Depression Worsens Outcomes in Head and Neck Cancer, But Not All Hope Is Lost

Patients with head and neck cancer who suffer from even mild depressive symptoms have poorer overall survival, according to the findings of a study published in Cancer.

Researchers from the University of Louisville School of Medicine in Kentucky examined 134 patients with head and neck cancers who reported depressive symptoms during treatment planning. Following a two-year follow-up, data showed patients with greater depressive symptoms had shorter survival, higher rates of chemoradiation interruption and poorer treatment response.

“Patients with head and neck cancer have high rates of depression compared with patients who have other cancer types,” lead author Elizabeth Cash, Ph.D., who is a clinical health psychologist at the University of Louisville School of Medicine, said in an interview with CURE. “This may be because this disease can impact social function. For example, patients may have treatments that affect the tongue or voice box and impact speech production.”

The researchers found that patients ranked the feeling of being “slowed down” highest and they also felt like they couldn’t enjoy things as much as they used to.

Treatment interruptions were associated with side effects, such as nausea and vomiting; decline in physical health; or social factors, such as legal or transportation issues. “Treatment compliance may also be affected by other factors, such as patient-provider relationships and communication,” said Cash.

Factors commonly used to determine cancer prognosis — patient’s age at diagnosis, site of disease and smoking history — did not have a significant effect.

“This suggests that depressive symptoms may be as powerful as the clinical features that health care professionals typically use to understand the prognosis of patients with head and neck cancer,” she said.

Managing Depression

Signs of depression are different for everyone. They can range from weight loss, diminished ability to concentrate, mood changes and loss of interest in activities. “Although these experiences can be common for any patient with cancer, at any stage of disease, getting help to manage these symptoms is important,” said Cash.

One step is seeking professional counseling or participating in a support group. Patients can also discuss anti-depression medication with their health care team.

Alternative therapies to help treat depression may include acupuncture, mindfulness meditation, yoga, Tai chi and vitamin and herbal supplements, according to Support for People with Oral and Head and Neck Cancer, Inc. (SPOHNC). The nonprofit organization has more than 125 chapters throughout the United States that host support groups and offer a mentoring program.

SPONHC also recommends lifestyle changes, such as regular exercise, proper nutrition, sufficient sleep, stress reduction and building a solid network of family and friends.

Patients should talk with their health care team about what to expect of the disease and treatment, then plan accordingly, noted Cash.

“We want patients to know that it is normal to get depressed when they are diagnosed,” said Cash. “But it is important to seek help and to not stay depressed because it can lead to poorer outcomes.”