Patients with head and neck cancer who had depressive symptoms prior to treatment experienced shorter survival, according to a study published in Cancer.
Many patients did not have clinically diagnosed depression, suggesting even mild depressive symptoms may affect outcomes.
Treatment response largely drove effects in overall mortality.
“Patients with head and neck cancer endorse a wide range of depressive symptomatology. They experience rates of clinical depression higher than those of the general population, and they have some of the highest rates among cancer patients,” Elizabeth D. Cash, PhD, clinical health psychologist and director of research in the department of otolaryngology at University of Louisville School of Medicine in Kentucky, and colleagues wrote. “Depression has been shown to predict early mortality across a number of different cancers. A meta-analysis examining multiple cancer types found that depressed patients may have a 26% to 39% greater mortality risk than their nondepressed counterparts.”
Psychosocial factors, including depression, can affect cancer survival through treatment adherence, biological pathways and modifiable preventive self-care, such as diet, exercise and smoking.
Cash and colleagues assessed depression symptomology among 134 patients (mean age, 61 years; 73.9% men) who had recently been diagnosed with head and neck cancer and who attended the clinic for treatment planning. Thirty-nine percent had previously undergone surgical procedures to confirm extent of the malignancy or for extirpation.
Patients were followed-up for 2 years.
Depressive symptoms appeared associated with shorter survival (HR = 0.86; 95% CI, 0.81-0.92), higher rates of chemoradiation interruption (OR = 0.86; 95% CI, 0.77-0.96) and poorer treatment response (OR = 0.87; 95% CI, 0.80-0.96).
Poorer response to treatment appeared partially responsible for the association between depressive symptoms and decreased survival.
“We observed that head and neck cancer patients who reported more depressive symptoms at their initial appointment were more likely to miss scheduled treatment appointments and were more likely to have tumors that persisted after medical treatment,” Cash said in a press release. “We also observed that patients with depressive symptoms suffered greater 2-year overall mortality rates, and this was especially true for those who did not achieve optimal response to medical treatment.”
Researchers did not observe significant associations between disease site, age, sex, race, marital status and smoking status.
Sixty-seven percent of patients did not meet the criteria for diagnosis of major depressive disorder. This suggests patients with head and neck cancer who had subclinical symptoms of depression may be at risk for decreased survival.
“We want patients to know that it is normal to get depressed when they are diagnosed, but it is important to seek help for any depression symptoms because they may lead to poorer outcomes related to their cancer treatment,” Cash said. – by Cassie Homer
Disclosures: The authors report no relevant financial disclosures.