Reduced Mortality With Treatment of Anxiety and Depression Among Head and Neck Cancer Survivors

OBJECTIVE: This study seeks to evaluate the relationship between anxiety and/or depressive disorders and survival among head and neck cancer (HNC) survivors as well as the impact of treatment of mental health disorders on survival. METHODS: This is a retrospective cohort study utilizing deidentified electronic medical record data from TriNetX. Cohorts of adults were generated, including HNC survivors with and without a diagnosis of selected anxiety and/or depressive disorders. Among those with a selected anxiety and/or depressive disorder, cohorts were created for those with and without treatment of those disorders. Finally, Kaplan-Meier curves were utilized to compare the risk of mortality between groups after propensity score matching groups for relevant demographic and medical characteristics. RESULTS: Among 258,259 adult HNC survivors, 65,486 (25.4%) were diagnosed with an anxiety and/or depressive disorder. After propensity score matching between groups, adults with an anxiety and/or depressive disorder (HR: 1.07 95% CI: 1.05-1.09), an anxiety disorder (HR: 1.08 95% CI: 1.05-1.10), but not a depressive disorder (HR: 1.01 95% CI: 0.99-1.04) had a significantly higher risk of mortality than those without. Among those diagnosed with HNC and anxiety and/or depressive disorders, 39,923 (61.0%) received pharmacotherapy and/or psychotherapy. Those treated with pharmacotherapy and/or psychotherapy (HR: 0.94 95% CI: 0.91-0.97), pharmacotherapy (HR: 0.94 95% CI: 0.91-0.97), or psychotherapy (HR: 0.75 95% CI: 0.68-0.82) had a lower risk of mortality compared to those without. CONCLUSIONS: This retrospective cohort study suggests that a history of anxiety and/or depressive disorder is associated with worse survival among HNC survivors and that treatment of that anxiety and/or depressive disorder may ameliorate that increased risk of mortality.