Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Patients with head and neck cancer (HNC) are at a high risk of developing depression given the potential functional impairments and cosmetic disfigurement associated with its treatment. Depression within this population of patients not only results in a lower quality of life but is also associated with increased complications and mortality rates. The objective of this study is to further characterize factors associated with depression and its management for patients with HNC.
Methods: This was a retrospective database study using the TriNetX Research Network. Patients with HNC were identified using ICD-10 codes within the TriNetX database. Cohorts of patients with and without a diagnosis of a depressive episode were compared to determine risk factors associated with the development of depression. Additionally, the effect of the timing of depression diagnosis and the modality of psychiatric intervention on 5-year survivorship were compared.
Results: A total of 327,832 patients with HNC were identified. HNC patients diagnosed with depression had a significantly lower 5-year survival rate when compared to their age and sex-matched counterparts without depression (HR=1.15, 95% CI: [1.12,1.18]). Patients who underwent radiation therapy had a 6.79% higher risk of developing depression than patients who underwent chemotherapy treatment (p<0.01). Patients with a pre-existing depression diagnosis had a significantly higher 5-year survival rate compared to those with a post-cancer depression diagnosis (HR=0.95, 95% CI: [0.92,0.99]). The use of SSRIs in conjunction with psychotherapy conferred a 7% higher rate of 5-year survival when compared to the use of SSRIs alone for the treatment of depression (HR=0.70, 95% CI: [0.61,0.81]).
Conclusions: The early identification of depression in patients with head and neck cancer may enable patients to establish effective psychiatric support. This may result in more favorable head and neck cancer outcomes, as evidenced by a higher 5-year survival rate found in patients with pre-existing depression. The multimodal treatment of depression, including both pharmacologic and behavioral interventions, may also improve both survivorship and quality of life within this population.