Patients with head and neck cancer have more than 3 times the incidence of suicide compared with the general population, with rates highest among patients with cancers of the larynx and hypopharynx, according to a study published online by JAMA Otolaryngology-Head & Neck Surgery.

Suicide is a significant cause of death in most Western countries and is the 10th leading cause of death in the U.S. In patients with cancer, the risk for suicide is even higher. Richard Chan Woo Park, M.D., of Rutgers New Jersey Medical School, Newark, and colleagues examined the incidence rate, trends, and risk factors of suicide in patients with cancer of the head and neck. The researchers used data from the Surveillance, Epidemiology, and End Results (SEER) program. In total, 350,413 cases of patients with head and neck cancer were recorded within the SEER registry between 1973 and 2011. Data analyses were performed in 2014. Incidence data were calculated from the subset of that population that had the cause of death category coded as "suicide and self-inflicted injury."

Among the 350,413 SEER registry patients with head and neck cancer, 857 suicides were identified. Compared with the suicide rate of the general population, the researchers found that patients with head and neck cancer have more than 3 times the incidence of suicide. Suicide rates were higher in those treated with radiation alone compared with those treated with surgery alone.

There was a nearly 12-fold higher incidence of suicide in patients with hypopharyngeal cancer and a 5-fold higher incidence in those with laryngeal cancer. "This may be linked to these anatomic sites' intimate relationship with the ability to speak and/or swallow. Loss of these functions can dramatically lower patients' quality of life. It is possible that the increased rates of tracheostomy dependence and dysphagia [difficulty swallowing] and/or gastrostomy tube dependence in these patients are exacerbating factors in the increased rate of suicide observed," the authors write.

"While there is a considerable body of research that examines survival outcomes for patients with head and neck cancer, additional research and effort should also be devoted to the psychological toll that the cancer, treatments, and resulting morbidity have on patients."