PSYCHOSOCIAL ISSUE IN
PATIENTS WITH HEAD AND
NECK CANCER
林口長庚醫院整外復健治療中心
吳芷萱、連淑惠、蘇尚文
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Outline
◦ Introduction
◦ Psychological Factors in HNC
1.
2.
3.
4.
5.
6.
7.
Depression / anxiety
Suicide
Body image
Fear of cancer recurrence
Personality differences
Social support and Interpersonal relations
Substance Dependence and Abuse
◦ Conclusion
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Introduction
◦Head and neck cancer (HNC)
◦ Affecting the paranasal sinus, nasal and oral cavities,
pharynx, and larynx.
◦ Face a life-threatening diagnosis, treatments results in
significant disfigurement and disruptions of essential
functioning. (Howren et al., 2013)
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Introduction-(cont.)
◦ Survival among patients with HNC has improved
significantly (Rodriguez, Adelstein., 2015; Pulte, Brenner., 2010).
◦ HNC: most emotionally and psychologically traumatic
cancer experiences (Bjorklund et al., 2010)
◦ Patients with HNC view outcomes related to their
appearance, energy, voice, and pain with similar
importance to survival (List et al., 2000)
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Psychological Factors in HNC –
1.Depression/Anxiety -(cont.)
◦ Prevalence of major depressive disorder (MDD) in patients
with HNC ranges from 11 to 52% (Sehlen et al., 2003; Paula et al., 2012)
◦ Incident depression in HNC is both caused by, and lead to,
complex psychosocial problems (Joshua et al., 2017)
◦ Inadequate social support
◦ Dissatisfaction with oncologic care providers and medical
information
◦ Substance abuse
◦ Inadequate coping skills
◦ Struggles with self-image
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Psychological Factors in HNC –
1.Depression/Anxiety -(cont.)
◦ Anxiety and depression in patients with head and neck cancer:
6-month follow-up study (Yi-Shan et al., 2016)
◦ Psychiatric morbidities at pretreatment, 3 and 6 months after treatment.
◦ Materials and methods:
◦ 106 patients with newly diagnosed HNC
◦ Assess HRQL : quality of life questionnaire of the European Organisation
◦ Anxiety : High rates of anxiety, but declined over time (27.3% →6.4%→ 3.3%).
◦ Depression :
◦ Prevalence rates from 8.5% →24.5% →14%
◦ Loss of sense, loss of speech, low libido, dry mouth, weight loss
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◦ Risk factors : Dysfunction in salivation, problems with eating and social contacts
Psychological Factors in HNC –
2.Suicide
◦ One national study of 1.3 million cancer patients even
found that HNC carried the highest risk of suicide
among cancer survivors. (Kendal, 2007)
◦ Quality-of-life issues associated with suicide
◦ Pain, disability, esthetic compromise and body image issues,
psychosocial function, anxiety, emotional distress, and
depression. (Osazuwa-Peters et al., 2016)
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Psychological Factors in HNC –
2.Suicide -(cont.)
◦ Incidence of Suicide in Patients With Head and Neck Cancer
(Kam et al., 2015)
◦ 350,413 patients with HNC recorded between 1973 and 2011.
◦ Suicide rate of 37.9/100,000 person-years.
◦ CONCLUSIONS
1. HNC have more than 3 times the incidence of suicide compared
with general US population.
2. Suicide rates: RT alone > Surgery alone
3. Highest suicide rates: Cancers of larynx and hypopharynx
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Psychological Factors in HNC –
3.Body image
◦Body image :
◦ One of the most universal and distressing psychosocial
issues due to frequent disfigurement and dysfunction
caused by HNC. (Joshua et al., 2017)
◦ Encompasses egocentric perceptions, feelings, and
satisfaction with appearance and bodily function
(Rhoten et al., 2013)
◦ Contributes to self-worth, self-confidence, and
participation and comfort in social interactions and
intimate relationships (Fingeret M., 2010)
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Psychological Factors in HNC –
3. Body image-(cont.)
◦ Fingeret and colleagues (2011)
◦ 280 HNC surgical patients at different stages regarding
dissatisfaction with body image and its relation to condition specific
HRQOL.
◦ >50% patients: frequent concern about changes in appearance
◦ 1/3 patients:
◦ They like additional resources to help cope with such concerns
◦ Self-reported dissatisfaction with body image predicted worse HRQOL.
◦ Katz et al (2003)
◦ Disfigurement was significantly related to depression in 82 patients
approximately two years removed from treatment.
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Psychological Factors in HNC –
4.Fear of cancer recurrence
◦Fear of cancer recurrence (FCR)
◦ Multidimensional construct
◦ Fear or worry (and related, dysfunctional behaviors) associated with the
possibility that one may be faced with another cancer diagnosis.
(Howren et al., 2013)
◦ FCR is a chief HNC patient concern affecting from half to more than
three-fourths of patients (Howren et al., 2013)
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Psychological Factors in HNC –
4. Fear of cancer recurrence-(cont.)
◦Ghazali and colleagues (2012) investigated
predictors of FCR.
◦ A prospective study of 189 posttreatment HNC patients
◦ 35% : experienced significant FCR
◦ Younger age, mood/anxiety issues were predictive of
significant FCR
◦ Disease-related and treatment-related factors were not
predictive of significant FCR
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Psychological Factors in HNC –
5.Personality differences
◦ Association of dispositional optimism with health outcomes
in HNC patients
 Allison et al (2000)
Prospective design - Dispositional optimism was positively related to several
HRQOL domains at both timepoints, including the global, role, cognitive, and
pain domains
 Kung et al (2006) : Optimism was unrelated to HRQOL.
 Yu and colleagues (2001)
No association between optimism measured at the conclusion of
treatment and HRQOL four months later in 211 Chinese HNC patients.
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Psychological Factors in HNC –
6.Social support and Interpersonal
relations
◦Social support
◦ Predicts improved HRQoL before and after treatment
among patients with HNC. (Howren et al., 2012)
◦ Incourages patient adherence to treatment and
rehabilitative measures. (Joshua et al., 2017)
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Psychological Factors in HNC –
6. Social support and Interpersonal
relations -(cont.)
◦ Interpersonal relations
◦ Depression, anxiety, symptoms of PTSD → Worse interpersonal
communication and partner intimacy. (Joshua et al., 2017)
◦ Impair verbal communication and facial expression → Expression of
feelings, fears, and needs becomes challenging → Anger, resentment,
frustration. (Badr et al.,2016; O’Brien et al., 2012)
◦ Visible disfigurement, sleep disturbance, xerostomia, and bad breath
→ impact expressions of partner intimacy and sexual health
(O’Brien et al., 2012)
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Psychological Factors in HNC –
7. Substance Dependence and Abuse
◦ Tobacco and/or alcohol use persists in up to 45%of
current users after HNC diagnosis (Pinto et al., 2011)
◦ Continued tobacco and/or alcohol use
◦ Worse oncologic outcomes and detrimental physical and
psychosocial health parameters (Howren et al., 2013)
◦ Continue to smoke → Worse survival, more frequent recurrence,
and nearly 50% chance of second primary cancer. (Joshua et al.,
2017)
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Psychological Factors in HNC –
7. Substance Dependence and Abuse -(cont.)
◦ Cigarette exposure in the home → Prolonged the time-to-quit.
(Kashigar et al., 2013)
◦ Novel evidence suggests self efficacy the degree to which they
feel inherently capable of succeeding in tobacco and/or alcohol
cessation, may be the strongest predictor of successful attempts
to quit after HNC diagnosis. (Joshua et al., 2017)
◦ Illness cognitions such as fear of cancer recurrence and
perceived degree to which substance use is causative in HNC
development and recurrence (illness self-blame) often play a
predominant role in cessation success.
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Conclusion
◦ Faced a life-threatening diagnosis, debilitating treatment,
and grueling functional rehabilitation programs,
individuals with HNC also cope with a barrage of insults to
psychosocial health.
◦ Distressing psychosocial issues in HNC patients
◦ Depression
◦ Suicidal ideation
◦ Continued use of tobacco and alcohol
◦ Interpersonal isolation and conflict
◦ Altered self-image, and diminished self-confidence
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Conclusion -(cont.)
◦Prevention, identification, and treatment of
psychosocial comorbidities are imperative.
◦Psychosocial interventions in the HNC clinic
◦ promises to improve QoL and alleviate psychosocial
distress.
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References
1. Joshua DS, Andrew GS, Michelle BR. Psychosocial Issues in Patients with Head and
Neck Cancer: an Updated Review with a Focus on Clinical Interventions. Curr
Psychiatry Rep. 2017 Sep;19(9):56.
2. Howren MB, Christensen AJ, Karnell LH, Funk GF. Psychological factors associated
with head and neck cancer treatment and survivorship: evidence and
opportunities for behavioral medicine. J Consult Clin Psychol. 2013;81(2):299–317.
3. Wu YS, Lin PY, Chien CY, et al. Anxiety and depression in patients with head and
neck cancer: 6-month follow-up study. Neuropsychiatr Dis Treat. 2016;12:1029–36.
4. Chen AM, Daly ME, Vazquez E, et al. Depression among longterm survivors of
head and neck cancer treated with radiation therapy. JAMA Otolaryngol Head
Neck Surg. 2013;139(9):885–9.
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References -(cont.)
5. Osazuwa-Peters N, Boakye EA,Walker RJ, et al. Suicide: a major threat to head
and neck cancer survivorship. J Clin Oncol. 2016;34(10):1151.
6. Kam D, Salib A, Gorgy G, et al. Incidence of suicide in patients with head and
neck cancer. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1075–81.
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Thanks for your attention
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