Objective  To explore risk factors for suicide in patients with pancreatic cancer. 

Methods  The SEER Research Plus database (Surveillance, Epidemiology, and End Results) was searched from 1975 to 2018 for patients with pancreatic cancer. The characteristics and distribution of suicidal and non-suicidal death and cancer survivors were described. The person-year mortality rate from suicide and standard mortality ratio were calculated to analyze characteristics of corresponding groups. Regression analysis was used to investigate risk factors for suicide in patients with pancreatic cancer, with further analysis of male patients having risk factors associated with suicide. 

Results  The proportions of patients with characteristics of Caucasian (80.68%), up to 65 years old (65.02%), surgery not recommended (70.57%), neoplasm with distant metastasis (57.28%), married (56.06%), median annual household income between 50,000 to 74,999 dollars (47.17%) and no chemotherapy (52.48%) were relatively high in 153,612 patients with pancreatic cancer, which was similar to the stratified population distribution of characteristics of 138 patients with pancreatic cancer who committed suicide. The results of Poisson regression analysis showed that male [aRR=12.81, 95%CI(6.85, 23.96), P<0.001], Caucasian [aRR=3.56, 95%CI (1.43, 8.85), P=0.006], up to 65 years old [aRR=1.55, 95%CI (1.07, 2.26), P=0.022], surgery not recommended [aRR=2.06, 95%CI(1.23, 3.44), P=0.006], surgery recommended but not undertaken [aRR=2.86, 95%CI(1.37, 5.98), P=0.005] had a higher risk of suicide; while tumor regional metastasis [aRR=0.56, 95%CI(0.37, 0.85), P=0.006] and local metastasis [aRR=0.44, 95%CI(0.23, 0.86), P=0.015], married [aRR=0.57, 95%CI(0.40, 0.82), P=0.002], chemotherapy [aRR=0.34, 95%CI(0.23, 0.51), P<0.001] have a relatively low risk of suicide. The suicide risk of male patients with pancreatic cancer is significantly higher than that of female patients. The risk of suicide among male patients with pancreatic cancer showed significant differences between different races, surgical options, marital status, and chemotherapy options. 

Conclusion  Gender, race, age at diagnosis, choice of surgery, SEER stage, marital status and choice of chemotherapy were important risk factors for suicide in patients with pancreatic cancer. Identification, intervention and care need to be promoted among patients with pancreatic cancer having the following characteristics: male, Caucasian, up to 65 years old, surgery either not recommended or recommended but not undertaken, neoplasm with distant metastasis, single status or not having chemotherapy.

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