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Original Investigation |

Depression Among Long-term Survivors of Head and Neck Cancer Treated With Radiation Therapy

Allen M. Chen, MD1,3; Megan E. Daly, MD1; Esther Vazquez, RN1; Jean Courquin, RN1; Quang Luu, MD2; Paul J. Donald, MD2; D. Gregory Farwell, MD2
[+] Author Affiliations
1Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento
2Department of Otolaryngology–Head and Neck Surgery, University of California, Davis, Comprehensive Cancer Center, Sacramento
3now with the Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles.
JAMA Otolaryngol Head Neck Surg. 2013;139(9):885-889. doi:10.1001/jamaoto.2013.4072.
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Importance  The diagnosis and subsequent treatment of head and neck cancer can have a potentially devastating impact on psychosocial functioning. Although the long-term physical adverse effects of radiation therapy (RT) for head and neck cancer have been well described, relatively few studies have evaluated psychosocial functioning after treatment.

Objective  To determine the prevalence of self-reported depression among survivors of head and neck cancer returning for follow-up after being treated with RT.

Design, Setting, and Participants  Cross-sectional analysis among 211 comprehensive cancer center patients with squamous cell carcinoma of the head and neck, who had been previously treated with RT and were disease-free with at least 1 year of follow-up. Patients with a history of mood disorder, use of mental health services in the past, or previous or current use of antidepressants or anxiolytics, excluding sleep medications, were specifically excluded.

Interventions  The University of Washington Quality of Life instrument (UW-QOL), a brief, previously validated, self-administered questionnaire, was used to analyze rates of depression.

Main Outcomes and Measures  The UW-QOL assigned scores of 0, 25, 50, 75, and 100 subjective responses of mood being “extremely depressed,” “somewhat depressed,” “neither in a good mood or depressed,” “generally good,” and “excellent,” respectively.

Results  The mean mood score did not differ at 1, 3, and 5 years after treatment, with scores of 52.0, 55.7, and 62.1, respectively. The proportion of patients who reported their mood as “somewhat depressed” or “extremely depressed” was 17%, 15%, and 13% at 1, 3, and 5 years, respectively. Variables that were significantly associated with post-RT depression included the presence of tracheostomy tube or laryngeal stoma (P = .01), gastrostomy tube dependence (P = .01), and continued smoking at the time of follow-up (P < .001). Among the patients reporting their mood as either “somewhat depressed” or “extremely depressed” at 1, 3, and 5 years, the proportion using antidepressants at the time was 6%, 11%, and 0%, respectively. The corresponding proportion of patients actively undergoing or seeking psychotherapy and/or counseling was 3%, 6%, and 0%, respectively.

Conclusions and Relevance  Despite a relatively high rate of depression among patients with head and neck cancer in the post-RT setting, mental health services are severely underutilized.

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Figure.
University of Washington Quality of Life (UW-QOL) Mood Scores

Mean mood scores as determined serially using the UW-QOL over time for patients after completion of radiation therapy for head and neck cancer. The depicted error bars represent 1 standard deviation.

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