Background: Head and neck cancers (HNC) can have a devastating impact on activities of daily living such as swallowing along with residual facial disfigurement. Combined, these stressors predispose HNC patients to mental health disorders (MHDs), including anxiety and depression. While few studies have shown that mental health disorders such as depression strongly predict the first five-year survival and recurrence in HNC patients, none have been replicated in a large-scale study. Using MarketScan, a large private claims database, we explored the prevalence of MHDs in these patients. We hypothesize that the prevalence of MHDs is higher in patients with HNC after diagnosis and treatment as compared to before their diagnosis.
Objective: To describe the prevalence of MHD in HNC patients and potential associations using a large claims database.
Method: We performed a retrospective cohort study of head and neck cancer patients from the MarketScan database - a longitudinal database including demographics and clinical diagnosis of the patients. We used ICD-9 codes to identify mental health disorders in these patients. The diagnoses of head and neck cancer included hypopharyngeal, laryngeal, lip, mandibular, nasal cavity, nasopharynx, oral cavity, oropharyngeal, tongue and tracheal cancer as well as Kaposi sarcoma of the palate. McNemar’s tests for independence were used for comparing the frequency of MHDs pre- and post-diagnosis of HNC. Odds ratios were obtained by comparing prevalence of MHDs in patients with oral cavity cancer to other cancer sites in the head and neck.
Results: A study of 524,641 subjects showed that males between ages 55-64 from the southern US were most commonly affected by HNCs. Oral cavity cancers (24%) were the most common type of HNC based on the MarketScan data, followed by cancers of the tongue (17%) and larynx (16%). Of the various cancer sites, the odds ratio for MHD prevalence was significantly increased in patients with cancers of the trachea compared to those with cancers of the oral cavity (OR=2.09, 95% CI 1.8-2.3). The prevalence of MHDs in patients with HNC increased from 20% to 30% post-diagnosis. Specifically, women (51% vs 37%), patients with history of tobacco use (46% vs 32%) and alcohol use (7% vs 3%) were most likely to be diagnosed with MHD after HNC diagnosis. These comparisons were all statistically significant (p<0.0001).
Conclusion: The burdens of mental health disorders manifest in a decrease in survival rate of HNC patients. Although the baseline prevalence of 20% MHD pre-diagnosis was close to the national average (17.9% according to the National Survey on Drug Use and Health), it increased to 30% after HNC diagnosis. Women and patients with a history of tobacco and alcohol use were most susceptible to MHDs after HNC diagnosis. Individualized care must be provided by recognizing and addressing the particular sociodemographic variables affecting mental health of the patients with HNC.