Mapping the mental health correlates of head and neck cancer: A systemic review and meta-analysis.

Abstract

6077 Background: Patients with head and neck cancer (HNC) present particularly high levels of mental health disorders. Yet the actual rate of relevant mental health symptoms and disorders, along with its determinants, remains unclear. Methods: A PRISMA/MOOSE-compliant systematic review and quantitative effects meta-analysis (PROSPERO: CRD42023441432) was conducted to determine the prevalence of depression, anxiety, distress, post-traumatic stress, insomnia and suicide among patients with HNC. MEDLINE, WebofScience, Cochrane Central Register, KCI-Korean Journal, SciELO, Russian Science Citation Index and Ovid/PsycINFO databases were searched from database inception to August 1, 2023. Secondary analyses were used to assess longitudinal trajectories of the samples over time. Results: 208 studies (n=713,527, median age 60.7; 25.5% female) were included. 19.5% patients reported depressive symptoms (95% confidence interval [CI]=17-21%), 17.8% anxiety symptoms (95%CI=14-21%), 34.3% distress (95%CI=29-39%), 17.7% post-traumatic symptoms (95%CI=6-41%) and 43.8% insomnia symptoms (95%CI=35-52%). Diagnostic criteria assessments revealed lower prevalence of disorders: 10.3% depression (95%CI=7-13%), 5.6% anxiety (95%CI=2-10%), 9.6% insomnia (95%CI=1-40%), and 1% post-traumatic stress (95%CI=0-84.5%). Pooled suicide incidence was 161.16 per 100,000 individuals per year (95%CI=82-239). A higher prevalence of anxiety was found in patients undergoing primary chemoradiation compared to surgery, and increased distress in smokers and advanced tumor staging. European samples exhibited lower prevalence of distress. Patients were more likely to be depressed after finishing radiation treatment. Conclusions: Patients with HNC exhibited a notable prevalence of mental health issues across various domains, where suicide emerged as a particular concern. There is a need for improved methods of assessment and intervention for these mental health concerns. Preventive interventions should be implemented before the start of radiation treatments. [Table: see text]