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Invited Commentary
October 7, 2021

Lethal Suicidal Acts Among Head and Neck Cancer Survivors: The Tip of a Distress Iceberg

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Saint Louis University Hospital, St Louis, Missouri
  • 2Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
JAMA Otolaryngol Head Neck Surg. Published online October 7, 2021. doi:10.1001/jamaoto.2021.2840

Patients treated for head and neck cancer (HNC) often experience inordinate amounts of stress. These cancers occur more frequently in populations with limited resources and high rates of mental illness—even before a life-altering cancer diagnosis and the toxic effects of treatments take their toll. Considering these circumstances, it is perhaps unsurprising, but no less concerning, that in this issue of JAMA Otolaryngology–Head & Neck Surgery Nugent and colleagues1 found a high rate of suicidal self-directed violence (SSDV) in this population. Importantly, this study highlights that factors beyond depression are associated with suicidal outcomes, including pain and supportive care services. Nonetheless, considering the high burdens on this population, these rare suicidal outcomes likely represent the tip of the iceberg—the most severe manifestation of very common survivorship distress.

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