Persistent Suicide Risk in Survivors of Testicular Cancer: A Population-Based Cohort Study

Testicular cancer is the most common solid malignancy in males who are 15-40 years old. Once these young men receive this life-altering diagnosis, not only are they faced with the physical challenges of cancer and its treatment, but they are also burdened with additional psychological stressors. At diagnosis, concerns about fertility preservation, body image, and survivorship are likely contributing factors. During treatment, debilitations from major surgery or systemic treatment can limit activities, careers, and hobbies. In addition, concerns arise from having to rely on others for assistance with daily life. After treatment, recurrent visits and time commitments associated with surveillance, as well as the fear of relapse, can all add to the psychological stress these patients experience.

Mental health plays a critical role in cancer survivorship overall, and when focusing specifically on testicular cancer patients, prior studies have shown a significant and elevated prevalence of mental health disorders, including those with early-stage disease. Given the excellent disease-specific survival of testis cancer, mental health becomes even more important for overall survival. Our study focused specifically on suicide risk among testicular cancer patients and associated factors. We utilized a nationwide registry with cancer-specific data and identified all patients with testicular cancer who have succumbed to suicide or self-inflicted injury. We identified the risk of suicide compared to age and gender-matched US general population, and then investigated factors associated with suicide compared to testis cancer patients who were alive at last follow-up.

Our study had four key findings. First, the standardized mortality ratio (SMR) for suicide among testis cancer patients was 1.38, indicating these patients are 38% more likely to die of suicide compared to the matched US population. Second, the SMR was significantly elevated across all stages but increased with more advanced disease. Third, the highest risk for suicide was within the first year of diagnosis, but remained significantly elevated for up to 10 years. Fourth, race/ethnicity and relationship status both significantly affect the risk of suicide. Hispanic patients had lower suicide risk, while Native Americans had the highest risk. Being separated, divorced, or widowed was also associated with higher suicide risk.

The findings of this study highlight the importance of incorporating psychological screening and adequate access to mental health professionals as part of the multidisciplinary approach to the management of testicular cancer. Early access to mental health care, as well as continued support and long-term follow-up, are crucial elements for the long-term overall survivorship of patients with testicular cancer.

Written by: Kai Wen Cheng,¹ Ala'a Farkouh,¹ Jersey-Kate Castillo,¹ Daniel Jhang,¹ Sikai Song,¹ Peter Zaki,² John Shin,³ Martin Hofmann,¹ Antoin Douglawi,¹ Brian Hu,¹ Herbert Ruckle,¹ Muhannad Alsyouf¹

Department of Urology, Loma Linda University Health, Loma Linda, CA.
Department of Radiation Oncology, Loma Linda University Health, Loma Linda, CA.
Department of Medical Oncology, Loma Linda University Health, Loma Linda, CA.

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