Depressive symptoms in relation to overall survival in people with head and neck cancer: A longitudinal cohort study

Femke Jansen*, Irma M Verdonck-de Leeuw, Pim Cuijpers, C René Leemans, Tim Waterboer, Michael Pawlita, Chris Penfold, Steven J Thomas, Andrea Waylen, Andrew R Ness

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

30 Citations (Scopus)
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OBJECTIVE: To investigated the relation between pre-treatment depressive symptoms (DS) and the course of DS during the first year after cancer diagnosis, and overall survival among people with head and neck cancer (HNC).

METHODS: Data from the Head and Neck 5000 prospective clinical cohort study were used. DS were measured using the Hospital Anxiety and Depression Scale (HADS) pre-treatment, at 4 and 12 months follow-up. Also socio-demographic, clinical, lifestyle and mortality data were collected. The association between pre-treatment DS (HADS-depression>7) and course (never DS, recovered from DS, or persistent/recurrent/late DS at 12 months follow-up), and survival was investigated using Cox regression. Unadjusted and adjusted analyses were performed.

RESULTS: In total, 384 of the 2,144 persons (18%) reported pre-treatment DS. Regarding DS course, 63% never had DS, 16% recovered, and 20% had persistent/recurrent/late DS. People with pre-treatment DS had a higher risk of earlier death than people without DS (Hazard Ratio (HR) =1.65; 95% confidence interval (CI) 1.33-2.05), but this decreased after correcting for socio-demographic, clinical, and lifestyle-related factors (HR=1.21; 95%CI 0.97-1.52). Regarding the course of DS, people with persistent/recurrent/late DS had a higher risk of earlier death (HR=2.04; 95%CI 1.36-3.05), while people who recovered had a comparable risk (HR=1.12; 95%CI 0.66-1.90) as the reference group who never experienced DS. After correcting for socio-demographic and clinical factors, people with persistent/recurrent/late DS still had a higher risk of earlier death (HR=1.66; 95%CI 1.09-2.53).

CONCLUSIONS: Pre-treatment DS and persistent/recurrent/late DS were associated with worse survival among people with HNC.

Original languageEnglish
Pages (from-to)2245-2256
Number of pages12
Issue number9
Early online date21 Jun 2018
Publication statusPublished - Sept 2018


  • cancer
  • depression
  • depressive symptoms
  • head and neck cancer
  • mortality
  • oncology
  • survival


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  • NIHR BRC Nutrition

    Ness, A. R.


    Project: Research, Parent

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