Suicidal death within a year of a cancer diagnosis: A population‐based study

Background

The suicide risk after a new cancer diagnosis remains a controversial issue. This study examines the suicide risk within the year after a cancer diagnosis. This is the largest study to assess recent trends in suicide risk after a cancer diagnosis.

Methods

Data were obtained from the Surveillance, Epidemiology, and End Results Program. All patients diagnosed with cancer between 2000 and 2014 were selected. The event was defined as death due to suicide within the first year after a cancer diagnosis, and patients who experienced the event after their diagnosis were observed. The observed/expected (O/E) ratio was assessed as well as the excess risk per 10,000 person‐years to determine the suicide risk change after the diagnosis in comparison with the general population.

Results

A total of 4,671,989 patients with cancer were included; 1585 committed suicide within 1 year of their diagnosis. The risk of suicide increased significantly with an O/E ratio of 2.52 and with an excess risk of 2.51 per 10,000 person‐years. When the risk of suicide was studied according to the cancer site, the highest increases in the O/E ratio came after diagnoses of pancreatic cancer (8.01) and lung cancer (6.05). The risk of suicide also increased significantly after a diagnosis of colorectal cancer with an O/E ratio of 2.08. However, the risk of suicidal death did not increase significantly after breast and prostate cancer diagnoses.

Conclusions

The risk of suicide increases significantly in the first year after a diagnosis of cancer in comparison with the general population, and this increase varies with the type and prognosis of cancer. Close observation and referral to mental health services, when indicated, are important for mitigating such risk.

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Trends in the risk and burden of second primary malignancy among survivors of smoking‐related cancers in the United States

While there are a growing number of cancer survivors, this population is at increased risk of developing second primary malignancies (SPMs). We described the incidence, most common tumor sites, and trends in burden of SPM among survivors of the most commonly diagnosed smoking‐related cancers. The current study was a population‐based study of patients diagnosed with a primary malignancy from the top 10 smoking‐related cancer sites between 2000 and 2014 from Surveillance, Epidemiology, and End Results data. SPM risks were quantified using standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person‐years at risk (PYR). Trends in the burden of SPM were assessed using Joinpoint regression models. A cohort of 1,608,607 patients was identified, 119,980 (7.5%) of whom developed SPM (76% of the SPMs were smoking‐related). The overall SIR of developing second primary malignancies was 1.51 (95% CI, 1.50–1.52) and the EAR was 73.3 cases per 10,000 PYR compared with the general population. Survivors of head and neck cancer had the highest risk of developing a SPM (SIR=2.06) and urinary bladder cancer had the highest excess burden (EAR=151.4 per 10,000 PYR). The excess burden of SPM for all smoking‐related cancers decreased between 2000 and 2003 (annual percentage change [APC] = ‐13.7%; p=0.007) but increased slightly between 2003 and 2014 (APC=1.6%, p=0.032). We show that 1‐in‐12 survivors of smoking‐related cancers developed an SPM. With the significant increase in the burden of SPM from smoking‐related cancers in the last decade, clinicians should be cognizant of long‐term smoking‐related cancer risks among these patients as part of their survivorship care plans.

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Concurrent chemoradiotherapy with/without induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma: Long‐term results of phase 3 randomized controlled trial

To report long‐term results of a randomized controlled trial that compared cisplatin/fluorouracil/docetaxel (TPF) induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) with CCRT alone in locoregionally advanced nasopharyngeal carcinoma (NPC). Patients with stage III–IVB (except T3–4N0) NPC were randomly assigned to receive IC plus CCRT (n=241) or CCRT alone (n=239). IC included three cycles of docetaxel (60 mg/m² d1), cisplatin (60 mg/m² d1), and fluorouracil (600 mg/m²/d civ d1–5) every 3 weeks. Patients from both groups received intensity‐modulated radiotherapy concurrently with three cycles of 100 mg/m² cisplatin every 3 weeks. After a median follow‐up of 71.5 months, the IC plus CCRT group showed significantly better 5‐year failure‐free survival (FFS, 77.4% vs. 66.4%, P=0.019), overall survival (OS, 85.6% vs. 77.7%, P=0.042), distant failure‐free survival (88% vs. 79.8%, P=0.030), and locoregional failure‐free survival (90.7% vs. 83.8%, P=0.044) compared with the CCRT alone group. Post hoc subgroup analyses revealed that beneficial effects on FFS were primarily observed in patients with N1, stage IVA, pretreatment lactate dehydrogenase ≥ 170 U/L, or pretreatment plasma Epstein‐Barr virus DNA ≥ 6000 copies/mL. Two nomograms were further developed to predict the potential FFS and OS benefit of TPF IC. The incidence of grade 3 or 4 late toxicities was 8.8% (21/239) in the IC plus CCRT group and 9.2% (22/238) in the CCRT alone group. Long‐term follow‐up confirmed that TPF IC plus CCRT significantly improved survival in locoregionally advanced NPC with no marked increase in late toxicities and could be an option of treatment for these patients.

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Erratum

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Decreased incidence of Kaposi sarcoma after kidney transplant in Italy and role of mTOR‐inhibitors: 1997‐2016

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Efficacy and Safety of Osimertinib in Treating EGFR‐Mutated Advanced NSCLC: A Meta‐analysis

Osimertinib is the only Food and Drug Administration‐approved third‐generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI). A meta‐analysis was performed to aggregate the mixed results of published clinical trials to assess the efficacy and safety of osimertinib. A systematic search of the PubMed, Web of Science and Cochrane Library electronic databases was performed to identify eligible literature. The primary endpoints were overall response rate (ORR), disease control rate (DCR), progression‐free survival (PFS), and adverse events (AEs). A total of 3086 advanced non‐small‐cell lung cancer (NSCLC) patients from 11 studies have been identified. The aggregate efficacy parameters for treatment‐naïve patients with EGFR‐TKI sensitizing mutations are as follows: ORR 79% (95% CI 75%‐84%), DCR 97% (95% CI 95%‐99%), 6‐month PFS 83% (95% CI 80%‐87%), and 12‐month PFS 64% (95% CI 59%‐69%). The aggregate efficacy parameters for advanced NSCLC harboring T790M mutations after earlier‐generation EGFR‐TKI therapy are as follows: ORR 58% (95% CI 46%‐71%), DCR 80% (95% CI 63%‐98%), 6‐month PFS 63% (95% CI 58%‐69%), and 12‐month PFS 32% (95% CI 17%‐47%). EGFR‐TKI‐naïve patients with EGFR‐positive mutations tend to have longer median PFS than EGFR‐TKI‐pretreated counterparts (19.17 months vs. 10.58 months). The most common AEs were diarrhea and rash, of which the pooled incidences were 44% and 42%, respectively. Generally, osimertinib is a favorable treatment option for previously treated T790M mutation‐positive advanced NSCLC as well as a preferable therapy for untreated EGFR mutation‐positive advanced NSCLC. Additionally, osimertinib is well tolerated by most patients.

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“Decreased incidence of Kaposi sarcoma after kidney transplant in Italy and role of mTOR‐inhibitors: 1997‐2016” Reply to Letter re: Risk of Kaposi sarcoma after solid organ transplantation in the United States

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