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A Longitudinal Study of Depressive Symptoms in Patients With Head and Neck Cancer Undergoing Radiotherapy

Astrup, Guro Lindviksmoen MSc, RN; Rustøen, Tone PhD, RN; Miaskowski, Christine PhD, RN; Paul, Steven M. PhD; Bjordal, Kristin PhD, MD

doi: 10.1097/NCC.0000000000000225

Background: Although patients with head and neck cancer are at increased risk for depressive symptoms compared with other cancer patients, few longitudinal studies have evaluated changes in and predictors of this symptom over time.

Objective: The aim of this study was to determine whether levels of depressive symptoms changed over time and whether specific demographic, clinical, symptom, or psychosocial characteristics were associated with depressive symptoms.

Methods: In a longitudinal study of patients with head and neck cancer, depressive symptoms were assessed with the Center for Epidemiologic Studies–Depression scale, from the initiation of radiotherapy and for 6 months after. Hierarchical linear modeling was used to evaluate for changes in as well as for potential predictors of interindividual differences in depressive symptoms.

Results: The severity of depressive symptoms increased during radiotherapy and then decreased over time. The portion of patients who reported clinically meaningful levels of depressive symptoms at each assessment ranged from 29% to 42%. Several known predictors of pretreatment severity of depressive symptoms (ie, physical symptoms, less social support, dissatisfaction with looks) were corroborated. In addition, having surgery before radiotherapy was associated with lower levels of depressive symptoms at initiation of radiotherapy.

Conclusion: A moderate proportion of patients with head and neck cancer reported levels of depressive symptoms that indicated the need for clinical evaluation. Several patient characteristics were associated with depressive symptoms.

Implications for Practice: Knowledge on prevalence, time course, and predictors of depressive symptoms from this study can be used to identify patients at higher risk for more severe depressive symptoms.

Author Affiliations: Department of Oncology, Division of Cancer Medicine, Surgery, and Transplantation (Ms Astrup and Dr Bjordal); Department of Research and Development, Division of Emergencies and Critical Care (Dr Rustøen); and Research Support Services (Dr Bjordal), Oslo University Hospital, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway (Dr Rustøen); School of Nursing, University of California, San Francisco (Drs Miaskowski and Paul); Institute of Clinical Medicine, University of Oslo, Oslo, Norway (Ms Astrup and Dr Bjordal).

The study was funded by the Norwegian Cancer Society. The PhD fellowship for G.L. Astrup was provided by the Regional Health Authority of South-Eastern Norway, and additional support was provided by The Norwegian Radium Hospital Foundation. Dr Miaskowski is supported by grants from the National Cancer Institute and the American Cancer Society.

The authors have no conflicts of interest to disclose.

Correspondence: Guro Lindviksmoen Astrup, MSc, RN, Oslo University Hospital, Radiumhospitalet, Pb 4953 Nydalen, 0424 Oslo, Norway (

Accepted for publication October 28, 2014.

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