Abstract A178: Death by suicide in patients with early-onset head and neck cancer

Abstract

Suicide rates among U.S. patients with cancer are approximately twice those of the general population, with patients with head and neck squamous cell carcinoma (HNSCC) experiencing among the highest risks. Meanwhile, the burden of early-onset (EO) cancers continues to increase, and adolescents and young adults (AYA), particularly males, have been reported to experience among the highest suicide mortality rates across age groups diagnosed with cancer. Together, these findings suggest younger patients with HNSCC may be particularly vulnerable. However, whether suicide outcomes differ between younger patients with HNSCC, traditional-onset HNSCC, and other EO cancers is unclear. We compared suicide incidence and cumulative incidence across AYA/EO HNSCC, typical-onset HNSCC, and EO non-HNSCC. We conducted a retrospective cohort study using the SEER Research data (17 registries; Nov 2025 sub), including patients ≥15 years with a first primary HNSCC or EO cancer from 2000–2023. Patients were classified as AYA (15–39yrs), EO (40–49yrs), or typical-onset (≥50yrs). For descriptive and competing-risk analyses, AYA and EO HNSCC were combined. EO non-HNSCC included the 14 most common EO cancers. Poisson regression estimated suicide incidence rates (per 100,000 person-years) and adjusted incidence rate ratios (aIRRs), adjusting for sex, race, and cancer site. Fine and Gray competing risk models estimated subdistribution hazard ratios (sHRs) while adjusting for sex, race, marital status, median household income, and stage. Typical-onset HNSCC had the highest suicide incidence (61.0 per 100,000 person-years), followed by AYA/EO HNSCC (40.7) and EO non-HNSCC (15.2). Males had substantially higher suicide incidence rates than females (aIRR 4.71, 95% CI 3.53–6.29), while racial groups other than non-Hispanic White (NHW) had lower incidence rates (aIRR 0.40, 95% CI 0.32–0.51). In competing risk analyses, combined AYA/EO HNSCC had a higher suicide risk than typical-onset HNSCC (sHR 1.15, 95% CI 0.94–1.40). However, compared with EO non-HNSCC, AYA/EO HNSCC had a significantly higher suicide risk (sHR 1.60, 95% CI 1.29–1.98). Other factors associated with higher suicide risk in competing risks model included males (sHR 2.60, 95% CI 2.28–2.96) and unmarried patients (sHR 1.57, 95% CI 1.38–1.80), while non-NHW patients were associated with reduced risks (sHR 0.35, 95% CI 0.30–0.42). Younger patients with HNSCC experience a suicide burden comparable to that of traditional-onset HNSCC with males, white and unmarried patients experiencing higher suicide risk. Compared with other EO cancers, younger patients with HNSCC remain at significantly greater suicide risk even after accounting for competing mortality. These findings support integrating routine psychosocial screening, mental health services, and survivorship care into HNSCC management, particularly for patients diagnosed at younger ages. Kwabena D. Boateng, Sena A. Gbeku, Morgan Byrd, Kaitlyn Garcia, Eric Adjei Boakye, Nosa Peters. Death by suicide in patients with early-onset head and neck cancer [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A178.