Depression: a survival predictor in head and neck cancer

3 Dec 2015

Depression is a significant predictor of five-year survival and recurrence in head and neck cancer patients, according to a new study from The University of Texas MD Anderson Cancer Center. These findings represent one of the largest reported impacts of depression on cancer survival.

Uncovering the profound effect of depression

Although depression can have obvious detrimental effects on an individual's quality of life, the impact on that of cancer patients is becoming more apparent, explained Eileen Shinn, Ph.D., assistant professor, Behavioral Science, MD Anderson, and lead author of the study. There is increasing evidence for modest associations between elevated symptoms of depression and increased mortality risk in lung, breast, ovarian and kidney cancer.

To clarify the influence of depression on survival, the research team focused their analysis on a single cancer type. By limiting the sample set and adjusting for factors known to affect outcome, such as age, tumor size and previous chemotherapy, they were able to uncover a more profound effect of depression.

Patients were monitored for a median period of five years

The researchers followed 130 MD Anderson patients newly diagnosed with oropharyngeal squamous cell carcinoma (OSCC), a type of head and neck cancer in which the tumor originates at the back of the throat and base of the tongue.

At the beginning of their radiation therapy, patients completed a validated questionnaire to identify those with symptoms of clinical depression. Researchers monitored the participants, all of whom completed treatment, until their last clinic visit or death, a median period of five years.

"The results of this study were quite intriguing, showing depression was a significant factor predicting survival at five years, even after controlling for commonly accepted prognostic factors," said senior author Adam Garden, M.D., professor, Radiation Oncology.

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Clinical results: depression is connected to survival

In fact, depression was the only factor shown to have a significant impact on survival. In particular,

  • Patients scoring as depressed on the questionnaire were 3½ times less likely to have survived to the five-year interval, compared to those who were not depressed on this scale.
  • The degree of depression was also found to be significant, as every unit increase on this scale resulted in a 10% higher risk for reduced survival.

The results were replicated with a different psychological health survey and were not influenced by how soon following diagnosis the depression assessment was done. Moreover, neither alcohol nor tobacco use, also surveyed in this group, had a significant impact on survival. HPV infection status, when available, did not appear correlated either.

Depression and smoking: the only two factors linked to cancer recurrence

Despite a high cure rate for oropharyngeal squamous cell carcinoma, normally between 60-80%, there is an unusually high rate of recurrence in these patients of about 30%. As depression was connected to survival, the researchers also investigated a potential link to disease recurrence.

"When we controlled for all variables, depression was linked with a nearly four times higher risk of recurrence," said Shinn. "Also, those who had never smoked, compared to current smokers, had a 73% lower chance of recurrence." Those were the only two factors associated with cancer recurrence.

Future research to focus on the biological connection between depression and cancer

While the researchers stress caution in generalizing these results to other cancer types, the results do suggest an important role for depression in influencing oropharyngeal squamous cell carcinoma patient outcome. Although the current study does not address potential psychotherapy interventions, screening for depression in this population may be appropriate, explained Shinn.

Looking ahead, the researchers would like not only to replicate the findings in a larger sample but also to determine the biological reason depression makes this cancer more lethal. Possible mechanisms include poor lifestyle behaviors associated with depression, or a different biological response to chronic inflammation that affects cancer biology. These questions, however, will need to be answered in future research.

Source: Science Daily
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