In general, the risk of suicide among cancer survivors is about 50% higher than in the general population, but this risk is especially elevated among survivors of head and neck cancer, according to research presented by Nosayaba Osazuwa-Peters, BDS, MPH, CHES, of the Department of Otolaryngology–Head and Neck Surgery, St. Louis University School of Medicine, St. Louis.1 According to Dr. Osazuwa-Peters, head and neck cancer accounts for about 4% of new cancer cases in the United States, but the incidence of suicide in this population may be significantly higher due to quality-of-life issues associated with head and neck cancer survivorship.
“Many cancer survivors will end up dying of something other than their cancer,” he said at the 2018 ASCO Cancer Survivorship Symposium in Orlando. “Is it time that we start considering suicidality as a comorbidity among cancer survivors?”
Survivorship Comes at a Cost
Currently, more than 16 million cancer survivors are living in the United States, and that survivorship comes at a cost, revealed Dr. Osazuwa-Peters. As more cancer survivors outlive their initial diagnosis, there is now an increased focus on competing causes of death and comorbidities in this population, increased risk of acute and late toxicities, longer-term follow-up, unmet psychosocial needs, and life-long surveillance. “When all of these issues come together without adequate attention, some patients commit suicide,” he said.
Closer Look at Study Suicide Rates
Dr. Osazuwa-Peters and his colleagues conducted a retrospective cohort study to estimate the incidence of head and neck cancer–associated suicide vs other common cancers. They queried the Surveillance, Epidemiology, and End Results (SEER) 18 database of the National Cancer Institute from 2000 to 2014 for all cancer deaths confirmed as suicide. Mortality rates from suicide were estimated for the 20 most common cancers in the United States, including head and neck cancer.
Suicide is indeed a problem among head and neck cancer survivors, and we’re hoping this issue is addressed specifically.— Nosayaba Osazuwa- Peters, BDS, MPH, CHES
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There were 4,513 suicides among 4,235,657 total survivors in the study, yielding an incidence rate of 23.6 suicides per 100,000 person-years. In this study, males and females were equally represented (51.2% and 48.8%, respectively), but suicide was found to occur predominantly among males: 84% vs 16% among females.
Combined, all other cancers had a 45% decreased suicide ratio compared with head and neck, for both males and females. Only male patients with pancreatic cancer had a higher suicide risk compared with those with head and neck cancer, but among females, there was no other cancer site with a higher risk of suicide than head and neck.
However, after adjusting for clinical and nonclinical variables, the investigators found that patients with head and neck cancer were almost twice as likely to commit suicide when compared with those with cancer at all other sites. “That is really remarkable,” noted Dr. Osazuwa-Peters.
A Group in Need of Help
“Suicide is indeed a problem among head and neck cancer survivors, and we’re hoping this issue is addressed specifically,” he said. “What we have right now is a lot of conversation around depression, but depression doesn’t always equate to suicide.” Other factors, such as pain and fear of recurrence, may provoke patients to commit suicide.
Dr. Osazuwa-Peters emphasized the need for providing psychosocial surveillance for patients with cancer, integrating suicide prevention clinics into the mainstream of individualized cancer care plans, and incorporating lifelong suicide surveillance into the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines®), in the hope of eventually making it standard practice. ■
DISCLOSURE: Dr. Osazuwa-Peters reported no conflicts of interest.
1. Osazuwa-Peters N, Simpson MC, Zhao L, et al: Suicide risk among cancer survivors: Head and neck versus other cancers. 2018 Cancer Survivorship Symposium. Abstract 146. Presented February 17, 2018.
Christopher J. Recklitis, PhD, MPH
Christopher J. Recklitis, PhD, MPH, of Dana-Farber Cancer Institute and Harvard Medical School, called the results “instructive.” He said the study highlights the need for integrating mental health care into survivorship medical care.
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