Suicide Risk and Associated Factors in Patients with Pancreatic Cancer: A Systematic Review.

BACKGROUND/OBJECTIVES: Pancreatic cancer (PC) is characterized by poor survival and a substantial psychological burden. Growing evidence suggests that individuals diagnosed with PC are at an increased risk of suicide. This systematic review aimed to synthesize the available evidence on suicide risk among patients with PC and to identify factors associated with increased vulnerability. METHODS: Following the PRISMA 2020 guidelines, a systematic review of the PubMed/MEDLINE and Scopus databases was conducted in August 2026. Of the 1015 records initially identified, 23 studies published between 2010 and July 2026 were included. Eligible studies specifically examined suicide risk among patients with PC using registry-based, administrative, or death certificate data. Risk of bias was assessed using the ROBINS-E tool. RESULTS: Most included studies reported a higher suicide risk among patients with PC compared with the general population and, in many analyses, compared with patients with other cancer types. Large population-based studies generally reported standardized mortality ratios of approximately 2 to 11, although substantially higher estimates were observed in selected populations and specific subgroups. Suicide risk was particularly elevated during the early post-diagnosis period (with several studies identifying the greatest excess risk within the first two months following diagnosis), remained elevated throughout the first year and gradually declined thereafter. Male sex emerged as the most consistently demonstrated risk factor for suicide, while associations with unmarried status were observed across several studies but were derived largely from partially overlapping SEER-based cohorts. Additional evidence suggests a potential role for social vulnerability and poor prognostic factors. CONCLUSIONS: Despite the predominantly observational nature of the available evidence, the consistency of the findings highlights the importance of increased awareness of suicide vulnerability among patients with PC and supports consideration of psychosocial assessment and mental health support within routine pancreatic cancer care. Future prospective studies are needed to better characterize high-risk patients and to inform targeted suicide prevention strategies.