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. doi: 10.1016/j.oraloncology.2018.03.017. Epub 2018 Apr 11.


Objectives: Cancer diagnosis is considered an independent predictor of suicide. We aimed to determine whether gender and human papillomavirus (HPV)-relatedness are associated with increased risks of suicide in the head and neck cancer (HNC) population.

Materials and methods: Adult patients ≥18 years with HNC were selected using the Surveillance, Epidemiology, and End Results (SEER) data from 1973 to 2014. Using anatomic sites as proxy, patients were grouped as HPV-related or not HPV-related. Standardized Mortality Ratios (SMRs) were calculated, and association between suicide, gender, HPV-relatedness were estimated as adjusted rate ratios (aRR) using multivariable Poisson regression model.

Results: There were 1036 suicides among 287,901 HNC patients in the study period (63 suicides per 100,000 person-years). Male patients were six times more likely to commit suicide compared to female patients (aRR = 5.74, 95% CI 3.88, 8.50); however, HPV-relatedness did not increase risk of suicide (aRR = 0.87, 95% CI 0.58, 1.29). Compared with white patients, blacks (aRR = 0.20, 95% CI 0.12, 0.33) and Hispanics (aRR = 0.25, 95% CI 0.14, 0.43) were less likely to commit suicide. Additionally, increased risks of suicide were found among the widowed (aRR = 1.48, 95% CI 1.10, 1.99) and divorced/separated (aRR = 1.30, 95% CI 1.00, 1.69), compared with married patients.

Conclusion: Gender, not HPV-relatedness, was associated with risk of suicide in our study. We identified HNC patients more likely to commit suicide as: previously married, white, male, widowed, divorced or separated, ≥70 years. Our findings may be useful clinically in planning personalized cancer care and lifelong surveillance of HNC patients with higher risks of suicide.

Keywords: Cancer survivorship; Gender; HPV-relatedness; Head and neck cancer; SEER; Suicide.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Head and Neck Neoplasms / epidemiology*
  • Head and Neck Neoplasms / psychology*
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Suicide / psychology*
  • Survivors*
  • Young Adult