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- Title
Association of Human Papillomavirus Status With Suicide Risk Among Patients With Head and Neck Cancer.
- Authors
Chakoma, Tatenda; Moon, Peter K.; Osazuwa-Peters, Oyomoare L.; Megwalu, Uchechukwu C.; Osazuwa-Peters, Nosayaba
- Abstract
Key Points: Question: Is human papillomavirus (HPV)–positive tumor status associated with increased suicide risk in patients with head and neck cancer? Findings: In this cohort study of 60 361 patients with head and neck cancer, HPV-positive tumor status was not associated with suicide risk (adjusted hazard ratio, 1.18; 95% CI, 0.79-1.79). Meaning: The study results suggest that patients with HPV-positive and HPV-negative head and neck cancer share similar suicide risk, despite differences in overall prognosis. Importance: Human papillomavirus (HPV) is strongly associated with head and neck cancer, and HPV status is considered a prognostic factor. Being a sexually transmitted infection, HPV-related cancers may have greater risk of stigma and psychological distress; however, the potential association of HPV-positive status with psychosocial outcomes, such as suicide, is understudied in head and neck cancer. Objective: To investigate the association between HPV tumor status and suicide risk among patients with head and neck cancer. Design, Setting, and Participants: This population-based retrospective cohort study included adult patients with clinically confirmed cases of head and neck cancer based on HPV tumor status from the Surveillance, Epidemiology, and End Results database from January 1, 2000, to December 31, 2018. Data analysis was conducted from February 1 to July 22, 2022. Main Outcomes and Measures: The outcome of interest was death by suicide. Primary measure was HPV status of tumor site, dichotomized as positive or negative. Covariates included age, race, ethnicity, marital status, cancer stage at presentation, treatment modality, and type of residence. Cumulative risk of suicide among patients with HPV-positive and HPV-negative head and neck cancer was assessed using Fine and Gray competing risk models. Results: Of 60 361 participants, the mean (SD) age was 61.2 (13.65) years, and 17 036 (28.2%) were women; there were 347 (0.6%) American Indian, 4369 (7.2%) Asian, 5226 (8.7%) Black, 414 (0.7%) Native Hawaiian or Other Pacific Islander, and 49 187 (81.5%) White individuals. A competing risk analysis showed a significant difference in the cumulative incidence of suicide between HPV-positive cancers (5-year suicide-specific mortality, 0.43%; 95% CI, 0.33%-0.55%) and HPV-negative cancers (5-year suicide-specific mortality, 0.24%; 95% CI, 0.19%-0.29%). Tumor status that was HPV positive was associated with increased suicide risk in the unadjusted model (hazard ratio [HR], 1.76; 95% CI, 1.28-2.40), but not the fully adjusted model (adjusted HR, 1.18; 95% CI, 0.79-1.79). Among people with oropharyngeal cancer only, HPV status was associated with increased suicide risk, but the width of the confidence interval prevented definitive conclusion (adjusted HR, 1.61; 95% CI 0.88-2.94). Conclusions and Relevance: The results of this cohort study suggest that patients with HPV-positive head and neck cancer have similar risk of suicide as patients with HPV-negative cancer, despite differences in overall prognosis. Early mental health interventions may be associated with reduced suicide risk in all patients with head and neck cancer and should be assessed in future work. This cohort study examines the association between human papillomavirus tumor status and suicide risk among patients with head and neck cancer.
- Publication
JAMA Otolaryngology-Head & Neck Surgery, 2023, Vol 149, Issue 4, p291
- ISSN
2168-6181
- Publication type
Article
- DOI
10.1001/jamaoto.2022.4839