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Few head and neck cancer survivors seek mental help

By Kathryn Doyle

NEW YORK (Reuters Health) - Survivors of cancers of the head and neck, including those of the tongue and thyroid, often suffer from depression but rarely seek treatment, according to a new study.

Doctors are increasingly recognizing depression in cancer survivors, according to lead author Dr. Allen M. Chen, though it's still unclear exactly how common mental health issues are following cancer treatment.

"The results of our study suggest that survivors of head and neck cancer are at significantly elevated risk of developing mental health problems," Chen, a radiation oncologist at the David Geffen School of Medicine in Los Angeles, told Reuters Health.

That could be because those particular cancers and their treatments have physical side effects leading to trouble swallowing or speaking, as well as social isolation, and patients tend to have a history of alcohol or smoking, he said.

For the study, Chen and his coauthors analyzed data from brief questionnaires about mood given to 211 head and neck cancer survivors at one, three and five years after their radiation treatment ended.

The researchers had excluded patients with diagnosed depression or use of antidepressant medications before cancer treatment, so as to focus on mental health problems arising after treatment.

They found that depression was common but did seem to decrease over time.

One year after treatment, 17 percent of patients reported feeling "somewhat" or "extremely" depressed, which dropped to 15 percent at three years and 13 percent at five years post-treatment.

Depression was more common among patients who needed tracheostomy tubes or stomas to breathe, gastronomy tubes to eat and those who continued smoking post-treatment, according to the results in JAMA Otolaryngology-Head and Neck Surgery.

A small percentage of the most depressed patients reported using antidepressants or undergoing psychotherapy at one and three years after treatment, but that dropped to zero percent at five years after treatment.

"The fact that patients are not receiving treatment for their depression is alarming and points to the need for greater screening and treatment in (head and neck cancer) settings, as many of these patients may be too sick to attend appointments in more traditional mental health settings," said Sonia Duffy, who researches quality of life among head and neck cancer patients at the Department of Veterans Affairs center for clinical management research in Ann Arbor, Michigan.

A landmark study in 2006 found that suicide risk among head and neck cancer survivors was four times that of the general population, and increases the more advanced the disease.

Though many providers have been taught to screen and refer for depression, it is often overlooked in busy oncology practices where diagnosis and treatment are the main focus, said Duffy, who was not involved in the study.

She noted that tubes for breathing and digestion were linked to depression, which makes sense since they may exclude a patient from talking and eating, which are both important social activities.

About three percent of the cancers in the U.S. occur in the head or neck, and those are more common among men and people over age 50, according to the National Cancer Institute.

Most cancer survivors are not offered mental health assistance, Chen said.

Physicians should recognize that just because a patient is cured of their head and neck cancer doesn't mean they are without problems, he said.

"More resources dedicated to screening and treatment of depression and targeting this population are needed," he said, especially since head and neck cancers are being cured at a higher rate than ever before.

SOURCE: http://bit.ly/14zrn7v JAMA Otolaryngology-Head and Neck Cancer, online August 15, 2013.

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