Updated Incidence of Suicide Among Patients With Head and Neck Cancer

Abstract

OBJECTIVE: To assess incidence, temporal trends, and risk factors for suicide among patients with HNC using Surveillance, Epidemiology, and End Results (SEER) data. METHODS: A total of 222,222 patients were diagnosed with HNC from the SEER 17 registries between 2012 and 2021. Suicide deaths were identified using the SEER cause-of-death category "suicide and self-inflicted injury." We calculated age-, sex-, and race-adjusted suicide incidence rates and standardized mortality ratios relative to the US general population. Risk factors analyzed included demographic variables, tumor site, disease stage, treatment modality, and time since diagnosis. RESULTS: There were 298 suicides among patients with HNC over 1.9 million person-years (33.53 per 100,000 person-years; SMR, 1.90; 95% CI, 1.69-2.13). Suicide rates were highest among men (SMR, 2.23), unmarried individuals (SMR, 2.78), and patients with distant metastatic disease (SMR, 2.87). Site-specific analysis showed elevated suicide risk for hypopharyngeal (SMR, 4.18) and laryngeal (SMR, 2.95) cancers. Radiation-only treatment was associated with a higher suicide rate (SMR, 3.23), as was receiving no surgery or radiation (SMR, 5.39). Most suicides occurred within 5 years of diagnosis, particularly among patients with oral cavity and oropharyngeal cancers (SMR, 3.09). In some cancers, elevated suicide risk persisted beyond 10 years. CONCLUSION: While there was an observed reduction in SMR relative to earlier cohorts, this should be interpreted cautiously given rising general-population suicide rates during the study period. High-risk subgroups, including males, unmarried individuals, patients with cancer of the hypopharynx or larynx, and those receiving radiation alone or no definitive treatment, continue to face disproportionately elevated risk.