Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Treatment modalities for head and neck cancer (HNC) continue to improve, implicating the need for work on survivorship. While a correlation between HNC and depression has been described, fewer studies have examined the risk of suicide attempts or suicidal ideations. We sought to use a large national database to further characterize treatment specific factors contributing to the risk of suicide attempts and ideation after HNC.
Methods: The TriNetX research network, comprised of over 90 healthcare organizations’ up-to-date electronic medical record data, was queried using ICD-10 codes for patients diagnosed with HNC including of the lip, oral cavity, pharynx, nasal cavity, middle ear, accessory sinuses, and larynx. Cohorts were created based on the presence/absence of variables of interest, and the primary outcome was suicidal ideation or suicide attempt (SI/SA). Propensity score matching for age, sex, race and AJCC cancer stage was performed. Odds ratios (OR) were calculated with 95% confidence intervals (CI), within the platform.
2857 patients with SI/SA after HNC diagnosis were identified in the database. Compared to patients without SI/SA, these patients were younger (62.7 vs. 69.4 years, p<0.0001), and a higher proportion were white (72%, vs. 58%, <0.0001) although a similar proportion were male between cohorts (68%).
After matching for age, sex, race, and American Joint committee on cancer (AJCC) cancer stage (I-IV), HNC patients receiving chemotherapy or radiotherapy but not surgery (within 1 year of diagnosis), had higher odds of SI/SA compared to those who received surgery alone (Matched cohort N=37,550, n=207 vs. n=154, OR:1.346, 95% CI: 1.092-1.659). When stratifying by time elapsed since starting chemotherapy or radiotherapy, there were increasing odds of SI/SA post treatment although these results became significant after 6 months. At 3 months post treatment the OR was 1.392 (n=64 vs. n=46, 95% CI: 0.953-2.034). At 6 months the OR was 1.743 (n=94 vs n=54, 95% CI: 1.247-2.436), at 1 year the OR was 1.577 (n=126 vs. n = 80, 95% CI: 1.191-2.088), and at 5 years the OR was 1.454 (n=196 vs. n=135, 95% CI: 1.167-1.811).
HNC patients who underwent free flap reconstructive procedures had higher overall odds of SA/SI compared to those who did not undergo free flap reconstructive procedures (matched cohort N=14,551, n=178 vs. n=124, OR: 1.441, 95% CI: 1.144 -1.814). Increased odds were noted when closest to the procedure. At 3 months post procedure the OR was 3.228 (n=90 vs. 28, 95% CI: 2.111-4.936), at 6 months the OR was 2.586 (n=103 vs. n=40, 95% CI:1.794-3.729), at 1 year the OR was 2.257 (n=128 vs. 57, 95% CI: 1.65-3.086), and 5 years the OR was 1.709 (n=165 vs. 97, 95% CI: 1.329-2.199).
Conclusion: Suicide is a devastating, albeit relatively rare sequalae after HNC. More morbid treatments may predispose to suicide attempts or ideations, with the period of time closest to treatment being particularly risky. Ongoing investigation into the utility of early targeted screening programs, in addition to robust interdisciplinary care, is needed.