Panwar A, et al. - Authors assessed factors that may be related to the development of moderate or severe depression during treatment of head and neck cancer (HNC) in this randomized clinical trial. Findings suggested a probable association of baseline symptoms and initial radiotherapy-based treatment with the development of moderate or greater depression in patients with HNC. Pharmacologic prophylaxis of depression may be most beneficial for those patients exhibiting Quick Inventory of Depressive Symptomatology–Self Report (QIDS-SR) baseline scores of ≥ 2.

Methods

• Experts conducted a retrospective, ad hoc, secondary analysis of prospectively collected data from a randomized, double-blind, placebo-controlled clinical trial.
• They screened the patients at academic- and community-based tertiary care HNC centers from January 2008 to December 2011.
• Of 125 evaluable patients with stages II-IV HNC but without baseline depression, 60 were randomized to prophylactic antidepressant escitalopram oxalate and 65 to placebo at the time of the initial diagnosis.
• They conducted data analyses from May 2016 to April 2017.
• They measured depression outcomes using QIDS-SR scores (range of 0-27, with a score of ≥ 11 indicative of moderate or greater depression).
• They assessed the factors that may be associated with development of moderate or severe depression, including: patient demographics; cancer site and stage; primary treatment modality (surgery or radiotherapy); history of depression or other psychiatric diagnosis; previous treatment of depression or suicide attempt; family history of depression, suicide, or suicide attempt; and baseline score on the QIDS-SR and clinician-rated QIDS instruments.
• They stratified the participants by study site, sex, cancer stage (early [stage II] vs advanced [stage III or IV]), primary modality of treatment (radiotherapy with or without chemotherapy vs surgery with or without radiotherapy), and randomization to placebo or escitalopram and balanced within these strata.

Results

• The mean (SD) age of the 148 patients in the study population was 63.0 (11.9) years; 118 (79.7%) were men and 143 (96.6%) were white.
• In the evaluable population of 125 patients, among patients who did not receive prophylactic antidepressants, baseline QIDS-SR score and initial radiotherapy-based treatment were found to be related to the likelihood of developing moderate or greater depression during the study period, as suggested by the receiver operating characteristic analyses assessing the area under the curve for these two variables.
• Experts noted an improvement in the diagnostic sensitivity for identifying patients at risk of depression using the baseline QIDS-SR score to 100% at a threshold of two from 94% at a threshold of four.