More Suicides but Fewer Cardiovascular and Pneumonia Deaths Occurring in Patients With Head and Neck Cancer

Using data from a large nationwide cancer registry, US investigators have found that suicide rates in recent years have significantly increased in patients with oral cavity and oropharyngeal (OC/OP) cancer.

In addition, while cardiovascular disease- and pneumonia-related mortality has decreased over the same time period, rates still far exceed those seen in the general population.

Guo-Pei Yu, MD, MPH, with the New York Eye and Ear Infirmary in New York City, and associates used the Surveillance, Epidemiology, and End Results (SEER) cancer registry data to examine cause-specific mortality rates during the first year after diagnosis of OC/OP cancer and changes over time. Data from the SEER program cover 10% of the US population.

In order to compare changes in the cause of death over the past three decades, the team looked at four time periods: 1980 to 1984, 1990 to 1994, 2000 to 2003, and 2004 to 2007. Overall, 32,487 patients were included in the analysis.

While high rates of depression and suicide have been reported in patients with head and neck cancer, studies focusing specifically on suicide and other noncancer-related deaths in patients with OC/OP squamous cell carcinoma have not been published.

From 1980-1984 to 2004 -2007, mortality from suicide increased by 406.2% (P =.01), cardiovascular disease-related and pneumonia-related mortality decreased by 45.9% (P <.001) and 42.9% (P =.009), respectively, and rates of other noncancer-related deaths did not change.

Compared with the general population, patients diagnosed as having OC/OP cancer had a significantly higher risk of mortality from suicide (standardized mortality ratio [SMR], 7.8; 95% CI, 4.6-12.4; P <.001), cardiovascular disease (SMR, 2.4; 95% CI, 2.1-2.7; P <.001), and pneumonia (SMR, 8.9; 95% CI, 6.8-11.5; P <.001) during the first year after being diagnosed with cancer.

The study also found that patients who were 55 to 64 years old, who never married or were divorced or separated, who had regional or distant disease, who were treated with radiation therapy alone or untreated, and who had primary pharyngeal tumors were at increased risk of mortality from suicide, cardiovascular disease, and/or pneumonia during the first 3 years after being diagnosed with cancer.

The authors pointed out that their study relied on information from the SEER database, and thus cannot provide analyses related to variables that may have an impact on noncancer-related mortality from suicide, cardiovascular disease, or pneumonia such as radiation dose, treatment duration, exposure to chemotherapeutic drugs, surgical reconstruction, rates of depression or psychiatric disease, and the use of enteral feeding.

Finally, they said that increased knowledge of risk factors associated with noncancer-related mortality in OC/OP may lead to the development of a so-called “high-risk profile,” which may allow for early intervention and improved survival.

Yu GP, Mehta V, Branovan D, Huang Q, Schantz SP. Non-cancer related deaths from suicide, cardiovascular disease, and pneumonia in patients with oral cavity and oropharyngeal squamous carcinoma. Arch Otolaryngol Head Neck Surg. 2012;138 (1):25-32.