Association Between Nonfatal Self-Injury and Survival Following a Cancer Diagnosis: A Comparative Population-Based Cohort Study
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
ICES, Toronto, Ontario, Canada
Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
ICES, Toronto, Ontario, Canada
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Department of Psychosocial Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
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ICES, Toronto, Ontario, Canada
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Department of Psychiatry, Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
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Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
ICES, Toronto, Ontario, Canada
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
ICES, Toronto, Ontario, Canada
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Background: Nonfatal self-injury (NFSI) following a cancer diagnosis is a very serious mental health sequalae. Whether NFSI has an impact on patient outcomes is unknown. To help determine the impact and burden of NFSI in cancer care, this study examined the association between NFSI following a cancer diagnosis and subsequent overall survival (OS). Methods: A retrospective population-based cohort study using linked administrative health care included patients with a new cancer diagnosis in 2007 through 2019. The exposure was NFSI (emergency department visit for self-injury of intentional or undetermined intent), treated as time-varying. The outcome was OS, as death from any cause measured from cancer diagnosis. Extended Cox multivariable models examined the association between NFSI and OS, adjusting for patient, cancer, and mental health history characteristics. Results: Of 806,910 patients, 2,482 (0.31%) had NFSI at a median of 29 months (IQR, 11–57) from cancer diagnosis. Of those, 81 had >1 NFSI event. Patients with NFSI had inferior OS compared with those who had not yet experienced an NFSI (adjusted hazard ratio [HR], 1.73; 95% CI, 1.61–1.85). When treating NFSI as a count variable, there was an association between each additional NFSI and OS (adjusted HR, 1.17; 95% CI, 1.08–1.26). Conclusions: NFSI following a cancer diagnosis was independently associated with inferior OS. This finding highlights NFSI as a crucial event for patients with cancer and supports the importance of identifying and providing treatment for patients with cancer with cancer-related distress, such as marked by higher risk of NFSI.
Submitted June 4, 2024; final revision received October 13, 2024; accepted for publication October 15, 2024. Published online February 11, 2025.
Members of the Enhanced Supportive Psycho-Oncology Canadian Care (ESPOC) Group are listed in Appendix 1 (available online in the supplementary materials).
Author contributions: Conceptualization: Eskander, Sutradhar, Isenberg-Grzeda, Mahar, Vigod, Bolton, Deleemans, Hallet. Data curation: Eskander, Sutradhar, Isenberg-Grzeda, Chan, Coburn, Hallet. Formal analysis: Eskander, Sutradhar, Fu, Chan, Coburn, Hallet. Funding acquisition: Eskander, Sutradhar, Hallet. Investigation: Eskander, Sutradhar, Fu, Chan, Coburn, Hallet. Methodology: Eskander, Sutradhar, Fu, Chan, Hallet. Project administration: Eskander, Isenberg-Grzeda, Hallet. Resources: Eskander, Isenberg-Grzeda, Hallet. Supervision: Eskander, Sutradhar, Coburn, Hallet. Validation: Eskander, Sutradhar, Coburn, Hallet. Visualization: All authors. Writing—original draft: Eskander, Sutradhar, Fu, Bolton, Hallet. Writing—review & editing: All authors.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: This work was supported by funding from Hanna Research Award from the division of Surgical Oncology at the Odette Cancer Centre - Sunnybrook Health Sciences Center, and by the Sunnybrook Health Sciences Centre Alternate Funding Plan Innovation grant.
Disclaimer: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from ©Canada Post Corporation and Statistics Canada. Parts of this material are based on data and information compiled and provided by the Ontario Ministry of Health, Ontario Health, and the Canadian Institute for Health Information. We thank the Toronto Community Health Profiles Partnership for providing access to the Ontario Marginalization Index. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Parts of this report are based on Ontario Registrar General (ORG) information on deaths, the original source of which is ServiceOntario. The views expressed therein are those of the authors and do not necessarily reflect those of ORG or the Ministry of Public and Business Service Delivery.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7083. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
Supplementary Materials
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