Prevalence of Mental Disorders Higher in Patients With Head, Neck Cancers After Cancer Diagnosis

Patients with cancers of the head and neck are more likely to have an increased prevalence of mental health disorders after their cancer is diagnosed compared with the general population, according to a report published today in JAMA Otolaryngology-Head and Neck Surgery.

There appears to be an especially strong association between mental health disorders and cancers of the trachea. Additionally, patients who received multimodal therapy—radiotherapy, chemotherapy, and/or surgery—have a higher risk of developing mental health disorders compared with those who receive only surgery, according to the report.

“High mortality and morbidity associated with HNCs [head and neck cancers] may predispose these patients to MHDs [mental health disorders],” wrote Neerav Goyal, M.D., M.P.H., of Pennsylvania State University and colleagues. “In addition, morbidity is associated with the treatment.”

Goyal and colleagues analyzed data from the Truven Health Market Scan Commercial Claims and Encounters database from January 1, 2005, through December 31, 2014. They tracked diagnostic codes from ICD-9-CM associated with head and neck cancers and mental health disorders. Head and neck cancers included cancer of the lip, tongue, oral cavity, oropharynx, nasopharynx, hypopharynx, nasal cavity and sinus, larynx, trachea, mandible, Kaposi sarcoma of the palate, and malignant neoplasm of the head and neck. Mental health disorders included episodic mood disorders, including depression, anxiety, nonalcohol drug dependence, adjustment reaction, and depressive disorder not otherwise specified.

The researchers measured the prevalence of mental health disorders and compared points before and after the diagnosis of head and neck cancers. In this cohort study of 52,641 patients with a diagnosis of head and neck cancer, the proportion with mental health disorders at baseline was 20.6% compared with the national average of 17.9%, as estimated by the National Survey on Drug Use and Health. After diagnosis, the prevalence rose to 29.9%. Patients with tracheal cancers had twice the odds of developing mental health disorders compared with patients with oral cavity cancer.

A total of 15.2% of the cohort received radiotherapy, chemotherapy, and surgery; 12.9%, radiotherapy and surgery; and 2.9%, chemotherapy and surgery. Patients who received all three treatments were more likely to develop mental health disorders than those who had only surgery.

Patients with head and neck cancer should be monitored for mental health issues, Goyal and colleagues wrote. “Our results further support the importance of addressing psychosocial needs in routine treatment discussions.”

For related information, see the Psychiatric News article “Researchers Look at Improving Well-Being of Families Affected by Cancer.”

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Chronic Sinusitis Linked to Depression, Anxiety, Study Finds

People who have chronic rhinosinusitis (commonly referred to as chronic sinusitis and characterized by inflammation of nasal passages lasting more than 12 weeks) may be more likely to have depression and anxiety, according to a study published yesterday in JAMA Otolaryngology–Head & Neck Surgery.

Jong-Yeup Kim, M.D., Ph.D., of Hallym University College of Medicine, in South Korea and colleagues analyzed the health insurance records of 16,244 South Korean patients who received inpatient and outpatient care for chronic rhinosinusitis from January 2002 through December 2004. Each patient was tracked until December 31, 2013, or until the occurrence of depression and anxiety. The researchers then compared the rates of depression and anxiety in this group with those of 32,448 patients who did not have chronic rhinosinusitis in that period.

During the follow-up period, there were 24.2 incidences of depression per 1,000 person-years in the chronic rhinosinusitis group, compared with 16 in the control group. There were 42.2 incidences of anxiety per 1,000 person-years in the chronic rhinosinusitis group, compared with 27.8 in the control group.

In their discussion, the researchers noted that although people with chronic rhinosinusitis have higher rates of depression and anxiety, the relationship between chronic rhinosinusitis and these conditions remains unclear: “Despite its clinical importance, the causal association between [chronic rhinosinusitis] and psychiatric comorbidities is not fully understood. For example, whether depression and anxiety amplify the symptoms of [chronic rhinosinusitis] or whether these conditions are the consequence of [chronic rhinosinusitis] is unknown,” they wrote.

In an accompanying editorial, Edward D. McCoul, M.D., M.P.H., of the Ochsner Clinic in New Orleans noted that it may be helpful for physicians to keep depression and anxiety in mind when treating patients with chronic rhinosinusitis.

“Given the current state of knowledge, the physician may choose to screen patients with newly diagnosed [chronic rhinosinusitis] for the presence of depression or anxiety disorders. Brief, patient-reported questionnaires are a low-cost measure that may reduce morbidity in the long term and improve the success of treatments directed at [chronic rhinosinusitis],” he wrote.

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