Increased Risk for Mental Health Disorders Seen With Head and Neck Cancers

Incidence of MHDs by Cancer Type

A result that the researchers had not anticipated was that tracheal cancer showed a high unadjusted OR for MHD of 2.11 (95% CI, 1.87-2.38) vs that for oral cavity cancer. The most prevalent HNC in the study was oral cavity cancer, at 40.4% of cases.³

Cancers of the nasopharynx and hypopharynx also showed a higher association with MHDs than oral cavity cancer did. Compared with oral cavity cancer, cancer of the nasopharynx showed an unadjusted OR of 1.22 (95% CI, 1.14-1.31), and cancer of the hypopharynx showed an unadjusted OR of 1.21 (95% CI, 1.10-1.33). Laryngeal cancer did not show an elevated prevalence of MHDs.³

A matched-cohort study that was conducted in Sweden, and included patients with any cancer diagnosis, showed that MHDs became elevated during the year before cancer diagnosis. In that study, at half a year prior to cancer diagnosis the hazard ratio (HR) for MHDs was 1.8 (95% CI, 1.7-1.9), with the HR peaking a week after diagnosis at 6.7 (95% CI, 6.1-7.4). The rate of MHDs also remained elevated for years after cancer diagnosis.¹

Regarding increased MHD levels in the period leading up to a cancer diagnosis, the authors of the Swedish study suggested that the diagnostic process itself, in addition to symptoms of cancer and possible paraneoplastic syndromes, can contribute to a higher prevalence of MHDs just before a cancer diagnosis.¹

A separate study specifically examining depression in patients with HNC showed that worse depression severity was related to shorter survival (HR, 0.868; 95% CI, 0.819-0.921). Patients with more severe depression were also more likely to interrupt chemoradiation treatment (OR, 0.865; 95% CI, 0.774-0.966) and to show a worse treatment response (OR, 0.879; 95% CI, 0.803-0.963). In this study, treatment interruption was not strongly correlated with treatment response.²

Conclusion

Beyond the important effects on quality of life, the relationship between mental health and treatment outcomes in patients with HNC makes this a critical aspect of a patient’s condition that should be monitored.^{2, 3}

From their study of a large number of patient claims, the results by Lee and colleagues demonstrated that treatment for HNC is associated with development of MHDs, in addition to the risks posed by other patient characteristics. “Individualized care may help recognize and address the sociodemographic variables affecting mental health of the patients with HNC,” they stated.³

Reference

1. Lu D, Andersson TM, Fall K, et al. Clinical diagnosis of mental disorders immediately before and after cancer diagnosis: a nationwide matched cohort study in Sweden. JAMA Oncol. 2016;2(9):1188-1196.