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Letters to the Editor
December 15, 2008

Misleading Report on the Prevention of Major Depression Among Patients With Head and Neck Cancer—Reply

Arch Otolaryngol Head Neck Surg. 2008;134(12):1345-1346. doi:10.1001/archotol.134.12.1345-b

In reply

We thank Coyne for the opportunity to clarify the issues that concern him. Coyne mentions a number of the limitations of our study that we addressed in detail in our article. We concur that this small pilot study is unable to offer any statistical certainty about the outcome of this approach.

We obviously have no control over how our findings have been perceived or reported in the medical or general press. We believe that the positive (and, perhaps in Coyne's case, negative) reactions to our preliminary data are related to the unique approach that we took to the enormous problem of depression in persons with cancer of the head and neck. Depression is very common in these patients (we quoted the literature range of 15%-40%, and we observed in our small study a rate of 50% on 1 measure of depression at 1 time point, hardly straining our credulity) and affects not only their quality of life but also, as we discussed, potentially their ultimate prognosis. Depression prevention is an ideal strategy in a disorder with such high rates of depression. Prevention as a strategy has recently been shown to be effective in other medical illnesses that are accompanied by high rates of depression, including stroke1 and macular degeneration.2 Whether prevention will be ultimately be found to be useful in the population with head and neck cancer is something that remains to be determined.