Suicide risk among cancer survivors: Head and neck versus other cancers

Cancer. 2018 Oct 15;124(20):4072-4079. doi: 10.1002/cncr.31675. Epub 2018 Oct 18.


Background: Cancer survivors face psychosocial issues that increase their risk of suicide. This study examined the risk of suicide across cancer sites, with a focus on survivors of head and neck cancer (HNC).

Methods: The Surveillance, Epidemiology, and End Results 18-registry database (from 2000 to 2014) was queried for the top 20 cancer sites in the database, including HNC. The outcome of interest was suicide as a cause of death. The mortality rate from suicide was estimated for HNC sites and was compared with rates for 19 other cancer sites that were included in the study. Poisson regression was used to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) for 1) HNC versus non-HNC sites (the other 19 cancer sites combined), and 2) HNC versus each individual cancer site. Models were stratified by sex, controlling for race, marital status, age, year, and stage at diagnosis.

Results: There were 404 suicides among 151,167 HNC survivors from 2000 to 2014, yielding a suicide rate of 63.4 suicides per 100,000 person-years. In this timeframe, there were 4493 suicides observed among 4219,097 cancer survivors in the study sample, yielding an incidence rate of 23.6 suicides per 100,000 person-years. Compared with survivors of other cancers, survivors of HNC were almost 2 times more likely to die from suicide (aRR, 1.97; 95% CI, 1.77-2.19). There was a 27% increase in the risk of suicide among HNC survivors during the period from 2010 to 2014 (aRR, 1.27; 95% CI, 1.16-1.38) compared with the period from 2000 to 2004.

Conclusions: Although survival rates in cancer have improved because of improved treatments, the risk of death by suicide remains a problem for cancer survivors, particularly those with HNC.

Keywords: Epidemiology; Surveillance; and End Results (SEER) program; cancer survivorship; cancer-associated suicide; head and neck cancer; suicide.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cancer Survivors / psychology
  • Cancer Survivors / statistics & numerical data*
  • Female
  • Head and Neck Neoplasms / epidemiology*
  • Head and Neck Neoplasms / psychology
  • Head and Neck Neoplasms / rehabilitation
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / classification
  • Neoplasms / epidemiology*
  • Neoplasms / psychology
  • Neoplasms / rehabilitation
  • Registries
  • Risk Factors
  • SEER Program
  • Suicide / psychology
  • Suicide / statistics & numerical data*
  • Suicide, Attempted / psychology
  • Suicide, Attempted / statistics & numerical data
  • Survival Rate
  • Survivorship
  • United States / epidemiology
  • Young Adult