Optimal Interventions for Depression after Diagnosis of Head and Neck Cancer: A Systematic Review

Abstract

Objectives: Depression in head and neck cancer (HNC) patients is undertreated and under-recognized, yet has been shown to be present in up to 40% of patients. The objective in this study was to perform a systematic review of the literature regarding the optimal psychologic intervention for HNC patients with depressive symptomatology. Methods: A systematic review. PubMed, Medline, and ENCASE were searched in December 2013 for studies examining psychologic interventions in head and neck cancer patients. Results were screened by 2 independent reviewers. The level of evidence for each study and intervention were evaluated using criteria put forth by the Agency for Healthcare Research and Quality US Preventative Services Task Force. Subsequent analysis was then planned according to the criteria in the Cochrane Handbook for Systematic Reviews. Results: Eleven studies met inclusion criteria. Three studies were rated “good” for internal validity and 6 for external validity. Psychologic education and cognitive behavior therapy were evaluated by 8 studies, and antidepressant use was examined by 2 studies. Support group therapy was examined by 1 study. Meta-analysis was precluded by significant heterogeneity. Strongest evidence for successful treatment of depression was demonstrated by psycho-education. Conclusions: Evidence for the optimal psychologic intervention for depression in HNC patients is limited by the small number of studies examining treatment types, lack of high level of evidence in research methodology, and poor comparability of studies. Future studies should target a standardized assessment and diagnosis as well as evaluation of treatment type.