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

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.

• Authors: Allen M Chen, Megan E Daly, Esther Vazquez, Jean Courquin, Quang Luu, Paul J Donald, D Gregory Farwell
• Journal: JAMA otolaryngology-- head & neck surgery (JAMA Otolaryngol Head Neck Surg) Vol. 139 Issue 9 Pg. 885-9 (Sep 2013) ISSN: 2168-619X [Electronic] United States
• PMID: 23949013 (Publication Type: Comparative Study, Journal Article)

Topics

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