Diagnosing and Treating Depression in Head and Neck Cancer Patients

Among the many challenges facing patients with head and neck cancer, depression can be an added stressor that, if unrecognized and untreated, contributes to decreased quality of life and early mortality.

This information is not new. Evidence has long shown that depression rates in cancer patients are among the highest in those with head and neck cancers, occurring in approximately 15% to 50% of these patients. Some of these patients will present with or have a prior history of depression, while others will develop depression in the year following diagnosis. For patients who do develop depression, symptoms typically peak two to three months after diagnosis (Cancer Epidemiol. 2016;43:42-48; Clin Adv Hematol Oncol. 2009;7:397-403).

Recognizing the increased risk for and prevalence of depression in head and neck patients is the first critical step in addressing the problem. Diagnosis can be tricky, however, because many of the symptoms of depression are similar to side effects of cancer treatment. Additionally, treatment may be unfamiliar territory for clinicians who don’t typically address behavioral health issues.

Although diagnosing and treating depression may not be considered a part of standard otolaryngologic care, the high rates of depression in head and neck patients and associated decrease in quality of life and survival make it imperative that physicians address this issue more effectively.

“Looking at historical norms, we don’t do a very good job of addressing depression in our patients,” said William M. Lydiatt, MD, chair in the department of surgery at Nebraska Methodist Hospital and clinical professor of surgery at Creighton University in Omaha, who has written extensively on the issue. This lack in addressing depression occurs not only because otolaryngologists and other members of a typical treatment team (i.e., radiation oncologists and medical oncologists) lack the training and facility to diagnose it, said Dr. Lydiatt, but also because it is an issue that patients themselves don’t want to address. “Many patients just don’t want to address one more thing,” he said.

One way to better address this issue is to include a behavioral therapist in the treatment team to ensure that depression is identified early and treated appropriately. Another strategy suggested by recent data is the prophylactic use of antidepressants as part of the treatment protocol for all head and neck patients, particularly for those at high risk of depression.

Although there is currently no standard approach to address depression in these patients, what is clear is the need to do so and to address it with more success. “Depression is common and impacts quality of life and survival,” said Dr. Lydiatt. “It can be treated or prevented in many cases.”

Need to Address All Depression, Even Mild Cases

The substantial effect depression can have on these patients is underscored by ongoing data showing their reduced survival rates due to the depression. A study published in 2018 confirmed this evidence, showing that depressive symptoms predicted shortened survival among patients with head and neck cancer (Cancer. 2018;124:1053-1060).