The study, which included 134 patients with head and neck cancers who presented with depressive symptoms during treatment planning, followed these patients for two years. Clinical data at two years showed shorter survival in the patients with greater depressive symptoms. In addition, these patients also had higher rates of chemoradiation interruption and poorer treatment response.
Explore This IssueAugust 2018
Importantly, the study showed that depression predicted survival independent of other commonly used variables associated with prognosis, such as patient age, tumor stage, or extent of smoking history. According to the investigators, this suggests that depressive symptoms may be an important predictor of survival and a prognostic indicator as powerful as traditional clinical features to determine the prognosis of these patients.
Another important study finding was that the adverse effects of depression on survival and other measures cited above were seen even in patients with mild depression.
“The majority of patients in our study did not meet criteria for diagnosis of major depressive disorder,” said senior author of the study Liz Cash, PhD, clinical health psychologist, director of research, and assistant professor in the department of otolaryngology-HNS and communicative disorders at the University of Louisville School of Medicine in Louisville, Ky. “This means that even mild symptoms of depression may interfere with head and neck cancer treatment outcomes.”
Dr. Cash noted that signs of depression are different for everyone. Instead of looking for a “hallmark” sign of depression for all patients, she encourages otolaryngologists to look for two common signs that indicate depression in most patients: depressed mood and losing interest in activities for most of the day, every day, for two weeks or more.
Given the prevalence of depression in head and neck patients and its impact on survival even in patients with only minor depressive symptoms, Dr. Cash emphasizes the need for screening for all patients. “We feel this underscores the importance of screening even for depressive symptoms in patients with head and neck cancer, particularly during the medical treatment planning phase,” she said.
Amy Williams, PhD, senior staff psychologist in the department of otolaryngology–head and neck surgery at the Henry Ford Health System in Detroit, Mich., pointed out that the American College of Surgeons Commission on Cancer (ACS CoC) recommends regular screening of all cancer patients throughout their treatment for distress, including depression. “The use of regular distress screening mandated by the ACS CoC can help identify those patients who are struggling and help identify those patients who warrant further questioning,” she said.