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

Zimmaro, Lauren A.; Sephton, Sandra E.; Siwik, Chelsea; Phillips, Kala; Rebholz, Whitney N.; Kraemer, Helena C.; Giese‐Davis, Janine; Wilson, Liz; Bumpous, Jeffrey M.; Cash, Elizabeth

doi:10.1002/cncr.31109

Cited by 64 publications

(102 citation statements)

References 54 publications

(118 reference statements)

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“…In addition, we found that, in people with oral cavity and HPV‐negative oropharyngeal and laryngeal cancer, DS were associated with worse survival, while in people with HPV‐positive oropharyngeal cancer, no such association was found. Previous studies on the association between pretreatment DS and overall survival have shown inconsistent results . Two studies in people with different types of HNC found no evidence for such an association (after adjustment), while Shinn et al targeting people with oropharyngeal cancer, Zimmaro et al targeting people with mixed HNC treated with (chemo)radiation, and Chen et al also targeting people with mixed HNC reported an increased risk of earlier death or poorer overall survival among those with pretreatment DS.…”

Section: Discussionmentioning

confidence: 96%

“…Previous studies on the association between pretreatment DS and overall survival have shown inconsistent results . Two studies in people with different types of HNC found no evidence for such an association (after adjustment), while Shinn et al targeting people with oropharyngeal cancer, Zimmaro et al targeting people with mixed HNC treated with (chemo)radiation, and Chen et al also targeting people with mixed HNC reported an increased risk of earlier death or poorer overall survival among those with pretreatment DS. In contrast to our study, Shinn et al did not stratify for HPV status, as HPV status was only available for a subsample.…”

Section: Discussionmentioning

confidence: 96%

“…Previous studies on the association between clinical depression or DS and survival in people with HNC reported mixed results. Some studies reported no association, while others reported worse survival or higher mortality in people with depression or DS . Half of these studies were, however, limited by small number of events (eg, disease‐related or overall deaths), hampering the ability to account for different covariates in the survival analyses.…”

Section: Introductionmentioning

confidence: 92%

“…Some studies reported no association, while others reported worse survival or higher mortality in people with depression or DS . Half of these studies were, however, limited by small number of events (eg, disease‐related or overall deaths), hampering the ability to account for different covariates in the survival analyses. In addition, most studies were limited to a single measurement of clinical depression or DS, mostly prior to treatment .…”

Section: Introductionmentioning

confidence: 99%

“…Half of these studies were, however, limited by small number of events (eg, disease‐related or overall deaths), hampering the ability to account for different covariates in the survival analyses. In addition, most studies were limited to a single measurement of clinical depression or DS, mostly prior to treatment . As previously reported, pretreatment DS may result from the short‐term response to cancer diagnosis and may not necessarily reflect a person's long‐term course of DS and, therefore, may be a less important associated factor of survival than DS at follow‐up.…”

Section: Introductionmentioning

confidence: 99%

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Depressive symptoms in relation to overall survival in people with head and neck cancer: A longitudinal cohort study

et al. 2018

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ObjectiveThe objective of the study is to investigate the relation between pretreatment depressive symptoms (DS) and the course of DS during the first year after cancer diagnosis, and overall survival among people with head and neck cancer (HNC).MethodsData from the Head and Neck 5000 prospective clinical cohort study were used. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) pretreatment, at 4 and 12‐month follow‐up. Also, socio‐demographic, clinical, lifestyle, and mortality data were collected. The association between before start of treatment DS (HADS‐depression > 7) and course (never DS, recovered from DS, or persistent/recurrent/late DS at 12‐month follow‐up) and survival was investigated using Cox regression. Unadjusted and adjusted analyses were performed.ResultsIn total, 384 of the 2144 persons (18%) reported pretreatment DS. Regarding DS course, 63% never had DS, 16% recovered, and 20% had persistent/recurrent/late DS. People with pretreatment DS had a higher risk of earlier death than people without DS (hazard ratio (HR) = 1.65; 95% confidence interval (CI) 1.33‐2.05), but this decreased after correcting for socio‐demographic, clinical, and lifestyle‐related factors (HR = 1.21; 95% CI 0.97‐1.52). Regarding the course of DS, people with persistent/recurrent/late DS had a higher risk of earlier death (HR = 2.04; 95% CI 1.36‐3.05), while people who recovered had a comparable risk (HR = 1.12; 95% CI 0.66‐1.90) as the reference group who never experienced DS. After correcting for socio‐demographic and clinical factors, people with persistent/recurrent/late DS still had a higher risk of earlier death (HR = 1.66; 95% CI 1.09‐2.53).ConclusionsPretreatment DS and persistent/recurrent/late DS were associated with worse survival among people with HNC.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Depressive symptoms in relation to overall survival in people with head and neck cancer: A longitudinal cohort study

et al. 2018

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Association of Head and Neck Cancer With Mental Health Disorders in a Large Insurance Claims Database

Lee

Liu

et al. 2019

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Although a few studies have shown that mental health disorders (MHDs) are strongly associated with the 5-year survival and recurrence rates in patients with head and neck cancer (HNC), none have been replicated in a large-scale study.OBJECTIVE To describe the prevalence of MHDs in patients with HNC and the potential associations with survival and recurrence using a large insurance claims database.

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Depressive Symptoms, Systemic Inflammation, and Survival Among Patients With Head and Neck Cancer

Cash,

Albert,

Palmer

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportancePatients with head and neck cancer experience high rates of depression. Depression and systemic inflammation have been found to be associated in numerous cancer types, often independently from disease status. Depression-related inflammation may elevate the risks for poor tumor response to treatment and early mortality, and comprises a mechanism by which depression is associated with survival in head and neck cancer.ObjectiveTo assess mediation pathways incorporating pretreatment depressive symptoms, pretreatment inflammation, and tumor response posttreatment on overall survival among patients with head and neck cancer.Design, Setting, and ParticipantsThis was a prospective observational cohort study of patients with head and neck cancer treated in a single multidisciplinary head and neck cancer clinic from May 10, 2013, to December 30, 2019, and followed up for 2 years. Data analysis was performed from June 29, 2022, to June 23, 2023.ExposuresPatient-reported depressive symptoms using the Patient Health Questionnaire−9 item (PHQ−9) at treatment planning; pretreatment hematology workup for systemic inflammation index (SII) score; and clinical data review for tumor response (complete vs incomplete) and overall survival.Main OutcomesTwo-year overall survival.ResultsThe total study cohort included 394 patients (mean [SD] age, 62.5 [11.5] years; 277 [70.3%] males) with head and neck cancer. Among 285 patients (72.3%) who scored below the clinical cutoff for depression on the PHQ−9, depressive symptoms were significantly associated with inflammation (partial r, 0.168; 95% CI, 0.007-0.038). In addition, both depression and inflammation were associated with early mortality (PHQ−9: hazard ratio [HR], 1.04; 95% CI, 1.02-1.07; SII: HR, 1.36; 95% CI, 1.08-1.71). The depression-survival association was fully mediated by inflammation (HR, 1.28; 95% CI, 1.00-1.64). Depressive symptoms were also associated with poorer tumor response (odds ratio, 1.05; 95% CI, 1.01-1.08), and the depression-survival association was partially mediated by tumor response (HR, 9.44; 95% CI, 6.23-14.32). Systemic inflammation was not associated with tumor response.ConclusionsIn this cohort study, systemic inflammation emerged as a novel candidate mechanism of the association of depression with mortality. Tumor response partially mediated effects of depression on mortality, replicating prior work. Thus, depression stands out as a highly feasible target for renewed clinical attention. Even mild symptoms of depression during the treatment-planning phase may be associated with higher systemic inflammation in addition to poorer tumor response to treatment and survival outcomes; therefore, depression should be clinically addressed.

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

Cited by 64 publications

References 54 publications

Depressive symptoms in relation to overall survival in people with head and neck cancer: A longitudinal cohort study

Depressive symptoms in relation to overall survival in people with head and neck cancer: A longitudinal cohort study

Association of Head and Neck Cancer With Mental Health Disorders in a Large Insurance Claims Database

Depressive Symptoms, Systemic Inflammation, and Survival Among Patients With Head and Neck Cancer

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