A new study published in JAMA Otolaryngology-Head & Neck Surgery has identified symptoms that may be associated with developing moderate or severe depression in patients with head and neck cancer.1 Baseline symptoms and initial radiotherapy-based treatment were both linked with increased risk for depression among patients who did not receive any prophylactic antidepressants.

“These associations are clinically meaningful because they permit clinicians to better recognize at-risk patients,” the study researchers wrote. “Moreover, these results may inform patients, their caregivers, and health care professionals when considering the risk of clinically relevant depression during treatment of HNC, the contribution of depression to survivorship experience and quality of life, and the potential strategies for prevention and mitigation of depression.”1

The retrospective study was a secondary analysis of data from a randomized, placebo-controlled trial. Enrolled patients were screened at academic- and community-based tertiary head and neck cancer centers between January 2008 and December 2011. The study included 125 patients with stage II to stage IV disease without baseline depression. Sixty of these patients were randomly assigned to receive prophylactic antidepressant escitalopram oxalate and 65 were assigned to receive placebo at initial diagnosis.

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The researchers measured depression with the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR).

Patient age, sex, rural compared with urban residence, educational level, clinical stage, cancer site, family or personal history of depression, or a history of suicide attempt were not associated with the development of depression.

Among the patients assigned placebo, initial treatment with primary radiotherapy and QIDS-SR score at baseline were both associated with the development of moderate or severe depression. The researchers then conducted multivariable receiver operator characteristic analyses using these 2 factors in the placebo group. These analyses showed the baseline QIDS-SR score (0.816, 95% CI, 0.696-0.935) and the score after initial radiotherapy-based treatment (0.681; 95% CI, 0.552-0.811) were associated with the likelihood of developing moderate or greater depression during the study period.


  1. Panwar A, Rieke K, Burke W, et al. Identification of baseline characteristics associated with development of depression among patients with head and neck cancer: a secondary analysis of a randomized clinical trial [published online October 4, 2018]. JAMA Otolaryngol Head Neck Surg. doi.10.1001/jamaoto.2018.2228