Predicting depression and quality of life among long-term head and neck cancer survivors.
OBJECTIVE
The aim of this study is to identify clinical factors that are predictive of depression and quality of life (QOL) among long-term survivors of head and neck squamous cell carcinoma and to develop predictive scores using these factors.


METHODS
Cohort study


METHODS
Tertiary referral center.


METHODS
A total of 209 posttreatment (median follow-up, 38.7 months) head and neck cancer patients were prospectively evaluated using the Hospital Anxiety Depression Scale (HADS), the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30, and the EORTC Quality of Life Questionnaire Head and Neck 35, and pretreatment patient-related, tumor-related, and treatment-related predictors were identified using chart review. Bivariate (χ(2) and t test) and multivariate (linear regression) analyses were used to construct predictive models.


RESULTS
Significant pretreatment predictors of depression were identified on multivariate analysis as smoking at diagnosis, >14 alcoholic drinks per week, T3 or T4 status, and >3 medications (P < .001). Two or more of these factors yielded an 82.3% sensitivity in detecting significant depressive symptoms (defined as a HADS cutoff score of 5). Significant predictors of fatigue, global health/QOL, social contact, speech, pain, swallowing, and xerostomia were also identified.


CONCLUSIONS
Pretreatment predictors of long-term depression and QOL have been defined using multivariate models, and an easily applicable predictive score of long-term depression is proposed. Potential eventual clinical applications include prophylactic intervention in at-risk patients.
Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada Division of Surgical Research, Department of Surgery, McGill University, Montreal, Canada.
Sami P
SP
Moubayed
Division of Surgical Research, Department of Surgery, McGill University, Montreal, Canada.
John S
JS
Sampalis
Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada.
Tareck
T
Ayad
Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada.
Louis
L
Guertin
Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada.
Eric
E
Bissada
Department of Pathology, Université de Montréal Hospital Center, Montreal, Canada.
Olguta E
OE
Gologan
Medical Oncology Service, Université de Montréal Hospital Center, Montreal, Canada.
Denis
D
Soulières
Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada.
Louise
L
Lambert
Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada.
Edith
E
Filion
Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada.
Phuc Felix
PF
Nguyen-Tan
Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada a.christopoulos@umontreal.ca.
Apostolos
A
Christopoulos
D002294:Carcinoma, Squamous Cell / Q000150:complications*; D015331:Cohort Studies; D003863:Depression / Q000209:etiology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D011379:Prognosis; D011788:Quality of Life; D000077195:Squamous Cell Carcinoma of Head and Neck; D017741:Survivors
depression; head and neck cancer; prediction; quality of life; score