Clinical Factors and Income Status are Associated with Depression and Anxiety in Head and Neck Cancer Patients

IMPORTANCE: Depression and anxiety affect a significant portion of head and neck cancer (HNC) patients. Furthermore, depression has been shown to result in decreased survival and worse functional outcomes. OBJECTIVE: The purpose of this study is to determine the prevalence of depression and anxiety in a cohort of HNC patients at all subsites. DESIGN: This is a retrospective review of prospectively gathered data in a cohort of patients aged 18 years of age and over, diagnosed with HNC, between August 2011 and December 2017, treated at the Princess Margaret Cancer Centre in Toronto, Canada. SETTING/PARTICIPANTS: Adult Patients with a new diagnosis of HNC treated at the Princess Margaret Cancer Center/University Health Network between August 2011 and December 2017 were included in the study. EXPOSURES: Patients were initially screened using the Direct Assessment and Response Tool (DART), which includes the Edmonton Symptom Assessment Scale (ESAS) to identify psychosocial distress. MAIN OUTCOME MEASURES: If positive on DART, patients were then asked to complete the Generalized Anxiety Disorder 7-Item Scale and the Patient Health Questionnaire-9. Associations with anxiety/depression and variables were assessed using univariate and multivariate logistic regressionResults:A total of 586 patients were included in our study. The median age of the group was 60 (22-89 years), with a male predominance (78.2%). Most patients (78.8%) had advanced disease at diagnosis. The oropharynx was the most common site (46.5%). The prevalence of depression and anxiety was 13.1% and 9.9%, respectively. Multivariate analysis showed that nonmarried status, non-white ethnicity, disease progression, lower income, and increased out-of-pocket costs were associated with depression. Definitive surgery, ECOG ≥1, and lower income were associated with anxiety. Disease stage, smoking/drinking history, and HPV status were not associated with anxiety/depression. CONCLUSIONS: A portion of patients are at higher risk of developing sustained depression and anxiety at 12 months following treatment, which may be predicted early, facilitating early mental health intervention. RELEVANCE: Identifying factors associated with depression and anxiety in HNC patients will aid in providing early intervention.