Is suicide a significant contributor to mortality in head and neck cancer - A surveillance, epidemiology, and end results database study

Abstract

Introduction: Patients with oral and orofacial cancers have been suggested at increased risk for suicide, but only a few studies have described the survival characteristics. The purpose of this study was to describe survival (5-years), mortality, and suicide among patients with mid-facial head and neck cancer (HNC) and to identify the patient and disease characteristics associated with higher suicide rates. Methods: Patients in the study were residents of geographic areas served by the Surveillance, Epidemiology, and End Results (SEER) program who were diagnosed with cancer from 1973 to 2014. This was a retrospective cohort study of survival (classified into 5 groups), mortality with a focus on suicide in persons with HNC. All relevant details were collected and analyzed. P ≤ 0.05 was considered significant. Results: There were 218,048 cases of HNC of who 774 committed suicide, 63,262 succumbed to HNC, 44,113 died due to other causes, and 81,779 are alive. Tongue was the most common site and most common type was squamous cell carcinomas. The overall mean 5-year survival period did not remarkably change since 1974. The mean survival period significantly varied between the outcome groups. Mean 5-year survival in cases of suicide was progressively decreasing with time frame while death due to other causes occurred at a relatively less time in 2003–08 as compared to 1973–78. Of interest is the nearly stable survival, by volume in death due to HNC in the entire span of time 1973–2008 but different in percentage level. Conclusion: It has been documented that patients with HNC in the SEER database have a higher incidence of suicides influenced by oral sites, stages, and number of tumors. These points to the need for psychological evaluation of patients with HNC and the relationship of tumor stage with survival characteristics. The study also highlights the burden of oral cancer and mental health issues that are largely neglected.