Date on Senior Honors Thesis


Document Type

Senior Honors Thesis

Degree Name



Psychological and Brain Sciences

Degree Program

College of Arts and Sciences

Author's Keywords

Head and Neck Cancer; Anxiety; NF-kB; GAD-7



Head and neck cancers (HNC) are associated with high rates of depression, which seems to affect overall survival. However, little attention has been paid to the effects of anxiety on overall survival, though anxiety has been shown to activate inflammatory pathways implicated in cancer symptom development and progression. Here it was hypothesized that higher pre-treatment anxiety levels in HNC patients would predict poorer overall two-year survival and a higher likelihood of subsequent HNC treatment failure. Additionally, we expected that the relationship between higher pre-treatment anxiety and poorer two-year overall survival would be mediated by treatment failure.


Patients (n = 242) reported anxiety symptomatology via the GAD-7 at treatment planning. Clinical data were reviewed at treatment completion, six-month, and two-year follow-up.


Higher pre-treatment anxiety levels were not associated with significantly poorer two-year overall survival (hazard ratio [HR], 1.032; 95% confidence interval [CI], 0.995 – 1.070, p = 0.094). The association between GAD-7 total scores (mean centered) and treatment response was also nonsignificant (B = 0.006; odds ratio [OR], 1.006; 95% CI, 0.959 – 1.055, p = 0.805). Therefore, criteria for the mediation of pre-treatment anxiety levels and two-year overall survival by treatment response were not met, and the presence of a mediating relationship could not be tested. However, when transformed into a categorical variable, a significant relationship between only the Moderate category of anxiety and two-year overall survival was shown (HR, 2.827; 95% CI, 1.209 – 6.609; p = 0.016). The associations between all other GAD-7 score categories and treatment response returned non-significant (Very Minimal odds ratio [OR] = 1.295; 95% confidence interval [CI] = 0.523 – 3.206, Mild OR = 1.280; CI = 0.482 – 3.397, Moderate OR = 1.477; CI = 0.551 – 3.959, Severe OR = 1.067; CI = 0.366 – 3.109).


Most head and neck cancer patients experience anxiety in the treatment planning phase, though only those who scored in the Moderate category of the GAD-7 appeared to have significantly poorer two-year overall survival. Screening anxiety with another questionnaire such as the State-Trait Anxiety Inventory may be beneficial to future studies assessing the relationship between anxiety and survival if multiple measurements are taken during and after treatment.

Lay Summary

This study was about anxiety’s effect on surviving cancer of the head or neck. Specifically, our hypotheses were that people with more anxiety would die sooner and would also respond worse to treatment. We also thought that how well an individual responded to treatment would influence the relationship between anxiety and survival. To test this, we examined a sample of 242 head and neck cancer patients who completed an anxiety questionnaire (the GAD-7) within two weeks of their diagnosis and tracked their response to treatment as well as if/when they died within two years after their diagnosis. We concluded that only individuals who possessed a Moderate amount of anxiety had a significantly poorer survival time, and that anxiety did not affect how well individuals responded to treatment.