Gaps in Depression Symptom Management for Patients With Head and Neck Cancer

Abstract

ObjectiveTo understand practice patterns and identify care gaps within a large‐scale depression screening program for patients with head and neck cancer (HNC).Study DesignRetrospective cohort study.MethodsThis 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.ResultsOf 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.ConclusionA 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.Level of Evidence3 Laryngoscope, 133:2638–2646, 2023