Supportive Care in Cancer

, Volume 19, Issue 7, pp 871–881

Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature

Review Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Head and neck cancer Psychological interventions Systematic review Distress Anxiety Depression Quality of life 

References

  1. 1.
    National Cancer Institute (2010) Head and neck cancer. http://www.cancer.gov/cancertopics/types/head-and-neck. Accessed 19th Sept 2010.
  2. 2.
    Bofetta P, Hashibe M, La Vecchia C, Zatonski W, Rehm J (2006) The burden of cancer attributable to alcohol drinking. Int J Cancer 119:884–887CrossRefGoogle Scholar
  3. 3.
    Deleyiannis FW, Thomas DB, Vaughan TL et al (1996) Alcoholism: independent predictor of survival in patients with head and neck cancer. J Natl Cancer Inst 88:542–549PubMedCrossRefGoogle Scholar
  4. 4.
    IOM (Institute of Medicine) (2009) State of the USA health indicators: letter report. The National Academies Press, WashingtonGoogle Scholar
  5. 5.
    Conway DI, McKinney PA, McMahon AD et al (2010) Socioeconomic factors associated with risk of upper aerodigestive tract cancer in Europe. Eur J Cancer 46:588–598PubMedCrossRefGoogle Scholar
  6. 6.
    Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho Oncol 10(1):19–28CrossRefGoogle Scholar
  7. 7.
    Ledeboer QCP, Velden LA, Boer MF, Feenstra L, Pruyn JFA (2005) Physical and psychosocial correlates of head and neck cancer: an update of the literature and challenges for the future (1996–2003). Clin Otolaryngol 30(4):303–319PubMedCrossRefGoogle Scholar
  8. 8.
    Llewellyn CD, McGurk M, Weinman J (2005) Are psycho-social and behavioural factors related to health related-quality of life in patients with head and neck cancer? A systematic review. Oral Oncol 41(5):440–454PubMedCrossRefGoogle Scholar
  9. 9.
    Rogers SN, Ahad SA, Murphy AP (2007) A structured review and theme analysis of papers published on ‘quality of life’ in head and neck cancer: 2000–2005. Oral Oncol 43(9):843–868PubMedCrossRefGoogle Scholar
  10. 10.
    Murphy BA, Ridner S, Wells N, Dietrich M (2007) Quality of life research in head and neck cancer: a review of the current state of the science. Crit Rev Oncol Hematol 62(3):251–267PubMedCrossRefGoogle Scholar
  11. 11.
    Callahan C (2004) Facial disfigurement and sense of self in head and neck cancer. Soc Work Health Care 40(2):73–87PubMedCrossRefGoogle Scholar
  12. 12.
    Frampton M (2001) Psychological distress in patients with head and neck cancer: review. Br J Oral Maxillofac Surg 39(1):67–70PubMedCrossRefGoogle Scholar
  13. 13.
    Haman KL (2008) Psychologic distress and head and neck cancer: part 1–review of the literature.[see comment]. J Support Oncol 6(4):155–163PubMedGoogle Scholar
  14. 14.
    Ziegler L, Newell R, Stafford N, Lewin R (2004) A literature review of head and neck cancer patients information needs, experiences and views regarding decision-making. Eur J Cancer Care 13(2):119–126CrossRefGoogle Scholar
  15. 15.
    Humphris GM, Ozakinci G (2006) Psychological responses and support needs of patients following head and neck cancer. Int J Surg 4:37–44PubMedCrossRefGoogle Scholar
  16. 16.
    Chen AM, Jennelle RLS, Grady V et al (2009) Prospective study of psychosocial distress among patients undergoing radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 73(1):187–193PubMedCrossRefGoogle Scholar
  17. 17.
    Neilson KA, Pollard AC, Boonzaier AM et al (2010) Psychological distress (depression and anxiety) in people with head and neck cancers. Med J Aust 193:S48–S51PubMedGoogle Scholar
  18. 18.
    Uitterhoeve RJ, Vernooy M, Litjens M et al (2004) Psychosocial interventions for patients with advanced cancer - a systematic review of the literature. Br J Cancer 91(6):1050–1062PubMedGoogle Scholar
  19. 19.
    Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36(1):13–34PubMedCrossRefGoogle Scholar
  20. 20.
    Rodin G, Lloyd N, Katz M et al (2007) The treatment of depression in cancer patients: a systematic review. Support Care Cancer 15(2):123–136PubMedCrossRefGoogle Scholar
  21. 21.
    Jacobsen PB, Jim HS (2008) Psychosocial interventions for anxiety and depression in adult cancer patients: achievements and challenges. CA Cancer J Clin 58(4):214–230PubMedCrossRefGoogle Scholar
  22. 22.
    Semple CJ, Sullivan K, Dunwoody L, Kernohan WG (2004) Psychosocial interventions for patients with head and neck cancer: past, present, and future. Cancer Nurs 27(6):434–441PubMedCrossRefGoogle Scholar
  23. 23.
    National Comprehensive Cancer Network (NCCN) (1999) NCCN practice guidelines for the management of psychosocial distress. Oncology 13:113–147Google Scholar
  24. 24.
    De Boer MF, McCormick LK, Pruyn JF, Ryckman RM, van den Borne BW (1999) Physical and psychosocial correlates of head and neck cancer: a review of the literature. Otolaryngol Head Neck Surg 120(3):427–436PubMedCrossRefGoogle Scholar
  25. 25.
    Owen C, Watkinson JC, Pracy P, Glaholm J (2001) The psychosocial impact of head and neck cancer. Clin Otolaryngol Allied Sci 26(5):351–356PubMedCrossRefGoogle Scholar
  26. 26.
    Newell SA, Sanson-Fisher RW, Savolainen NJ (2002) Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst 94(8):558–584PubMedGoogle Scholar
  27. 27.
    Williams S, Dale J (2006) The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. Br J Cancer 94(3):372–390PubMedCrossRefGoogle Scholar
  28. 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. 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. 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. 31.
    Cohen J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Lawrence Erlbaum, HillsdaleGoogle Scholar
  32. 32.
    Bailey JJ (2001) Development of a multi-modal psychological intervention as adjunctive therapy for smoking-related cancers. Dissertation, University of Memphis, USGoogle Scholar
  33. 33.
    Feldman JE, Baker KH (1988) The psychodynamics of prolonged treatment in a patient with cancer of the hypopharynx. Cancer Nurs 11(6):362–367PubMedCrossRefGoogle Scholar
  34. 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
  35. 35.
    Petruson KM, Silander EM, Hammerlid EB (2003) Effects of psychosocial intervention on quality of life in patients with head and neck cancer. Head Neck 25(7):576–584PubMedCrossRefGoogle Scholar
  36. 36.
    Hammerlid E, Persson LO, Sullivan M, Westin T (1999) Quality-of-life effects of psychosocial intervention in patients with head and neck cancer. Otolaryngol Head Neck Surg 120(4):507–516PubMedCrossRefGoogle Scholar
  37. 37.
    Katz MR, Irish JC, Devins GM (2004) Development and pilot testing of a psychoeducational intervention for oral cancer patients. Psycho Oncol 13(9):642–653CrossRefGoogle Scholar
  38. 38.
    Semple CJ, Dunwoody L, Kernohan WG, McCaughan E (2009) Development and evaluation of a problem-focused psychosocial intervention for patients with head and neck cancer. Support Care Cancer 17(4):379–388PubMedCrossRefGoogle Scholar
  39. 39.
    Allison PJ, Edgar L, Nicolau B, Archer J, Black M, Hier M (2004) Results of a feasibility study for a psycho-educational intervention in head and neck cancer. Psycho Oncol 13(7):482–485CrossRefGoogle Scholar
  40. 40.
    Vilela LD, Nicolau B, Mahmud S et al (2006) Comparison of psychosocial outcomes in head and neck cancer patients receiving a coping strategies intervention and control subjects receiving no intervention. J Otolaryngol 35(2):88–96PubMedCrossRefGoogle Scholar
  41. 41.
    Allison PJ, Nicolau B, Edgar L, Archer J, Black M, Hier M (2004) Teaching head and neck cancer patients coping strategies: results of a feasibility study. Oral Oncol 40(5):538–544PubMedCrossRefGoogle Scholar
  42. 42.
    Fiegenbaum W (1981) A social training program for clients with facial disfigurations: a contribution to the rehabilitation of cancer patients. Int J Rehabil Res 4(4):501–509PubMedCrossRefGoogle Scholar
  43. 43.
    Duffy SA, Ronis DL, Valenstein M et al (2006) A tailored smoking, alcohol, and depression intervention for head and neck cancer patients. Cancer Epidemiol Biomark Prev 15(11):2203–2208CrossRefGoogle Scholar
  44. 44.
    Vakharia KT, Ali MJ, Wang SJ (2007) Quality-of-life impact of participation in a head and neck cancer support group. Otolaryngol Head Neck Surg 136(3):405–410PubMedCrossRefGoogle Scholar
  45. 45.
    Zimmermann T, Heinrichs N, Baucom DH (2007) “Does one size fit all?” Moderators in psychosocial interventions for breast cancer patients: a meta-analysis. Ann Behav Med 34(3):225–239PubMedCrossRefGoogle Scholar
  46. 46.
    Berglund G, Petersson LM, Eriksson KC et al (2007) “Between Men”: a psychosocial rehabilitation programme for men with prostate cancer. Acta Oncol 46(1):83–89PubMedCrossRefGoogle Scholar
  47. 47.
    Penedo FJ, Molton I, Dahn JR et al (2006) A randomized clinical trial of group-based cognitive-behavioral stress management in localized prostate cancer: development of stress management skills improves quality of life and benefit finding. Ann Behav Med 31(3):261–270PubMedCrossRefGoogle Scholar
  48. 48.
    Parker PA, Pettaway CA, Babaian RJ et al (2009) The effects of a presurgical stress management intervention for men with prostate cancer undergoing radical prostatectomy. J Clin Oncol 27(19):3169–3176PubMedCrossRefGoogle Scholar
  49. 49.
    Holland J, Weiss T (2008) The new standard of quality cancer care: integrating the psychosocial aspects in routine cancer from diagnosis through survivorship. Cancer J 14(6):425–428PubMedCrossRefGoogle Scholar
  50. 50.
    Katz MR, Kopek N, Waldron J, Devins GM, Tomlinson G (2004) Screening for depression in head and neck cancer. Psycho Oncol 13(4):269–280CrossRefGoogle Scholar
  51. 51.
    Center for Epidemiologic Studies (1971) Center for Epidemiologic Studies Depression Scale (CES-D). National Institute of Mental Health, RockvilleGoogle Scholar
  52. 52.
    Ullrich de Muynck R, Ullrich R (1977) Der Unsicherheitsfragebogen. Testmanual und Anleitung fur den Therapeuten (Section III). Pfeiffer, MunichGoogle Scholar
  53. 53.
    Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376PubMedCrossRefGoogle Scholar
  54. 54.
    Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67(6):361–370PubMedCrossRefGoogle Scholar
  55. 55.
    Telch CF, Telch MJ (1986) Group coping skills instruction and supportive group therapy for cancer patients: a comparison of strategies. J Consult Clin Psychol 54(6):802–808PubMedCrossRefGoogle Scholar
  56. 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. 57.
    Bradburn N (1969) The Structure of Psychological Well-Being. Aldine, ChicagoGoogle Scholar
  58. 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
  59. 59.
    Rogers SN, Gwanne S, Lowe D, Humphris G, Yueh B, Weymuller EAJ (2002) The addition of mood and anxiety domains to the University of Washington quality of life scale. Head Neck 24(6):521–529PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • T. Luckett
    • 1
    • 2
    • 6
  • B. Britton
    • 3
    • 4
  • K. Clover
    • 3
    • 4
  • N. M. Rankin
    • 1
    • 5
  1. 1.Psycho-oncology Co-operative Research Group (PoCoG)The University of SydneySydneyAustralia
  2. 2.Improving Palliative Care through Clinical Trials (ImPaCCT) South Western Sydney Clinical School, Faculty of Medicine,University of NSW (UNSW)SydneyAustralia
  3. 3.Psycho-oncology ServiceCalvary Mater HospitalNewcastleAustralia
  4. 4.Centre for Brain and Mental Health ResearchUniversity of NewcastleNewcastleAustralia
  5. 5.Health research consultantBulliAustralia
  6. 6.Department of Palliative CareBraeside HospitalWetherill ParkAustralia

Personalised recommendations