Disfigurement and Mental Health in Head and Neck Cancer

Abstract

Objective: Evaluate the relationship between physician-rated patient disfigurement and mental health status and quality of life variables in a 1-year posttreatment head and neck cancer population.

Method: Cross-sectional study, academic, tertiary referral center. One hundred fifty patients with a diagnosis of head and neck cancer at least 1 year status posttreatment completed a series of mental health and quality of life intake questionnaires. A single physician completed an observer-rated disfigurement scale for all patients.

Results: Racial stratification included: 61% Caucasian, 33% Hispanic, 4% African American, and 2% other. Gender stratification included: 69% male and 31% female. Mean age: 63 (range 20-89). Thirteen percent of the patient population was noted to have untreated depression/anxiety, 100% of which had undergone some type of surgical intervention. No anxiety/depression was noted in patients who had only undergone chemo and/or radiotherapy and no surgery. Physician rated disfigurement was higher in the surgical treatment group, though the highest physician-rated disfigurement scores did not correlate to the highest anxiety/depression scores, nor the lowest quality of life scores.

Conclusion: While physician-rated disfigurement is higher in surgically treated patients, the most disfigured patients did not report the worst quality of life. Therefore all head and neck patients should be assessed for adverse mental health and quality of life outcomes posttreatment, not only the most disfigured.