{"id":2210,"date":"2021-09-24T00:00:00","date_gmt":"2021-09-24T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/incidence-of-and-factors-associated-with-nonfatal-self-injury-after-a-cancer-diagnosis-in-ontario-canada\/"},"modified":"2023-06-14T19:44:11","modified_gmt":"2023-06-14T23:44:11","slug":"incidence-of-and-factors-associated-with-nonfatal-self-injury-after-a-cancer-diagnosis-in-ontario-canada","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/incidence-of-and-factors-associated-with-nonfatal-self-injury-after-a-cancer-diagnosis-in-ontario-canada\/","title":{"rendered":"Incidence of and factors associated with nonfatal self-injury after a cancer diagnosis in Ontario, Canada"},"content":{"rendered":"<p><strong>Importance <\/strong>&#x2014; Psychological distress is a key component of patient-centered cancer care. While a greater risk of suicide among patients with cancer has been reported, more frequent consequences of distress, including nonfatal self-injury (NFSI), remain unknown.<\/p>\n<p><strong>Objective <\/strong>&#x2014; To examine the risk of NFSI after a cancer diagnosis.<\/p>\n<p><span class=\"bold\">Design, Setting, and Participants<\/span> &#x2014; This population-based retrospective cohort study used linked administrative databases to identify adults diagnosed with cancer between 2007 and 2019 in Ontario, Canada.<\/p>\n<p><strong>Exposures <\/strong>&#x2014; Demographic and clinical factors.<\/p>\n<p><span class=\"bold\">Main Outcomes and Measures <\/span>&#x2014; Cumulative incidence of NFSI, defined as emergency department presentation of self-injury, was computed, accounting for the competing risk of death from all causes. Factors associated with NFSI were assessed using multivariable Fine and Gray models.<\/p>\n<p><strong>Results <\/strong>&#x2014; In total, 806 910 patients met inclusion criteria. The mean (SD) age was 65.7 (14.3) years, and 405 161 patients (50.2%) were men. Overall, 2482 (0.3%) had NFSI and 182 (&lt;0.1%) died by suicide. The 5-year cumulative incidence of NFSI was 0.27% (95% CI, 0.25%-0.28%). After adjusting for key confounders, prior severe psychiatric illness, whether requiring inpatient care (subdistribution hazard ratio [sHR], 12.6; 95% CI, 10.5-15.2) or outpatient care (sHR, 7.5; 95% CI, 6.5-8.8), and prior self-injury (sHR, 6.6; 95% CI, 5.5-8.0) were associated with increased risk of NFSI. Young adults (age 18-39 years) had the highest NFSI rates relative to individuals aged 70 years or older (sHR, 5.4; 95% CI, 4.5-6.5). The magnitude of association between prior inpatient psychiatric illness and NFSI was greatest for young adults (sHR, 17.6; 95% CI, 12.0-25.8). Certain cancer subsites were also associated with increased risk, including head and neck cancer (sHR, 1.5; 95% CI, 1.2-1.9).<\/p>\n<p><span class=\"bold\">Conclusions and Relevance <\/span>&#x2014; In this study, patients with cancer had a higher incidence of NFSI than suicide after diagnosis. Younger age, history of severe psychiatric illness, and prior self-injury were independently associated with risk of NFSI. These exposures appeared to act synergistically, placing young adults with a prior mental health history at the greatest risk of NFSI. These factors should be used to identify at-risk patients.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Importance &#x2014; Psychological distress is a key component of patient-centered cancer care. While a greater risk of suicide among patients with cancer has been reported, more frequent consequences of distress, including nonfatal self-injury (NFSI), remain unknown. Objective &#x2014; To examine the risk of NFSI after a cancer diagnosis. Design, Setting, and Participants &#x2014; This population-based [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-2210","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Noel CW, Eskander A, Sutradhar R, Mahar A, Vigod SN, Isenberg-Grzeda E, Bolton J, Deleemans J, Chan WC, Vasdev R, Zuk V, Haas B, Mason S, Coburn NG, Hallet J; Enhanced Supportive Psycho-oncology Canadian Care (ESPOC) Group. <em>JAMA Netw Open<\/em>. 2021; 4(9):e2126822. Epub 2021 Sep 24.","source_url":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2784474","ices_scientist":[1370,1227,1312,1116,1265,1202,1258,1329,22740],"site":[6733],"research_program":[6741],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"0448BD85-87AD-444A-892C-776549F08019","sitecore_item_name":"Incidence-of-and-factors-associated-with-nonfatal-self-injury-after-a-cancer-diagnosis","sitecore_field_values":"{\n  \"Title\": \"Incidence of and factors associated with nonfatal self-injury after a cancer diagnosis in Ontario, Canada\",\n  \"Short title\": \"Incidence of and factors associated with\",\n  \"Summary\": \"The objective of this study was to examine the risk of  nonfatal self-injury after a cancer diagnosis.\",\n  \"Citation\": \"<p>Noel CW, Eskander A, Sutradhar R, Mahar A, Vigod SN, Isenberg-Grzeda E, Bolton J, Deleemans J, Chan WC, Vasdev R, Zuk V, Haas B, Mason S, Coburn NG, Hallet J; Enhanced Supportive Psycho-oncology Canadian Care (ESPOC) Group. <em>JAMA Netw Open<\/em>. 2021; 4(9):e2126822. Epub 2021 Sep 24. DOI: <a href=\"https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.26822\" title=\"opens external link\">https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.26822<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Importance <\/strong>&mdash; Psychological distress is a key component of patient-centered cancer care. While a greater risk of suicide among patients with cancer has been reported, more frequent consequences of distress, including nonfatal self-injury (NFSI), remain unknown.<\/p>n<p><strong>Objective <\/strong>&mdash; To examine the risk of NFSI after a cancer diagnosis.<\/p>n<p><span class=\"bold\">Design, Setting, and Participants<\/span> &mdash; This population-based retrospective cohort study used linked administrative databases to identify adults diagnosed with cancer between 2007 and 2019 in Ontario, Canada.<\/p>n<p><strong>Exposures <\/strong>&mdash; Demographic and clinical factors.<\/p>n<p><span class=\"bold\">Main Outcomes and Measures <\/span>&mdash; Cumulative incidence of NFSI, defined as emergency department presentation of self-injury, was computed, accounting for the competing risk of death from all causes. Factors associated with NFSI were assessed using multivariable Fine and Gray models.<\/p>n<p><strong>Results <\/strong>&mdash; In total, 806 910 patients met inclusion criteria. The mean (SD) age was 65.7 (14.3) years, and 405 161 patients (50.2%) were men. Overall, 2482 (0.3%) had NFSI and 182 (&lt;0.1%) died by suicide. The 5-year cumulative incidence of NFSI was 0.27% (95% CI, 0.25%-0.28%). After adjusting for key confounders, prior severe psychiatric illness, whether requiring inpatient care (subdistribution hazard ratio [sHR], 12.6; 95% CI, 10.5-15.2) or outpatient care (sHR, 7.5; 95% CI, 6.5-8.8), and prior self-injury (sHR, 6.6; 95% CI, 5.5-8.0) were associated with increased risk of NFSI. Young adults (age 18-39 years) had the highest NFSI rates relative to individuals aged 70 years or older (sHR, 5.4; 95% CI, 4.5-6.5). The magnitude of association between prior inpatient psychiatric illness and NFSI was greatest for young adults (sHR, 17.6; 95% CI, 12.0-25.8). Certain cancer subsites were also associated with increased risk, including head and neck cancer (sHR, 1.5; 95% CI, 1.2-1.9).<\/p>n<p><span class=\"bold\">Conclusions and Relevance <\/span>&mdash; In this study, patients with cancer had a higher incidence of NFSI than suicide after diagnosis. Younger age, history of severe psychiatric illness, and prior self-injury were independently associated with risk of NFSI. These exposures appeared to act synergistically, placing young adults with a prior mental health history at the greatest risk of NFSI. These factors should be used to identify at-risk patients.<\/p>n<p><a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2784474\" title=\"Opens external link\">View full text<\/a><\/p>\",\n  \"Research Programs\": \"{85DE96A6-4C96-40C7-8E6D-7597A0EB5F80}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{56BF24FA-D81E-4114-BF1F-4715A424E26C}|{D7B53E18-8D1F-4D4F-8ADC-9FAB15D9E5EC}|{04BB25C9-253B-47EC-AA2C-F4A41947290E}|{BF772976-8535-47C9-B4B5-A9BE2045544C}|{1C4870B2-D67A-44C1-A951-81DA9558DA50}|{C51AF0D5-C0A0-4C68-9233-B0592AB5FCFA}|{CB18FFCD-AAB9-46C7-B049-7675C906E786}|{EBE2288F-AAE0-4B72-A737-9AE138D7AEEE}\",\n  \"Posted Date\": \"20210924T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2021\/September\/Incidence-of-and-factors-associated-with-nonfatal-self-injury-after-a-cancer-diagnosis"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Incidence of and factors associated with nonfatal self-injury after a cancer diagnosis in Ontario, Canada<\/title>\n<meta name=\"description\" content=\"Importance &#x2014; Psychological distress is a key component of patient-centered cancer care. 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