Depression Linked to Decreased Survival in Head and Neck Cancer

Pretreatment depression was linked with poorer nutritional and survival outcomes among newly diagnosed patients with head and neck squamous cell carcinoma (HNSCC), according to the results of a study published recently in Cancer.

“Beck Depression Inventory (BDI)-II scores in patients with head and neck cancer can be easily obtained and can be used to predict emotional status and treatment outcome,” wrote Shin-Ae Kim, MD, of the University of Ulsan College of Medicine, Korea, and colleagues. “Completing the BDI at the time patients are diagnosed with HNSCC may lead to better treatment outcomes by identifying those who are depressive and providing them with early intervention.”

According to background information in the study, patients newly diagnosed with HNSCC have the “highest rate of major depressive disorder among all oncology patients.” Kim and colleagues designed this study to evaluate if pretreatment depression was associated with pretreatment health-related quality of life, nutritional status, and survival outcomes among this patient population.

The study included 241 patients with previously untreated HNSCC who underwent curative treatment for their disease. The patients were evaluated using several surveys including the BDI-II, the European Organisation for Research and Treatment of Cancer (EORTC) 30-item Core QOL Questionnaire (QLQ-C30), and the EORTC QLQ Head and Neck Cancer module (QLQ-HN35). BDI-II scores of 14 or more were considered depressive.

About 25% of the patients in the study were classified as having pretreatment depression. Those patients classified as depressed had lower Karnofsky performance scores and higher clinical T classification.

Three-year overall survival among patients with pretreatment depression was 70.8% compared with 82.7% among those patients who were not depressed (P = .045). Similarly, the rates of recurrence were also worse among patients with depression. The 3-year recurrence-free survival was 63.5% among patients with pretreatment depression compared with 79.1% among those who were not depressed (P = .015). Pretreatment was predictive of disease-free survival as well (P = .032).

Results of the study also indicated that EORTC QLQ-C30 and QLQ-HN35 scores were also predictive of poor nutritional and survival outcomes.

In order to test if pretreatment depression affected nutritional outcomes, Kim and colleagues measured body weight and laboratory data before and after treatment.

“Although body mass index and body weight did not have consistent results after treatment, most of the treated patients had lower blood hemoglobin and albumin levels and higher C-reactive protein levels at 1 month after treatment than at pretreatment,” they wrote. “These findings suggest that pretreatment depression may have affected blood chemistry, immunologic homeostasis, and body weight, which can be taken as evidence that pretreatment depression affected nutritional status.”