Depressive symptoms and perceived stress in patients with head and neck cancer undergoing intensity-modulated...

Depressive symptoms and perceived stress are common mental health challenges among head and neck cancer (HNC) patients undergoing intensity-modulated radiation therapy (IMRT). This study examined longitudinal changes in these outcomes and identified associated risk factors.

A secondary analysis was conducted using data from a prospective longitudinal study of 197 patients, with four assessment points: pre-IMRT, end of IMRT, 6 months post-IMRT, and 1-year post-IMRT. Multivariable Generalized Estimating Equation (GEE) models were used to assess temporal changes and associated risk factors, adjusting for antidepressant use.

Depressive symptoms significantly increased from pre-IMRT to end-IMRT (B = 4.62, 95% CI [3.72, 5.53]), followed by non-significant declines at 6 months and 1 year. Perceived stress showed a non-significant increase at end-IMRT but decreased significantly at 6 months (B = -2.44, 95% CI [-3.80, -1.09]) and 1 year (B = -3.26, 95% CI [-4.88, -1.64]). Higher depressive symptoms were associated with unmarried status (B = 2.27, 95% CI [0.93, 3.61]) and percutaneous endoscopic gastrostomy (PEG) tube use (B = 1.72, 95% CI [0.57, 2.87]). Higher perceived stress was associated with younger age (B = -0.10, 95% CI [-0.18, -0.02]), female sex (B = 3.02, 95% CI [1.25, 4.80]), unmarried status (B = 4.42, 95% CI [2.62, 6.22]), and PEG tube use (B = 2.58, 95% CI [0.97, 4.19]).

Depressive symptoms and perceived stress worsened during IMRT, with partial recovery post-treatment. Patients who are unmarried, female, younger, or require PEG support are at elevated risk. These findings highlight the need for oncology nurses to implement routine psychosocial screening across the IMRT trajectory and targeted supportive interventions for vulnerable subgroups.