In a study of patients with head and neck cancer, even mild depressive symptoms were associated with poorer overall survival. The findings indicate that patients should be screened and treated for depressive symptoms at the time of diagnosis. In addition, studies should examine parallel biological pathways linking depression to cancer survival.
Many patients diagnosed with head and neck cancer experience symptoms of depression, which can make it difficult for them to manage treatment side effects, quit smoking, or maintain adequate nutrition or sleep habits. A team led by Dr Elizabeth Cash, of the University of Louisville School of Medicine, was interested to see if depressive symptoms might also affect patients' health outcomes.
The researchers studied 134 patients with head and neck cancers who reported depressive symptoms during the planning of their treatment. When the investigators examined the patients' clinical data over the following two years, they found that patients with greater depressive symptoms had shorter survival, higher rates of chemo-radiation interruption, and poorer treatment response.
"We observed that head and neck cancer patients who reported more depressive symptoms at their initial appointment were more likely to miss scheduled treatment appointments and were more likely to have tumours that persisted after medical treatment," explained Cash, who serves as the director of research for the department of otolaryngology-head and neck surgery and communicative disorders at UofL. "We also observed that patients with depressive symptoms suffered greater two-year overall mortality rates, and this was especially true for those who did not achieve optimal response to medical treatment."
Poorer treatment response partially explained the depression-survival relationship; however, there were no significant effects from factors commonly used to determine cancer prognosis – such as the patient's age, the stage of tumour advancement, or extent of smoking history. "This suggests that depressive symptoms may be as powerful as the clinical features that physicians typically use to determine the prognosis of patients with head and neck cancer," said Cash.
Cash noted that most patients in the study did not meet criteria for diagnosis of major depressive disorder, suggesting that even mild symptoms of depression may interfere with head and neck cancer treatment outcomes. She also stressed that the findings need to be replicated in a larger study but suggest that depressive symptoms may affect head and neck cancer patients' survival through mechanisms that potentially coincide with the activities of their tumour.
"We want patients to know that it is normal to get depressed when they are diagnosed, but it is important to seek help for any depression symptoms because they may lead to poorer outcomes related to their cancer treatment," said Cash. She and her colleagues are hopeful that this information can facilitate discussions between patients and psycho-oncologists or behavioural oncology specialists to expedite the development of targeted behavioural interventions, which may have high potential to complement medical treatment efficacy.
Abstract
Background: Head and neck cancers are associated with high rates of depression, which may increase the risk for poorer immediate and long-term outcomes. Here it was hypothesized that greater depressive symptoms would predict earlier mortality, and behavioral (treatment interruption) and biological (treatment response) mediators were examined.
Methods: Patients (n = 134) reported depressive symptomatology at treatment planning. Clinical data were reviewed at the 2-year follow-up.
Results: Greater depressive symptoms were associated with significantly shorter survival (hazard ratio, 0.868; 95% confidence interval [CI], 0.819-0.921; P < .001), higher rates of chemoradiation interruption (odds ratio, 0.865; 95% CI, 0.774-0.966; P = .010), and poorer treatment response (odds ratio, 0.879; 95% CI, 0.803-0.963; P = .005). The poorer treatment response partially explained the depression-survival relation. Other known prognostic indicators did not challenge these results.
Conclusions: Depressive symptoms at the time of treatment planning predict overall 2-year mortality. Effects are partly influenced by the treatment response. Depression screening and intervention may be beneficial. Future studies should examine parallel biological pathways linking depression to cancer survival, including endocrine disruption and inflammation.
Authors
Lauren A Zimmaro, Sandra E Sephton, Chelsea J Siwik, Kala M Phillips, Whitney N Rebholz, Helena C Kraemer, Janine Giese-Davis, Liz Wilson, Jeffrey M Bumpous, Elizabeth D Cash
[link url="https://www.sciencedaily.com/releases/2018/01/180122091323.htm"]Wiley material[/link]
[link url="http://onlinelibrary.wiley.com/doi/10.1002/cncr.31109/abstract?systemMessage=Please+be+advised+that+we+experienced+an+unexpected+issue+that+occurred+on+Saturday+and+Sunday+January+20th+and+21st+that+caused+the+site+to+be+down+for+an+extended+period+of+time+and+affected+the+ability+of+users+to+access+content+on+Wiley+Online+Library.+This+issue+has+now+been+fully+resolved.++We+apologize+for+any+inconvenience+this+may+have+caused+and+are+working+to+ensure+that+we+can+alert+you+immediately+of+any+unplanned+periods+of+downtime+or+disruption+in+the+future."]Cancer abstract[/link]