Depression Predicted Head and Neck Cancer Survival

Those patients with head and neck cancer who had depressive symptoms at the time of treatment planning had worse overall 2-year mortality, according to the results of a study published in Cancer.

“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,” said Elizabeth D. Cash, PhD, of the University of Louisville School of Medicine, who serves as the director of research for the department of otolaryngology-head and neck surgery and communicative disorders. “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.”

According to the study, patients with head and neck cancer have some of the highest rates of depressive symptoms among all patients with cancer. In addition, patients with depressive symptoms have lower rates of chemoradiation adherence and completion.

In order to examine how depression may influence survival, Cash and colleagues looked at data from 134 patients with head and neck cancer over a 2-year period. Patients reported depressive symptoms at treatment planning, and clinical data were reviewed at the 2-year follow-up.

They found that depressive symptoms at treatment planning predicted 2-year overall survival (hazard ratio [HR], 0.868; P < .001). In addition, early depressive symptoms were significantly associated with the likelihood of subsequent treatment interruption (odds ratio [OR], 0.865; P = .010) and poorer treatment response (OR, 0.879; P = .005).

The researchers noted that the relation between depressive symptoms and overall survival was not mediated by treatment interruption, “likely because of the low percentage of patients with treatment disruption.” The relation between depressive symptoms and overall survival was mediated by treatment response. However, there were no significant effects from factors commonly used to determine cancer prognosis-such as the patient’s age, the stage of tumor advancement, or extent of smoking history.

“This suggests that depressive symptoms may be as powerful as the clinical features that physicians typically use to determine the prognosis of patients with head and neck cancer,” Cash said.

Cash noted that most patients in the study did not meet criteria for diagnosis of major depressive disorder, suggesting that even mild symptoms of depression may interfere with head and neck cancer treatment outcomes. She also stressed that the findings needed to be replicated in a larger study, but suggested that depressive symptoms may affect head and neck cancer patients’ survival through mechanisms that potentially coincide with the activities of their tumor.

“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.