Depression as a predictor of postoperative functional performance status (PFPS) and treatment adherence in head and neck cancer patients: a prospective study
Depression as a predictor of postoperative functional performance status (PFPS) and treatment adherence in head and neck cancer patients: a prospective study
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DOI：
10.1186/s40463-015-0092-4
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发表时间：
2015-09-18
影响因子：
3.4
通讯作者：
Seikaly, Hadi
中科院分区：
文献类型：
--
作者：
Barber, Brittany;Dergousoff, Jace;Seikaly, Hadi
背景：头颈癌（HNC）是一种使人衰弱的疾病，部分原因是它对功能的影响，包括语言，吞咽和美容。以前关于HNC抑郁症的研究主要集中在人口统计学预测因素、发病率和生活质量研究。然而，缺乏客观地解决HNC患者的抑郁症状及其对治疗后功能表现状态的影响的研究。本研究的目的是评估术前抑郁症状（PDS）和术后功能状态（PFPS）之间的关系，除了其他预测的康复和survival.Methods：一项前瞻性队列研究进行了阿尔伯塔大学，包括所有新的成人HNC患者接受手术作为主要治疗HNC从2013年5月至2014年1月。术前2周采用抑郁症状快速调查表（QIDS）问卷测量基线抑郁症状，术后12个月采用癌症治疗功能评估-头颈部（FACT-HN）量表评估PFPS。次要结局包括辅助治疗的完成、麻醉剂依赖、有害习惯的恢复、失访和住院时间（LOHS）。使用Mann-Whitney和Fischer精确统计分析评估正常轻度和中度重度QIDS组之间的差异。轻度和中重度PDS分别为35.2%和18.3%。12个月时，中重度组的FACT-HN评分显著较低（p = 0.03）。中重度组12个月时FACT-HN评分<50%的风险比（RR）为5.66。此外，在中重度组中观察到辅助治疗完成率显著较低（p = 0.03）、麻醉药依赖发生率显著较高（p = 0.004）和LOHS显著较高（24天vs. 18天; p = 0.02）。两组之间的失访率无显著差异（p = 0.64）。结论：手术治疗的HNC患者PDS的发生率和严重程度较高（53.5%）。中重度PDS患者PFPS显著降低，麻醉剂使用增加，辅助治疗完成率降低，LOHS延长。应密切监测HNC患者的抑郁症状。
Background: Head and neck cancer (HNC) is a debilitating disease due in part to its effects on function, including speech, swallowing, and cosmesis. Previous studies regarding depression in HNC have focused on demographic predictors, incidence, and quality of life studies. There is, however, a paucity of studies that objectively address depressive symptoms in HNC patients and the resultant effects on post-treatment functional performance status. The aim of this study was to assess the relationship between preoperative depressive symptoms (PDS) and postoperative functional performance status (PFPS), in addition to other predictors of rehabilitation and survival.Methods: A prospective cohort study was undertaken at the University of Alberta, including all new adult HNC patients undergoing surgery as primary therapy for HNC from May 2013 to January 2014. Baseline depressive symptoms were measured on the Quick Inventory of Depressive Symptoms (QIDS) questionnaire 2 weeks preoperatively and PFPS was assessed 12 months postoperatively on the Functional Assessment of Cancer Therapy-Head & Neck (FACT-HN) scale. Secondary outcomes included completion of adjuvant therapy, narcotic dependence, return to detrimental habits, loss of follow-up, and length of hospital stay (LOHS). Differences between the Normal-Mild and Moderate-Severe QIDS groups were assessed using Mann-Whitney and Fischer Exact statistical analyses.Results: Seventy-one patients were included in the study. Mild and Moderate-Severe PDS were 35.2 % and 18.3 %, respectively. Significantly lower FACT-HN scores were noted in the Moderate-Severe group at 12 months (p = 0.03). The risk ratio (RR) for FACT-HN score < 50 % at 12 months in the Moderate-Severe group was 5.66. In addition, significantly lower completion of adjuvant treatment (p = 0.03), significantly higher incidence of narcotic dependence (p = 0.004), and significantly higher LOHS (24 days vs. 18 days; p = 0.02) was observed in the Moderate-Severe group. There was no significant difference in loss of follow-up between the 2 groups (p = 0.64).Conclusions: The incidence and severity of PDS in HNC patients treated with surgery is high (53.5 %). Patients with Moderate-Severe PDS have significantly decreased PFPS, increased narcotic use, decreased completion of adjuvant therapy, and a longer LOHS. HNC patients should be monitored closely for depressive symptoms.