Depression and Adherence in Head and Neck Cancer

You will be asked to fill out a questionnaire containing questions about your mood, coping with cancer, how closely you follow your treatment schedule, your thoughts, your demographic information (such as age and race), and your medical history. It should take between 25-35 minutes to complete the questionnaire. If you score as nondepressed on the questionnaire, you will be contacted again every week for 6 weeks during radiation treatment, to check for depression again. If you score as depressed during a later screening, you will then be asked additional questions about your symptoms, coping, and social support. It should take between 10-20 minutes to complete these additional questions.

If the answers to your questionnaire indicate that you may be depressed, you will be offered the intervention portion of the study. Only those participants who score as depressed on the questionnaire will be assigned to the intervention. You will then be informed of your test results, and provided with a list of community referrals. Whoever is responsible for your treatment, whether he or she is a M.D. Anderson physician, community referring physician, or both, will also be informed of these test results, and a note will be added to your medical record.

You will be asked to take part in 7 sessions with a trained doctoral-level psychologist or advanced clinical doctoral student under the supervision of a licensed psychiatrist. The first two sessions may be conducted in person, face to face, or may be conducted over the telephone. The remaining five sessions will be done over the telephone. These sessions will last between 30 and 45 minutes and will occur every week for seven weeks.

The 30-45 minute telephone sessions will use "cognitive-behavioral" techniques, a method proven to be effective in relieving depressive symptoms. Cognitive-behavioral techniques will teach you skills in relaxation and activity scheduling, as well as ways to recognize and fight negative thoughts. You will also be given a journal to record and practice ways of fighting depression. The intervention will include an educational component for your spouse/partner or caregiver on the nature of clinical depression. The spouse/caregiver will be given a booklet which explains facts about depressive disorders and helpful ways that they can support you. You may also be given over-the counter samples of toothpaste and oral products if approved by your doctor or dentist. You will also be given the use of a mini-food-blender to help you problem solve issues of eating during the course of the study. You will be asked to return the mini-food-blender at the end of the study.

If you participate in the intervention, upon completion, you will receive a short survey asking about your satisfaction with the intervention. After completing the first questionnaire, you may be contacted again to complete five follow-up questionnaires, at the beginning of radiation treatment, as well as, six and twelve weeks and again, six and twelve months after radiation treatment begins. The questionnaires will be similar to the first one but will also contain questions about any additional depression care you received while participating in the study or after the intervention. This information will include prescription of antidepressants, formal referral to psychiatric services, referral to support groups, and any depression care you received in addition to the intervention in this study. You will also be asked how closely you followed the swallowing exercises, your dental care habits, and your referrals to other sources in the community.