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Suicide, other externally caused injuries and cardiovascular death following a cancer diagnosis: study protocol for a nationwide population-based study in Japan (J-SUPPORT 1902)
  1. Saki Harashima1,2,
  2. Maiko Fujimori1,
  3. Tatsuo Akechi3,
  4. Tomohiro Matsuda4,
  5. Kumiko Saika4,
  6. Takaaki Hasegawa5,
  7. Keisuke Inoue1,6,
  8. Kazuhiro Yoshiuchi2,
  9. Isao Miyashiro7,
  10. Yosuke Uchitomi1,8,
  11. Yutaka J Matsuoka1
  1. 1 Division of Health Care Research, Behavioral Science and Survivorship Research Group, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
  2. 2 Department of Stress Sciences and Psychosomatic Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
  3. 3 Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
  4. 4 Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center Japan, Tokyo, Japan
  5. 5 Division of Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
  6. 6 Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
  7. 7 Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
  8. 8 Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
  1. Correspondence to Dr. Maiko Fujimori; mfujimor{at}


Introduction A growing body of literature has demonstrated that cancer patients have a higher risk of suicide and cardiovascular mortality compared with the general population, especially immediately after a cancer diagnosis. Using data from the National Cancer Registry in Japan launched in January 2016, we will conduct the first nationwide population-based study in Japan to compare incidence of death by suicide, other externally caused injuries (ECIs) and cardiovascular disease following a cancer diagnosis with that of the general population in Japan. We will also aim to identify the patient subgroups and time periods associated with particularly high risk.

Methods and analysis Our study subjects will consist of cancer cases diagnosed between 1 January 2016 and 31 December 2016 in Japan and they will be observed until 31 December 2018. We will calculate standardised mortality ratios (SMRs) and excess absolute risks (EARs) for suicide, other ECIs and cardiovascular death compared with the general population in Japan, after adjustment for sex, age and prefecture. SMRs and EARs will be calculated separately in relation to a number of factors: sex; age at diagnosis; time since cancer diagnosis; prefecture of residence at diagnosis; primary tumour site; behaviour code of tumour; extension of tumour; whether definitive surgery of the primary site was performed; and presence/absence of multiple primary tumours.

Ethics and dissemination The study protocol was approved by the institutional review board and ethics committee of the National Cancer Center Japan and Nagoya City University Graduate School of Medical Sciences. The findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number UMIN000035118; Pre-results.

  • neoplasms
  • suicide
  • cardiovascular diseases
  • registries
  • standardised mortality ratio

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  • Contributors SH, MF, TA, TM, KS, TH, KI, KY, IM, YU and YJM contributed to the study conception and design. TM and KS advised on statistical analysis and management of the database. TA and YU supervised the project. SH and MF will perform the data analysis and all coauthors will be involved in interpretation of the data. SH and MF wrote the first draft of the manuscript and all coauthors reviewed the manuscript and provided critical revisions. All authors have approved the final version of the manuscript.

  • Funding This work is supported by the Innovative Research Program on Suicide Countermeasures (IRPSC) (1-2), Japan Support Center for Suicide Countermeasures (JSSC), National Center of Neurology and Psychiatry (NCNP).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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