Pretreatment depression linked to survival outcomes in HNSCC

Pretreatment depression appeared to negatively affect pretreatment quality of life, nutritional status and survival outcomes in patients with head and neck squamous cell carcinoma, according to the results of a prospective study.

“Individuals with newly diagnosed head and neck squamous cell carcinoma (HNSCC) are at substantial risk for depressive mood because of the life-threatening nature of the disease and treatment-induced morbidity,” Jong-Lyel Roh, MD, of the department of otolaryngology at University of Ulsan College of Medicine in Seoul, Korea, and colleagues wrote. “Patients with newly diagnosed HNSCC have the highest rate of major depressive disorder among all oncology patients, with an incidence that ranges from 15% to 50%. The well-being of cancer patients is of great importance, and mental health is becoming a key component of cancer treatment.”

Roh and colleagues sought to observe the associations between the presence of pretreatment depression and pretreatment quality of life, nutritional status and survival outcomes in patients with HNSCC.

Patients completed the Beck Depression Inventory (BDI)-II, the EORTC 30-item Core Quality-of-Life Questionnaire (QLQ-C30) and the EORTC QLQ Head and Neck Cancer module (QLQ-HN35). Pretreatment BDI-II scores of at least 14 indicated depression. 

The researchers compared EORTC QLQ scores between depressive and nondepressive patients. Further, they assessed whether depression produced an association with OS, DFS or posttreatment changes to nutritional status.

The study included data from 241 patients (median age, 61 years; 85% men). The researchers observed pretreatment depression in 60 patients (24.9%).

Pretreatment EORTC QLQ-C30 and QLQ-HN35 scores — representing quality of life and nutritional status — varied between depressive and nondepressive patients in all areas except for feeding tube, nutritional supplement and difficulty with mouth opening (P < .05 for all). Depressive patients had significantly worse scores for items such as pain in the mouth (P = .008), swallowing (P = .001), sexuality (P ˂ .001) and symptom scores such as fatigue (P ˂ .001), nausea and vomiting (P ˂ .001), and pain (P ˂ .001). Global health status, physical functioning, and cognitive functioning all appeared worse in depressive patients (P ˂ .001 for all).

Further, the researchers observed that patients with pretreatment depression had lower pretreatment serum albumin levels (P < .05).

Median follow-up for survival analyses was 33.5 months (range, 12-55.3).

At follow-up, 39 patients had died of HNSCC and nine patients had died of other causes, including one documented incidence of suicide in a patient from the depressive group.

A smaller proportion of patients in the depressive group achieved 3-year OS compared with patients in the nondepressive group (70.8% vs. 82.7%; P = .045).

Further, fewer patients in the depressive group achieved 3-year DFS compared with nondepressed patients (63.6% vs. 79.1%; P = .012).

In a univariate analysis, pretreatment depression significantly predicted 3-year DFS (HR = 1.98; 95% CI, 1.14-3.42) and OS (HR = 1.82; 95% CI, 1.01-3.28). However, after controlling for clinical factors, pretreatment depression remained a significant predictor of DFS only (HR = 1.83; 95% CI, 1.05-3.17).

The researchers acknowledged limitations of their study, including the study’s inclusion of patients with tumors at various sites. Further, they noted that treatment modalities varied across the study population and that the follow-up period (< 5 years) was relatively short.

“The current results suggest that there is a significant correlation between pretreatment depressive symptoms (as evaluated using the BDI-II score) and pretreatment quality-of-life, nutritional status and survival outcomes in patients with HNSCC,” Roh and colleagues wrote. “BDI-II scores in patients with head and neck cancer can be easily obtained and can be used to predict emotional status and treatment outcomes. 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.” – by Cameron Kelsall

 

Disclosure: The researchers report no relevant financial disclosures.