Sage Journals: Discover world-class research

Abstract

Background

The diagnosis and treatment of head and neck cancer (HNC) is associated with several life-altering morbidities including change in appearance, speech, and swallowing, all of which can significantly affect quality of life and cause psychosocial stress.

Commentary

The aim of this narrative review is to provide an overview of the evidence on psychosocial interventions for patients with HNC. Evidence regarding screening tools, psychological interventions, smoking and alcohol cessation, and antidepressant therapy in the HNC population is reviewed.

Conclusion

There is a large body of evidence describing various psychosocial interventions and several of these interventions have shown promise in the literature to improve psychosocial and health outcomes in the HNC population. Psychosocial interventions should be integrated into HNC care pathways and formal recommendations should be developed.

Graphical abstract

Keywords

psychosocial stress head and neck cancer counseling

Background

The treatment of head and neck cancer (HNC) often involves intense multimodal therapy including surgery, radiation, and chemotherapy. These therapeutic strategies can lead to challenges with form and function including speech and swallowing.¹ Quality of life is often severely affected, and a patient’s body image, communication, and social interactions may be compromised. As such, rates of psychological distress are high among HNC patients.^2,3 Compared to other cancer populations, HNC patients are more likely to experience depression, anxiety, and psychosocial distress.^4-8 In one study of over 50,000 patients with a new diagnosis of HNC, the proportion of patients with mental health disorders increased from 20% to 30% after diagnosis.⁹ The physical visibility of HNC itself and the associated social implications are intricately tied to the anxiety that several patients experience. Sources of anxiety and depression in HNC have been associated with the fear of cancer recurrence, loss of occupation, and loss of social status.^10,11 Furthermore, the rates of suicide in patients with HNC are 3 times higher than those of the general population and they carry the highest rates of self-harm relative to other cancer sites.^4,12,13 Within head and neck oncology, mental health is an extremely important factor to consider given that psychiatric conditions have been shown to modulate treatment response, adherence to therapy, and serve as an important risk factor in overall survival.^5,9 While different interventions exist, there are no formal recommendations or consensus guidelines for HNC patients experiencing psychosocial distress. The current literature describes the efficacies of different interventions in a multidisciplinary HNC team, but there is no cohesive summary of these interventions framed in a clinically relevant format. The goal of this narrative review was to provide a succinct, clinically applicable overview of the current state of evidence on psychosocial interventions for HNC patients and highlight gaps in the literature and potential avenues for future research. A brief summary of the various interventions discussed can be found in Table 1.

Table 1.

Summary of Interventions to Reduce Psychosocial Burden in HNC Patients.

Intervention	Summary	Pros	Cons	GRADE overall quality
Screening tools	General - PHQ-9, GAD-7, Distress thermometer Oncology - ESAS, MDASI-HN HNC - UW-QOL, IMAGE-HN, MBIS-HNC, EORTC QLQ—HN35, MDASI-HN	HNC-specific scales are more helpful for HNC symptoms and body image concerns. Updated versions of scales factor in new treatment modalities, such as immunotherapy. Can improve access to psychosocial interventions.	Lack of consensus for which is the best screening tool. Longer questionnaires contribute to screening burden.	Low
Psychological interventions and therapies	- Mindfulness/meditation-based interventions - CBT (led by nurses, psychologist) - Psychoeducation - Alternative therapies such as music therapy, yoga	CBT has been shown to improve emotional well-being. Physical activity-based therapy improves strength, fatigue, and muscle tension.	Variable compliance No improvement in global QOL.	Moderate
External support groups	- Couples-based therapy - Support and teaching for caregivers from healthcare workers	Improvement in pain, emotion and eating for patients in support groups.	Variable impact on QOL. Requires investment from both patient and partner.	Low
Smoking cessation	- CBT, pharmacotherapy, counseling sessions (led by nurse, physician)	Improves short-term and long-term mental health outcomes, specifically nurse-led. Greatest benefit seen with combined approach (counseling and pharmacotherapy).	Long-term interventions are required for efficacy (more than 6 months). Relies on patient motivation to quit.	Low
Antidepressant medication	- Prophylactic SSRI/SNRI administration	QOL and mood improved compared to placebo, lower rates of depression.	Medication side effects.	Moderate

Abbreviations: CBT, cognitive behavior therapy; EORTC QLQ—HN35, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module; ESAS, Edmonton Symptom Assessment System; GAD-7, Generalized Anxiety Disorder Scale-7; GRADE, Grading of Recommendations Assessment, Development and Evaluation; HNC, head and neck cancer; IMAGE-HN, Inventory to Measure and Assess Image Disturbance-Head and Neck; MBIS-HNC, McGill Body Image Concerns Scale for Head and Neck Cancer; MDASI-HN, MD Anderson Symptom Inventory-Head and Neck Module; PHQ-9, Personal Health Questionnaire-9; QOL, quality of life; SNRI, serotonin norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; UW-QOL, University of Washington Head and Neck Cancer Questionnaire.

Screening Tools

Early use of validated tools can be implemented by clinicians to identify patients who are socially and psychologically in distress because of their HNC diagnosis.¹⁴ The Personal Health Questionnaire-9 (PHQ-9)¹⁵ and Generalized Anxiety Disorder Scale-7 (GAD-7)¹⁶ are examples of commonly used general depression and anxiety scales based on the DSM-5. When used in the HNC population, studies found that approximately 5% to 21% of HNC patients reported clinically significant psychological distress.¹⁷ When employing more oncology-specific scales that are commonly used in HNC, such as the Distress Thermometer, the Edmonton Symptom Assessment System (ESAS), MD Anderson Symptom Inventory (MDASI), and the University of Washington Head and Neck Cancer Questionnaire (UW-QOL V4), studies revealed even higher distress rates up to 60%.^14,17-20

There have been several screening tools focused on symptoms specific to HNC patients including the Inventory to Measure and Assess Image Disturbance—Head and Neck (IMAGE-HN) and McGill Body Image Concerns Scale for Head and Neck Cancer (MBIS-HNC), which can be especially useful as approximately 75% of HNC patients express body image concerns.^21-23 The IMAGE-HN has been demonstrated to be reliable and valid with scores correlating directly to clinically significant cancer-related body-image distress.²⁴ Similarly to the IMAGE-HN, the Shame and Stigma Scale for HNC patients has been validated in Canadian French and English-speaking populations and is based on 4 core domains including: shame with appearance, sense of stigma, regret, and social/speech concerns.²⁵ The MD Anderson Symptom Inventory-Head and Neck module is another tool which contains 11 HNC-specific items and has been demonstrated to be reliable and valid.^26,27 Last, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ—HN35) was initially validated in 1999 as a 35-item questionnaire based on 7 scales: pain, swallowing, senses, speech, social eating, social contact, sexuality.²⁸ It has since been replicated successfully worldwide and is applicable before, during, and after HNC treatment whether that includes radiation, surgery, or chemotherapy.^29,30 More recently, modifications to this scale were introduced due to advances in HNC treatment, such as immune checkpoint inhibitors or tailored dose-dependent radiation that did not previously exist when the EORTC QLQ was first created.

Unfortunately, there is no consensus on which of these screening tools is the most appropriate for the HNC population and few studies compare the various tools.¹⁷ In Ontario and many other jurisdictions, the ESAS is widely implemented in cancer centers.⁵ It measures 9 cancer-related symptoms, 2 of which are depression and anxiety, and is well studied in the overall cancer and HNC literature.^5,31 Gascon et al¹⁷ demonstrated that longer screening tools such as the PHQ-9 and GAD-7 had lower volumes of positive screens but higher sensitivity, whereas shorter tools such as the ESAS or MD Anderson Symptom Inventory-Head and Neck Module (MDASI-HN) captured a range of symptoms that all contributed to distress while decreasing screening burden.

Psychological Interventions and Therapies

Individual psychotherapy comes in many forms, ranging from individual-led mindfulness to psychiatrist-led therapy.³² A few studies have demonstrated that mindfulness and/or meditation-based interventions can lead to some improvements in emotional well-being in patients with HNC.^33,34 These studies, however, were limited by variable rates of compliance which have been similarly echoed in other reviews on adherence to psychological interventions in the general oncology population.^35,36 Other individual studies investigating nurse-led counseling programs,³⁷ home-delivered psychosocial interventions, and psychologist-led therapeutic interventions^38-41 have reported improved psychosocial functioning, depression, and anxiety. However, when looking at consensus studies, such as the 2013 Cochrane review on psychological interventions for HNC patients which included 7 studies, it concluded that there was no evidence to suggest that psychosocial intervention promotes global quality of life.⁴² Psychoeducation in the context of HNC consists of meetings with nurse specialists or other providers, such as care coordinators, who inform patients and their families about the symptoms and side effects of HNC, as well as the impact those side effects may have on their social life and work.^38,43-48 Three randomized control trials (RCTs) have been conducted examining the impact of psychoeducation in HNC and found that patients who received psychoeducation had a better oropharyngeal function, less fear and anxiety related to social interaction, and a better perception of facial disfigurement.^43,44,49 In addition, cognitive behavior therapy (CBT) is another form of psychotherapy which focuses on challenging thoughts and beliefs and their associated behaviors to promote emotional regulation and improve coping strategies.⁵⁰ CBT has been proven to be one of the most effective treatments for improving cancer-related fatigue, improving quality of life, and reducing fear of cancer recurrence.^51-53 A meta-analysis from Calver et al⁵⁴ showed an improvement in emotional well-being for patients who underwent CBT, but no change in functional or physical well-being. Overall, the evidence regarding CBT in HNC patients remains inconclusive. This may be due to the unique voicelessness and inability to communicate verbally among HNC patients which is not only a driver for emotional distress, but also as a barrier in engaging in verbal psychotherapy.^55,56 One RCT found that 6 nurse-led CBT sessions led to improved emotional functioning, pain, swallowing, and mouth opening at 12 months.⁵⁷ However, other RCTs investigated 6 or more sessions of CBT and reported no difference in depressive symptoms and failed to demonstrate sustained improvements in psychological outcomes at timepoints greater than 12 months after therapy.^57-60

Alternative types of therapy, such as physical activity, acupuncture, or music, have also been described to improve outcomes in survivors of HNC. In a recent systematic review evaluating the impact of physical activity on HNC survivors, more than half of the studies included demonstrated that physical activity resulted in improvement of at least one patient reported outcome with the most common being fatigue.^61,62 Given that muscle wasting and cachexia are prevalent in this patient population, it is important to note that many of these studies have demonstrated improvements in lean body mass, muscular strength, and physical functioning both during and after treatment. These preliminary findings suggest that exercise and physical activity may represent an important component of HNC management; however, further research is needed to determine the best type of exercise and timing of physical activity interventions.⁶¹ Specifically, yoga has been proposed as a therapy to improve muscular tension in head and neck survivors, where neck fibrosis, lymphedema, and trismus is a significant side effect of radiation therapy.^63,64 Music therapy has also been discussed as an intervention to decrease anxiety in oncology patients undergoing radiation therapy, which may be particularly applicable in the HNC population as it appeals to an unaltered sense.^65,66

External Support Groups and Systems

Spouses and partners often bear the responsibility of being caregivers for their loved ones with HNC providing emotional support, assistance with symptom management, and rehabilitation. The distress rates among spouses and partners with HNC has been found to be comparable to the distress rates among the patients themselves and one study reported 83% of couples reported increased conflict during treatment.^67,68 In addition to the stress associated with being a caregiver, human papillomavirus (HPV)-related tumors can have unique impacts on partners due to the sexually transmitted nature of HPV. One study reported partners experience guilt and responsibility associated with HPV-related cancers and significant declines in the frequency of sexual intercourse.⁶⁹ There is preliminary evidence suggesting that couples-based therapy may have a positive impact on individual and relationship functioning in HNC patients.^1,67,70 Couples-based interventions reported in the literature include combinations of educational material focused on self-care, symptom management, and caregiving skills in addition to group sessions with trained mental health professionals.⁶⁷

HNC patients share an understanding of the unique psychosocial impacts of their disease. Thus, group sessions have been proposed for these patients which both encompasses their loved ones and/or other HNC cancer patients. One study by Vakharia et al⁷¹ investigated the impact of participation in a support group on quality of life for HNC survivors and found that they had significantly better scores in the domains of eating, emotion, and pain. Conversely, Mowry and Wang⁷² found that patients who participated in support groups did not demonstrate improved quality of life but concluded that this may be due to the fact that more patients who participated in the support group had oropharyngeal cancer and were undergoing chemotherapy at time of participation.

Smoking Cessation

Smoking and alcohol intake are shared risk factors both for developing HNC and poor mental health outcomes.^73-75 Continued smoking after diagnosis is common and is associated with concurrent depressive symptomatology, more pain, lower quality of life scores, and worse performance status postoperatively.^76-79 In the general population, it has been shown that smoking cessation leads to improved mental health outcomes in short-term and long-term studies.^80,81 Within the HNC population, 2 pilot studies compared various smoking cessation interventions and found that nurse delivered CBT and pharmacotherapy resulted in significant increases in smoking cessation rates, up to 16% increase when compared to no intervention at a 6-month follow-up.^59,82 Interestingly, in similar studies with a shorter follow-up time such as 1 or 3 months, there were no significant difference in rates of smoking cessation between interventions such as CBT, pharmacotherapy, or individual counseling, suggesting that perhaps longer courses of intervention are needed.^83,84 Other studies have looked at physician-delivered advice to stop smoking with a contracted quit date, tailored written materials, and booster advice sessions, which have not shown changes in cessation rates but had patient-reported positive mental health effects.⁸⁵

A patient’s motivation to quit is also important in predicting the response to smoking cessation therapies, and HNC patients are oftentimes less likely to enroll in cessation interventions due to low perceived risk of recurrence and low quitting self-efficacy.^86,87 In a large (N = 186), randomized controlled trial of a provider-based smoking cessation intervention, Gritz et al⁸⁵ concluded that the intervention effect was not significant, but that smokers in the contemplation phase were more likely to maintain abstinence in a 1 year follow-up. These findings emphasize the need to integrate early, targeted cessation interventions into the standard HNC care path. Despite the existence of smoking cessation counseling programs, there is insufficient knowledge of these resources among head and neck surgeons especially as it is not currently considered a priority in the treatment process.^88,89 The role of motivational support, relationship with alcohol, and health knowledge and beliefs surrounding smoking and cancer have all been discussed as key elements in the holistic approach to a HNC patient and are an important considerations in smoking cessation.⁷⁷

Antidepressant Medication

Major depressive disorder has been reported in up to 52% of patients diagnosed with HNC cancer, which is significantly higher when compared to other forms of cancer.^5,90,91 In fact, a recent study showed a 64% prevalence rate of depressive symptoms on ESAS screening in HNC patients in Ontario.⁹² Moreover, the HNC population is at higher risk of self-injury and suicide.^4,13,93 Higher rates of depression among cancer patients can lead to decreased adherence to treatment and overall lower survival, which makes it even more important to address early on.^94,95 Within HNC, studies have shown consistent depression levels as far as 5 years post-surgery, but close to zero use of mental health resources and nonadherence to antidepressant medication.⁹⁶ The role of antidepressant therapy as a prophylactic measure has only recently been described among the HNC population. Lydiatt et al conducted a pilot study in 2008 and a larger-scale RCT in 2013 testing whether prophylactic selective serotonin reuptake inhibitors (SSRIs) could reduce the incidence of depression among patients with HNC. The pilot study only included 36 patients but showed that citalopram improved quality of life and improved mood when compared to placebo.⁹⁷ Later, this study was expanded in 2013 to include 148 HNC patients and compared escitalopram to placebo.⁹⁸ They found a 14% reduction in rates of developing depression when patients were prophylactically treated with a 16 week course of escitalopram and a 7-fold risk reduction [hazard ratio 0.37, 95% confidence interval (0.14-0.96), P = .04]. The number needed to treat was 7 for treatment versus placebo. Despite these favorable outcomes, there have been no other studies looking at the role of pharmacotherapy in the primary prevention of depression in HNC patients.⁹⁹ Moreover, antidepressants are associated with side effects including sexual dysfunction, nausea, decreased appetite, and sleep disturbance all of which could be detrimental to HNC patients who are concurrently dealing with treatment side effects.

Conclusions

The diagnosis and management of HNC can potentially lead to a substantial impact on patients’ psychosocial functioning. These patients are at high risk of mental health distress and reducing this burden can improve both morbidity and mortality. Early detection using various screening tools to identify high-risk patients, smoking cessation programs, prophylactic pharmacotherapy, and psychological counseling are different modalities that have demonstrated variable benefit. Formal recommendations should be developed and a greater focus on psychosocial interventions should be emphasized in all HNC treatment pathways.

Footnotes

Acknowledgements

None.

Author Contributions

TC and EG preformed the literature review. AE and TC proposed the idea for this report. All authors wrote, reviewed, and edited the manuscript. All authors read and approved the final manuscript before submission.

Availability of Data and Materials

Not applicable.

Consent for Publication

Not applicable.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article

Ethics Approval and Consent to Participate

Not applicable.

References

Gremore

Brockstein

Porter

, et al. Couple-based communication intervention for head and neck cancer: a randomized pilot trial. Support Care Cancer. 2021;29(6):3267-3275.

Bjordal

Kaasa

Psychological distress in head and neck cancer patients 7-11 years after curative treatment. Br J Cancer. 1995;71(3):592-597.

Oskam

Verdonck-de Leeuw

Aaronson

, et al. Prospective evaluation of health-related quality of life in long-term oral and oropharyngeal cancer survivors and the perceived need for supportive care. Oral Oncol. 2013;49(5):443-448.

Noel

Eskander

Sutradhar

, et al. Incidence of and factors associated with nonfatal self-injury after a cancer diagnosis in Ontario, Canada. JAMA Netw Open 2021;4(9):e2126822.

Philteos

Noel

Hallet

Eskander

Mental health considerations in patients undergoing complex head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2022;30(5):380-383.

Doss

Ghani

WMN

Razak

Yang

Rogers

Zain

RB.

Changes in health-related quality of life of oral cancer patients treated with curative intent: experience of a developing country. Int J Oral Maxillofac Surg. 2017;46(6):687-698.

Chen

Y-W

Lin

T-R

Kuo

P-L

, et al. Psychosocial adjustment changes and related factors in postoperative oral cancer patients: a longitudinal study. Biomedicines. 2022;10(12):3231.

Hallet

Sutradhar

Isenberg-Grzeda

, et al. Association of patient-reported outcomes with subsequent nonfatal self-injury after a new cancer diagnosis. JAMA Oncol. 2022;8(5):e220203.

Lee

Liu

Leslie

Zacharia

Goyal

Association of head and neck cancer with mental health disorders in a large insurance claims database. JAMA Otolaryngol Head Neck Surg. 2019;145(4):339-344.

10.

Dropkin

MJ.

Anxiety, coping strategies, and coping behaviors in patients undergoing head and neck cancer surgery. Cancer Nurs. 2001;24(2):143-148.

11.

Nikoloudi

Lymvaios

Zygogianni

, et al. Quality of life, anxiety, and depression in the head-and-neck cancer patients, undergoing intensity-modulated radiotherapy treatment. Indian J Palliat Care. 2020;26(1):54-59.

12.

Kam

Salib

Gorgy

, et al. Incidence of suicide in patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1075-1081.

13.

Potter

Haridas

Neumann

, et al. Incidence, timing, and factors associated with suicide among patients undergoing surgery for cancer in the US. JAMA Oncol. 2023;9(3):308-315.

14.

Humphris

Psychological management for head and neck cancer patients: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S45-S48.

15.

Kroenke

Spitzer

Williams

JB.

The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.

16.

Löwe

Decker

Müller

, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46(3):266-274.

17.

Gascon

Panjwani

Mazzurco

Screening for distress and health outcomes in head and neck cancer. Curr Oncol. 2022;29(6):3793-3806.

18.

Kunz

Wichmann

Lehmann-Laue

Mehnert-Theuerkauf

Dietz

Wiegand

Screening for distress, related problems and perceived need for psycho-oncological support in head and neck squamous cell carcinoma (HNSCC) patients: a retrospective cohort study. BMC Cancer. 2021;21(1):478.

19.

Dunne

Mooney

Coffey

, et al. Psychological variables associated with quality of life following primary treatment for head and neck cancer: a systematic review of the literature from 2004 to 2015. Psychooncology. 2017;26(2):149-160.

20.

Hammerlid

Persson

Sullivan

Westin

Quality-of-life effects of psychosocial intervention in patients with head and neck cancer. Otolaryngol Head Neck Surg. 1999;120(4):507-516.

21.

Fingeret

Yuan

Urbauer

Weston

Nipomnick

Weber

The nature and extent of body image concerns among surgically treated patients with head and neck cancer. Psychooncology. 2012;21(8):836-844.

22.

Graboyes

Hand

Ellis

, et al. Validation of a novel, multidomain head and neck cancer appearance- and function-distress patient-reported outcome measure. Otolaryngol Head Neck Surg. 2020;163(5):979-985.

23.

Rodriguez

Frenkiel

Desroches

, et al. Development and validation of the McGill body image concerns scale for use in head and neck oncology (MBIS-HNC): a mixed-methods approach. Psychooncology. 2019;28(1):116-121.

24.

Macias

Hand

Pipkorn

, et al. Association of Inventory to Measure and Assess imaGe Disturbance—Head and Neck scores with clinically meaningful body image-related distress among head and neck cancer survivors. Front Psychol. 2021;12:794038.

25.

Bobevski

Kissane

Desroches

De Simone

Henry

Validation of the Canadian version of the Shame and Stigma Scale for head and neck cancer patients. Curr Oncol. 2023;30(8):7553-7565.

26.

Rosenthal

Mendoza

Chambers

, et al. Measuring head and neck cancer symptom burden: the development and validation of the M. D. Anderson symptom inventory, head and neck module. Head Neck. 2007;29(10):923-931.

27.

Rosenthal

Mendoza

Chambers

, et al. The M. D. Anderson symptom inventory-head and neck module, a patient-reported outcome instrument, accurately predicts the severity of radiation-induced mucositis. Int J Radiat Oncol Biol Phys. 2008;72(5):1355-1361.

28.

Bjordal

Hammerlid

Ahlner-Elmqvist

, et al. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire—H&N35. J Clin Oncol. 1999;17(3):1008-1019.

29.

Sherman

Simonton

Adams

Vural

Owens

Hanna

. Assessing quality of life in patients with head and neck cancer: cross-validation of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Head and Neck module (QLQ-H&N35). Arch Otolaryngol Head Neck Surg. 2000;126(4):459-467.

30.

Chaukar

Das

Deshpande

, et al. Quality of life of head and neck cancer patient: validation of the European organization for research and treatment of cancer QLQ-C30 and European organization for research and treatment of cancer QLQ-H&N 35 in Indian patients. Indian J Cancer. 2005;42(4):178-184.

31.

Noel

Forner

Chepeha

, et al. The Edmonton Symptom Assessment System: a narrative review of a standardized symptom assessment tool in head and neck oncology. Oral Oncol. 2021;123:105595.

32.

Senchak

Fang

Bauman

. Interventions to improve quality of life (QOL) and/or mood in patients with head and neck cancer (HNC): a review of the evidence. Cancers Head Neck. 2019;4:2.

33.

Boxleitner

Jolie

Shaffer

Pasacreta

Bai

McCorkle

Comparison of two types of meditation on patients’ psychosocial responses during radiation therapy for head and neck cancer. J Altern Complement Med. 2017;23(5):355-361.

34.

Pollard

Burchell

Castle

, et al. Individualised mindfulness-based stress reduction for head and neck cancer patients undergoing radiotherapy of curative intent: a descriptive pilot study. Eur J Cancer Care (Engl). 2017;26(2):e12474.

35.

Newell

Sanson-Fisher

Savolainen

, Program FtNCCCER Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst. 2002;94(8):558-584.

36.

Brebach

Sharpe

Costa

Rhodes

Butow

Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. Psychooncology. 2016;25(8):882-890.

37.

van der Meulen

May

de Leeuw

, et al. Long-term effect of a nurse-led psychosocial intervention on health-related quality of life in patients with head and neck cancer: a randomised controlled trial. Br J Cancer. 2014;110(3):593-601.

38.

Allison

Edgar

Nicolau

Archer

Black

Hier

Results of a feasibility study for a psycho-educational intervention in head and neck cancer. Psychooncology. 2004;13(7):482-485.

39.

Kilbourn

Anderson

Costenaro

Lusczakoski

Borrayo

Raben

Feasibility of EASE: a psychosocial program to improve symptom management in head and neck cancer patients. Support Care Cancer. 2013;21(1):191-200.

40.

Krebber

Jansen

Witte

, et al. Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: a randomized, controlled trial. Ann Oncol. 2016;27(9):1754-1760.

41.

Humphris

. The missing member of the head and neck multidisciplinary team: the psychologist. Why we need them. Curr Opin Otolaryngol Head Neck Surg. 2008;16(2):108-112.

42.

Semple

Parahoo

Norman

McCaughan

Humphris

Mills

. Psychosocial interventions for patients with head and neck cancer. Cochrane Database Syst Rev. 2013(7):CD009441.

43.

Katz

Irish

Devins

GM.

Development and pilot testing of a psychoeducational intervention for oral cancer patients. Psychooncology. 2004;13(9):642-653.

44.

Hansson

Carlström

Olsson

Nyman

Koinberg

Can a person-centred-care intervention improve health-related quality of life in patients with head and neck cancer? A randomized, controlled study. BMC Nurs. 2017;16:9.

45.

Vilela

Nicolau

Mahmud

, et al. Comparison of psychosocial outcomes in head and neck cancer patients receiving a coping strategies intervention and control subjects receiving no intervention. J Otolaryngol. 2006;35(2):88-96.

46.

D’Souza

Blouin

Zeitouni

Muller

Allison

PJ.

An investigation of the effect of tailored information on symptoms of anxiety and depression in Head and Neck cancer patients. Oral Oncol. 2013;49(5):431-437.

47.

Malik

Maganti

McQuestion

, et al. Pre-treatment psychoeducational intervention and outcomes in head and neck cancer patients undergoing radiotherapy. Support Care Cancer. 2021;29(3):1643-1652.

48.

Björklund

Sarvimäki

Berg

Living with head and neck cancer: a profile of captivity. J Nurs Healthc Chronic Illn. 2010;2(1):22-31.

49.

Chen

Huang

Lin

, et al. Psychosocial effects of a skin camouflage program in female survivors with head and neck cancer: a randomized controlled trial. Psychooncology. 2017;26(9):1376-1383.

50.

Zhang

Guo

, et al. Effectiveness of mindfulness-based cognitive therapy against suicidal ideation in patients with depression: a systematic review and meta-analysis. J Affect Disord. 2022;319:655-662.

51.

Zhang

Gao

Liu

Zhu

Qiu

Therapies for cognitive impairment in breast cancer survivors treated with chemotherapy: a protocol for systematic review. Medicine (Baltimore). 2020;99(19):e20092.

52.

Mustian

Alfano

Heckler

, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3(7):961-968.

53.

Park

Lim

JW.

Cognitive behavioral therapy for reducing fear of cancer recurrence (FCR) among breast cancer survivors: a systematic review of the literature. BMC Cancer. 2022;22(1):217.

54.

Calver

Tickle

Moghaddam

Biswas

The effect of psychological interventions on quality of life in patients with head and neck cancer: a systematic review and meta-analysis. Eur J Cancer Care (Engl). 2018;27(1):e12789.

55.

Noel

Baran

, et al. Enhancing outpatient symptom management in patients with head and neck cancer: a qualitative analysis. JAMA Otolaryngol Head Neck Surg. 2022;148(4):333-341.

56.

Howren

Christensen

Karnell

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.

57.

van der Meulen

May

Ros

, et al. One-year effect of a nurse-led psychosocial intervention on depressive symptoms in patients with head and neck cancer: a randomized controlled trial. Oncologist. 2013;18(3):336-344.

58.

Humphris

Ozakinci

The AFTER intervention: a structured psychological approach to reduce fears of recurrence in patients with head and neck cancer. Br J Health Psychol. 2008;13(Pt 2):223-230.

59.

Duffy

Ronis

Valenstein

, et al. A tailored smoking, alcohol, and depression intervention for head and neck cancer patients. Cancer Epidemiol Biomarkers Prev. 2006;15(11):2203-2208.

60.

Faller

Schuler

Richard

Heckl

Weis

Küffner

Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol. 2013;31(6):782-793.

61.

Lynch

Horani

Lee

, et al. Effectiveness of physical activity interventions in improving objective and patient-reported outcomes in head and neck cancer survivors: a systematic review. Oral Oncol. 2021;117:105253.

62.

Capozzi

Nishimura

McNeely

Lau

Culos-Reed

SN.

The impact of physical activity on health-related fitness and quality of life for patients with head and neck cancer: a systematic review. Br J Sports Med. 2016;50(6):325-338.

63.

Adair

Murphy

Yarlagadda

Deng

Dietrich

Ridner

SH.

Feasibility and preliminary efficacy of tailored yoga in survivors of head and neck cancer: a pilot study. Integr Cancer Ther. 2018;17(3):774-784.

64.

Smith

Pukall

CF.

An evidence-based review of yoga as a complementary intervention for patients with cancer. Psychooncology. 2009;18(5):465-475.

65.

Rossetti

Chadha

Torres

, et al. The impact of music therapy on anxiety in cancer patients undergoing simulation for radiation therapy. Int J Radiat Oncol Biol Phys. 2017;99(1):103-110.

66.

Zang

Cheng

Zhou

Liu

Music therapy effect on anxiety reduction among patients with cancer: a meta-analysis. Front Psychol. 2022;13:1028934.

67.

Badr

Herbert

Chhabria

Sandulache

Chiao

Wagner

Self-management intervention for head and neck cancer couples: results of a randomized pilot trial. Cancer. 2019;125(7):1176-1184.

68.

Badr

Herbert

Reckson

Rainey

Sallam

Gupta

Unmet needs and relationship challenges of head and neck cancer patients and their spouses. J Psychosoc Oncol. 2016;34(4):336-346.

69.

Taberna

Inglehart

Pickard

, et al. Significant changes in sexual behavior after a diagnosis of human papillomavirus-positive and human papillomavirus-negative oral cancer. Cancer. 2017;123(7):1156-1165.

70.

Badr

Herbert

Bonnen

Asper

Wagner

Dyadic coping in patients undergoing radiotherapy for head and neck cancer and their spouses. Front Psychol. 2018;9:1780.

71.

Vakharia

Ali

Wang

SJ.

Quality-of-life impact of participation in a head and neck cancer support group. Otolaryngol Head Neck Surg. 2007;136(3):405-410.

72.

Mowry

Wang

MB.

The influence of support groups on quality of life in head and neck cancer patients. ISRN Otolaryngol. 2011;2011:250142.

73.

Beynon

Lang

Schimansky

, et al. Tobacco smoking and alcohol drinking at diagnosis of head and neck cancer and all-cause mortality: results from head and neck 5000, a prospective observational cohort of people with head and neck cancer. Int J Cancer. 2018;143(5):1114-1127.

74.

Di Credico

Polesel

Dal Maso

, et al. Alcohol drinking and head and neck cancer risk: the joint effect of intensity and duration. Br J Cancer. 2020;123(9):1456-1463.

75.

Deleyiannis

Thomas

Vaughan

Davis

Alcoholism: independent predictor of survival in patients with head and neck cancer. J Natl Cancer Inst. 1996;88(8):542-549.

76.

Florou

Gkiozos

Tsagouli

Souliotis

Syrigos

KN.

Clinical significance of smoking cessation in subjects with cancer: a 30-year review. Respir Care. 2014;59(12):1924-1936.

77.

Smith

Woolley

Brown

Vangaveti

Chilkuri

Smoking cessation in head and neck cancer patients: factors influencing successes and failures. J Med Imaging Radiat Oncol. 2021;65(2):233-241.

78.

Gritz

Fingeret

Vidrine

Lazev

Mehta

Reece

GP.

Successes and failures of the teachable moment: smoking cessation in cancer patients. Cancer. 2006;106(1):17-27.

79.

Duffy

Ronis

Valenstein

, et al. Depressive symptoms, smoking, drinking, and quality of life among head and neck cancer patients. Psychosomatics. 2007;48(2):142-148.

80.

Taylor

GMJ

Lindson

Farley

, et al. Smoking cessation for improving mental health. Cochrane Database Syst Rev. 2021;3(3):CD013522.

81.

Taylor

McNeill

Girling

Farley

Lindson-Hawley

Aveyard

Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014;348:g1151.

82.

McCarter

Martínez

Britton

, et al. Smoking cessation care among patients with head and neck cancer: a systematic review. BMJ Open. 2016;6(9):e012296.

83.

Gosselin

M-H

Mahoney

Cummings

, et al. Evaluation of an intervention to enhance the delivery of smoking cessation services to patients with cancer. J Cancer Educ. 2011;26(3):577-582.

84.

Schnoll

Rothman

Wielt

, et al. A randomized pilot study of cognitive-behavioral therapy versus basic health education for smoking cessation among cancer patients. Ann Behav Med. 2005;30(1):1-11.

85.

Gritz

Carr

Rapkin

, et al. Predictors of long-term smoking cessation in head and neck cancer patients. Cancer Epidemiol Biomarkers Prev. 1993;2(3):261-270.

86.

Schnoll

Rothman

Lerman

, et al. Comparing cancer patients who enroll in a smoking cessation program at a comprehensive cancer center with those who decline enrollment. Head Neck. 2004;26(3):278-286.

87.

Gritz

Schacherer

Koehly

Nielsen

Abemayor

Smoking withdrawal and relapse in head and neck cancer patients. Head Neck. 1999;21(5):420-427.

88.

Nightingale

Sterba

Tooze

King

Weaver

KE.

Cessation attitudes and preferences in head and neck cancer patients and implications for cessation program design: a brief report. Glob Adv Health Med. 2019;8:2164956119847117.

89.

Rzepakowska

Marcinkiewicz

Żurek

Wiśniewska

Niemczyk

Motivation to smoking cessation in head and neck cancer and dysplasia patients in confrontation with the attitudes of otorhinolaryngologists in delivering anti-smoking therapies. Eur Arch Otorhinolaryngol. 2022;279(7):3645-3655.

90.

Lydiatt

Moran

Burke

WJ.

A review of depression in the head and neck cancer patient. Clin Adv Hematol Oncol. 2009;7(6):397-403.

91.

Hammerlid

Ahlner-Elmqvist

Bjordal

, et al. A prospective multicentre study in Sweden and Norway of mental distress and psychiatric morbidity in head and neck cancer patients. Br J Cancer. 1999;80(5):766-774.

92.

Noel

Sutradhar

Chan

, et al. Gaps in depression symptom management for patients with head and neck cancer. Laryngoscope. 2023;133(10):2638-2646.

93.

Osazuwa-Peters

Barnes

Okafor

, et al. Incidence and risk of suicide among patients with head and neck cancer in rural, urban, and metropolitan areas. JAMA Otolaryngol Head Neck Surg. 2021;147(12):1045-1052.

94.

DiMatteo

Lepper

Croghan

TW.

Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160(14):2101-2107.

95.

Barber

Dergousoff

Nesbitt

, et al. Depression as a predictor of postoperative functional performance status (PFPS) and treatment adherence in head and neck cancer patients: a prospective study. J Otolaryngol Head Neck Surg. 2015;44(1):38.

96.

Chen

Daly

Vazquez

, et al. Depression among long-term survivors of head and neck cancer treated with radiation therapy. JAMA Otolaryngol Head Neck Surg. 2013;139(9):885-889.

97.

Lydiatt

Denman

McNeilly

Puumula

Burke

WJ.

A randomized, placebo-controlled trial of citalopram for the prevention of major depression during treatment for head and neck cancer. Arch Otolaryngol Head Neck Surg. 2008;134(5):528-535.

98.

Lydiatt

Bessette

Schmid

Sayles

Burke

WJ.

Prevention of depression with escitalopram in patients undergoing treatment for head and neck cancer: randomized, double-blind, placebo-controlled clinical trial. JAMA Otolaryngol Head Neck Surg. 2013;139(7):678-686.

99.

Arif

Marzouki

Silver

Al Thomali

Merdad

Sadeghi

Primary prevention of depression in head and neck cancer patients: a scoping review. Eur Arch Otorhinolaryngol. 2023;280(4):1547-1554.

Interventions to Reduce Psychosocial Burden in Head and Neck Cancer Patients: A Narrative Review

Abstract

Background

Commentary

Conclusion

Keywords

Background

Screening Tools

Psychological Interventions and Therapies

External Support Groups and Systems

Smoking Cessation

Antidepressant Medication

Conclusions

Footnotes

Acknowledgements

Author Contributions

Availability of Data and Materials

Consent for Publication

Declaration of Conflicting Interests

Funding

Ethics Approval and Consent to Participate

References