(0632) Depression and Survival in Head and Neck Cancer Patients: A Systematic Review and Meta-analysis

Introduction: While previous studies have demonstrated a high incidence of depression in head and neck cancer (HNC) patients, there is still a lack of consensus regarding the impact that depression has on prognosis and overall survival (OS) in this patient population. The purpose of this study is to conduct the first comprehensive systematic review and meta-analysis examining the relationship between depression and OS in HNC with the goal of determining if timing of depression onset (i.e. pre vs post HNC treatment) affects OS. Additionally, we seek to determine if treatment of depression in this patient population impacts OS.

Methods: A comprehensive search of the literature was performed using Embase, PsycINFO, Web of Science, Ovid MEDLINE, and Ovid All EBM Reviews. Study selection was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) strategy. Studies met inclusion criteria if they reported OS and/or disease specific survival in depressed vs non depressed HNC patients. Random effects meta-analyses were used to analyze the compiled data.

Results: The literature search returned 4,195 articles for initial review of which 14 (9,408 participants) met criteria for inclusion and meta-analysis. Meta-analysis revealed that depression in HNC patients was associated with significant decrease in OS regardless of timing of depression onset. Additionally, while studies involving the management of depression in the HNC population are limited, it appears that early detection and treatment of depression improves outcomes in HNC patients.

Conclusions: Depression is common among HNC survivors and is associated with significantly decreased OS. Therefore, we propose that HNC patients undergo routine mental health screening via validated and easy to administer psychometric instruments to ensure early detection and treatment of depression.