Depression at the time of treatment planning in patients with head and neck cancer may predict worse 2-year survival outcomes, treatment interruption, and treatment response compared with nondepressed patients, according to a study published in Cancer.

Depressive symptoms in patients with cancer have been linked to poorer survival outcomes — particularly for those with head and neck cancer — and psychosocial and biological mechanisms may contribute to increased mortality.

For this study, researchers evaluated 144 patients with recently diagnosed head and neck cancer. Participants completed depression assessments at the time of study entry, prior to treatment with radiotherapy and/or chemotherapy. Outcomes including treatment data, clinical response, appointment attendance, and survival, were included in the final 2-year follow-up evaluation.

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Results show that depressive symptoms at the time of treatment planning were not only significantly predictive of 2-year overall survival (OS) (P <.001), they were also significantly associated with treatment interruption (P =.010), and poorer treatment response (P =.005).

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Treatment interruption was not observed to a mediator of early depressive symptoms and OS, but poor treatment response significantly impacted the depression-survival outcomes relationship.

Other factors typically associated with poor survival outcomes in other cancers, such as disease site, age, race, sex, marital status, and pack years, were not found to significantly mediate depression and survival; the only mediator that was associated was clinical cancer stage at time of diagnosis.

The authors concluded that “these findings highlight the need for a careful assessment of depressive symptoms among patients with head and neck cancer preparing to undergo treatment, which may help to identify patients who may be at risk for an incomplete therapeutic response and poorer long-term outcomes.”


Zimmaro LA, Sephton SE, Siwik CJ, et al. Depressive symptoms predict head and neck cancer survival: examining plausible behavioral and biological pathways [published online January 22, 2018]. Cancer. doi: 10.1002/cncr.31109