Why Suicide Rates Among Head and Neck Cancer Survivors Are High — and What We Can Do About It

A cancer researcher shares his findings and the urgent need to support survivors' mental health

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Head and neck cancer survivors are four times as likely to die by suicide than members of the general population — and twice as likely as survivors of other cancers, a 2018 in the journal Cancer found.

Suicide takes a life every 40 seconds, according to the World Health Organization. And as more and more people survive cancer, more attention needs to be paid to their quality of life, says Nosayaba Osazuwa-Peters, B.D.S., Ph.D., M.P.H., lead researcher on the 2018 study and assistant professor of otolaryngology at Saint Louis University School of Medicine.

About one-half of head and neck cancer survivors can’t return to work after treatment, and many experience physical disfigurement.

“We need to talk more about it,” he says. “We’re hoping more high-level funding will be made available for more research into the psychosocial issues of cancer. There’s still lots to be learned about this problem. People are living longer, so it needs to be discussed now more than ever.”

HealthCentral spoke with Dr. Osazuwa-Peters about the study, the issues facing head and neck cancer survivors, and what can be done to support their mental health.

HealthCentral (HC): Why are survivors of head and neck cancer more likely to die by suicide?

Dr. Osazuwa-Peters: When you compare this cancer with the other cancers in terms of suicide rate, pancreatic cancer is the only one with a higher rate — and pancreatic cancer is very painful and has a single-digit survival rate.

For head and neck cancer, it could be a bunch of different things. One thing I’ve always said is suicide is so complex that there’s no one factor that accounts for it; it’s a combination of factors. There’s a lot of quality-of-life issues associated with head and neck cancer. Survival is not just about being alive every day. Cancer can take its toll on you: Say you’re functionally disabled, unable to go to work, or you lose your job and your insurance, and you start racking up crazy bills because head and neck cancer is one of most expensive cancers to treat. And it’s often disfiguring. So it can create the perfect storm.

HC: How does disfigurement play into the mental health issues related to this head and neck cancer?

Dr. Osazuwa-Peters: What’s unique for head and neck cancer survivors is that if you see a head and neck patient, you often know they have had cancer. Everyone can see, and some people lose their voice completely, or they sound different with an electronic voice. When you have that level of disfigurement, it can just drive depression. Also, something most of us take for granted every day is sharing meals with family. A lot of things we do revolve around food and family. So when a grandpa doesn’t feel comfortable with that, because he’s lost the ability to taste food or has a constantly dry mouth or tooth decay, it can be devastating.

HC: Why are pain issues and substance abuse more prevalent in head and neck cancer survivors?

Dr. Osazuwa-Peters: We know from past research that opioid use and pain management related to cancer is a big problem. For head and neck cancer, you might have radical neck dissection and hours and hours of surgery. It would be crazy not to prescribe pain meds. These patients are in a lot of pain. But the problem is, we know using these kinds of meds can lead to people becoming dependent. Research suggests there’s a high prevalence of substance abuse — alcohol and tobacco and drug — in this population.

HC: What can be done to support people with head and neck cancer?

Dr. Osazuwa-Peters: As with everything, the first thing is creating awareness. It’s important to talk about from the cancer patient’s perspective. There needs to be more conversation between physicians and patients.

Some head and neck oncologists have told me how difficult it is to have conversations about how their patients are feeling. When you look at the head and neck cancer population, there are far more males than females who develop it. And many males have this concept that they should man up and take their treatment and beat it. They don’t want to talk about it all the time, and they have a much smaller social network where they let their guard down and be vulnerable. So the problem is not just physicians, but patients being willing to share. We need more study on physician-patient communication, and we need to find better ways to promote communication. Because some people will not take the step [of suicide] if they just communicate.

HC: How can family and friends help loved ones with head and neck cancer?

Dr. Osazuwa-Peters: I think that humans are designed to live with other people, and you need to be around other people when you’re in a crisis like cancer. Cancer itself is enough to create depression in patients who didn’t have depression before. One study showed that cancer patients who are married fare better than patients who are not married.

It’s also great to know there are other people who can be there with you who have been through it. I once visited a support group to talk to them about dental problems, and I left feeling so educated — it taught me how much going to that kind of structured support group really helps. There was so much I didn’t know about what patients are really going through, and to see patients and families and see how strong and very courageous people are is a good experience.