Depression Among Long-term Survivors of Head and Neck Cancer Treated With Radiation Therapy
Depression Among Long-term Survivors of Head and Neck Cancer Treated With Radiation Therapy
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DOI：
10.1001/jamaoto.2013.4072
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发表时间：
2013-09-01
影响因子：
7.8
通讯作者：
Farwell, D. Gregory
中科院分区：
文献类型：
--
作者：
Chen, Allen M.;Daly, Megan E.;Farwell, D. Gregory
重要性 头颈癌的诊断和随后的治疗可能会对心理社会功能产生潜在的破坏性影响。尽管头颈癌放射治疗 (RT) 对身体的长期不良影响已得到充分描述，但评估治疗后心理社会功能的研究相对较少。 目的 确定接受放疗治疗后返回随访的头颈癌幸存者中自我报告的抑郁症患病率。 设计、环境和参与者 对 211 名综合癌症中心患有头颈鳞状细胞癌的患者进行横断面分析，这些患者之前接受过放疗，并且接受过放疗。至少 1 年随访后无疾病。有情绪障碍病史、过去使用过心理健康服务、或者以前或当前使用过抗抑郁药或抗焦虑药（不包括安眠药物）的患者被明确排除在外。 干预措施 华盛顿大学生活质量工具 (UW-QOL) 是一份简短的、之前经过验证的自填问卷，用于分析抑郁症发生率。 主要结果和测量 UW-QOL 的评分为 0、25、50、 75 个和 100 个情绪主观反应分别为“极度抑郁”、“有些抑郁”、“心情不好或抑郁”、“一般好”和“优秀”。 结果 治疗后 1 年、3 年和 5 年的平均情绪得分没有差异，得分分别为 52.0、55.7 和 62.1。在 1 年、3 年和 5 年时，报告自己情绪“有些抑郁”或“极度抑郁”的患者比例分别为 17%、15% 和 13%。与 RT 后抑郁显着相关的变量包括气管造口管或喉造口的存在 (P = .01)、胃造口管依赖 (P = .01) 以及随访时继续吸烟 (P < .001)。在1年、3年和5年时报告自己情绪“有些抑郁”或“极度抑郁”的患者中，当时使用抗抑郁药物的比例分别为6%、11%和0%。积极接受或寻求心理治疗和/或咨询的患者的相应比例分别为 3%、6% 和 0%。 结论和相关性 尽管头颈癌患者在放疗后的抑郁症发生率相对较高，但心理健康服务的利用严重不足。
IMPORTANCE The diagnosis and subsequent treatment of head and neck cancer can have a potentially devastating impact on psychosocial functioning. Although the long-term physical adverse effects of radiation therapy (RT) for head and neck cancer have been well described, relatively few studies have evaluated psychosocial functioning after treatment.OBJECTIVE To determine the prevalence of self-reported depression among survivors of head and neck cancer returning for follow-up after being treated with RT.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis among 211 comprehensive cancer center patients with squamous cell carcinoma of the head and neck, who had been previously treated with RT and were disease-free with at least 1 year of follow-up. Patients with a history of mood disorder, use of mental health services in the past, or previous or current use of antidepressants or anxiolytics, excluding sleep medications, were specifically excluded.INTERVENTIONS The University of Washington Quality of Life instrument (UW-QOL), a brief, previously validated, self-administered questionnaire, was used to analyze rates of depression.MAIN OUTCOMES AND MEASURES The UW-QOL assigned scores of 0, 25, 50, 75, and 100 subjective responses of mood being "extremely depressed," "somewhat depressed," "neither in a good mood or depressed," "generally good," and "excellent," respectively.RESULTS The mean mood score did not differ at 1, 3, and 5 years after treatment, with scores of 52.0, 55.7, and 62.1, respectively. The proportion of patients who reported their mood as "somewhat depressed" or "extremely depressed" was 17%, 15%, and 13% at 1, 3, and 5 years, respectively. Variables that were significantly associated with post-RT depression included the presence of tracheostomy tube or laryngeal stoma (P = .01), gastrostomy tube dependence (P = .01), and continued smoking at the time of follow-up (P < .001). Among the patients reporting their mood as either "somewhat depressed" or "extremely depressed" at 1, 3, and 5 years, the proportion using antidepressants at the time was 6%, 11%, and 0%, respectively. The corresponding proportion of patients actively undergoing or seeking psychotherapy and/or counseling was 3%, 6%, and 0%, respectively.CONCLUSIONS AND RELEVANCE Despite a relatively high rate of depression among patients with head and neck cancer in the post-RT setting, mental health services are severely underutilized.