Mood and malignancy: head and neck cancer and depression

Abstract

Head and neck cancer patients have been reported to show high rates of depression. However, it is important to differentiate between depressive symptoms and a depressive disorder. This review critically examines the relationship between head and neck cancer and depression. There appears to be little evidence for depression leading to an increased risk of developing cancer and although depressive symptoms in head and neck cancer patients are common, very few studies have investigated depressive disorders. The studies that investigated the incidence of a comorbid depressive disorder report a prevalence very close to that of the general population, implying that major depression is not a normal response to cancer. Finally, the evidence suggests that comorbidity of depression with cancer has a negative impact on morbidity and mortality. Both psychosocial and biological factors could account for this. Dysregulation of the stress hormone axis and increased inflammation are common in depressive disorders and have been suggested as underlying pathological mechanisms and are both markers of poor prognosis in cancer. This evidence suggests that a relatively small number of patients develop a depressive disorder following a diagnosis of cancer, but for those that do it may have a substantial impact on their prognosis.

Sleep-Related Breathing Disorders in Patients With Tumors in the Head and Neck Region

“…The latter, occurring after radiation therapy, may adversely impact sleep via excessive consumption of liquids resulting in nocturia, frequent arousals, and difficulty returning to sleep after awakening. Disfiguring therapies (surgery, radiation) and socially distressing losses of function (eating, speaking, and swallowing) may also predispose these patients to depression [23].Thus, a heightened clinical awareness is important because the presentation of OSA in cancer patients may not be typical. Often systemic manifestations of the malignancy or its treatments may obscure other etiologies of the patient's complaints.…”

Depressão e câncer

“…Entretanto, em estudo recente, a prevalência de depressão foi 21% em 258 casos de câncer de pâncreas, avaliados retrospectivamente 13 . Archer et al (2008) 14 estimaram a prevalência de sintomas depressivos associada ao câncer de cabeça e pescoço entre 6% e 15%, em contraste com taxas de até 40%, em estudo realizado na década de 1980 15 . Em dois outros estudos, realizados no Japão e no Canadá, as prevalências de transtornos depressivos também foram menores: 3,7% e 5% 16,17 .…”

“…A depressão tem sido associada a pior prognóstico e a aumento da mortalidade em pacientes com câncer de cabeça e pescoço 7,14 . Fatores biológicos, como a desregulação do eixo hormonal associado ao estresse, e o aumento da resposta inflamatória são comuns em pacientes com transtornos depressivos e têm sido considerados como possíveis mecanismos patológicos responsáveis por um pior prognóstico de pacientes com câncer 14 .…”

The Association between Malnutrition and Psychological Distress in Patients with Advanced Head-and-Neck Cancer

“…The subsequent physical disfiguration and dysfunction may lead to problems with mastication and swallowing, and impairments in communication, emotional expression, and social interactions. Those problems often result in social isolation and distress 2,3 .…”