Depression among long-term survivors of head and neck cancer treated with radiation therapy

JAMA Otolaryngol Head Neck Surg. 2013 Sep;139(9):885-9. doi: 10.1001/jamaoto.2013.4072.

Abstract

Importance: The diagnosis and subsequent treatment of head and neck cancer can have a potentially devastating impact on psychosocial functioning. Although the long-term physical adverse effects of radiation therapy (RT) for head and neck cancer have been well described, relatively few studies have evaluated psychosocial functioning after treatment.

Objective: To determine the prevalence of self-reported depression among survivors of head and neck cancer returning for follow-up after being treated with RT.

Design, setting, and participants: Cross-sectional analysis among 211 comprehensive cancer center patients with squamous cell carcinoma of the head and neck, who had been previously treated with RT and were disease-free with at least 1 year of follow-up. Patients with a history of mood disorder, use of mental health services in the past, or previous or current use of antidepressants or anxiolytics, excluding sleep medications, were specifically excluded.

Interventions: The University of Washington Quality of Life instrument (UW-QOL), a brief, previously validated, self-administered questionnaire, was used to analyze rates of depression.

Main outcomes and measures: The UW-QOL assigned scores of 0, 25, 50, 75, and 100 subjective responses of mood being "extremely depressed," "somewhat depressed," "neither in a good mood or depressed," "generally good," and "excellent," respectively.

Results: The mean mood score did not differ at 1, 3, and 5 years after treatment, with scores of 52.0, 55.7, and 62.1, respectively. The proportion of patients who reported their mood as "somewhat depressed" or "extremely depressed" was 17%, 15%, and 13% at 1, 3, and 5 years, respectively. Variables that were significantly associated with post-RT depression included the presence of tracheostomy tube or laryngeal stoma (P = .01), gastrostomy tube dependence (P = .01), and continued smoking at the time of follow-up (P < .001). Among the patients reporting their mood as either "somewhat depressed" or "extremely depressed" at 1, 3, and 5 years, the proportion using antidepressants at the time was 6%, 11%, and 0%, respectively. The corresponding proportion of patients actively undergoing or seeking psychotherapy and/or counseling was 3%, 6%, and 0%, respectively.

Conclusions and relevance: Despite a relatively high rate of depression among patients with head and neck cancer in the post-RT setting, mental health services are severely underutilized.

Publication types

  • Comparative Study

MeSH terms

  • Age Distribution
  • Aged
  • Analysis of Variance
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / psychology
  • Carcinoma, Squamous Cell / radiotherapy
  • Cross-Sectional Studies
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology*
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / psychology*
  • Head and Neck Neoplasms / radiotherapy*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Quality of Life*
  • Self Report
  • Severity of Illness Index
  • Sex Distribution
  • Surveys and Questionnaires
  • Survivors
  • Time Factors