Depression and Oropharynx Cancer Outcome

Abstract

Background Studies have shown a modest relationship between depression and mortality in cancer patients. Our study addressed methodological weaknesses in the literature by restricting the sample to patients with one cancer type, adjusting for factors known to affect outcome, and following patients for a sufficient period of time. Methods We prospectively followed patients newly diagnosed with squamous cell oropharyngeal cancer from the start of radiation therapy until death or until date of last clinical visit. All patients were optimally treated with radiation and sometimes chemotherapy. After adjusting for tumor stage, treatment, comorbidities, smoking, excessive alcohol use, and demographic factors, we assessed the effects of baseline self-reported depression on overall survival and recurrence. Results One hundred thirty participants were followed for a median of 5 years. The average age was 56 years, and 83% were male. Eighteen participants died during the study and 15 experienced disease recurrence. Self-reported depression was associated with decreased overall survival duration (hazard ratio [HR] = 3.6; 95% confidence interval [CI] = 1.2-10.8), and disease recurrence (HR = 3.8; 95% CI = 1.2-12.2) in multivariate analysis. In addition, smoking was associated with disease recurrence. Conclusion Patients with oropharyngeal cancer may benefit from depression screening and evidence-based treatments, if appropriate. Future studies are needed to determine whether depression is an independent prognostic factor of outcome and to elucidate biobehavioral mechanisms involved in patients with oropharyngeal cancer. Precis This prospective study evaluated the impact of self-reported depression on outcomes of patients diagnosed with oropharyngeal cancer and treated with radiation (with or without chemotherapy). After following one hundred thirty participants for a median of 5 years, we found that patients' self-reported depression was associated with decreased overall survival duration and disease recurrence.

Depressive symptoms predict head and neck cancer survival: Examining plausible behavioral and biological pathways

“…Depressive symptoms before chemoradiation treatment predict shortened survival among patients with head and neck cancer. Our findings are consistent with recent studies showing that depression predicts early mortality among patients with head and neck cancer . Although we found that depressive symptoms were associated with increased treatment disruption, we did not find evidence that this mediated survival, likely because of the low percentage of patients with treatment disruption.…”

“…This emphasizes the importance of capturing or attending to subclinical symptoms of depression in patients with head and neck cancer because they may significantly influence overall survival. Our data are similar to those of other head and neck cancer samples in which the majority of patients also endorsed subclinical depressive symptomatology . Thus, our data highlight the importance of screening for depression among all patients with head and neck cancer.…”

“…All statistical tests were 2‐sided with α set at .05 (SPSS 21; IBM, Armonk, New York). The power analysis was based on a comparable study reporting depressive symptoms as a significant predictor of head and neck cancer survival among 130 patients experiencing 18 deaths . The results suggested that our sample of 134 patients with 39 deaths would attain 100% power to detect significant effects.…”

“…Studies examining mixed head and neck tumor sites have revealed depressive symptoms to be prognostic for 2‐ and 3‐year overall survival . Depression has also been shown to predict 5‐year overall survival for patients with advanced‐stage oropharyngeal cancer . A recent epidemiological analysis using Surveillance, Epidemiology, and End Results data from 3466 patients with head and neck cancer demonstrated significantly elevated mortality rates for cancer patients diagnosed with depression .…”

Depression in cancer: The many biobehavioral pathways driving tumor progression

“…In addition, maladaptive dietetic and non-dietetic habits appear to modify the susceptibility to associated comorbidities and to worsen the prognostic outcome of cancer, thus representing a target for behavioral adjunctive treatment strategies. For instance, smoking has been associated with a high risk of recurrence in oropharynx cancer 171 , as well as with lower adherence to treatments in breast cancer 172 …”