title: Depression as a predictor of postoperative functional performance status (PFPS) and treatment adherence in head and neck cancer patients: a prospective study.
abstract: BACKGROUND
  Head and neck cancer (HNC) is a debilitating disease due in part to its effects on function, including speech, swallowing, and cosmesis. Previous studies regarding depression in HNC have focused on demographic predictors, incidence, and quality of life studies. There is, however, a paucity of studies that objectively address depressive symptoms in HNC patients and the resultant effects on post-treatment functional performance status. The aim of this study was to assess the relationship between preoperative depressive symptoms (PDS) and postoperative functional performance status (PFPS), in addition to other predictors of rehabilitation and survival.
  
  
  METHODS
  A prospective cohort study was undertaken at the University of Alberta, including all new adult HNC patients undergoing surgery as primary therapy for HNC from May 2013 to January 2014. Baseline depressive symptoms were measured on the Quick Inventory of Depressive Symptoms (QIDS) questionnaire 2 weeks preoperatively and PFPS was assessed 12 months postoperatively on the Functional Assessment of Cancer Therapy-Head & Neck (FACT-HN) scale. Secondary outcomes included completion of adjuvant therapy, narcotic dependence, return to detrimental habits, loss of follow-up, and length of hospital stay (LOHS). Differences between the Normal-Mild and Moderate-Severe QIDS groups were assessed using Mann-Whitney and Fischer Exact statistical analyses.
  
  
  RESULTS
  Seventy-one patients were included in the study. Mild and Moderate-Severe PDS were 35.2 % and 18.3 %, respectively. Significantly lower FACT-HN scores were noted in the Moderate-Severe group at 12 months (p = 0.03). The risk ratio (RR) for FACT-HN score < 50 % at 12 months in the Moderate-Severe group was 5.66. In addition, significantly lower completion of adjuvant treatment (p = 0.03), significantly higher incidence of narcotic dependence (p = 0.004), and significantly higher LOHS (24 days vs. 18 days; p = 0.02) was observed in the Moderate-Severe group. There was no significant difference in loss of follow-up between the 2 groups (p = 0.64).
  
  
  CONCLUSIONS
  The incidence and severity of PDS in HNC patients treated with surgery is high (53.5 %). Patients with Moderate-Severe PDS have significantly decreased PFPS, increased narcotic use, decreased completion of adjuvant therapy, and a longer LOHS. HNC patients should be monitored closely for depressive symptoms.
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada. brittanybarber0@gmail.com.
authors.forename: Brittany
authors.initials: B
authors.lastname: Barber
authors.affiliation: Department of Psychiatry, University of Alberta Hospital, 1E1, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Jace
authors.initials: J
authors.lastname: Dergousoff
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Nesbitt
authors.affiliation: Department of Psychiatry, University of Alberta Hospital, 1E1, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mitchell
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Harris
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: O'Connell
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Côté
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Vincent
authors.initials: V
authors.lastname: Biron
authors.affiliation: Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
authors.forename: Hadi
authors.initials: H
authors.lastname: Seikaly
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D003131:Combined Modality Therapy; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires