Suicide rate high in patients with head and neck cancer



Patients with head and neck cancer had a threefold higher risk of suicide, compared with the general population, with higher rates among male patients and those with later-stage disease, according to an analysis of SEER data.

Patients with cancers of the hypopharynx had the highest rates (standardized mortality ratio, compared with the general population, 13.91), followed by cancer of the larynx (5.48) and cancer of the oral cavity and oropharynx (5.23).

“Routine screening for suicide risk may not be needed in every patient,” said David Kam, a medical student at Rutgers New Jersey Medical School, Newark, and his colleagues, “but we have identified a certain subset of patients often seen by otolaryngologists as being at increased risk (those who are older, male, with cancers of the hypopharynx, or with history of radiation therapy)” (JAMA Otolaryngol Head Neck Surg. 2015 Nov 12. doi: 10.1001/jamaoto.2015.2480).

Patients who underwent radiation therapy without surgery had about twice the suicide risk as those who underwent surgery alone (5.12 vs. 2.57). The researchers noted a potential selection bias among those treated with radiation alone, as patients with unresectable disease or significant comorbidities may undergo radiation instead of surgery.

Radiation therapy is integral to treating many head and neck cancers but is associated with a lower quality of life because of related morbidity. Despite improvements in quality of life measures associated with intensity-modulated radiation therapy (IMRT), the analysis showed no improvement in suicide rates after 2005, when IMRT was widely commercially available and a large fraction of patients would presumably have received the newer treatment.

An analysis of SEER (Surveillance, Epidemiology, and End Results) data from 1973 to 2011 showed 857 suicides among 350,413 individuals with head and neck cancer. Among all patients, the greatest increase in suicide rates occurred in the first 5 years after diagnosis.

Because of the significantly increased suicide risk among patients with head and neck cancers, research on survival outcomes should expand to include the psychological toll that the cancer, treatments, and resulting morbidity have on patients, the researchers said.

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