Christine G. Gourin, MD, professor in the department of otolaryngology–head and neck surgery and head and neck surgical oncology at Johns Hopkins University in Baltimore, Md., agreed that otolaryngologists need to be more aware of and look for depression in patients with head and neck cancer. She cited simple tests that can be used to screen for depression. Along with asking the patient about their mood or interest in daily activities, she also suggested using standardized assessment tools such as the Beck Depression Inventory or the Hospital Anxiety and Depression Scale.
Explore This IssueAugust 2018
In addition, new information on risk factors associated with the development of depression in these patients is shedding light on the possibility that most patients treated for head and neck cancer are at increased risk of developing depression and therefore should be treated prophylactically for depression as a part of their treatment planning.
We have randomized evidence that if we start an antidepressant prior to radiation therapy, we can reduce depression. This is one strategy that could be considered in our attempts to reduce the burden of depression among our head and neck cancer patients. —William M. Lydiatt, MD
Radiation as a Risk Factor, Prevention as Strategy
New research shows that radiation is a significant risk factor for the development of depression in head and neck patients. A recent study by Dr. Lydiatt and colleagues that looked at the efficacy of preventing depression by prophylactically treating patients with an anti-depressant within weeks of diagnosis and treatment initiation found that patients who received radiation therapy as initial treatment had significantly higher rates of depression than those who received surgery as initial therapy (38% vs. 12%, respectively) (JAMA Otolaryngol Head Neck Surg. 2013;139:678–686).
“I think one of the misconceptions is that surgery is this disfiguring thing that makes people depressed,” said Dr. Lydiatt. “The reality is that there is something in radiation that increases the risk of depression and suicide in these patients.”
Dr. Lydiatt speculated that this effect of radiation could result from a number of things: the length of a course of radiation therapy; post-traumatic stress-type disorder, in which patients have episodes of anxiety due to airway compromise; requiring a mask to hold the patient in place as they undergo radiation, which may create a sense of claustrophobia; and also some kind of cytokine produced by the radiation. “All of these factors [likely] contribute to the higher depression rates with radiation,” he said.