Depression among head and neck cancer patients treated with chemoradiation

Abstract

Patients with head and neck cancer are prone to psychosocial problems because social interaction and emotional expression depend to a great extent upon the structural and functional integrity of the head and neck region. The objective of this study was to evaluate the changes in the level of depression in patients with head and neck cancer undergoing chemo radiation. A prospective analytical study was conducted at a tertiary care center and consecutive patients having histopathologically confirmed squamous cell carcinoma of head and neck region who were prescribed chemoradiation were included. Socio-demographic and clinical data were recorded. Validated Sinhala and Indian Tamil versions of the Center for Epidemiological Studies Depression scale (CES-D) were administered on three occasions; before the commencement of chemoradiation, at the end of the chemoradiation cycle (at six weeks from baseline) and at three month from baseline. Demographic characteristics were summarized by descriptive statistics. Changes in the level of depression were compared on three occasions with repeated measures ANOVA. A cut-off score of 16 or greater was considered as risk for clinical depression. Of the 47 patients, 66% showed risk of clinical depression at baseline and 23.4% after six weeks. However at three months after baseline risk of clinical depression was evident in all patients (100%). The level of depression had significantly reduced at six weeks (12.61±4.87), compared to baseline (19.14±8.38, P=0.001). However the level of depression had significantly increased three months following treatment (32.61±4.87, P=0.001). The initial reduction could be due to high levels of attention and positive attitudes towards treatment. The later rise could be due to complications associated with treatments such as fatigue, body weakness, hair loss and oral ulcerations. The results of the study indicate the need for attention of complications due to treatment and also psychological evaluation of patients