Depression & Adherence in Head and Neck Cancer

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DESCRIPTION (provided by applicant): The primary purpose of the proposed research is to develop and pilot test an in-home intervention for depression in depressed oropharyngeal cancer patients receiving radiation treatment. The intervention will be comprised of ten sessions, the bulk of which will be delivered over the telephone, supplemented with a cognitive behavioral structured journal. The pilot intervention will also apply cognitive-behavioral techniques to other issues relevant to this patient population, namely alcohol dependence, where relevant, in order to strengthen the depressed patient's support system, the patient's partner or caregiver will also be offered a psychoeducational component on the nature, course, and treatment for depression. A secondary purpose is to determine whether improvement in depression is related to oropharyngeal cancer patient's adherence to rehabilitative regimens, including swallowing exercises to prevent fibrosis of musculature and maintain normalcy of diet, and oral hygiene routines to prevent infections in the oral cavity and osteoradionecrosis. This feasibility study will use a one-group prospective design following 40 depressed oropharyngeal patients from the beginning of radiation treatment until twelve weeks later. Two follow-up assessments are planned, six weeks after baseline when the intervention will be completed, and again six weeks later. Patients' recruitment and refusal rates, satisfaction, questionnaire completion rates, and dropout will be measured. An inferential analysis testing the efficacy of the intervention in reducing depression will compare pre-and post-levels of depression. Secondary outcome variables will include self-control, as specified in Rehm's model of depression and quality of life. Pain, fatigue, and social support will be tested as mediators of the intervention's potential effect on depression levels.