Suicide in breast cancer patients: An individual-centered approach provides insight beyond epidemiology

Figures & data

Table I. Summary of characteristics of six breast cancer patients who committed suicide.

	Case 1	Case 2	Case 3
Primary breast cancer disease
age at initial diagnosis	40	60	54
TNM classification	pT2 pN0 cM0	ypT1c cN0 cM0	pT2 pN3a cM0
TNM stage^1	IIA	I	IIIC
Histological type, grading	Lobular, G3	Ductal, G2	Ductal, G3
HR status	ER- PR-	ER+PR+	ER- PR-
Kind of surgery	BCT + ALND	BCT	BCT + ALND
Adjuvant chemotherapy	No	No	Yes (epirubicin/cyclophosphamid)
Adjuvant endocrine therapy	No	Yes (tamoxifen)	No
Adjuvant radiotherapy	Yes	No	Yes
Metastatic disease
Recurrence occurred	Yes	No	Yes
Recurrence free survival (months)	169	n/a	7
Palliative chemotherapy, number of lines	Yes, 3 lines	n/a	Yes, 3 lines
History
Psychiatric history	No	Severe depression, histrionic personality disorder	No
Medical history	No	No	Colitis ulcerosa: minor symptoms, conservative management
Condition at time of suicide
Age	56	60	55
Metastatic site at time of suicide	OSS, LYM, CUT, HEP, PLE, PUL	n/a	OSS, LYM, CUT, BRA
Cancer-related symptoms	Severe: pain, dyspnea	None	Moderate: pain, dizziness, nausea
Symptoms of illness independent of cancer	No	Severe depression	No
Survival after initial cancer diagnosis (months)	199	9	16
Survival after diagnosis of recurrence (months)	30	n/a	9
Mechanism of suicide	PAS	Jumping from height	Suicide by train
	Case 4	Case 5	Case 6
Primary breast cancer disease
age at initial diagnosis	80	81	64
TNM classification	pT1c pN0 cM0	pT1c pN3a cM0	pT2 pN0 cM0
TNM stage^1	I	IIIC	IIA
Histological type, grading	Ductal, G2	Lobular, G3	Ductal, G1
HR status	ER- PR-	ER+PR+	ER+PR+
Kind of surgery	BCT + ALND	Mastectomy + ALND	BCT + Sentinel lymph node biopsy
Adjuvant chemotherapy	No	No	No
Adjuvant endocrine therapy	No	Yes (tamoxifen)	Yes (tamoxifen)
Adjuvant radiotherapy	No	No	No
Metastatic disease
Recurrence occurred	Yes	Yes	No
Recurrence free survival (months)	16	11	n/a
Palliative chemotherapy, number of lines	No	No	n/a
Palliative radiotherapy	No	No	n/a
History
Psychiatric history	No	No	No
Medical history	Chronic renal disease (hemodialysis), anal cancer, cardiovascular disease,	Hypertension	Rheumatoid arthritis, obesity, thyroid cancer, cardiovascular disease, type 2 diabetes
Condition at time of suicide
Age	82	83	66
Metastatic site at time of suicide	PUL	SKI, OSS	n/a
Cancer-related symptoms	Severe: pain, dyspnea	Severe: pain (cancer en cuirasse), lymphedema	None
Symptoms of illness independent of cancer	No	No	Severe: analgesic-resistant pain and nearby complete immobility due to rheumatoid arthritis
Survival after initial cancer diagnosis (months)	17	29	25
Survival after diagnosis of recurrence (months)	0.5	18	n/a
Mechanism of suicide	Discontinuation of hemodialysis	PAS	PAS

n/a, not applicable; G, Grade; HR, hormonal receptor; ER, estrogen receptor; PR, progesterone receptor; BCT, breast-conserving therapy; ALND, axillary lymph node dissection.

Notation of distant metastatic sites: BRA, brain; HEP, hepatic; LYM, lymph nodes; OSS, osseous; PLE, pleura; PUL, pulmonary; SKI, skin.

¹AJCC (American Joint Committee on Cancer)/UICC (International Union Against Cancer) TNM Classification [12,13].

Figure 1. Course of events in six cases of suicide after breast cancer diagnosis. ^aPreexistence of severe depression and personality disorder with repeated suicidal intentions; ^bPreexistence of chronic kidney disease and dependence on hemodialysis; *Voluntary death after request to stop hemodialysis; ^cPreexistence of severe progressive rheumatoid arthritis.

Table II. Observed number of suicide among breast cancer patients in our study and in different population-based cancer registries in USA and Scandinavia.

Cancer registry, registration period	No. of suicides/no. of cases	Incidence of suicide per 1000 patients
BBCD: 1990–2006	6/ 1'165	5.1
BBCD: 1990–2006 (excluding Cases 1, 4–6)	2/ 1'165	1.7
US SEER program: 1973–2001 [5]	92/21'6913	0.4
US SEER program: 1973–2002 [7]	294 /417'821	0.7
Schairer et al. [9]*
All patients	836/723'810	1.2
US SEER Program: 1973–2001	245 /375'797	0.7
Sweden: 1958–2001	241 / 153'902	1.6
Denmark: 1971–1999	166 / 68'045	2.4
Finland: 1953–2001	125/ 71'099	1.8
Norway: 1961–2000	59 / 5'967	1.1

BBCD: Basel Breast Cancer Database; SEER: Surveillance, Epidemiology, and End Results.

*Schairer et al. [9] restricted their analyses on patients who survived at least one year.

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