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Original Investigation |

Incidence of Suicide in Patients With Head and Neck Cancer

David Kam, BS1; Andrew Salib, BA2; George Gorgy, BA1; Tapan D. Patel, MD3; Eric T. Carniol, MD, MBA3; Jean Anderson Eloy, MD3,4,5; Soly Baredes, MD3,5; Richard Chan Woo Park, MD3
[+] Author Affiliations
1Medical student at Rutgers New Jersey Medical School, Newark
2medical student at Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey
3Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
4Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark
5Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark
JAMA Otolaryngol Head Neck Surg. 2015;141(12):1075-1081. doi:10.1001/jamaoto.2015.2480.
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Importance  Suicide rates among patients with cancer in the US are significantly higher than those of the general population. To our knowledge, large cohort studies examining suicide rates among patients with head and neck cancer have not been performed.

Objective  To identify incidence rate, trends, and risk factors of suicide in patients with cancer of the head and neck.

Design, Setting, and Participants  This was a retrospective cohort study of geographic areas served by the Surveillance, Epidemiology, and End Results (SEER) program. In total, 350 413 cases of patients with head and neck cancer were recorded within the SEER registry between 1973 and 2011. Data analyses were performed in 2014. Incidence data were calculated from the subset of that population that had the cause of death category coded as “suicide and self-inflicted injury.”

Exposures  Patients diagnosed as having a primary cancer of the head and neck region.

Main Outcomes and Measures  Influence of demographic factors, anatomic site of tumor, disease stage, and time since diagnosis on risk for suicide.

Results  Among 350 413 SEER registry patients with head and neck cancer, observed for 2 263 376 person-years, 857 suicides were identified with an age-, sex-, and race-adjusted suicide rate of 37.9/100 000 person-years. In contrast, the US general population suicide rate was 11.8 per 100 000 person-years. Suicide rates were higher in those treated with radiation alone (standardized mortality ratio [SMR], 5.12; 95% CI, 3.83-6.41) compared with those treated with surgery alone (SMR, 2.57; 95% CI, 1.66-3.49). The highest suicide risk was seen in patients with cancers of the hypopharynx (SMR, 13.91; 95% CI, 11.78-16.03) and larynx (SMR, 5.48; 95% CI, 4.14-6.81).

Conclusions and Relevance  Patients with head and neck cancer have more than 3 times the incidence of suicide compared with the general US population. Furthermore, suicide rates were highest among those with cancers of the larynx and hypopharynx.

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Suicide Rates in Persons With Head and Neck Cancer by Age at Diagnosis and Anatomic Site

Reference population is the general US population in corresponding age groups. SMR indicates standardized mortality ratio. Error bars indicate 95% CIs.

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