Association of surgery delay duration with suicidal ideation in cancer patients: a 3-year prospective cohort study.

BACKGROUND

The COVID-19 pandemic caused substantial delays in cancer surgeries. This study investigated the impact of surgery delay duration on the risk of suicidal ideation (SI) in cancer patients.

METHODS

In this prospective cohort study, we enrolled cancer patients from three medical centers in China (January-August 2020) whose surgeries were delayed by > 1 month. Patients were followed at 3, 6, 9, 12, 18, 24, and 36 months. SI was assessed at each visit using the Beck Scale for Suicidal Ideation (BSSI). Primary outcomes were the 3-year cumulative incidence of SI, time to SI onset, and SI severity. Intention-to-treat (ITT) and per-protocol analyses were employed for incidence and persistence outcomes, respectively. Findings Among 1864 patients in the ITT analysis, the 3-year cumulative SI incidence was 37.24%. Longer surgery delay was independently associated with a higher risk and earlier onset of SI. Compared to a 1-month delay, the adjusted hazard ratios were 1.89 (95% CI, 1.51-2.37) for a 2-month delay and 3.61 (95% CI, 2.97-4.38) for a 3-month delay. A history of psychiatric disorders or suicide attempts also significantly increased SI risk. Analyses of the per-protocol cohort (n = 1110) further showed that patients with earlier SI onset had more severe symptoms and higher rates of SI persistence (all P < 0.001). Sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS

The duration of surgery delay is a strong, independent predictor of subsequent suicidal ideation in cancer patients. These findings underscore the critical need to integrate mental health screening and early intervention into the surgical care pathway for cancer patients, particularly when treatment delays occur.