Depressive symptoms in relation to overall survival in people with head and neck cancer: a longitudinal cohort study
Menée aux Pays-bas auprès de 2 144 patients atteints d'un cancer de la tête et du cou, cette étude de cohorte évalue l'association entre des symptômes dépressifs, avant et pendant la première année suivant le diagnostic de la maladie, et la survie globale
Objective: To investigated the relation between pre‐treatment 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. DS were measured using the Hospital Anxiety and Depression Scale (HADS) pre‐treatment, at 4 and 12 months follow‐up. Also socio‐demographic, clinical, lifestyle and mortality data were collected. The association between pre‐treatment DS (HADS‐depression>7) and course (never DS, recovered from DS, or persistent/recurrent/late DS at 12 months follow‐up), and survival was investigated using Cox regression. Unadjusted and adjusted analyses were performed. Results : In total, 384 of the 2,144 persons (18%) reported pre‐treatment DS. Regarding DS course, 63% never had DS, 16% recovered, and 20% had persistent/recurrent/late DS. People with pre‐treatment 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 : Pre‐treatment DS and persistent/recurrent/late DS were associated with worse survival among people with HNC.