Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature
In addition to cancer-related distress, people with head and neck cancer (HNC) endure facial disfigurement and difficulties with eating and communication. High rates of alcohol use and socio-economic disadvantage raise concerns that patients with HNC may be less likely than others to participate in and adhere to psychological interventions. This article aims to inform future practice and research by reviewing the evidence in support of psychological interventions for this patient group.
We searched CENTRAL, Medline, Embase, PsycINFO and CINAHL in December 2009. Relevant studies were rated for internal and external validity against the criteria of the Agency for Healthcare Research and Quality (AHRQ) US Preventive Services Task Force. Wherever possible, outcomes were evaluated using effect sizes to confirm statistically significant results and enable comparison between studies. Meta-analysis was planned according to criteria in the Cochrane Handbook for Systematic Reviews. Levels of evidence for each intervention type were evaluated using AHRQ criteria.
Nine studies met inclusion criteria. One study was rated ‘good’ for internal validity and four for external validity. Psycho-education and/or cognitive–behavioural therapy were evaluated by seven studies, and communication skills training and a support group by one study each. Significant heterogeneity precluded meta-analysis. Based on a study-by-study review, there was most support for psycho-education, with three out of five studies finding at least some effect.
Research to date suggests it is feasible to recruit people with HNC to psychological interventions and to evaluate their progress through repeated-outcome measures. Evidence for interventions is limited by the small number of studies, methodological problems, and poor comparability. Future interventions should target HNC patients who screen positive for clinical distress and be integrated into standard care.
KeywordsHead and neck cancer Psychological interventions Systematic review Distress Anxiety Depression Quality of life
- 1.National Cancer Institute (2010) Head and neck cancer. http://www.cancer.gov/cancertopics/types/head-and-neck. Accessed 19th Sept 2010.
- 4.IOM (Institute of Medicine) (2009) State of the USA health indicators: letter report. The National Academies Press, WashingtonGoogle Scholar
- 23.National Comprehensive Cancer Network (NCCN) (1999) NCCN practice guidelines for the management of psychosocial distress. Oncology 13:113–147Google Scholar
- 28.Agency for Healthcare Research and Quality (2009) Current methods of the US Preventive Services Task Force: a review of the procedures. http://www.ahrq.gov/Clinic/ajpmsuppl/harris2.htm. Accessed August 11 2009
- 29.National Breast Cancer Centre & National Cancer Control Initiative (NBCC & NCCI) (2003) Clinical practice guidelines for the psychosocial care of adults with cancer. National Breast Cancer Centre, SydneyGoogle Scholar
- 30.Higgins JPT, Green S (2008) The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1: Available from www.cochrane-handbook.org.
- 31.Cohen J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Lawrence Erlbaum, HillsdaleGoogle Scholar
- 32.Bailey JJ (2001) Development of a multi-modal psychological intervention as adjunctive therapy for smoking-related cancers. Dissertation, University of Memphis, USGoogle Scholar
- 34.Clarke A (2001) Resourcing and training head and neck cancer nurse specialists to deliver a social rehabilitation programme to patients. Dissertation, City UniversityGoogle Scholar
- 51.Center for Epidemiologic Studies (1971) Center for Epidemiologic Studies Depression Scale (CES-D). National Institute of Mental Health, RockvilleGoogle Scholar
- 52.Ullrich de Muynck R, Ullrich R (1977) Der Unsicherheitsfragebogen. Testmanual und Anleitung fur den Therapeuten (Section III). Pfeiffer, MunichGoogle Scholar
- 56.Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA (1983) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists, Palo AltoGoogle Scholar
- 57.Bradburn N (1969) The Structure of Psychological Well-Being. Aldine, ChicagoGoogle Scholar
- 58.Atkinson T (1977) Is Satisfaction a good measure of the perceived quality of life? Annual Meeting of the American Statistical Association, Chicago, IllinoisGoogle Scholar