Suicide Screening Needed for Head and Neck Cancer Survivors

Head and neck cancer survivors have about a 45% higher suicide ratio compared to all other cancers, according to research recently presented at the 2018 Cancer Survivorship Symposium. (Pancreatic cancer was the only other malignancy to have higher suicide ratios compared to head and neck cancer, which was significantly prevalent among men.) This ratio is disproportionately high, and merits attention by the medical community.

“We were not surprised that the burden of suicide was high among survivors of head and neck cancer,” said study author Nosayaba Osazuwa-Peters, BDS, MPH, CHES, instructor in the Department of Otolaryngology-Head and Neck Surgery at St. Louis University, in an interview with Oncology Nursing News. “The surprise, however, was what we found when we compared head and neck specifically to the other common cancers in the US. Yet, we found it is indeed a top two cancer site for suicide. That was the surprise.”

Researchers examined the Surveillance, Epidemiology and End Results (SEER) database and gathered information on cancer deaths that were confirmed to be from suicide from 2000 to 2014. There were a total of 4,769 suicide-related deaths in an overall pool of about 4.6 million people, yielding an incidence rate of 23.6 suicides per 100,000 person-years.

One possible explanation for the findings is that survivors of head and neck cancer face significant and unique quality of life issues, such as facial disfiguration, taste change or, when it comes to swallowing, survivors face pain or a lack of ability to do so.

“There are so many ways in which head and neck cancer survivorship is unique, and that unfortunately takes a toll on some survivors and tilt them toward hastening their death,” Osazuwa-Peters said.

These findings bring light to a pressing problem in this patient population, and will hopefully pave the way for more awareness and potential change in practices. For example, Osazuwa-Peters noted that while National Comprehensive Cancer Center (NCCN) guidelines focus a great deal on depression, there is little about suicide.

“There are several other factors than depression that could drive a cancer survivor into suicide, and we are not addressing these very much because, from a clinical perspective, the focus has heavily been on depression,” he said.

Other contributing factors Osazuwa-Peters mentioned were pain, fear of recurrence, loss of employment, and financial toxicity.

“That means that if we continue to screen for depression in our cancer survivors using the existing screening tools, we will continue to have survivors who do not show any clinical red flags for depression, yet end up taking their lives,” Osazuwa-Peters said. “We need to tackle the suicide problem by screening specifically for suicide. The clinical guidelines for cancer care should incorporate such a screening as a part of standard practice.”

The work in this area is not yet finished, and there are still questions that remain unanswered.

Osazuwa-Peters said that he would like to have data on suicidal ideation, and deaths of other causes besides suicide. He would also like to see how often survivors attempted suicide.

“If we had that data, we could use it to prevent more suicides in the future,” he said. “No man or woman, boy or girl, brave enough to fight cancer should be allowed to slip away because he or she decided life is not worth fighting for. If you can fight cancer, you can fight anything!”