Objectives: The primary objective was to assess serial depression in patients undergoing major head and neck cancer surgery and determine if older adult patients have a greater change in depression compared to a younger cohort. A secondary objective was to determine predictors of depression.
Study Design: A single institution prospective cohort study
Methods: Patients 50 years and older undergoing head and neck cancer surgery were recruited to undergo serial depression assessments (baseline/pre-operative and 3, 6, and 12 month post-operative) using the geriatric depression scale from the Regional Geriatric Program of Metropolitan Toronto. Patients also completed serial quality of life (QOL) assessments including the Vulnerable Elders Survey (VES), Lawton-Brody Questionnaire (measure of activities of daily living), Fried’s Frailty Index, and Bradburn scale of psychological well-being at the same time points. The primary outcome measure was depression score. Older adult patients are defined as age 65 and older (65+). The primary outcome measure was QOL scores for each assessment. Predictor variables were analyzed using logistic regression model and linear regression model for univariable analysis. Multivariable analysis was performed on each endpoint separately based on a backward selection algorithm. The multivariable models were created to select covariates with p < 0.05. Odd ratios (OR) and regression coefficients were provided with 95% confidence interval (CI).
Results: A total of 274 patients completed baseline and serial post-operative depression and QOL assessments. Older adult patients had significantly lower depression scores compared to a younger cohort at 3, 6, and 12 months post-operatively. Older adult patients had increased depression scores from baseline at 3 and 6 months after surgery, but a return to baseline 12 months post-operatively. The younger cohort had persistently elevated depression scores up to 12 months post-operatively with no return to baseline. Decreased QOL measured by the VES, Lawton-Brody, Fried’s Frailty Index, and Bradburn scale were predictors of depression score for both age groups at all time points studied. Tumor site also predicted depression with higher depression scores in patients with neoplasms of the oral cavity, oropharynx, larynx and hypopharynx as compared to skin, thyroid, and salivary gland. Surgical complications were a predictor of depression at the 3 month post-operative time point.
Conclusions: Younger head and neck patients have higher depression scores that remain persistently elevated post-operatively compared to older adult patients. Post-operative QOL, tumor site, and surgical complications predict depression. Understanding predictors of depression may help identify patients who would benefit from pre-operative and post-operative counseling and pharmacotherapy for depression.