Otolaryngologists Can Play Vital Role in Helping Patients Manage Depression

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A recently published study involving patients with head and neck cancer adds to and confirms a growing body of data showing that depression contributes to premature mortality in general, as well as in patients with cancer in particular.

In the study, investigators from the University of Texas MD Anderson Cancer Center in Houston found that depression was a significant, independent factor predicting five-year survival in patients with newly diagnosed oropharyngeal squamous cell cancer (Psychosom Med. 2016;78:26-37).

Previous studies have also concluded that depression can be a predictor of mortality in patients with cancer (Nat Clin Pract Oncol. 2008; 5:466-475; Cancer. 2009;115:5349-5361).

In a review by Chida and colleagues of 165 studies that included patients with head and neck cancer as well as other cancer types, stress-related psychosocial factors were found to be significantly associated with poorer survival in patients with cancer in 330 studies and higher cancer morality in 53 studies (Nat Clin Pract Oncol. 2008;5:466-475).

Data on the relationship between psychological distress and premature death are reliable and cut across all illnesses, including cancer, according to Barbara Andersen, PhD, professor in the department of psychiatry and behavioral health at The Ohio State University Wexner Medical Center in Columbus, who has written extensively on this topic. She emphasized, however, that patients with head and neck cancers may be at particular risk of depression. “These patients tend, on average, to have lower economic and prior educational resources upon which to draw and, along with a smoking history, may have been heavy users of alcohol,” she said. “All of these factors complicate the picture, making it more difficult to cope with the diagnosis and the very difficult, life-changing treatments that follow. Prognoses are oftentimes poor.” Among all cancer patients, these patients are likely to be the most at risk for depression, social isolation, and premature death, she added.

Given the evidence of the connection between depression and premature death in patients with cancer, and the heightened risk in patients with head and neck cancers specifically, otolaryngologists can play a vital role in helping patients manage their cancer and the psychosocial difficulties that can accompany it—which can have a positive impact on rates of mortality.

Depression Can Impact Survival in Patients with Head and Neck Cancer

The most recent data showing increased mortality in depressed patients with oropharyngeal cancer come from the first study to examine the association of depression and mortality risk in cancer patients by focusing on only one type of cancer (Psychosom Med. 2016;78:26-37). According to Eileen Shinn, PhD, assistant professor of behavioral science at MD Anderson Cancer Center in Houston and lead author of the study, focusing on one cancer type allowed for a cleaner, more homogenous sample that permitted a more level playing field for comparison of all the different factors that could affect outcome. The study also followed patients for five years, enough time for outcomes to develop. The researchers aimed to examine the effects of depression on tumor progression as well as mortality.