Heading back to the office following head and neck cancer

Author: Daniel Caley

In Cancers of the Head & Neck launching today publishes the first study looking at disability and employment outcomes in patients with head and neck cancer related to the human papillomavirus (HPV). Dr Shrujal Baxi, Section Editor for survivorship and patient related outcomes and author of this study, explains more about their work in this Q&A:

The rates of patients diagnosed with HPV-related head and neck cancer is rising annually. By 2020, there will be more cases of HPV-related head and neck cancer than HPV-related cervical cancer in the United States. Numerous studies have shown that most patients with this diagnosis are likely to be cured of their disease, placing an increased emphasis on quality of life and non-cancer outcomes in this population of survivors. The majority of patients diagnosed with HPV-related head and neck cancer are working-age adults and employment is a serious issue both financially and psychologically.

How can treatment for head and neck cancer impact employment?
Treatment for head and neck cancer often involves a combination of chemotherapy and radiation given over a six to seven week period, often known as concurrent chemoradiation or combined modality chemoradiation. This process is considered toxic and can impact a patient’s ability to function normally including speaking, chewing, breathing and swallowing. Many patients require numerous supportive medications to get through treatment including narcotics for pain and anti-nausea medications. Patients can lose on average 10-15% of their weight within a few months and can suffer from severe fatigue and post-treatment depression.

Who was in your study?
We included 102 participants with HPV-related head and neck cancer treated with chemoradiation at our institution who were employed full-time for pay at the time of diagnosis.

How did the treatment impact employment?
97% of patients had to change their employment responsibilities in some way from reducing work, taking a break and then returning at a later date, or stopping altogether and not returning. There were 73 patients that stopped but eventually returned to work after treatment, and they required a median of 14.5 weeks to return. This is longer than the 12 weeks currently allowed according to the Family Medical Leave Act (FMLA).

Eight patients stopped working altogether and never went back. Eight patients stopped working during treatment and never returned to work. Aside from younger age predicting extra time off before returning to work, we did not find a patient, treatment or disease factor that accounted for needing extra time off.

What happened to these patients?
The majority of patients who returned to work continued. At nearly two years from completion of treatment, 85% of the original 102 patients were working for pay. Overall, survivors were doing very well in terms of quality of life with the majority not having any major limitations secondary to their treatment.

There were a group of survivors who were dissatisfied with their ability to work. Some were working but not satisfied with their abilities, while others were looking for work. Compared to those who were satisfied with their abilities, those that were unsatisfied were more likely to have more functional problems and more head and neck specific late toxicities from their treatment.

What does this mean for patients and providers?
I think that this study provides some guidance for patients and providers as they prepare for chemoradiation to treat HPV-related head and neck cancer. It is hopeful that most patients will return to work, but realistic expectations of ability to work will help in treatment planning. Employment is another reason why managing late toxicities remains an important aspect of optimal care for head and neck cancer survivors.

Head & Neck Cancer Patients Face Social Isolation, Financial Burdens

Author: Robert H. Carlson

SCOTTSDALE, Ariz.—Locally advanced head and neck cancer (LAHNC) has high morbidity and is expensive to treat. The cost of the disease, not only in financial burden but also degradation of the patient’s quality of life, was highlighted in a recent study from University of Chicago Pritzker School of Medicine.

The study, using data from 73 treatment-naïve LAHNC patients, showed that 69 percent relied on one or more lifestyle-altering cost-coping strategies while managing their cancer, including spending savings (62 percent), borrowing money (42 percent), selling possessions (25 percent), and having family members work more hours (23 percent).

A more subtle disruption of patients’ lives was also identified, that of perceived social isolation— defined as a lack of social support coupled with increased loneliness—as a risk factor for less than optimal medication adherence and use of health care resources during treatment. That meant more days of missed medication, more missed appointments, and longer inpatient hospital stays.

The study was presented at the 2016 Multidisciplinary Head & Neck Cancer Symposium, sponsored by the American Society for Radiation Oncology and the American Society of Clinical Oncology.

“Physical side effects are not the only ones our head and neck cancer patients endure,” said Sunny Kung, a second-year medical student and lead author on the study. “It is important for physicians to screen for social isolation just as we screen for depression and identify patients with high social isolation so we can intervene earlier on before they experience these negative financial side effects of their care.”

Senior study author is Jonas de Souza, MD, Assistant Professor of Medicine at The University of Chicago Medicine and frequent author on healthcare economics as well as head and neck malignancies.

Research Findings

The researchers examined factors associated with social side effects by following patients diagnosed with head and neck cancer over six months to assess how they coped with the cost of their cancer treatment, as well as whether perceived social isolation or the lack of social support was a barrier to their care.

“It was surprising that patients who had a high degree of perceived social isolation had a greater likelihood of using more lifestyle coping strategies,” Kung said, during an online press conference held in advance of the symposium.

The prospective longitudinal study collected six monthly lifestyle surveys from patients diagnosed between May 2013 and November 2014.

Most patients in the study were male (78 percent), Caucasian (74 percent), and covered by private health insurance (54.8 percent). Multivariable regression modeling was used to assess the influence of patient characteristics on the use of cost-coping strategies and perceived social isolation.

The survey assessed the use of lifestyle-altering financial burdens including extra out-of-pocket costs, loss of productivity, low compliance with their medication regimen, and added health care utilization, specifically, longer inpatient length of hospital stays and more missed appointments.

The researchers also measured patients’ demographics, health insurance status, wealth, household income, and type of tumor. Perceived social isolation was evaluated prior to treatment for each patient.

During the online preview of the symposium, Kung elaborated on the concept of social isolation as measured in two components: loneliness and lack of social support.

The first was measured using the validated UCLA Loneliness Scale, and the second by the 19-item Medical Outcomes Social Support Survey. The two scores were combined in a formula to determine low, intermediate, or high social isolation.

Kung said that, compared to LAHNC patients with adequate social support, those with a high level of perceived social isolation reported:

* more days missing the prescribed dose of medication, 21.4 days for those with high perceived social isolation versus 5.45 days for those with low/moderate perceived social isolation;

* more missed appointments, seven for those with high perceived social isolation versus three for those with low/moderate perceived social isolation; and

* longer inpatient hospital stays, 32.7 versus 27.6 days.

“Many of the patients we treat for advanced head and neck cancers need support beyond their medical care,” Kung concluded. “Social interventions can be introduced for patients who feel isolated in order to minimize financial burden while maximizing effective health care utilization.”

For example, she said, providers can work with patient navigators to improve adherence to medical care among vulnerable populations.

Need for Support

The moderator of the press preview, Randall Kimple, MD, Assistant Professor in the Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, said this study’s findings would have to be replicated in other institutions.

“Even so, these are important lessons for us to learn about what our patients go through, and potential areas of research into how to lessen social isolation and all the other hardships while still doing everything we can cure as many patients as possible,” Kimple said.

This study’s findings on social isolation may apply to other cancers, he said, but he noted that head and neck cancer is unique in the intensity of therapy and the side effects that come with therapy and that affect quality of life.

“Losing the ability speak, to eat, to work, and the social isolation that can result, these can be devastating, but we as physicians can help to address many of these issues with teaching and support, and have a real impact on the lives of our patients,” Kimple said.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

April, 2016|Oral Cancer News|

Suicide: A Major Threat to Head and Neck Cancer Survivorship

Authors: Nosayaba Osazuwa-Peters, Eric Adjei Boakye, and Ronald J. Walker
, Mark A. Varvares

TO THE EDITOR: The article by Ringash that was recently published in Journal of Clinical Oncology provided a compelling narrative of both the improvements made in head and neck cancer survivorship, as well as the challenges created by longer-term treatment and associated toxicities. There are currently at least 280,000 head and neck cancer survivors in the United States. As the article by Ringash stated, the upturn in head and neck cancer survivorship in the last three decades has coincided with the emergence of human papilloma virus-positive oropharyngeal cancer, as well as a decrease in tobacco use in the general population. These make it a challenge to isolate survival gains as a function of improved therapy from the natural prognostic value of a diagnosis of human papilloma virus-positive oropharyngeal cancer. Whatever the case, the fact that more than one-quarter million Americans are currently alive after a diagnosis of head and neck cancer means there needs to be a more deliberate effort in longer-term management of treatment-related toxicities, some of which are lifelong.

We agree with Ringash’s conclusion that new models of care need to be developed in response to the significant quality-of-life issues faced by patients with head and neck cancer. The Institute of Medicine publication From Cancer Patient to Cancer Survivor: Lost in Transition, also cited by Ringash, called for a clear individualized survivorship plan for cancer patients. There is a serious need for this model to be implemented universally in head and neck cancer management. Although we agree with Ringash that patients with head and neck cancer face competing mortality risks from second primary cancers and other noncancers, what we found lacking was recognition of an important competing cause of mortality in head and neck cancer survivors: suicide.

Suicide associated with head and neck cancer is not just a competing cause of death; it is also a quality-of-life issue. Many authors agree that head and neck cancer is among the top cancer sites associated with suicide. One national study of 1.3 million cancer patients even found that head and neck cancer carried the highest risk of suicide among cancer survivors. As a quality-of-life issue as well as a competing cause of death, the elevated risk of head and neck cancer-related suicide, although it peaks during the first few years after diagnosis, remains virtually throughout the course of the cancer survivor’s life. Additionally, some other well-known quality-of-life issues associated with head and neck cancer (eg, pain, disability, esthetic compromise and body image issues, psychosocial function, anxiety, emotional distress, and depression) are all associated with suicide. Therefore, it is difficult to have a discussion of quality-of-life interventions in head and neck cancer without addressing the issue of suicide.

Thus, we believe that suicide in patients with head and neck cancer should be addressed as a major threat to cancer survivorship. Cardiovascular disease, for example, is a known competing cause of death among patients with head and neck cancer, and is listed in Figure 4 of Ringash’s article. Cardiovascular disease may be managed for a long time; however, when a cancer patient decides that he/she is “better off dead,” a finality, or terminality, is invoked. This is quite unique to suicide compared with other competing causes of death.

Thus, in the urgent call for “new strategies and models of care to better address quality-of-life issues and meet the needs of survivors of head and neck cancer,” we believe it is pertinent that suicide is recognized as an important threat to head and neck cancer survivorship.

DOI: 10.1200/JCO.2015.65.4673; published online ahead of print at on January 19, 2016

To read or download the full article, please visit:

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
March, 2016|Oral Cancer News|

Depressed Head and Neck Cancer Patients Have Lower Survival and Higher Recurrence Risk

Author: Kathy Boltz, PhD

Depression is a significant predictor of 5-year survival and recurrence in patients with head and neck cancer, according to a new study published in Pyschosomatic Medicine (doi: 10.1097/PSY.0000000000000256). These findings represent one of the largest studies to report on the impact of depression on cancer survival.

Although depression can have obvious detrimental effects on a person’s quality of life, its impact on cancer patients is more apparent, explained lead author Eileen Shinn, PhD, assistant professor of Behavioral Science at The University of Texas MD Anderson Cancer Center, in Houston. Increasing evidence shows modest associations between elevated symptoms of depression and greater risk for mortality among patients with lung, breast, ovarian, and kidney cancers.

The research team sought to clarify the influence of depression on survival, focusing their analysis on a single cancer type. By limiting the sample set and adjusting for factors known to affect outcome, such as age, tumor size, and previous chemotherapy, they were able to uncover a more profound impact of depression.

The researchers followed 130 patients at MD Anderson with newly diagnosed oropharyngeal squamous cell carcinoma (OSCC), a type of cancer in which the tumor originates at the back of the throat and base of the tongue.

At the beginning of their radiation therapy, Patients completed a validated questionnaire at the beginning of their radiation therapy to identify symptoms of clinical depression. Researchers monitored the participants, all of whom completed treatment, until their last clinic visit or death, a median period of 5 years.

“The results of this study were quite intriguing, showing depression was a significant factor predicting survival at 5 years, even after controlling for commonly accepted prognostic factors,” said senior author Adam Garden, MD, professor, Radiation Oncology. Furthermore, depression was the only factor shown to have a significant impact on survival.

Patients who scored as depressed on the questionnaire were 3.5 times less likely to have survived to the 5-year interval compared with those who did not score as depressed. The degree of depression was also found to be significant, as every unit increase on this scale indicated a 10% higher risk for reduced survival.

The results were replicated with a different psychological health survey and were not influenced by how soon following diagnosis the depression assessment was done.

OSCC is diagnosed in 10 000 to 15 000 Americans each year. Major risk factors known to be associated with OSCC include smoking and tobacco use, alcohol consumption, and human papillomavirus (HPV) infection. Incidence of OSCC has doubled in the last 20 years due to increasing HPV infection rates, noted Shinn.

Neither alcohol nor tobacco use, also surveyed in this group, had a significant impact on survival. HPV infection status, when available, also did not appear correlated.

Despite a high cure rate, normally 60% to 80%, recurrence rate of disease is unusually high in these patients (approximately 30%). The researchers also investigated a potential link between depression and disease recurrence.

“When we controlled for all variables, depression was linked with a nearly 4 times higher risk of recurrence,” said Shinn. In addition, never smokers had a 73% lower chance of recurrence, compared with current smokers. Those were the only two factors associated with cancer recurrence.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

December, 2015|Oral Cancer News|

Depression and smoking linked to worse prognosis in oral cancer

Author: staff Interview with: Dr. Eileen H. Shinn PhD
Assistant Professor, Department of Behavioral Science
Cancer Prevention and Population Sciences, MD Anderson Cancer Center

Medical Research:
What is the background for this study? What are the main findings?

Dr. Shinn:
Recent studies with leukemia, breast, lung, renal and liver cancer patients have shown that patients with depression have worsened survival. These effect sizes are small, but independent of any of the traditional factors that are known to impact survival, such as extent of cancer, types of treatment administered and baseline health and age of the patient. The current thinking is that cancer patients who are depressed have chronically heightened responses to stress; the constant release of stress hormones trigger changes in the tumor itself (such as noradrenergically-driven tumor angiogenesis) or may weakens the body’s immune function and ability to resist tumor growth.

When we measured depression in newly diagnosed patients with oropharyngeal cancer (cancer of the base of tongue and tonsil), we found that those patients who scored as depressed were 3.5 times more likely to have died within the five year period after their diagnosis, compared to non-depressed patients. We also found that patients who were depressed were also 3.8 times more likely to have their cancer recur within the first five years after diagnosis. We also found that patients who continued to smoke after diagnosis were more likely to recur within the first five years. These effect sizes were larger than those typically found in recent studies. We believe that the larger effect size may be due to the tight eligibility criteria ( e.g., we did not include patients who already had recurrent disease, we only included patients with one specific type of head and neck cancer, oropharyngeal) and also due to controlling other known factors (all patients completed individualized treatment regimens of radiation/ chemoradiation at a comprehensive cancer center and patients with more advanced disease stage were more likely to have received treatment intensification compared to patients with early stage disease). In all, we had 130 patients, one of the largest prospective studies with oropharyngeal cancer to examine the effect of depression on cancer outcome.

Medical Research:
What should clinicians and patients take away from your report?

Dr. Shinn:
With important factors, such as careful diagnosis, staging and individualized multidisciplinary treatment plans, being equal, depression status may impact patient recurrence and survival in oropharyngeal cancer.

Medical Research:
What recommendations do you have for future research as a result of this study?

Dr. Shinn:
These results need to be replicated in a larger study, with particular attention paid to repeated measures of depression as well as possible bio-behavioral markers of tumor growth and chronic stress.

December, 2015|Oral Cancer News|

ASCO Launches New Survivorship Guidelines

Author: Roxanne Nelson

The American Society of Clinical Oncology (ASCO) has issued 3 new evidence-based clinical practice guidelines on the prevention and management of common symptoms that affect a large number of cancer survivors — neuropathy, fatigue, and depression and anxiety.

The number of cancer survivors in the United States has risen exponentially, from 3.0 million in 1971 to about 13.7 million currently.

That is good news, but the downside is that survivors often face long-term health issues related to their disease and treatment. Thus, there is an outstanding need for comprehensive guidance to assist clinicians in this management process. The ASCO recommendations reinforce the fact that both physical and psychological needs have to be addressed in this population.

The guidelines, published online April 14 in the Journal of Clinical Oncology, are the first in a series that will focus on survivorship care.

Peripheral Neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a common treatment-related adverse event and can affect a patient’s long-term quality of life. It is estimated that about 38% of patients who are treated with multiple agents develop CIPN, but this can vary, depending on the actual regimen and duration of treatment. Chemotherapy combinations associated with a higher incidence of CIPN are those that involve platinum drugs, vinca alkaloids, bortezomib, and/or taxanes.

Symptoms vary, and range from numbness and tingling to shooting pain in the arms and legs. If symptoms are really severe, dose reduction or another regimen might be necessary. For a minority of patients, severe symptoms can last for years.

“There is no clear panacea for neuropathy,” said Gary Lyman, MD, MPH, cochair of the ASCO Survivorship Guidelines Advisory Group, in a statement. “Some of the drugs used for prevention or treatment of neuropathy may cause side effects or interfere with other drugs. We want to be clear that if there is no evidence of benefit from those drugs, it’s probably best not to take them.”

The neuropathy guidance is based on a literature review that included 48 randomized controlled trials. However, the studies tended to be small and heterogeneous, and many had insufficient sample sizes to detect clinically important differences in outcomes, the authors note.

Key CIPN Recommendations

No established agents are recommended for preventing CIPN, because of the “paucity of high-quality, consistent evidence and a balance of benefits versus harms.”

The following agents should not be offered for prevention of CIPN: acetyl-L-carnitine, amifostine, amitriptyline, calcium plus magnesium, dietyldithiocarbamate, glutathione, nimodipine, Org 2766, all-trans retinoic acid, rhuLIF, and vitamin E.

Treating clinicians can offer duloxetine to patients with CIPN

Although recommendations cannot be made for tricyclic antidepressants, gabapentin, or topical gels containing baclofen, amitriptyline, and ketamine because of the lack of strong evidence, it might be reasonable to try them in select patients.

A number of nonpharmacologic interventions have been investigated for their role in preventing or treating peripheral neuropathy, but they could not be included in this review because of the lack of data from randomized trials, the guideline authors note.


The fatigue guideline provides recommendations on screening, assessment, and treatment approaches for adult cancer survivors experiencing this symptom.

It is recommended that all cancer survivors be evaluated for symptoms of fatigue after they complete their treatment, and that they be offered strategies for fatigue management.

“Fatigue is an extremely common symptom in people with cancer,” said Smita Bhatia, MD, MPH, cochair of the ASCO Survivorship Guidelines Advisory Group, in a statement. “We hope that this guideline will help ensure that screening for fatigue and appropriate management are incorporated in the care of every cancer survivor.

The authors conducted a systematic search of clinical practice guideline databases, guideline developer Web sites, and published health literature. This guideline is based on a Canadian guideline on fatigue and 2 guidelines from National Comprehensive Cancer Network on cancer-related fatigue and survivorship.

Key Fatigue Recommendations

Patients should be routinely screened for fatigue from diagnosis onward, including after the completion of primary treatment.

Screening should include a quantitative or semiquantitative assessment.

Patients should be educated about the differences between normal and cancer-related fatigue, causes of fatigue, and contributing factors.

Patients treated for fatigue should be observed and re-evaluated on a regular basis.

Patients should be offered strategies to manage fatigue, including physical activity, psychosocial interventions (e.g., cognitive and behavioral therapies, psychoeducational therapies), and mind–body interventions (e.g., yoga, acupuncture).

Anxiety and Depression Management

Most people experience some degree of depression, anxiety, and fear when diagnosed with cancer. Distress is very common, but the types and causes vary, said Dr. Bhatia. “Depression can go undetected unless it is specifically sought for and evaluated.”

Recommendations in the anxiety and depression guideline were adapted from the Pan-Canadian Guideline on Screening, Assessment and Care of Psychosocial Distress (Depression, Anxiety) in Adults with Cancer.

Key Anxiety and Depression Recommendations

All cancer patients should be evaluated for symptoms of depression and anxiety, using validated measures.

All patients should be offered supportive care services; those with moderate or severe symptoms of anxiety and depression should be referred for appropriate interventions.

Providers should reassess patients for compliance with individual or group psychological or psychosocial referrals.

“Doctors sometimes don’t give these symptoms much attention because they think it’s normal that their patients are a little anxious or depressed about their disease,” said Dr. Lyman. “But it’s important to keep an eye on the symptoms and step in when they start to interfere with the patients’ quality of life.”

The authors of the neuropathy and fatigue guidelines report numerous financial relationships, which are detailed in the guidelines. The authors of the depression and anxiety guideline have disclosed no relevant financial relationships.


*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
April, 2014|Oral Cancer News|

After-effects of oral cancer surgery forces patients into unemployment and depression

Author: Economic Voice Staff

Cancer Patients are being forced into unemployment due to the after-effects of surgery and higher levels of depression.

Research into head and neck cancer patients discovered the rate of those employed fell by more than 40 per cent five years after diagnosis, where only one in three managed to secure work. They also reported unemployed cancer survivors had lower social well-being and higher depression scores

For those cancer sufferers out of work prior to diagnosis, their reasons for not returning to work also included the knock-on effect of surgery as well as dangerous levels of alcohol consumption.

Figures from Cancer Research UK reveal more than 331,000 people were diagnosed with cancer in 2011 – around 910 every day. According to mouth cancer campaigners, the problems are exacerbated for mouth cancer patients.

Previous research identified mouth cancer survivors face a diminished quality of life. Survivors reported poor oral function, resulting in persistent eating problems and long term depression. More than half of respondents (51.6 per cent) reported problems with eating, while on average one in four survivors who lived for five or more years still experienced speech problems.

It was a similar story when it came to a patient’s physical and mental health, with more than a third (36.7 per cent and 39.3 per cent respectively) recording low functionality after the five year analysis.

According to Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, the study highlights the problems mouth cancer sufferers face on a daily basis.

Dr Carter said: “The results of the study show the scale of the problems cancer patients have to live with. For mouth cancer patients, the corrective surgery required to remove cancerous cells often leaves physical and emotional scars that can take years to heal.

While all cancer patients require a great deal of care, those recovering from mouth cancer clearly suffer from the after-effects of surgery, both physically and mentally. It can take a prolonged period of time to eat solid foods, learn to speak again, swallow without feeling discomfort and even breathe properly. In some cases, mouth cancer patients will experience these for the rest of their lives.

That is why early detection of this disease is so important. Most people with mouth cancer present late as stage 4 – the most advanced stage where time is of the essence in potentially saving a life and reducing the need for invasive surgery.

Warning signs for the disease include ulcers that do not heal within three weeks, red and white patches in the mouth and unusual lumps or swellings. If you spot any of these, or are unsure if it’s something normal or otherwise, our advice is crystal clear – if in doubt, get checked out.”

The research identified 55 head and neck cancer patients under the age of 60 who had survived more than two years. Each patient completed a survey including subscales from the Functional Assessment of Cancer Therapy (FACT) instrument, the Miller Behavioural Style Scale, the General Perceived Self-Efficacy Scale, the Patient Health Questionnaire-9 (PHQ-9) and the Hornheider Fragebogen-short version measuring need for psychological interventions.


*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

March, 2014|Oral Cancer News|

Psychosocial services underutilized by those with head and neck cancers

Author: Allen Chen

Despite high rates of depression among individuals with head and neck cancers after radiation therapy, mental health services are severely underutilized in this patient population, results of a cross-sectional analysis suggest.

Allen M. Chen, MD, of the department of radiation oncology at the David Geffen School of Medicine at UCLA, and colleagues evaluated data on 211 patients with squamous cell carcinoma of the head and neck. All patients underwent radiation therapy and were disease-free within at least 1 year of follow-up. Exclusion criteria included history of mood disorder, previous use of mental health services, or use of antidepressants or anxiolytics, not including sleep medications.

The researchers pooled data from self-administered questionnaires to assess depression rates in these patients. The following scores were assigned to subjective responses of mood: 0, extremely depressed; 25, somewhat depressed; 50, neither in a good mood nor depressed; 75, generally good; and 100, excellent.

Results suggested no differences in mean mood scores at 1 year (52), 3 years (55.7) or 5 years (62.1) after treatment. The presence of tracheostomy tube or laryngeal stoma (P=.01), gastrostomy tube dependence (P=.01) and continued smoking at the time of follow-up (P< .001) were significantly associated with depression after radiation therapy. At 1-year follow-up, 17% of patients reported their mood as “somewhat depressed” or “extremely depressed.” The rate was 15% at 3 years and 13% at 5 years. However, the percentage of patients who reported use of antidepressants was 6% at 1 year, 11% at 3 years and 0% at 5 years, whereas the rate of patients who reported actively seeking or undergoing counseling was 3% at 1 year, 6% at 3 years and 0% at 5 years. “This research points to a sorely unmet need for psychosocial services among these cancer survivors and significant underutilization of mental health resources by head and neck cancer patients for their depression,” Chen said in a press release. “This is important because research has shown that suicide rates among cancer patients can be up to 10 times higher than the general population. More studies with longer follow-up are needed to assess the potential impact of depression on quality of life for these patients to understand why they are not getting the help they need, and to determine what interventions can bridge this divide in the future.” Source: Chen AM. JAMA Otolaryngol Heart Surg 2013;doi:10.1001/jamaoto.2013.4072.

September, 2013|Oral Cancer News|

Cancer survivors not seeking help for depression

Author: staff

Long-term treatment can affect how cancer survivors manage in the world. The fancy phrase for this is “psychosocial functioning.” A recent study looked at how head and neck cancer survivors get along after treatment.

Depression is not uncommon among head and neck cancer survivors, researchers found in this new study. However, not many of the survivors in the study sought help for their depression with either antidepressants or therapy.

Physicians could assist by screening for psychosocial problems because depression is very treatable, according to one expert.

Allen M. Chen, MD, of the University of California, Davis, and now of the David Geffen School of Medicine at the University of California, Los Angeles, led this study. Dr. Chen and colleagues were looking at the rates of depression among head and neck cancer survivors who had received radiation therapy to treat the disease.

“The treatment of head and neck cancer can lead to devastating impact on psychosocial functioning due to the many important structures located in the head and neck region,” Tobenna Nwizu, MD, a solid tumor oncologist with the Taussig Cancer Institute at Cleveland Clinic, told dailyRx News.

“Functions like speech, swallowing, taste and salivation can all be affected,” said Dr. Nwizu, who was not involved in this study.

Treatment can also affect appearance, cause dry mouth and increase the risk of aspiration (sucking food into the airway), according to the authors.

For this study, the researchers asked 211 head and neck cancer survivors to complete a questionnaire. The University of Washington Quality of Life instrument was used to assess the rates of depression. Study members were all disease-free, and none had a history of mental health issues prior to their cancer diagnosis.

One year after treatment was completed, 17 percent of survivors reported being “somewhat depressed” or “extremely depressed.” Among three-year survivors, 15 percent said they felt depressed, as did 13 percent of those who were five years out from treatment. Of those who reported depression, 6 percent of one-year survivors, 11 percent of three-year survivors and 0 percent of five-year survivors reported taking antidepressants.

Very few survivors reported receiving psychotherapy and/or counseling. Only 3 percent of one-year survivors, 6 percent of three-year survivors and 0 percent of five-year survivors said they were getting help from mental health professionals for their depression.

“This study shows the need to screen for depression in patients treated for head and neck cancer, as depression can adversely affect a patient’s quality of life, and is easily treatable,” said Dr. Nwizu, who is a dailyRx Contributing Expert.

He added that economic factors, social support and other medical conditions, “which could all have an effect on a patient’s psychosocial well-being, were not accounted for in the study.”

The authors said a number of things may have influenced the survivors’ choices not to seek help for their depression, including lack of insurance, financial barriers, lack of follow-up care, not having a primary care physician and the perceived social stigma of mental illness.

1. This study was published August 15 in JAMA Otolaryngology–Head & Neck Surgery.

August, 2013|Oral Cancer News|

SSRI Prevents Depression in Head, Neck Cancer

Source: MedPage Today
By Salynn Boyles, Contributing Writer
Published: June 21, 2013


Prophylactic escitalopram cut the incidence of depression in head and neck cancer patients by more than 50% and improved quality of life, a clinical trial showed.

Significantly fewer patients taking the antidepressant developed depression, when compared with those on placebo (10% vs 24.6%; stratified log-rank test, P=.04), according to a study in the June 20 issue of JAMA Otolaryngology Head and Neck Surgery.

“Depression is very common among patients with this disease, but it is not easy to predict who will become depressed at the beginning of treatment,” University of Nebraska Medical Center professor of head and neck oncology William Lydiatt, MD, told MedPage Today. “That’s why the prevention paradigm may offer considerable benefit at an acceptable risk.”

As many as half of head and neck cancer patients develop clinical depression within months of their diagnosis and suicide rates are among the highest in patients with a medical illness, Lydiatt noted.

“The burden of treatment is extensive and frequently includes dysphagia, disfigurement, voice alterations, mucositis, need for tracheostomy and feeding tubes, fatigue and depression,” the researchers wrote.

They chose the generic version of the popular SSRI Lexapro for the trial to give patients an affordable treatment option that’s well tolerated in the elderly.

The randomized, double-blind trial included 148 newly diagnosed head and neck cancer patients entering treatment who did not yet have a diagnosis of depression. The patients were stratified by sex, site of disease, stage, and primary modality of treatment (surgery versus radiation).

Half were treated with escitalopram at a dosage of 10 mg/d for the first week (one tablet) followed by 20 mg/d (two tablets) until week 16, followed by an additional week of 10 mg/d. During the acute phase of the study, dosage was reduced to 10 mg/d when adverse events occurred. Patients not treated with the antidepressant received matching placebo pills.

Among the study’s major findings:

  • Patients undergoing radiation as their initial therapy were significantly more likely than those who had surgery to develop depression (hazard ratio, 3.6; 95% CI ,1.38-9.40; P=.009).
  • A Cox progression hazards regression model comparing the two groups, after controlling for age, smoking status, and other variables, demonstrated an advantage for escitalopram (hazard ratio, 0.37; 95% CI, 0.14-0.96: P=.04).
  • Patients who took escitalopram and who completed the study without developing depression rated their overall quality of life as significantly better than those in the placebo group for 3 consecutive months after ending treatment with the antidepressant (overall quality of life, good or outstanding at weeks 20, 24 and 28 – escitalopram group = 96%, 100%, 96%, respectively; placebo group = 77%, 86%, 85%).


Lydiatt said the finding that radiotherapy patients had a higher risk for depression than surgery patients is a big surprise with important potential clinical implications.

“The higher incidence of depression in the cohort receiving radiation suggests that radiation represents a greater and longer duration stress event than surgery,” the researchers wrote. “Radiation may also generate greater inflammatory cytokines during treatment, which could contribute to the higher rate (of depression).”

Although overall treatment success and survival were not study endpoints, Lydiatt said he hopes to conduct further research with these outcomes in mind.

“I would not be surprised to see a survival advantage associated with this approach,” he said. “Depression is associated with so many negative manifestations in these patients. Depressed patients don’t comply with their treatments to the same degree as patients who aren’t depressed and they don’t take care of themselves as well. They often lose their spark to live.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.


June, 2013|Oral Cancer News|