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Program Number: B335
Session Name: Poster Session

Gaps in depression screening and management in head and neck cancer care: an AHNS survey

Melanie D Hicks¹; Soroush Ershadifar, BS²; Madeline Deanne, BMA³; Jad Zeitouni, BBA⁴; Kelly Vittetoe, MD¹; Mark Varvares, MD⁴; Nosayaba Osazuwa-Peters, BDS, PhD, MPH⁵; Bethany Rhoten, PhD, RN, PMHNPBC⁶; Marianne Abouyared, MD²; Aru Panwar, MD⁷; ¹Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN; ²Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, CA; ³Creighton University School of Medicine, Omaha, NE; ⁴Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear & Harvard Medical School, Boston, MA; ⁵Department of Head and Neck Surgery & Communication Sciences, DukeUniversity School of Medicine, Durham, NC; ⁶School of Nursing, Vanderbilt University, Nashville, TN; ⁷Head and Neck Surgical Oncology, Methodist Estabrook Cancer Center, NebraskaMethodist Hospital, Omaha, NE

Background: Patients with head and neck cancer (HNC) are disproportionately affected by depression and suicide when compared to other cancer populations. Despite growing data that depression and suicidality/suicidal behavior? can negatively impact treatment outcomes and survival in patients with HNC, there remains an overall lack of consensus regarding best screening and management practices.

Methods: An anonymous survey was distributed to American Head and Neck Society (AHNS) members. Respondents recorded their practices and comfort level related to screening for and treating depression within their HNC clinic.

Results: Of the 74 respondents, 23% screen for depression at every clinic visit, and 43% screen only when patients exhibit signs of depression. Of those who screen for depression, 56% use informal history instead of a validated screening tool. Only 15% of those who use a depression screening tool personally review the score. Fifty-two percent of respondents report that they assess patients with HNC for suicide risk. Self-reported barriers to screening for depression include a lack of formal education/training (63%), volume of patients in clinic (64%), lack of knowledge regarding antidepressant medication (59%), and discomfort in treating/managing depression (47%). Only 16% of respondents routinely prescribe antidepressant medications. Barriers to prescribing antidepressants include lack of formal training in use of antidepressant medication (66%), lack of time due to clinical volume (50%), discomfort with the prospect of adverse outcomes (46%), insufficient clinical support staff (42%), and concern for medicolegal liability (35%). An overwhelming majority (97%) of head and neck surgeons who participated in the survey agree that depression significantly influences the overall care and survivorship experience of patients with head and neck cancer.

Conclusions: There was near universal acceptance of the clinical importance of depression in HNC amongst our survey respondents. There is major heterogeneity in screening practices and comfort in managing depression and suicide risk in patients with HNC. These findings highlight gaps in clinician knowledge and limitation in resources which may be targeted to enhance workforce competency and develop clinical pathways that improve access to meaningful behavioral health interventions as part of comprehensive, high quality survivorship care for patients with HNC.

 

 

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