Long-term suicide risk in lung cancer patients: a nationwide cohort study

Lung cancer patients have a higher risk of suicide, but the long-term patterns and how they differ by treatment type have not been fully characterized. To investigate longitudinal suicide risk among lung cancer patients who underwent surgery compared to matched controls and to examine variations over time by treatment modality and patient characteristics.

We identified 37,215 individuals newly diagnosed with lung cancer between 2010 and 2017 who underwent lung resection within 1 year of diagnosis, along with 1:3 age- and sex-matched controls. Subdistribution hazard ratios (sHRs) and 95% confidence intervals (CIs) for suicide were estimated using a competing risk analysis.

The cohort (mean age 64.0 years; 62.5% male) was followed for a mean of 7.6 years. There were 154 suicides among lung cancer patients (incidence rate 0.6 per 1,000 person-years). Suicide risk peaked during the first year after surgery (sHR 1.88, 95% CI 1.23-2.87) and declined in subsequent years. Patients who underwent surgery alone had a higher risk in the first year (sHR 1.66, 95% CI 1.02-2.69), which gradually decreased over time. In contrast, patients treated with adjuvant chemotherapy or radiotherapy experienced a substantially higher initial risk (e.g., sHR 7.00, 95% CI 3.00-16.37 for surgery + radiotherapy) and maintained a moderate increase in suicide risk even beyond 5 years. Subgroup analyses showed an especially elevated first-year suicide risk among younger adults aged 20-49 years, males, and never smokers.

Suicide risk for lung cancer patients is highest during the first postoperative year, particularly for those who receive multimodal therapy, or are younger adults, males, or never smokers. These findings emphasize the need to prioritize early, tailored psychosocial support in survivorship care to help mitigate long-term suicide risk.