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Gaps in depression symptom management for patients with head and neck cancer

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Objective — To understand practice patterns and identify care gaps within a large-scale depression screening program for patients with head and neck cancer (HNC).


Study Design
— Retrospective cohort study.


Methods
— This was a population-based study of adults diagnosed with a HNC between January 2007 and October 2020. Each patient was observed from time of first symptom assessment until end of study date, or death. The exposure of interest was a positive depressive symptom screen on the Edmonton Symptom Assessment System (ESAS). Outcomes of interest included psychiatry/psychology assessment, social work referral, or palliative care assessment. Cause specific hazard models with a time-varying exposure were used to investigate the exposure-outcome relationships.


Results
— Of 14,054 patients with HNC, 9016 (64.2%) reported depressive symptoms on at least one ESAS assessment. Within 60 days of first reporting depressive symptoms, 223 (2.7%) received a psychiatry assessment, 646 (7.9%) a social work referral, and 1131 (13.9%) a palliative care assessment. Rates of psychiatry/psychology assessment (HR 3.15 [95% CI 2.67–3.72]), social work referral (HR 1.83 [95% CI 1.64–2.02]), and palliative care assessment (HR 2.34 [95% CI 2.19–2.50]) were higher for those screening positive for depression. Certain patient populations were less likely to receive an assessment including the elderly, rural residents, and those without a prior psychiatric history.


Conclusion
— A high proportion of head and neck patients report depressive symptoms, though this triggers a referral in a small number of cases. These data highlight areas for improvement in depression screening care pathways.

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Citation

Noel CW, Sutradhar R, Chan WC, Fu R, Philteos J, Forner D, Irish JC, Vigod S, Isenberg-Grzeda E, Coburn NG, Hallet J, Eskander A. Laryngoscope. 2023; 133(10):2638-46. Epub 2023 Feb 7.

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