Depressive symptoms in relation to overall survival in people with head and neck cancer: A longitudinal cohort study

Femke Jansen*, Irma M. Verdonck-de Leeuw, Pim Cuijpers, C. René Leemans, Tim Waterboer, Michael Pawlita, Chris Penfold, Steven J. Thomas, Andrea Waylen, Andrew R. Ness

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Objective: The objective of the study is to investigate the relation between pretreatment depressive symptoms (DS) and the course of DS during the first year after cancer diagnosis, and overall survival among people with head and neck cancer (HNC). Methods: Data from the Head and Neck 5000 prospective clinical cohort study were used. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) pretreatment, at 4 and 12-month follow-up. Also, socio-demographic, clinical, lifestyle, and mortality data were collected. The association between before start of treatment DS (HADS-depression > 7) and course (never DS, recovered from DS, or persistent/recurrent/late DS at 12-month follow-up) and survival was investigated using Cox regression. Unadjusted and adjusted analyses were performed. Results: In total, 384 of the 2144 persons (18%) reported pretreatment DS. Regarding DS course, 63% never had DS, 16% recovered, and 20% had persistent/recurrent/late DS. People with pretreatment DS had a higher risk of earlier death than people without DS (hazard ratio (HR) = 1.65; 95% confidence interval (CI) 1.33-2.05), but this decreased after correcting for socio-demographic, clinical, and lifestyle-related factors (HR = 1.21; 95% CI 0.97-1.52). Regarding the course of DS, people with persistent/recurrent/late DS had a higher risk of earlier death (HR = 2.04; 95% CI 1.36-3.05), while people who recovered had a comparable risk (HR = 1.12; 95% CI 0.66-1.90) as the reference group who never experienced DS. After correcting for socio-demographic and clinical factors, people with persistent/recurrent/late DS still had a higher risk of earlier death (HR = 1.66; 95% CI 1.09-2.53). Conclusions: Pretreatment DS and persistent/recurrent/late DS were associated with worse survival among people with HNC.

Original languageEnglish
Pages (from-to)2245-2256
Number of pages12
JournalPsycho-Oncology
Volume27
Issue number9
Early online date21 Jun 2018
DOIs
Publication statusPublished - Sept 2018

Funding

4National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK KWF Kankerbestrijding, Grant/Award Num ber: VU 2013‐5930; National Institute for Health Research (NIHR) under its Programme Grants for Applied Research, Grant/Award Number: RP‐PG‐0707‐10034; Cancer Research UK Programme, Grant/Award Number: C18281/A19169 The study was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP‐PG‐0707‐10034). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Human papillomavirus serology was supported by a Cancer Research UK Programme Grant, the Integrative Cancer Epidemiology Programme (grant number: C18281/A19169). Funding for the survival analyses was obtained from the KWF Kankerbestrijding (grant number: VU 2013‐5930).

FundersFunder number
Cancer Research UK ProgrammeC18281/A19169
Integrative Cancer Epidemiology Programme
National Institute for Health ResearchRP‐PG‐0707‐10034
Cancer Research UK
KWF KankerbestrijdingVU 2013‐5930

    Keywords

    • cancer
    • depression
    • depressive symptoms
    • head and neck cancer
    • mortality
    • oncology
    • survival

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