Conceptual Model Development to Understand the Pathway to Depression among Head and Neck Cancer Patients

background: Depression is more prevalent in cancer patients than previously thought and certain patient populations, such as those with head and neck cancers (HNC), may be at increased risk. Shared risk factors, such as smoking and alcohol consumption, put this particular cancer population at higher risk for depression. Additionally, HNC may be emotionally distressing because of physical disfigurement and treatment side-effects, as well as the social stigma that can accompany these cancers. Although many contributing factors in this population have been suggested, the pathway to how these factors influence depression development is unknown. The purpose of this study was to propose a conceptual model to understand the development of depression in HNC patients.

methods: We conducted literature reviews of existing conceptual models of depression among chronic disease patients and risk factors of depression in cancer patients. Factors that were related to HNC patients were included in the model in relation to both depression and the effects of depression on HNC outcomes.

results: The model pathways showed that both individual and contextual level factors can indirectly lead to depression by affecting social support and risk behaviors, or may directly affect depression outcomes. Additionally, depression diagnosis was also shown to impact treatment decisions and lead to poor survival outcomes.

implications: Depression has been associated with worse treatment outcomes and poorer quality of life in cancer patients. The resulting model can help guide future research in this and other cancer populations, and be used to develop targeted interventions for depression in cancer patients.