Depression Affects Two-Year Survival Rates in Head and Neck Cancer Patients

Comment: The significance of this publication is that it improves our understanding of how depressive symptoms, which affect nearly 70% of patients with head and neck cancer, may affect treatment response and survival. The authors found that patients with greater depressive symptoms at the time of treatment planning experienced worse overall survival and were at greater risk for treatment interruptions and poorer therapeutic responses. The article helps to underscore the importance of carefully assessing patients with head and neck cancer preparing to undergo treatment for depressive symptoms to identify those patients at risk for worse long term outcomes. —Andres Bur, MD

Do greater depressive symptoms predict earlier mortality in head and neck cancer patients, particularly when accounting for behavioral (treatment interruption) and biological (treatment response) mediators?

Bottom line: Depression at time of treatment planning appeared to be as important a predictor of two-year survival as traditional clinical prognostic indicators. Effects were partly influenced by the treatment response.

Background: Head and neck cancer patients experience clinical depression rates higher than those of the general population, and they have some of the highest rates among cancer patients. Burgeoning evidence supports the relationship between depression and early mortality among these patients. There are limited pathways by which psychosocial factors, including depression, may affect cancer survival including treatment adherence, biological pathways, and self-care.

Study design: Clinical data review of 134 patients from October 2012 to October 2013 who reported depressive symptomatology at treatment planning.

Setting: University of Louisville, Ky.

Synopsis: Fourteen patients had at least one treatment interruption (three consecutive days without). Interruptions typically occurred early (within the first three weeks) because of acute toxicity (nausea/vomiting), a decline in functional status (falls or stroke), or social factors (legal, transportation issues). Entry depressive symptoms were significantly associated with subsequent treatment interruption as well as with poorer treatment response. The relation between depressive symptoms and survival could not be shown to be mediated by treatment interruption. The only variable associated both with depressive symptoms and overall survival was clinical stage at the time of diagnosis; associations with disease site, age, sex, race, marital status, and pack-years were all non-significant.

Citation: Zimmaro LA, Sephton SE, Siwik CJ, et al. Depressive symptoms predict head and neck cancer survival: examining plausible behavioral and biological pathways. Cancer. 2018;124:1053–1060.