Depression as a predictor of postoperative functional performance status PFPS and treatment adherence in head and neck cancer patients: a prospective studyReport as inadecuate

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Journal of Otolaryngology - Head and Neck Surgery

, 44:38

Poliquin Resident Research Competition 2015


BackgroundHead and neck cancer HNC is a debilitating disease due in part to its effects on function, including speech, swallowing, and cosmesis. Previous studies regarding depression in HNC have focused on demographic predictors, incidence, and quality of life studies. There is, however, a paucity of studies that objectively address depressive symptoms in HNC patients and the resultant effects on post-treatment functional performance status. The aim of this study was to assess the relationship between preoperative depressive symptoms PDS and postoperative functional performance status PFPS, in addition to other predictors of rehabilitation and survival.

MethodsA prospective cohort study was undertaken at the University of Alberta, including all new adult HNC patients undergoing surgery as primary therapy for HNC from May 2013 to January 2014. Baseline depressive symptoms were measured on the Quick Inventory of Depressive Symptoms QIDS questionnaire 2 weeks preoperatively and PFPS was assessed 12 months postoperatively on the Functional Assessment of Cancer Therapy-Head and Neck FACT-HN scale. Secondary outcomes included completion of adjuvant therapy, narcotic dependence, return to detrimental habits, loss of follow-up, and length of hospital stay LOHS. Differences between the Normal-Mild and Moderate-Severe QIDS groups were assessed using Mann–Whitney and Fischer Exact statistical analyses.

ResultsSeventy-one patients were included in the study. Mild and Moderate-Severe PDS were 35.2 % and 18.3 %, respectively. Significantly lower FACT-HN scores were noted in the Moderate-Severe group at 12 months p = 0.03. The risk ratio RR for FACT-HN score < 50 % at 12 months in the Moderate-Severe group was 5.66. In addition, significantly lower completion of adjuvant treatment p = 0.03, significantly higher incidence of narcotic dependence p = 0.004, and significantly higher LOHS 24 days vs. 18 days; p = 0.02 was observed in the Moderate-Severe group. There was no significant difference in loss of follow-up between the 2 groups p = 0.64.

ConclusionsThe incidence and severity of PDS in HNC patients treated with surgery is high 53.5 %. Patients with Moderate-Severe PDS have significantly decreased PFPS, increased narcotic use, decreased completion of adjuvant therapy, and a longer LOHS. HNC patients should be monitored closely for depressive symptoms.

KeywordsDepression Head neck cancer Postoperative functional performance AbbreviationsHNCHead and neck cancer

PFPSPostoperative functional performance status

PDSPreoperative depressive symptoms:

QIDSQuick Inventory of Depressive Symptoms

FACT-HNFunctional Assessment of Cancer Therapy for Head and Neck Cancer patients

RTOGRadiation Therapy Oncology Group

CCICharlson Comorbidity Index

MDADIMD Anderson Dysphagia Index

BDI-FSBeck Depression Inventory Fast Screen

DSSDisease-specific survival

OSOverall survival

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Author: Brittany Barber - Jace Dergousoff - Margaret Nesbitt - Nicholas Mitchell - Jeffrey Harris - Daniel O’Connell - David Côt


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