Western Kentucky University

Poster Title

Psychological Distress and Malnutrition Biomarkers are associated with Head and Neck Cancer Progression and Survival

Institution

Western Kentucky University

Abstract

Our data show that depressive symptoms predict greater likelihood of interruption and incomplete response to treatment in head and neck cancer (HNC). Given relationships between depression and appetite, these patients are at high risk for cachexia. We hypothesized that greater psychological symptoms and malnutrition biomarkers would be associated with increased weight loss, and poorer two-year disease-free (DFS) and overall survival (OS). Patients with primary HNC (N=98) completed distress, anxiety and depression measures. Pretreatment albumin and hemoglobin, ALT, AST, weight lost during treatment, and two-year follow-up data were collected. Hierarchical and Cox regressions adjusted for age, stage, site, and treatment tested hypotheses. Oropharyngeal (33.7%), laryngeal (17.3%), and oral (10.2%) cancers were included. Many patients reported clinically significant anxiety (42%) and/or depressive symptoms (33%). The vast majority demonstrated biomarker levels WNL, and N=65 demonstrated weight loss averaging 3.6kg. Anxiety, depressive symptoms, and malnutrition biomarkers did not relate to weight loss over the course of treatment. Anxiety was associated with poorer DFS (HR=1.124, 95% CI=1.005-1.258, p=.041), depressive symptoms were associated with poorer OS (HR=1.109, 95% CI=1.012-1.216, p=.027). Lower pretreatment hemoglobin was associated with poorer OS (HR=.740, 95%CI=.561-.977, p=.033). Depressive symptoms are associated with a greater likelihood of poorer short-term (treatment interruption and incomplete response) and long-term (OS) outcomes in HNC. Malnutrition biomarkers should be further examined to determine their predictive value. Future studies should also examine biological (e.g., inflammatory, immunologic) factors with the potential to mediate psychosocial symptoms and their relationship to tumor progression and survival. (Support: NCI R25-CA134283).

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Psychological Distress and Malnutrition Biomarkers are associated with Head and Neck Cancer Progression and Survival

Our data show that depressive symptoms predict greater likelihood of interruption and incomplete response to treatment in head and neck cancer (HNC). Given relationships between depression and appetite, these patients are at high risk for cachexia. We hypothesized that greater psychological symptoms and malnutrition biomarkers would be associated with increased weight loss, and poorer two-year disease-free (DFS) and overall survival (OS). Patients with primary HNC (N=98) completed distress, anxiety and depression measures. Pretreatment albumin and hemoglobin, ALT, AST, weight lost during treatment, and two-year follow-up data were collected. Hierarchical and Cox regressions adjusted for age, stage, site, and treatment tested hypotheses. Oropharyngeal (33.7%), laryngeal (17.3%), and oral (10.2%) cancers were included. Many patients reported clinically significant anxiety (42%) and/or depressive symptoms (33%). The vast majority demonstrated biomarker levels WNL, and N=65 demonstrated weight loss averaging 3.6kg. Anxiety, depressive symptoms, and malnutrition biomarkers did not relate to weight loss over the course of treatment. Anxiety was associated with poorer DFS (HR=1.124, 95% CI=1.005-1.258, p=.041), depressive symptoms were associated with poorer OS (HR=1.109, 95% CI=1.012-1.216, p=.027). Lower pretreatment hemoglobin was associated with poorer OS (HR=.740, 95%CI=.561-.977, p=.033). Depressive symptoms are associated with a greater likelihood of poorer short-term (treatment interruption and incomplete response) and long-term (OS) outcomes in HNC. Malnutrition biomarkers should be further examined to determine their predictive value. Future studies should also examine biological (e.g., inflammatory, immunologic) factors with the potential to mediate psychosocial symptoms and their relationship to tumor progression and survival. (Support: NCI R25-CA134283).