The relationship between depressive symptoms and initial quality of life and function in head and neck cancer

Objectives: To determine the incidence of depression in head and neck cancer (HNCA) patients and the effect of depression on baseline head- and neck-specific measures of quality of life and function. Study Design: Prospective cohort analysis. Methods: A total of 255 patients were prospectively evaluated using the Beck Depression Inventory Fast-Screen (BDIFS) survey, University of Washington Quality of Life (UW QOL), Voice Handicap Index (VHI), and MD Anderson Dysphagia Inventory (MDADI) questionnaires. Patients with a preexisting diagnosis of depression were excluded. Results: Complete data were available for 77 patients with HNCA and 53 controls. Depressive symptoms were identified in 9% of controls and 19% of HNCA patients, and were significantly associated with a HNCA diagnosis (OR ¼ 4.1, P ¼ .044). Among patients with HNCA, depression was significantly more common in black patients (OR ¼ 15.8, P ¼ .017). A significant negative correlation was found between BDI-FS score and UW global QOL score (r ¼� 0.4, P ¼ .0019). Depression was significantly associated with poorer UW global QOL (b ¼� 22.46, P ¼ .0004), recreation (b ¼� 13.77, P ¼ .037), speech (b ¼ � 24.05, P ¼ .004), and MDADI functional (b ¼� 17.31, P ¼ .009), physical (b ¼� 14.99, P ¼ .032), and emotional (b ¼ � 11.60, P ¼ .049) domain scores but not with other UW QOL or VHI domains, after controlling for all other variables. Conclusions: Patients with HNCA have a high incidence of depressive symptoms at diagnosis, which is significantly higher in black patients, and is associated with poorer QOL and MDADI scores. Pretreatment depression may serve as a marker for patients with increased risk of swallowing impairment and reduced QOL who would benefit from targeted intervention.