Persistent suicide risk in survivors of testicular cancer: A population-based cohort study

PURPOSE: To evaluate the risk of suicide among patients with testicular cancer, with particular emphasis on the associations with disease stage and timing from diagnosis. METHODS: The Surveillance, Epidemiology, and End Results database was analyzed to identify patients diagnosed with testicular cancer (2000-2021). Sociodemographic and oncologic factors were compared between those who were alive at last follow-up and those who died of suicide. Standardized mortality ratios (SMR) were calculated to assess the risk of suicide in patients with testicular cancer compared to that of an age-adjusted gender-matched US population, stratified by disease stage and time from diagnosis (<1, 1-5, and 5-10 years). RESULTS: Among 46,395 patients with testicular cancer, 125 (0.27%) died by suicide. Variables associated with increased risk of suicide included relationship status (separated, divorced, or widowed) and race. The SMR for suicide for patients with testicular cancer were significantly elevated compared to an age-adjusted gender-matched US general population (1.31; 95% confidence interval [CI]: 1.29, 1.35). Suicide SMR were significant across all disease stages and increased with advancing disease stage: localized (SMR: 1.07), regional (SMR: 1.48), and distant (SMR: 2.29). Suicide risk was greatest within the first year after diagnosis (SMR: 2.21; 95% CI: 2.10, 2.32) and persisted at 1 to 5 years (SMR: 1.24; 95% CI: 1.19, 1.29) and 5 to 10 years (SMR: 1.08; 95% CI: 1.03, 1.14) after diagnosis. CONCLUSION: Patients with testicular cancer face a significantly elevated risk of suicide, particularly within the first year following diagnosis, and remain at a persistently higher risk of suicide long after their diagnosis. These findings underscore the need for early targeted psychosocial screening and mental health support to optimize survivorship.