Suicide in Head and Neck Cancer Survivors

During a recent speaking engagement, there was an audible gasp from the crowd as I relayed a startling statistic from the 2018 Cancer Survivorship Symposium: The mortality rate due to suicide in head and neck cancer patients is more than double the suicide rate of the most common other cancers in the United States.[1] Only male pancreatic cancer survivors have a higher suicide ratio. (see Figure 1)

Figure 1: Click to enlarge. Adapted from – 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.

In the general population, suicide is already one of the ten leading causes of death in the United States.[2] The recent deaths of fashion designer Kate Spade and chef Anthony Bourdain only heighten concerns of “suicide contagion” among mental health experts who fear that vulnerable youth are susceptible to the influence of reports and portrayals of suicide in the mass media.[3]

Following a period of nearly consistent decline from 1986 through 1999, suicide rates in the United States have increased almost steadily from 1999 through 2014.[4] The average annual percent increase in the age-adjusted suicide rate was about 1 percent per year from 1999 through 2006 but rose to 2 percent per year from 2006 through 2014.

Coincidentally, on January 9, 2007, Apple first introduced the iPhone[5] and the percentage of the United States population using any social media soared from 24 percent in 2008 to 67 percent in 2014.[6] In a study published in November 2017 in Clinical Psychological Science, Jean Twenge, a psychologist at San Diego State University, correlates the increasing use of social media, gaming and internet browsing with rising symptoms of depression and suicidal behaviors in teenagers.

One particular at-risk group are cancer survivors, who have nearly twice the incidence of suicide compared with the general population.[7] And patients with head and neck cancer have more than three times the prevalence of suicide compared with the general population.

Depression and hopelessness are the strongest predictors of a desire for death among terminally ill cancer patients.[8] Despite the impact of depression on people with cancer, available studies to assess the efficacy, tolerability, and acceptability of antidepressants for treating depressive symptoms in adults with cancer (any site and stage) are very few and of low quality.[9]

However, there are several other factors than depression that could drive a cancer survivor into suicide. This is especially true for head and neck cancer survivors who deal with unique physical, social, and emotional issues after their treatment.

Significant psychosocial distress in patients with head and neck cancer throughout their illness is well-documented. Depression, suicidality, posttraumatic stress disorder (PTSD), substance dependence/abuse, issues with body image, self-confidence, interpersonal relationships, social stigma, and loss of work and productivity almost universally afflict those with head and neck cancer in some combination.[10]

In one study, hypopharyngeal, laryngeal, and oral cavity and/or oropharyngeal cancers were associated with the highest rates of suicide.[11] Increased rates of tracheostomy dependence – a surgical procedure to create an opening in the neck for direct access to the trachea – and difficulty swallowing and/or feeding tube dependence in these patients may help explain the higher rate of suicide observed. The impact of newer technologies with reduced side-effects, such as transoral robotic surgery (TORS) and intensity-modulated radiation therapy (IMRT), have not yet been investigated.

More than 15 million individuals in the United States are currently living with a cancer diagnosis, 430,000 of whom are head and neck cancer survivors.[12] Many of these patients will experience distortions of voice, hearing, taste, chewing, swallowing, and breathing for decades after successful treatment. Although a relatively rare event, additional research and effort should be devoted to the psychological toll that cancer, treatments, and resulting morbidity have on patients to help prevent more suicides in the future.

References

[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.

[2] Heron M. Deaths: Leading causes for 2013. National vital statistics reports; vol 65 no 2. Hyattsville, MD: National Center for Health Statistics. 2016.

[3] Gould M, Jamieson P, Romer D. Media Contagion and Suicide Among the Young. American Behavioral Scientist, Vol. 46 No. 9, May 2003 1269-1284.

[4] Curtin SC, Warner M, Hedegaard H. Increase in suicide in the United States, 1999–2014. NCHS data brief, no 241. Hyattsville, MD: National Center for Health Statistics. 2016.

[5] Apple press release January 9, 2007. https://www.apple.com/newsroom/2007/01/09Apple-Reinvents-the-Phone-with-iPhone/

[6] Statista. Percentage of U.S. population who currently use any social media from 2008 to 2017. https://www.statista.com/statistics/273476/percentage-of-us-population-with-a-social-network-profile/

[7] Anguiano L, Mayer DK, PivenML, Rosenstein D. A literature review of suicide in cancer patients. Cancer Nurs. 2012;35(4):E14-E26.

[8] Breitbart W, Rosenfeld B, Pessin H, et al. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA. 2000;284(22):2907Y2911.

[9] Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev. 2018 Apr 23;4:CD011006.

[10] Smith JD, Shuman AG, Riba MB. Psychosocial Issues in Patients with Head and Neck Cancer: an Updated Review with a Focus on Clinical Interventions. Curr Psychiatry Rep. 2017 Sep;19(9):56.

[11] Kam D, Salib A, Gorgy G, Patel TD, Carniol ET, Eloy JA, Baredes S, Park RC. Incidence of Suicide in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. 2015 Dec;141(12):1075-81.

[12] Osazuwa-Peters N, Arnold LD, Loux TM, Varvares MA, Schootman M. Factors associated with increased risk of suicide among survivors of head and neck cancer: A population-based analysis. Oral Oncol. 2018 Jun;81:29-34.

13 thoughts on “Suicide in Head and Neck Cancer Survivors”

  1. Very good points ….still another part of the f…ing disease that many don’t realize. Keep working it Michael…people need to hear these things. And keep up the good fight…we need to hear your voice!!!

    • Hello Mr. Becker,
      Thank you for the great article. What I am writing you about is several weeks ago I was watching ABC news
      And they had a report on a woman with Stage 4 breast cancer that is in complete remission after using this experimental treatment. I know you said you don’t like experimental treatments, however, I think this treatment could be used across a variety of cancers with a great outcome. The name of the Dr. Is Dr.
      Steven A. Rosenberg in New York. Go to: https://ccr.cancer.gov/Surgery-
      Branch/steven-a-rosenberg
      It might be worth a look. Keep the fight going!

    • Thanks Maureen! I think it speaks to how bad the side effects of treatment can be for head and neck cancer patients.

  2. I have to admit that I wasn’t able to finish reading your article, it was a little too close to home and I am currently struggling …. I was diagnosed with a head and neck cancer in March of last year. The primary cancer was in my right tonsil, the secondary in my right lymph node. I had surgery and daily radiotherapy for 6 weeks. I have survived but am struggling with the after effects – not being able to eat as I used to – I was a real foodie. Not being able to drink red wine !!! Every swallow is uncomfortable … I have lost a lot of weight which as a woman everyone assumes is nirvana however I was happy with my body I was strong and athletic. My confidence has vanished along with my appetite . As a woman there is so much info’ on Breast cancer, cervical cancer, ovarian, I can go on but there is so little on head and neck cancers … apologies I am having a low moment and came across you while doing some research … now I have found you I will find the strength to read the whole thing…

    • I can relate to so much of what you wrote (my cancer started in my right tonsil, did radiation, taste changes, etc). I’d tell you to read my memoir, but my bet is that it would be mostly deja vu for you. While we may not be the same as we were before cancer, that doesn’t mean different can’t be good. I’ve found new tastes that I like (beer instead of red wine, and I used to dislike beer!). All kidding aside, if you are really struggling now – please reach out to family, friends, or a professional for help. I know the struggle, I’m living it too. Some days are easier than others, but hopefully you find comfort that you are NOT alone.

      • Thank you … I always thought it a bit of a cliche to go to social media for support but a friend recommend it. A wonderful lady called Liz O’Riordan who is a Breast Surgeon coping & surviving with Breast cancer . She encourages me to write it all down which I have but it is tough and with a young family – well 19 & 15 I need to keep strong and positive for them . I am worried that publishing anything will draw their attention to the issues I am having and I want to shield them from my pain… I am surprised by how reassured I am by your words …. Thank you Sarah

      • Happy to help and please keep in touch. Writing has been very cathartic for me, so I hope you can continue. If you do a blog, it could be under an alias (Grumpy Bear Mom?) instead of your real name to shield your family. That way, you still get to put information out in the public and can interact with readers via blog posts and comments. All my best!

  3. Is there a specific research organization that you would recommend that funds support/ research in this particular area? My husband committed suicide 2 weeks ago. He was struggling post stage III right tonsil HPV type cancer, surgery, radiation, hyperbaric chamber wound healing, etc. Diagnosed in January, healing slowly, had therapist, had enough…ended his remarkable yet short 52 year old life. We are devastated. I am looking for an organization to direct research donations to in his obituary.

    • I don’t know what to say. Other than I’m so very sorry to hear about your husband. It is a devastating disease. I’ll look out for appropriate organizations to direct donations.

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