# Risk Factors for Suicide in Patients With Head and Neck Squamous Cell Carcinoma

## TL;DR

This study finds that patients with hypopharyngeal cancer have a higher risk of suicide compared to other head and neck cancers, but suicide risk does not align with cancer mortality rates.

## Contribution

Identifies hypopharyngeal cancer as an independent risk factor for suicide in HNSCC patients, despite no correlation with cancer mortality.

## Key findings

- Hypopharyngeal cancer had the highest suicide rate (123.6 per 100,000 person-years).
- Suicide risk was independently linked to hypopharyngeal primary tumors, male sex, and earlier diagnosis years.
- Suicide risk did not correlate with cancer or non-cancer mortality across subsites.

## Abstract

Background

Head and neck squamous cell carcinoma (HNSCC) is associated with a high risk of suicide, partly because of the functional morbidity caused by the disease and its treatment. This study aimed to identify risk factors for suicide among patients with HNSCC, focusing on the subsites of the primary tumor.

Methodology

Using the Surveillance, Epidemiology, and End Results database, we obtained data from 212,675 cases diagnosed as HNSCC. Causes of death were categorized as suicide, cancer, or non-cancer-related. Cumulative incidence functions were used to estimate cause-specific mortality, and Fine-Gray competing risks models were applied to assess prognostic factors. Weighted linear regression was performed to examine associations between site-specific suicide risk and cancer/non-cancer mortality across subsites.

Results

During follow-up, 708 patients died by suicide. The five- and ten-year cumulative incidence of suicide was 0.3% and 0.4%, respectively. Suicide incidence varied by primary site, with hypopharyngeal cancer demonstrating the highest rate (123.6 per 100,000 person-years) and nasopharyngeal cancer the lowest (25.3 per 100,000 person-years). Multivariate analysis revealed hypopharyngeal primary tumor as an independent risk factor for suicide (subdistribution hazard ratio = 2.30, 95% confidence interval = 1.01-5.23, p = 0.046), along with male sex and earlier year of diagnosis. Although hypopharyngeal cancer also exhibited high cancer mortality, weighted regression demonstrated no significant association between site-specific suicide and cancer mortality risks (p = 0.235). Similarly, suicide risk did not correlate with non-cancer mortality (p = 0.112).

Conclusions

Hypopharyngeal cancer was independently associated with a high risk of suicide. However, suicide risk did not parallel cancer prognosis across primary sites. Further studies are required to determine specific risk factors for suicide and develop preventive measures.