discrimination, and a calibration plot for the calibration of the proposed model.

RESULTS

We obtained complete information on 112372 patients diagnosed with lung cancer from the SEER cohort. Multivariate Cox regression identified sex, race, marital status, tumour grade, surgery, radiation, and chemotherapy as significant predictors for suicide. A nomogram and a risk matrix were developed to visualize the risk for suicide within 5 years after lung cancer diagnosis. The bootstrapped and validated C-indices of the nomogram were 0.77 and 0.78, respectively. The calibration plot indicated good agreement between the prediction and actual observation.

CONCLUSIONS

The proposed model demonstrated good discrimination and calibration performance for predicting the risk for suicide within 5 years after lung cancer diagnosis. Reliable and feasible risk assessment tools can be promising for preventing unnecessary suicides among lung cancer patients.

Prevalence and risk factors for suicidality in cancer patients and oncology healthcare professionals strategies in identifying suicide risk in cancer patients

PURPOSE OF REVIEW

The aim of this study was to summarize the literature on prevalence and risk factors for suicidality in cancer patients and to document the research on oncology healthcare professionals' strategies in identifying this risk.

RECENT FINDINGS

Cancer patients exhibit increased risk of suicidality compared with the general population. Various risk factors have been identified including sociodemographic factors such as poverty, being male and elderly as well as disease-related attributes such as cancer type and stage. The literature on how healthcare professionals identify suicide risk is sparse. Ten articles were found that focused on two main themes. These included information on systematic strategies in identifying suicide risk and factors that affect healthcare professionals' ability to identify risk in their patients.

SUMMARY

Although there is an immense amount of literature documenting the problem of suicidality among patients, the research on how healthcare professionals identify and respond to these indications in patients is nearly nonexistent. Cancer centres should implement standardized and systematic screening of cancer patients for suicidality and research on this patient population should collect and report these data. Ongoing training and education for healthcare professionals who work in the oncology setting on how to identify and respond to suicide risk among cancer patients is urgently needed.

Biological Function of Long Non-coding RNA (LncRNA) Xist

Long non-coding RNAs (lncRNAs) regulate gene expression in a variety of ways at epigenetic, chromatin remodeling, transcriptional, and translational levels. Accumulating evidence suggests that lncRNA X-inactive specific transcript (lncRNA Xist) serves as an important regulator of cell growth and development. Despites its original roles in X-chromosome dosage compensation, lncRNA Xist also participates in the development of tumor and other human diseases by functioning as a competing endogenous RNA (ceRNA). In this review, we comprehensively summarized recent progress in understanding the cellular functions of lncRNA Xist in mammalian cells and discussed current knowledge regarding the ceRNA network of lncRNA Xist in various diseases. Long non-coding RNAs (lncRNAs) are transcripts that are more than 200 nt in length and without an apparent protein-coding capacity (Furlan and Rougeulle, 2016; Maduro et al., 2016). These RNAs are believed to be transcribed by the approximately 98-99% non-coding regions of the human genome (Derrien et al., 2012; Fu, 2014; Montalbano et al., 2017; Slack and Chinnaiyan, 2019), as well as a large variety of genomic regions, such as exonic, tronic, and intergenic regions. Hence, lncRNAs are also divided into eight categories: Intergenic lncRNAs, Intronic lncRNAs, Enhancer lncRNAs, Promoter lncRNAs, Natural antisense/sense lncRNAs, Small nucleolar RNA-ended lncRNAs (sno-lncRNAs), Bidirectional lncRNAs, and non-poly(A) lncRNAs (Ma et al., 2013; Devaux et al., 2015; St Laurent et al., 2015; Chen, 2016; Quinn and Chang, 2016; Richard and Eichhorn, 2018; Connerty et al., 2020). A range of evidence has suggested that lncRNAs function as key regulators in crucial cellular functions, including proliferation, differentiation, apoptosis, migration, and invasion, by regulating the expression level of target genes via epigenomic, transcriptional, or post-transcriptional approaches (Cao et al., 2018). Moreover, lncRNAs detected in body fluids were also believed to serve as potential biomarkers for the diagnosis, prognosis, and monitoring of disease progression, and act as novel and potential drug targets for therapeutic exploitation in human disease (Jiang W. et al., 2018; Zhou et al., 2019a). Long non-coding RNA X-inactive specific transcript (lncRNA Xist) are a set of 15,000-20,000 nt sequences localized in the X chromosome inactivation center (XIC) of chromosome Xq13.2 (Brown et al., 1992; Debrand et al., 1998; Kay, 1998; Lee et al., 2013; da Rocha and Heard, 2017; Yang Z. et al., 2018; Brockdorff, 2019). Previous studies have indicated that lncRNA Xist regulate X chromosome inactivation (XCI), resulting in the inheritable silencing of one of the X-chromosomes during female cell development. Also, it serves a vital regulatory function in the whole spectrum of human disease (notably cancer) and can be used as a novel diagnostic and prognostic biomarker and as a potential therapeutic target for human disease in the clinic (Liu et al., 2018b; Deng et al., 2019; Dinescu et al., 2019; Mutzel and Schulz, 2020; Patrat et al., 2020; Wang et al., 2020a). In particular, lncRNA Xist have been demonstrated to be involved in the development of multiple types of tumors including brain tumor, Leukemia, lung cancer, breast cancer, and liver cancer, with the prominent examples outlined in Table 1. It was also believed that lncRNA Xist (Chaligne and Heard, 2014; Yang Z. et al., 2018) contributed to other diseases, such as pulmonary fibrosis, inflammation, neuropathic pain, cardiomyocyte hypertrophy, and osteoarthritis chondrocytes, and more specific details can be found in Table 2. This review summarizes the current knowledge on the regulatory mechanisms of lncRNA Xist on both chromosome dosage compensation and pathogenesis (especially cancer) processes, with a focus on the regulatory network of lncRNA Xist in human disease.

Risk factors for suicide in individuals with cancer: an integrative literature review

OBJECTIVE

to develop an integrative literature review on risk factors for suicide in individuals with cancer.

METHOD

searching for articles was conducted in the Scientific Electronic Library Online, Medicinal Literature Analysis and Retrieval System Online, Latin American & Caribbean Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature and SciVerse Scopus databases, using the descriptors "suicide" and "cancer".

RESULTS

eighteen articles were selected. Lung, bladder and colorectal cancers are the types of highest risk for suicide. Male, white and over 60 years of age are demographic factors with higher risk for suicide in individuals with cancer.

CONCLUSION

this review made it possible to verify that cancer may be a risk factor for suicide. This evidence can be useful for planning preventive actions in order to reduce the risk of suicide.

Risk factors associated with suicide among hepatocellular carcinoma patients: A surveillance, epidemiology, and end results analysis

BACKGROUND

Throughout the world, hepatocellular carcinoma (HCC) remains the primary type of liver cancer. The suicide risk was higher among patients with HCC than the general population. Hence, the purpose of this study was to confirm the suicide rates, standardized mortality ratios (SMRs), and the potential risk factors associated with suicide among HCC patients.

METHODS

HCC patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database during 1975-2016. Suicide rates and SMRs among these patients were calculated, and the general population of the United States (U.S.) during 1975-2016 was used as a reference. Univariable and multivariable Cox regression were taken to find out the underlying risk factors of suicide in HCC patients.

RESULTS

There were 70 suicides identified among 102,567 individuals with HCC observed for 160,500.88 person years. The suicide rate was 43.61 per 100,000 person-years, and SMR was 2.26 (95% CI: 1.78-2.84). On Cox regression, year of diagnosis (1975-1988 vs. 2003-2016, HR: 3.00, 95% CI: 1.01-8.89, P = 0.047; 1989-2002 vs. 2003-2016, HR: 1.92, 95% CI: 1.10-3.34, P = 0.021), gender (male vs. female, HR: 8.72, 95% CI: 2.73-27.81, P < 0.001), age at diagnosis (63-105 years old vs. 0-55 years old, HR: 2.28, 95% CI: 1.21-4.31, P = 0.011), race (white race vs. American Indian/Alaska Native, Asian/Pacific Islander, HR: 3.02, 95% CI: 1.35-6.76, P = 0.007) were independent risk factors of suicide among HCC patients.

CONCLUSIONS

Diagnosed in the early years (1975-2002), male sex, the older age (63-105 years old), white race, survival months (＜2 months) were significantly associated with suicide among HCC patients. For the sake of preventing suicide behaviors, the government, clinicians, and family members should take adequate measures to decrease the rate of suicide, especially in patients with high-risk factors of suicide.

Suicide among cancer patients: adolescents and young adult (AYA) versus all-age patients

Background

Many researchers have studied suicide risk factors of patients with one specific cancer. But there is no comprehensive study to compare suicide issues between adolescents and young adult (AYA) group and all-age groups in a pan-cancer view.

Methods

Patients diagnosed with 20 solid malignancies were identified from SEER database. Multivariable logistic regression was operated to find out risk factors of suicide.

Results

Male sex has less impact on AYA than all-age patients (OR 2.72, 95% CI: 2.23-3.31, P<0.001 vs. OR 4.64, 95% CI: 4.37-4.94, P<0.001), while white race (OR 3.28, 95% CI: 2.02-5.77, P<0.001 vs. OR 3.40, 95% CI: 3.02-3.84, P<0.001) and unmarried status (OR 1.51, 95% CI: 1.24-1.83, P<0.001 vs. OR 1.39, 95% CI: 1.33-1.46, P<0.001) have similar impact on AYA and all-age groups. Localized cancer stage may have stronger impact on AYA than all-age (OR 2.90, 95% CI: 1.83-4.84; P<0.001 vs. OR 1.76, 95% CI: 1.61-1.92; P<0.001), while surgery only influence all-age (OR 1.14, P=0.451 vs. 1.24, P<0.001). Within 5 years from cancer diagnosis, longer survival time is associated with higher suicide risk of both all-age and AYA patients.

Conclusions

Male sex, white race and unmarried status, earlier cancer stage and longer survival time within 5 years are similar prevalent risk factors for both AYA group patients and all-age patients. It is not necessary to pick AYA cancer patients out when considering suicide risk of cancer patients.

Risk factors associated with suicide among kidney cancer patients: A Surveillance, Epidemiology, and End Results analysis

Background

The suicide risk was higher in kidney cancer patients than in the general population. The purpose of this study was to characterize the suicide rates among kidney cancer patients and to identify the potential risk factors associated with suicide from the Surveillance, Epidemiology, and End Results (SEER) database.

Methods

Kidney cancer patients were identified from the SEER database during 1973‐2015. Suicide rates and standardized mortality ratios (SMRs) of this population were calculated, and the US general population during 1981‐2015 was chosen as a reference. Univariable and multivariable Cox regression were performed to find out potential risk factors of suicide.

Results

There were 207 suicides identified among 171 819 individuals with kidney cancer observed for 948 272 person‐years. The suicide rate was 21.83 per 100 000 person‐years, and SMR was 1.83 (95% CI: 1.59‐2.10). On Cox regression, diagnosis in early years (1973‐1982 vs 2003‐2015, HR: 2.03, 95% CI: 1.01‐4.11, P = 0.048; 1983‐1992 vs 2003‐2015, HR: 1.99, 95% CI: 1.18‐3.35, P = 0.010), male sex (vs female sex, HR: 4.43, 95% CI: 2.95‐6.65, P < 0.001), unmarried status (vs married status, HR: 2.54, 95% CI: 1.91‐3.38, P < 0.001), non‐black race (white race vs black race, HR: 4.47, 95% CI: 2.09‐9.58, P < 0.001; other races vs black race, HR: 3.01, 95% CI: 1.08‐8.37, P = 0.035), higher histologic grade (grade IV vs grade I, HR: 3.27, 95% CI: 1.50‐7.13, P = 0.003; grade III vs grade I, HR: 2.13, 95% CI: 1.19‐3.81, P = 0.011) and cancer‐directed surgery not performed (vs performed, HR: 2.78, 95% CI: 1.52‐5.11, P < 0.001) were independent risk factors of suicide among kidney cancer patients.

Conclusions

Diagnosis in early years, male sex, unmarried status, non‐black race, higher histologic grade, and cancer‐directed surgery not performed were significantly associated with suicide among kidney cancer patients. In order to prevent suicidal death, clinicians should pay more attention to patients with high‐risk factors of suicide.

Trends in incidence and associated risk factors of suicide mortality in patients with non-small cell lung cancer

Lung cancer patients have an increased risk for committing suicide. But no comprehensive study about the suicide issues among non-small-cell lung cancer (NSCLC) patients has been published. We aimed to estimate the trend of suicide rate and identify the high-risk group of NSCLC patients. Patients diagnosed with primary NSCLC were identified from Surveillance, Epidemiology, and End Results (SEER) database (1973-2013). Suicide mortality rate (SMR) were calculated. Multivariable logistic regression was employed to find out independent risk factors for suicide. Among 495 889 NSCLC patients, 694 (0.14%) of them died from suicide. The suicide mortality rates have significantly decreased (before 1993: 0.21%, 1994-2003: 0.16%, after 2004: 0.09%, P < .001). Male (OR 6.22, 95% CI: 4.96-7.98, P < .001), white (OR 3.89, 95% CI: 2.66-5.97, P < .001), being unmarried (OR 1.43, 95% CI: 1.22-1.67, P < .001), the elderly (60-74 vs <60: OR 1.24, 95% CI: 1.03-1.50, P = .024, >75 vs <60: OR 1.31, 95% CI: 1.05-1.63, P = .018) were independently associated with higher risk of suicide mortality. Surgery (OR: 1.44, 95% CI: 1.19-1.73, P < .001) was also relative with higher risk of suicide. Our study observed significant decrease in suicide mortality among NSCLC patients in US over past decades. Older age, male sex, unmarried status, and surgery were risk factors of committing suicide. Clinicians should be aware of these high-risk groups.