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Program Number: B346
Session Name: Poster Session

Global Incidence and Risk Factors for Suicide in Head and Neck Cancer versus other Cancer population: A Systematic Review and Meta-Analysis

Srivatsa Surya Vasudevan, MD, MS; Victor Albornoz Alvarez, MD; Sydney Schwab, BS; Lindsay Olinde, MD; Cherie-Ann O. Nathan, MD, FACS; LSU Health Shreveport

Background: In head and neck cancer (HNC) patients, the suicide incidence and associated risk factors differ among literature sources. Our primary aim was to evaluate the suicide incidence in patients diagnosed with HNC versus other cancer types and to assess the associated positive and negative predictors. 

Methods: Databases comprising Pubmed, Embase, ScienceDirect, and Web of Science - were reviewed systematically to screen for articles on suicide in the HNC and the availability of non-HNC population comparators. A random-effects model meta-analysis was performed to determine the incidence and risk factors associated with suicide in HNC patients. The stability of the overall effect was evaluated via sensitivity analysis with one-study removal method.

Results: Out of 1,186 articles screened, 20 studies comprising 2,420,232 HNC patients were included. The pooled incidence rate of suicide was 288.2 per 100,000 HNC patients. Our analyses found that HNC patients had the highest incidence of suicide compared to other tumors (Figure 1). Compared to the general population, the HNC population had a significantly elevated standardized mortality ratio (SMR) for suicide of 2.98 (95% CI: 2.57-3.45, p < 0.0001). We found that HNC had the 3rd highest SMR compared to other tumors (Figure 2). Risk factor analysis showed that male HNC patients faced a significantly higher risk of suicide, with a hazard ratio of 5.85 (95% CI: 4.27-8.02, p < 0.0001) (Table 1). Additionally, patients with distant metastases (HR = 1.56, 95% CI: 1.25-1.95, p < 0.0001) and regional spread (HR = 1.40, 95% CI: 1.15-1.69, p = 0.001) had higher suicide risk compared to those with localized tumor patients. However, Hispanics (HR: 0.30, 95% CI: 0.21-0.45, p < 0.0001), African American (HR: 0.19, 95% CI: 0.14-0.26, p < 0.0001), and other racial groups (HR: 0.44, 95% CI: 0.33-0.59, p < 0.0001) exhibited lower suicide risks compared to the White Caucasian population. Geographically, suicide incidence among HNC patients was highest in Asia at 515.5 cases per 100,000, followed by North America with 184.6 cases per 100,000. The lowest incidence was seen in Europe with 62 cases per 100,000. Sensitivity analyses with one-study removed confirmed the stability of the study, with no change in the overall effects.

Conclusion: This is the first systematic review evaluating the incidence of suicide in HNC with 25 non-HNC types. The incidence of suicide was highest in HNC patients, particularly in Asia. When compared to the general population, head and neck cancer had the third highest suicide incidence. Male gender, White Caucasian population, and tumor metastasis were associated with a higher risk of suicide. 

Figure 1. Head and neck Vs other cancers in suicide incidences

Figure 2. Head and neck Vs other cancers in standardized mortality ratio

Table 1. Incidence, SMR and Risk Factors of Suicide in HNC Patients

 

 

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