{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T19:29:26Z","timestamp":1778182166748,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Otolaryngology - Head &amp; Neck Surgery"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Importance:<\/jats:title>\n                    <jats:p>Depression and anxiety affect a significant portion of head and neck cancer (HNC) patients. Furthermore, depression has been shown to result in decreased survival and worse functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The purpose of this study is to determine the prevalence of depression and anxiety in a cohort of HNC patients at all subsites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>This is a retrospective review of prospectively gathered data in a cohort of patients aged 18\u2009years of age and over, diagnosed with HNC, between August 2011 and December 2017, treated at the Princess Margaret Cancer Centre in Toronto, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/Participants:<\/jats:title>\n                    <jats:p>Adult Patients with a new diagnosis of HNC treated at the Princess Margaret Cancer Center\/University Health Network between August 2011 and December 2017 were included in the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposures:<\/jats:title>\n                    <jats:p>Patients were initially screened using the Direct Assessment and Response Tool (DART), which includes the Edmonton Symptom Assessment Scale (ESAS) to identify psychosocial distress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures:<\/jats:title>\n                    <jats:p>If positive on DART, patients were then asked to complete the Generalized Anxiety Disorder 7-Item Scale and the Patient Health Questionnaire-9. Associations with anxiety\/depression and variables were assessed using univariate and multivariate logistic regression<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 586 patients were included in our study. The median age of the group was 60 (22-89\u2009years), with a male predominance (78.2%). Most patients (78.8%) had advanced disease at diagnosis. The oropharynx was the most common site (46.5%). The prevalence of depression and anxiety was 13.1% and 9.9%, respectively. Multivariate analysis showed that nonmarried status, non-white ethnicity, disease progression, lower income, and increased out-of-pocket costs were associated with depression. Definitive surgery, ECOG \u22651, and lower income were associated with anxiety. Disease stage, smoking\/drinking history, and HPV status were not associated with anxiety\/depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A portion of patients are at higher risk of developing sustained depression and anxiety at 12\u2009months following treatment, which may be predicted early, facilitating early mental health intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance:<\/jats:title>\n                    <jats:p>Identifying factors associated with depression and anxiety in HNC patients will aid in providing early intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19160216251398771","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T10:50:47Z","timestamp":1773917447000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Factors and Income Status are Associated with Depression and Anxiety in Head and Neck Cancer Patients"],"prefix":"10.1177","volume":"55","author":[{"given":"Ashok R.","family":"Jethwa","sequence":"first","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catriona M.","family":"Douglas","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, Scotland, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrina","family":"Hueniken","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Bayley","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shao Hui","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9062-3719","authenticated-orcid":false,"given":"Douglas","family":"Chepeha","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3791-4925","authenticated-orcid":false,"given":"Leba M.","family":"Sarkis","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David 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