Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: The treatment of laryngeal cancer can involve highly invasive approaches, including surgery, radiation, and chemotherapy. Although these treatment modalities are successful at improving disease control and survival, patients often experience alteration of many fundamental basic functions such as speaking and eating, which can be both physically and psychologically taxing. As a result, these patients are at a higher risk of depression, which has been shown to affect treatment outcomes and survivorship in patients with cancer. The objective of this study is to determine the prevalence and contributing factors of depression in patients with laryngeal cancer.
Methods: This was a retrospective database study using the TriNetX Research Network. Patients with laryngeal cancer were identified using ICD-10 codes within the TriNetX database. Patients were separated into cohorts based on the type of treatment received (surgical versus non-surgical) and based on hypothesized factors that may influence the development of depression, including age, socioeconomic risk factors, and post-treatment side effects. The effect of these factors on the development of depression was analyzed while controlling for cancer stage.
Results: A total of 76,786 patients with laryngeal cancer were identified. Patients with laryngeal cancer were found to have a significantly higher risk of depression than the overall cohort of patients with head and neck cancer (RR=1.21, 95% CI: [1.17,1.25]). Younger patients under the age of 70 had a higher risk of depression than patients over the age of 70 (RR=1.34, 95% CI: [1.27,1.40]). Notably, patients with socioeconomic risk factors had over double the risk of depression compared to the overall cohort of patients with laryngeal cancer (RR=2.79, 95% CI: [2.50,3.13]). Patients who underwent surgical treatment, including total and partial laryngectomy, had a higher risk of depression than those who underwent non-surgical treatment, including chemotherapy and/or radiation treatment when controlling for cancer stage (RR=1.50, 95% CI: [1.20,2.25]). No significant differences were found between treatment modalities within the surgical and non-surgical cohorts. Following treatment, patients who experienced symptoms of dysphagia, aspiration, xerostomia, or malnutrition had a 7.17% increased risk of depression compared to the overall cohort of patients with laryngeal cancer (p<0.01).
Conclusions: Patients with laryngeal cancer are at a uniquely high risk of developing post-treatment depression. It is vital to connect these patients with psychosocial support at the onset of treatment, especially younger patients or those with socioeconomic risk factors who may be at higher risk of depression. Patient education before treatment, especially for those undergoing more invasive treatment including partial or total laryngectomy, may represent an opportunity to guide patient expectations and connect them with appropriate psychosocial resources.