Depression among people with head and neck cancers likely underreported, undertreated
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Key takeaways:
- Patients with head and neck cancer have a higher risk for depression than those with other cancers.
- Rates of self-reported depression did not differ significantly, suggesting a need for intervention or screening.
People with head and neck cancer experience depression twice as often as those with other types of cancer, according to results of a retrospective study.
However, researchers observed no differences in self-reported depression or antidepressant use based on cancer type, highlighting the importance of interventions to identify and ensure effective treatment for people with head and neck cancer who may have depression.
“It is important for clinicians to recognize that depression may be underreported, underdiagnosed and undertreated in this population,” researcher Michelle M. Chen, MD, MHS, assistant professor of otolaryngology, head and neck surgery, at Stanford University School of Medicine, told Healio.
Background and methods
Approximately 40% of individuals with head and neck cancer develop depression, according to study background.
Causes for depression could include treatment’s impact on speaking, eating and breathing, as well as high recurrence and progression rates.
“We know that patients with head and neck cancer are at high risk for depression,” Chen said. “[We] wanted to compare their rates with other patients with cancer, as well as look at differences in performance on validated screening tools as compared with other forms of subjective self-reported depression.”
Chen and colleagues used the 2019 National Health Interview Survey to identify 23,496,725 adults with a history of cancer who completed the self-administered Patient Health Questionnaire (PHQ-8), which has an 88% sensitivity and specificity for depression.
The head and neck cancer cohort consisted of 377,080 patients. The majority were men (77.9%), white (87.2%), and aged 51 to 84 years (87.5%).
Prevalence and severity of depression for those with head and neck cancer vs. those with other cancers based on PHQ-8 served as the primary endpoint.
Results and next steps
Adults with and head and neck cancer had a higher likelihood than those with other malignancies of positively screening for any depression (40.1% vs. 22.3%; difference = 17.8%; 95% CI, 2.3-33.2), mild depression (23.8% vs. 13.4%), and moderate or severe depression (16.4% vs. 9%).
Individuals with head and neck cancer had a substantially higher risk for depression (OR = 2.94; 95% CI, 1.39-6.22).
However, researchers did not observe a statistically significant difference between those with head and neck cancer vs. those with other cancer types regarding self-reported feelings of depression (59.7% vs. 53.7%; difference = 6%; 95% CI, 9.1 to 21), use of depression medication (10.1% vs. 13.9%; difference = 3.8%; 95% CI, 11.9 to 4.4), or anxiety (23.6% vs. 16%; difference = 7.6%; 95% CI, 5.9 to 21.1).
Chen and colleagues identified multiple factors associated with depression, including being unmarried or living without a partner (OR = 1.94; 95% CI, 1.55-2.43), screening positive for anxiety (OR = 23.14; 95% CI, 17.62-30.37) and living in the Midwest (OR = 1.56; 95% CI, 1.09-2.24).
Never smokers exhibited a lower likelihood of depression than current smokers (OR = 0.53; 95% CI, 0.38-0.74).
People with noncolorectal gastrointestinal cancer had an increased risk for depression compared with other non-head and neck malignancies (OR = 2.65; 95% CI, 1.04-6.77).
Researchers acknowledged study limitations, including its retrospective nature, the higher percentage of men and low number of patients with head and neck cancer, and lack of data on cancer stage and metastases.
“Future studies should work on developing interventions to improve compliance with routine depression screening, collaborate and involve primary care providers in monitoring for depression in patients with head and neck cancer, and consider prophylactic treatment in certain high-risk patients,” Chen said.
For more information:
Michelle M. Chen, MD, MHS, can be reached at michelle.chen@stanford.edu.
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