Prospective study of psychosocial distress among patients undergoing radiotherapy for head and neck cancer.
OBJECTIVE
To determine the prevalence of psychosocial distress among patients undergoing radiotherapy (RT) for head and neck cancer and to examine the association between depression and anxiety and demographic and medical variables.


METHODS
A total of 40 patients (25 men and 15 women) with nonmetastatic head and neck cancer were enrolled in this prospective study and underwent RT administered with definitive (24 patients) or postoperative (16 patients) intent. Twenty patients (50%) received concurrent chemotherapy. All patients completed the Hospital Anxiety and Depression Scale and Beck Depression Inventory-II instrument before RT, on the last day of RT, and at the first follow-up visit. The effect of patient-, tumor-, and treatment-related factors on psychosocial distress was analyzed.


RESULTS
The prevalence of mild to severe pre-RT depression was 58% and 45% using the Hospital Anxiety and Depression Scale-D and Beck Depression Inventory-II scale, respectively. The prevalence of severe pre-RT anxiety was 7%. The depression levels, as determined by the Hospital Anxiety and Depression Scale and Beck Depression Inventory-II instrument increased significantly during RT and remained elevated at the first follow-up visit (p < 0.001 for both). The variables that were significantly associated with post-RT depression included a greater pre-RT depression level, employment status (working at enrollment), younger age (<55 years), single marital status, and living alone (p < 0.05, for all).


CONCLUSIONS
The results of our study have shown that an alarming number of patients undergoing RT for head and neck cancer have symptoms suggestive of psychosocial distress even before beginning treatment. This proportion increases significantly during RT. Studies investigating the role of antidepressants and/or psychiatric counseling might be warranted in the future.
Department of Radiation Oncology, University of California, Davis, Cancer Center, Sacramento, CA, USA.
Allen M
AM
Chen
Richard L S
RL
Jennelle
Victoria
V
Grady
Adrienne
A
Tovar
Kris
K
Bowen
Patty
P
Simonin
Janice
J
Tracy
Dale
D
McCrudden
Jonathan R
JR
Stella
Srinivasan
S
Vijayakumar
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000523:psychology* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology*