The study included 130 patients with nonrecurrent, newly diagnosed oropharyngeal cancer, most of whom had late stage disease (91% head stage III-IVb disease). Most patients were male (83%) with an average age of 56 years. All patients received optimal doses of radiation and, if warranted, optimal doses of chemotherapy (the treatment team decided to give chemotherapy to patients with more extensive baseline disease). To screen for depression, researchers administered the Physicians Health Questionnaire (PHQ-9) to all patients at the beginning of their treatment with radiation therapy.
Explore This IssueApril 2016
At a median follow-up of five years, 112 patients (86%) were alive and 18 (14%) had died either from cancer or treatment complications. After adjusting for tumor stage, age, sex, smoking status, excessive alcohol use, number of comorbidities, and addition of chemotherapy to the standard protocol of radiation therapy, the study found that patients who were depressed at the beginning of treatment had a 3.6 times higher risk of dying within five years than patients who were not depressed. [Note, the study did not control for human papilloma virus (HPV) status because HPV typing was not yet standard of care when the study was designed.]
When analyzing whether depression increased the risk for cancer recurrence, the study found that depressed patients had a 3.8 times higher risk of disease recurrence than nondepressed patients. “When you control for all traditional treatment and disease variables, depression was the most significant variable,” said Dr. Shinn. The study highlights the need to screen all patients with newly diagnosed oropharyngeal cancer, she said.
Depression Screening as Part of Psychosocial Screening
Depression screening is not only good medicine; it is now a mandate for cancer programs accredited by the American College of Surgeons Commission on Cancer (CoC). Starting in 2015, cancer programs that want to earn or maintain CoC accreditation must include psychosocial distress screening, which includes screening for psychological issues such as depression and anxiety, for patients with cancer as mandated by CoC standard 3.2 (American College of Surgeons. Cancer Program Standards: Ensuring Patient-Centered Care 2015; Available at: facs.org).
The mandate carries significant challenges for cancer programs, according to Jeff Kendall, PsyD, clinical leader of oncology supportive services at the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern Medical Center in Dallas, who has been running such a program since 2011. The two major challenges, he said, are finding the expertise and resources needed to screen every cancer patient as well as those needed to address any psychosocial problems that are identified.