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

ABSTRACT 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. Level of Evidence 3.