Many Patients With Head and Neck Cancer Report Being Depressed, but Few Use Mental Health Services  

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Despite a relatively high rate of depression among patients with head and neck cancer following radiation therapy, mental health services were severely underutilized in this group, concluded researchers who analyzed questionnaire results from 211 patients. The patients had been previously treated with radiation therapy at a comprehensive cancer center and were disease-free with at least 1 year of follow-up.

The median age of the patients was 57 years, and 58% were male. During follow-up visits at 1, 3, and 5 years, the patients completed the questionnaires with the help of nursing and/or physician staff. By year 3, the number of evaluable patients had decreased to 120, and by year 5, to 54.

“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,” noted the investigators in their report published online in JAMA Otolaryngology-Head & Neck Surgery.

Significant Variables

Definitive radiotherapy was administered to 55% of patients, and 45% were treated postoperatively. Concurrent chemotherapy was administered to 42%. The proportion of patients who reported their mood as “somewhat depressed” or “extremely depressed” was 17% at 1 year, 15% at 3 years, and 13% at 5 years. The corresponding rates of those using antidepressants were 6%, 11%, and 0%, respectively, and the rates of those actively undergoing or seeking psychotherapy and/or counseling were 3%, 6%, and 0%, respectively.

Variables significantly associated with postradiotherapy depression included the presence of tracheostomy tube or laryngeal stoma (P = .01), gastrostomy tube dependence (P = .01), and continued smoking at time of follow-up (P < .001), the researchers reported.

“The fact that none of these patients had a preexisting diagnosis of mental health problems suggests that the diagnosis of cancer and/or sequelae of subsequent treatment were likely the primary causes for their psychosocial symptoms,” the investigators noted.

Some Reported ‘Excellent’ Mood

“No patient expressed suicidal ideation or required inpatient hospitalization because of his psychosocial functioning,” the investigators wrote. “The proportion of patients reporting ‘excellent’ mood at the 1-, 3-, and 5-year follow-up was 14%, 9%, and 11%, respectively.”

Rates for use of mental health services were low even though “patients with scores consistent with moderate or severe depression were generally referred for subsequent counseling and/or psychiatric care,” the authors stated. 

Their results, they added, “identify a sorely unmet need for survivors of head and neck cancer in that psychosocial services for this population are underutilized and/or inaccessible despite a relatively significant rate of depression. Clearly, additional studies with longer follow-up are needed to recognize and assess the potential impact of depression on patient quality of life, as well as to better define the role of aggressive and timely intervention in the future.” ■

Chen AM, et al: JAMA Ontolaryngol Head Neck Surg. August 15, 2013 (early release online).