Christopher J. Recklitis, PhD, MPH

Christopher J. Recklitis, PhD, MPH, of Dana-Farber Cancer Institute and Harvard Medical School, called the results “instructive.” He said the study highlights the need for integrating mental health care into survivorship medical care.

“We’re going to have to think about suicide prevention specifically, given this increased risk, but we also need to think about this population’s psychosocial needs more broadly,” Dr. Recklitis said. “Suicide is something of a ‘misery index.’ The number of people who are ending their lives through suicide strongly suggests there are a large number who are quite miserable and may be thinking about suicide—not taking that step—but suffering in a way that needs to draw our attention.”

Understanding the increased risk for suicide among head and neck cancer survivors requires exploring the risk factors that are typically higher in this population, including poor prognosis, pain, disfigurement, functional impairment, substance abuse, and depression. “But we don’t know if those are the culprits for this excess suicide risk we’re seeing,” he said. “There may also be other late effects—like sexual functioning, swallowing problems, and social isolation—that we need to explore more.”

“If we don’t understand the risk factors we won’t be able to identify the head and neck cancer survivors who are actually at risk,” he added. “We won’t have targets for interventions and we won’t know how to support the medical providers who are caring for these patients.”

Future Directions

Future directions should include examining specific outcomes associated with suicide risk in head and neck cancer, moving beyond registry data—by incorporating patient-reported outcomes, medical late effects, and utilization data—and studying suicide over the survivorship course.

Finally, he stressed the importance of de-stigmatizing conversations about suicide among patients, providers, and institutions. “Not asking is not helping,” he said. “Oncology providers need substantive support to help patients with psychiatric needs, and real-time point-of-care integration of mental health services can help them provide this level of care.” ■

DISCLOSURE: Dr. Recklitis reported no conflicts of interest.