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Depressive symptoms predict head and neck cancer survival: Examining plausible behavioral and biological pathways
Author(s) -
Zimmaro Lauren A.,
Sephton Sandra E.,
Siwik Chelsea J.,
Phillips Kala M.,
Rebholz Whitney N.,
Kraemer Helena C.,
GieseDavis Janine,
Wilson Liz,
Bumpous Jeffrey M.,
Cash Elizabeth D.
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31109
Subject(s) - medicine , hazard ratio , depression (economics) , confidence interval , odds ratio , cancer , head and neck cancer , proportional hazards model , oncology , economics , macroeconomics
BACKGROUND Head and neck cancers are associated with high rates of depression, which may increase the risk for poorer immediate and long‐term outcomes. Here it was hypothesized that greater depressive symptoms would predict earlier mortality, and behavioral (treatment interruption) and biological (treatment response) mediators were examined. METHODS Patients (n = 134) reported depressive symptomatology at treatment planning. Clinical data were reviewed at the 2‐year follow‐up. RESULTS Greater depressive symptoms were associated with significantly shorter survival (hazard ratio, 0.868; 95% confidence interval [CI], 0.819‐0.921; P < .001), higher rates of chemoradiation interruption (odds ratio, 0.865; 95% CI, 0.774‐0.966; P = .010), and poorer treatment response (odds ratio, 0.879; 95% CI, 0.803‐0.963; P = .005). The poorer treatment response partially explained the depression‐survival relation. Other known prognostic indicators did not challenge these results. CONCLUSIONS Depressive symptoms at the time of treatment planning predict overall 2‐year mortality. Effects are partly influenced by the treatment response. Depression screening and intervention may be beneficial. Future studies should examine parallel biological pathways linking depression to cancer survival, including endocrine disruption and inflammation. Cancer 2018;124:1053‐60 . © 2018 American Cancer Society .