BACKGROUND An increased risk of death by suicide in cancer patients has been documented since decades. We evaluated the risk of death by suicide in an Italian population-based cancer case series and added the results to a systematic review and meta-analysis of the literature. METHODS The Italian series, including 127,042 primary cancer patients diagnosed between 1996 and 2014, was obtained from the Romagna Cancer Registry (northern Italy). Standardised mortality ratios (SMRs) were calculated. Regarding the systematic review and meta-analysis, the PubMed database was searched for English language studies published up to 2017. Fifty-seven potentially eligible papers were reviewed in full, and 19 of them were selected for analysis. The SMR was the first outcome, replaced by rate ratio if the SMR was not available. FINDINGS In the Italian case series, an increased suicide risk was found for both sexes combined (SMR = 1.5; 95% confidence interval [CI]: 1.3-1.8), for males (SMR = 1.6; 95% CI: 1.4-1.9) but not females (SMR = 1.1; 95% CI: 0.7-1.7), for patients aged ≥55 years, with poor prognosis and advanced-stage disease and during the first year after diagnosis. The absolute excess risk of suicide was 0.9 per 10,000 patient-years. Multivariate analysis confirmed the role of univariate factors except for poor prognosis. Meta-analysis showed a strong heterogeneity between studies. The risk was significantly elevated for both sexes combined (pooled SMR = 1.7; 95% CI: 1.5-1.9), men (pooled SMR = 1.8; 95% CI: 1.6-2.0) and women (pooled SMR = 1.4; 95% CI: 1.3-1.6). There was no evidence for small-study effects. INTERPRETATION The Italian study confirmed the previous common finding that cancer patients are at increased risk for suicide. A clinical multidisciplinary approach to support them is needed.

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癌症患者的自杀死亡：来自意大利北部的新数据，对过去22年的系统评价和荟萃分析。

背景技术自数十年来以来，已经证明癌症患者自杀死亡的风险增加。我们在一个基于意大利人群的癌症病例系列中评估了自杀死亡的风险，并将结果添加到文献的系统评价和荟萃分析中。方法从Romagna Cancer Registry（意大利北部）获得意大利系列，包括在1996年至2014年期间诊断出的127,042名原发性癌症患者。计算标准化死亡率（SMR）。关于系统评价和荟萃分析，检索PubMed数据库以查找截至2017年的英语研究。对57篇符合条件的论文进行了全面综述，并选择了19篇进行分析。SMR是第一个结果，如果无法使用SMR，则将其替换为比率。结果在意大利病例系列中，发现男性和女性合并自杀风险增加（SMR = 1.5； 95％置信区间[CI]：1.3-1.8），男性（SMR = 1.6； 95％CI：1.4-1.9）但对于55岁以上，预后不良和晚期疾病以及诊断后第一年的患者，女性则不然（SMR = 1.1； 95％CI：0.7-1.7）。绝对绝对的自杀风险为每10,000患者年0.9。多因素分析证实了单因素的作用，除了预后较差外。荟萃分析显示研究之间存在很强的异质性。男女（合并SMR = 1.7; 95％CI：1.5-1.9），男性（合并SMR = 1.8; 95％CI：1.6-2.0）和女性（合并SMR = 1.4; 95％CI）的风险均显着增加：1.3-1.6）。没有证据表明有小规模的研究效果。解释意大利的研究证实了以前的普遍发现，即癌症患者自杀的风险增加。需要一种支持他们的临床多学科方法。