The impact of depression on survival of head and neck cancer patients: A population-based cohort study

BackgroundDepression is common among patients with head and neck cancer, thereby affecting their survival rate. However, whether close monitoring of depression affects the survival outcomes of these patients is unknown. Therefore, this study aimed to determine whether depression treatment continuity after the diagnosis of cancer affects the survival of these patients. MethodsA total of 55,069 patients diagnosed with head and neck cancer in the Cancer Registration System database in Taiwan were enrolled. This cohort was followed from January 1, 2007 to December 31, 2017. Furthermore, the patients were divided into four groups, namely, no depression, pre-cancer only, post-cancer only, and both before and after cancer, on the basis of the diagnosis of depression and the duration of the follow-up period in the psychiatric clinic. Further, the Cox proportional hazard model was applied to estimate the hazard of death for the four groups. ResultsA total of 6,345 (11.52%) patients were diagnosed with depression in this cohort. The pre-cancer only group had a lower overall survival (HR = 1.18; 95% CI = 1.11-1.25) compared with the no depression group. Moreover, the post-cancer only group had better overall survival (HR = 0.88; 95% CI = 0.83-0.94) compared with the no depression group, especially in advanced-stage patients. Patients who were diagnosed with depression before cancer and had continuous depression treatments after the cancer diagnosis had better overall survival (HR = 0.78; 95% CI = 0.71-0.86) compared with patients who had treatment interruptions. ConclusionPatients with pre-cancer depression had poorer survival outcomes, especially those who did not receive psychiatric clinic visits after their cancer diagnosis. Nonetheless, in patients with advanced-stage cancer, depression treatment may improve overall survival.

Automated summary

This study found that depression is common among patients with head and neck cancer and that depression treatment has a significant impact on their survival outcomes. Patients diagnosed with depression before cancer and who did not receive psychiatric clinic visits after their cancer diagnosis had poorer survival rates. However, in advanced-stage patients, depression treatment may improve overall survival.