Comorbidity Profile of Head and Neck Cancer Patients With and Without Depression

This population-based retrospective study used SEER-Medicare data from 2002-2010 to assess depression, comorbidity, and substance use in the elderly head and neck cancer population. Out of 3,533 head and neck cancer patients, 10.6% had depression diagnoses two years prior to cancer diagnosis, 8.9% were newly diagnosed with depression within one year after cancer diagnosis, and 44.5% of those with preexisting depression had an additional depression diagnosis within one year following cancer diagnosis. Comorbid conditions (p<0.0001) and substance use (p=0.0017) showed associations with depression prior to cancer diagnosis yet, no significant associations with incidence of depression in this head and neck cancer population. This study affirms the need for continual depression screenings in head and neck cancer patients and suggests the need for increased research into the burden of comorbid conditions and substance use within the head and neck cancer population. Chapter 1 – Introduction Head and neck cancers are a group of cancers within certain areas of the body, such as oral cavity, pharynx, larynx, nasal cavity, and paranasal sinuses. Although not the most common type of cancer, head and neck cancers account for about 4% of all cancers in the United States (American Society of Clinical Oncology (ASCO), 2017; National Cancer Institute NCI, 2017 (NCI), 2017). Each year, approximately 63,000 people are diagnosed with head and neck cancer, with diagnoses primarily occurring in individuals over the age of 50 (ASCO, 2017). It is estimated that about 14,000 people die each year from head and neck cancers, with men being 2-3 times more likely than women to develop these cancers (ASCO, 2017). The 5-year survival rate for head and neck cancers vary greatly, ranging from 35-80%, and mainly depend on location of cancer and stage of diagnosis, with an average 5-year survival rate across all locations of about 60% (ASCO, 2017). Later stage diagnosis is often associated with preexisting depression for cancer patients along with poorer survival rates and less definitive treatments (Baillargeon et al., 2011; Boyd et al., 2012). Depression following diagnosis is also associated with advanced stages of cancer and is highly prevalent in elderly populations (Spoletini et al., 2008; Parpa, Tsilika, Gennimata, & Mystakidou, 2015). Higher rates of depression are common in head and neck cancer patients, often related to disfigurement or dysfunctional eating and communication abilities, and depressive symptoms have been associated with lower survival rates (Haisfield-Wolfe, 2009; Zimmaro et al., 2018). Additionally, comorbidities are known to affect treatment plans for head and neck cancer patients and the severity of comorbidities has been associated with poorer outcomes and lower survival rates in this population (Piccirillo, 2000). Since patients diagnosed with head and neck cancer are particularly at risk for depression and other comorbidities before and after cancer diagnosis, it is important to understand the associations between additional comorbidities and depression in this population. However, little has been shown in the literature aimed at analyzing these connections. The purpose of this research report is to examine the associations between comorbidities and depression status in patients with head and neck cancers using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked data. The specific aims of this study are to: (1) estimate the prevalence of depression and common comorbidities before cancer diagnosis, (2) estimate the incidence of depression 1 year after cancer diagnosis, (3) compare comorbidity distributions between patients with and without depression, and (4) examine common comorbidities and other factors associated with prevalence and incidence of