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

## TL;DR

This study finds that clinical factors and lower income are linked to higher rates of depression and anxiety in head and neck cancer patients, suggesting opportunities for early mental health support.

## Contribution

The study identifies specific clinical and socioeconomic predictors of depression and anxiety in head and neck cancer patients.

## Key findings

- Depression and anxiety prevalence in HNC patients was 13.1% and 9.9%, respectively.
- Lower income, nonmarried status, and non-white ethnicity were associated with depression.
- Definitive surgery and lower income were linked to anxiety in HNC patients.

## Abstract

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.

The purpose of this study is to determine the prevalence of depression and anxiety in a cohort of HNC patients at all subsites.

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.

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.

Patients were initially screened using the Direct Assessment and Response Tool (DART), which includes the Edmonton Symptom Assessment Scale (ESAS) to identify psychosocial distress.

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 regression

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.

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.

Identifying factors associated with depression and anxiety in HNC patients will aid in providing early intervention.

Graphical Abstract