title: Depression and Oropharynx Cancer Outcome.
abstract: BACKGROUND
  Studies have shown a modest relationship between depression and mortality in patients with cancer. Our study addressed methodological weaknesses in the literature by restricting the sample to patients with one cancer type, adjusting for factors known to affect outcome, and following up patients for a sufficient period.
  
  
  METHODS
  We prospectively followed patients newly diagnosed with squamous cell oropharyngeal cancer from the start of radiation therapy until death or until date of last clinical visit. All patients were optimally treated with radiation and sometimes chemotherapy. After adjusting for tumor stage, treatment, comorbidities, smoking, excessive alcohol use, and demographic factors, we assessed the effects of baseline self-reported depression on overall survival and recurrence.
  
  
  RESULTS
  One hundred thirty participants were followed for a median of 5 years. The average age was 56 years, and 83% were male. Eighteen participants died during the study and 15 experienced disease recurrence. Self-reported depression was associated with decreased overall survival duration (hazard ratio = 3.6, 95% confidence interval = 1.2-10.8) and disease recurrence (hazard ratio = 3.8, 95% confidence interval = 1.2-12.2) in multivariate analysis. In addition, smoking was associated with disease recurrence.
  
  
  CONCLUSIONS
  Patients with oropharyngeal cancer may benefit from depression screening and evidence-based treatments, if appropriate. Future studies are needed to determine whether depression is an independent prognostic factor of outcome and to elucidate biobehavioral mechanisms involved in patients with oropharyngeal cancer.
authors.affiliation: From the Departments of Behavioral Science (Shinn, Jethanandani, Basen-Engquist, Atkinson), Psychiatry (Valentine), Biostatistics (Fellman, Urbauer), Cardiology (Yusuf, Woods), Thoracic Medical Oncology (Kies), Gynecologic Oncology and Reproductive Medicine, Cancer Biology (Sood), Palliative Care (Carmack), Radiation Oncology (Morrison, Garden), and Head and Neck Cancer Surgery (Gillenwater, Sturgis), University of Texas MD Anderson Cancer Center, Houston, Texas; and Department of Cardiology (Lenihan), Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Eileen H
authors.initials: EH
authors.lastname: Shinn
authors.forename: Alan
authors.initials: A
authors.lastname: Valentine
authors.forename: Amit
authors.initials: A
authors.lastname: Jethanandani
authors.forename: Karen
authors.initials: K
authors.lastname: Basen-Engquist
authors.forename: Bryan
authors.initials: B
authors.lastname: Fellman
authors.forename: Diana
authors.initials: D
authors.lastname: Urbauer
authors.forename: Emma
authors.initials: E
authors.lastname: Atkinson
authors.forename: Syed Wamique
authors.initials: SW
authors.lastname: Yusuf
authors.forename: Daniel
authors.initials: D
authors.lastname: Lenihan
authors.forename: Myrshia L
authors.initials: ML
authors.lastname: Woods
authors.forename: Merrill S
authors.initials: MS
authors.lastname: Kies
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sood
authors.forename: Cindy
authors.initials: C
authors.lastname: Carmack
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.forename: Ann
authors.initials: A
authors.lastname: Gillenwater
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy / Q000821:virology; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy / Q000821:virology; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016896:Treatment Outcome