HNCA post-treatment depression impairs life quality

Jul 18 2012

By MedWire Reporters

Individuals undergoing treatment for head and neck cancer (HNCA) have a high incidence of depression, US researchers show.

The depressive symptoms are associated with a poorer quality of life (QoL) and higher dysphagia scores suggestive of swallowing impairment.

"This relationship is independent of socioeconomic variables, type of primary treatment, or the development of recurrent disease," report Christine Gourin (Johns Hopkins Medical Institutions, Baltimore, Maryland) and colleagues.

Publishing their study in Laryngoscope, the researchers explain that patients with HNCA have one of the highest rates of depression among oncology patients, with incidences as high as 44%.

HNCA and its treatment are associated with pain, disability, functional impairment, and disfigurement, and these factors contribute to the high rates of depression.

Depression, the researchers point out, affects QoL, treatment compliance, disease progression, pain tolerance, fatigue, and increases the risk for suicide.

"Although depression in HNCA patients is well established, depression is often under-recognized and undertreated," write Gourin et al.

In a study of 246 individuals treated for HNCA, the researchers assessed depression, QoL, and functional impairment. However, complete 1-year post-treatment data were available in just 46 HNCA patients.

Of the 46 patients, depression was documented in nine (20%).

Regression analysis revealed that the mean QoL, voice handicap index (VHI), and MD Anderson Dysphagia Inventory (MDADI) scores differed significantly between HNCA patients with depression and those without depression.

Depressed patients had lower QoL, including more pain, reduced activity and recreation, as well as impaired swallowing, chewing, speech, taste, saliva, and global QoL, than those without depression.

In multivariable analysis that controlled for initial treatment modality, depression was significantly associated with reduced global QoL and overall MDADI scores, but not with VHI scores.

Depression measured by the Beck Depression Inventory Fast-Screen (BDI-FS) was significantly correlated with global QoL and overall MDADI scores, and global QoL was significantly correlated with overall MDADI scores.

"Although depression and swallowing function are highly correlated, depression has a greater effect on QoL than swallowing scores," according to the researchers.

These findings suggest that early and aggressive treatment of HNCA patients with depression symptoms is needed to maximize post-treatment QoL, they conclude.

From a research standpoint, they point out that the direction of the relationship between depression, swallowing function, and QoL is unclear. As a result, objective measures are needed to determine if depression confounds patient assessment of swallowing ability and the perception of QoL.

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