JAMA Otol Logo Orlando 2013 AHNS Meeting Location
American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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Presentation: S032
Topic: Clinical - Prevention
Type: Oral Presentation
Date: Thursday, April 11, 2013
Session: 03:45 PM - 04:45 PM Basic Science
Authors: William Lydiatt, MD, Diane Bessette, PA, Kendra Schmid, PhD, Harlan Dayles, MS, William Burke, MD
Institution(s): Nebraska Medical Center and Nebraska Methodist Hospital

Major depressive disorder develops in up to half of patients undergoing treatment for head and neck cancer resulting in significant morbidity. Preventing depression during the course of cancer treatment may, thus, be of great benefit.

To determine whether prophylactic use of the antidepressant escitalopram would decrease the incidence of depression in subjects receiving primary therapy for head and neck cancer.

Design, Setting, Participants and Outcome Measures
A randomized, double-blind, placebo-controlled trial of escitalopram versus placebo was conducted in a group of non-depressed subjects diagnosed with head and neck cancer who were about to enter cancer treatment. Subjects were stratified by gender, site, stage (early versus advanced), and by primary modality of treatment (radiation versus surgery). The primary outcome measure was the number of participants who developed moderate or greater depression (scores on the Quick Inventory of Depressive Symptomology-Self Rated > 11).

From January 6, 2008 to December 28, 2011, 148 patients were randomized. Significantly fewer subjects receiving escitalopram developed depression (24.6% placebo vs. 10% escitalopram, stratified log-rank test p=0.04). A Cox proportional hazard regression model compared the two treatment groups after controlling for age, baseline smoking status, and stratification variables. The hazard ratio of 0.37 (95% CI: 0.14, 0.96) demonstrated an advantage of escitalopram (p=0.04). Patients undergoing radiotherapy as the initial modality were significantly more likely to develop depression than those receiving surgery (radiotherapy, compared to surgery group, HR 3.6 [95%CI: 1.38, 9.40, p=0.009]). Subjects in the escitalopram group who completed the study and were not depressed rated their overall quality of life as significantly better for 3 consecutive months following cessation of drug.

In non-depressed subjects undergoing treatment for head and neck cancer, prophylactic escitalopram reduced the risk of developing depression by more than 50%. In non-depressed subjects who completed the trial, quality of life was also significantly better for 3 consecutive months following cessation of the drug in the escitalopram group. These findings have important implications for management of head and neck patients.

Trial Registration: ClinicalTrials.gov Protocol Registration System, ID=NCT00536172, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S00017GX&selectaction=View&uid=U0000GD7&ts=6&cx=-a8i1r4

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