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Scratching the Surface of Suicide in Head and Neck Cancer

Scratching the Surface of Suicide in Head and Neck Cancer To the Editor Cancer, both in its diagnosis and its management, imposes significant psychological distress. Kam et al1 recently published a retrospective review of data from the Surveillance, Epidemiology, and End Results (SEER) program, specifically investigating suicide in patients with head and neck (HN) cancer. They determined that suicide rates among patients with HN cancer are significantly higher than those in the general population, which is corroborated by previously published evidence.2 Among the broad category of HN cancers, hypopharyngeal cancer was associated with the highest incidence of suicide. The authors postulated that such a correlation may be linked with diminished quality of life (QOL) associated with the disease and its treatment. An additional factor, not discussed in their paper, is the fact that the 5-year survival rate for individuals with hypopharyngeal cancer is 31.9%3—a demoralizing prognosis for any patient. We agree with the authors that screening for depression and suicidal ideation should be considered for these patients who are at high risk for self-harm, because this is the standard of care based on the current American Society of Clinical Oncology (ASCO) recommendations for depression screening.4 We also applaud their efforts in promoting attention to the mental health of patients in whom such concerns often go unrecognized. However, we note that the authors focus primarily on the subject of depression to the exclusion of other possible causes of suicidality. While depression may respond to interventions like pharmacotherapy (eg, SSRIs) and cognitive behavioral therapy, other causes for suicidal ideation (eg, severe demoralization, existential distress, resignation to prognosis) may evade traditional solutions. For example, the combination of QOL impairment and poor prognosis mentioned above could promote a desire to end one’s life quickly, and this desire could occur outside the context of overt depression.5 Thus, focusing on mental illness as the solitary cause for increased suicide risk reduces the patient experience of cancer to only one potential nidus of improvement. Further research is required to improve the prognosis of HN cancer as well as posttreatment QOL, and to support the bio-psycho-social-spiritual experience of HN cancer patients. Studying demoralization and existential distress may lead to the development of interventions that improve rates of suicide and suicidal ideation in this population. Ultimately this will allow clinicians to better address their patients’ suffering. Back to top Article Information Corresponding Author: Jason A. Webb, MD, Duke Palliative Care, DUMC 2706, Durham, NC 27710 (jason.webb@duke.edu). Published Online: March 31, 2016. doi:10.1001/jamaoto.2016.0255. Conflict of Interest Disclosures: None reported. References 1. Kam D, Salib A, Gorgy G, et al. Incidence of suicide in patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1075-1081.Google ScholarCrossref 2. Misono S, Weiss NS, Fann JR, Redman M, Yueh B. Incidence of suicide in persons with cancer. J Clin Oncol. 2008;26(29):4731-4738.PubMedGoogle ScholarCrossref 3. National Cancer Institute. SEER Cancer Statistics Review. SEER Relative Survival (Percent) by Cancer Site, 2004 - 2010. http://seer.cancer.gov/archive/csr/1975_2011/results_single/sect_01_table.05_2pgs.pdf. Accessed December 2, 2015. 4. Andersen BL, DeRubeis RJ, Berman BS, et al; American Society of Clinical Oncology. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol. 2014;32(15):1605-1619.PubMedGoogle ScholarCrossref 5. Nissim R, Gagliese L, Rodin G. The desire for hastened death in individuals with advanced cancer: a longitudinal qualitative study. Soc Sci Med. 2009;69(2):165-171.PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Otolaryngology - Head & Neck Surgery American Medical Association

Scratching the Surface of Suicide in Head and Neck Cancer

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Publisher
American Medical Association
Copyright
Copyright © 2016 American Medical Association. All Rights Reserved.
ISSN
2168-6181
eISSN
2168-619X
DOI
10.1001/jamaoto.2016.0255
Publisher site
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Abstract

To the Editor Cancer, both in its diagnosis and its management, imposes significant psychological distress. Kam et al1 recently published a retrospective review of data from the Surveillance, Epidemiology, and End Results (SEER) program, specifically investigating suicide in patients with head and neck (HN) cancer. They determined that suicide rates among patients with HN cancer are significantly higher than those in the general population, which is corroborated by previously published evidence.2 Among the broad category of HN cancers, hypopharyngeal cancer was associated with the highest incidence of suicide. The authors postulated that such a correlation may be linked with diminished quality of life (QOL) associated with the disease and its treatment. An additional factor, not discussed in their paper, is the fact that the 5-year survival rate for individuals with hypopharyngeal cancer is 31.9%3—a demoralizing prognosis for any patient. We agree with the authors that screening for depression and suicidal ideation should be considered for these patients who are at high risk for self-harm, because this is the standard of care based on the current American Society of Clinical Oncology (ASCO) recommendations for depression screening.4 We also applaud their efforts in promoting attention to the mental health of patients in whom such concerns often go unrecognized. However, we note that the authors focus primarily on the subject of depression to the exclusion of other possible causes of suicidality. While depression may respond to interventions like pharmacotherapy (eg, SSRIs) and cognitive behavioral therapy, other causes for suicidal ideation (eg, severe demoralization, existential distress, resignation to prognosis) may evade traditional solutions. For example, the combination of QOL impairment and poor prognosis mentioned above could promote a desire to end one’s life quickly, and this desire could occur outside the context of overt depression.5 Thus, focusing on mental illness as the solitary cause for increased suicide risk reduces the patient experience of cancer to only one potential nidus of improvement. Further research is required to improve the prognosis of HN cancer as well as posttreatment QOL, and to support the bio-psycho-social-spiritual experience of HN cancer patients. Studying demoralization and existential distress may lead to the development of interventions that improve rates of suicide and suicidal ideation in this population. Ultimately this will allow clinicians to better address their patients’ suffering. Back to top Article Information Corresponding Author: Jason A. Webb, MD, Duke Palliative Care, DUMC 2706, Durham, NC 27710 (jason.webb@duke.edu). Published Online: March 31, 2016. doi:10.1001/jamaoto.2016.0255. Conflict of Interest Disclosures: None reported. References 1. Kam D, Salib A, Gorgy G, et al. Incidence of suicide in patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1075-1081.Google ScholarCrossref 2. Misono S, Weiss NS, Fann JR, Redman M, Yueh B. Incidence of suicide in persons with cancer. J Clin Oncol. 2008;26(29):4731-4738.PubMedGoogle ScholarCrossref 3. National Cancer Institute. SEER Cancer Statistics Review. SEER Relative Survival (Percent) by Cancer Site, 2004 - 2010. http://seer.cancer.gov/archive/csr/1975_2011/results_single/sect_01_table.05_2pgs.pdf. Accessed December 2, 2015. 4. Andersen BL, DeRubeis RJ, Berman BS, et al; American Society of Clinical Oncology. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol. 2014;32(15):1605-1619.PubMedGoogle ScholarCrossref 5. Nissim R, Gagliese L, Rodin G. The desire for hastened death in individuals with advanced cancer: a longitudinal qualitative study. Soc Sci Med. 2009;69(2):165-171.PubMedGoogle ScholarCrossref

Journal

JAMA Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Jun 1, 2016

Keywords: cancer and depression,head and neck cancer,depressive disorders,suicide,head and neck squamous cell carcinoma

References

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