Psychosocial Needs of Head and Neck Cancer Patients and the Role of the Clinical Social Worker

  • Natalie Thome
  • Nellie Garcia
  • Karen Clark
Part of the Cancer Treatment and Research book series (CTAR, volume 174)


In this chapter, we examine the demographics and risk factors in the population diagnosed with head and neck cancer (HNC), what challenges these patients face post-treatment and what the role of psychosocial support through clinical social work is in managing these stressors. While many forms of head and neck cancer found in the early stages have a high cure rate, the side effects of treatment for these cancers have major life-altering effects. Previously, the majority of those diagnosed with head and neck cancers were those who used excessive alcohol and tobacco, but the numbers are changing to include the human papillomavirus (HPV) as a major risk factor. Due to the behavioral risk factors that are often causes of head and neck cancers and the effects of treatment that often lend to psychosocial distress, the role of psychosocial intervention at time of diagnosis throughout the disease trajectory is essential for compliance with treatment and healthy coping post-treatment. Clinical social workers play an essential role within the multidisciplinary team of assessment and interventions for managing patient’s psychosocial distress.


Head and neck cancer Clinical social work Psychosocial distress Depression Anxiety SupportScreen Cognitive behavioral therapy 


  1. 1.
    Devins GM, Otto KJ, Irish JC, Rodin G (2015) Head and Neck Cancer. In Holland, JC et al (eds) Psycho-Oncology, 3rd edn. Oxford, New York, pp 92–97Google Scholar
  2. 2.
    Warnakulasuriya S (2009) Global epidemiology of oral and orapharyngeal cancer. Oral Oncol 45:309–316CrossRefPubMedGoogle Scholar
  3. 3.
    Ho PS, Ko YC, Yang YH, Shieh TY, Tsai CC (2002) The incidence of oropharyngeal cancer in Taiwan: an endemic betel quid chewing area. J Oral Pathol Med 31(4):213–219CrossRefPubMedGoogle Scholar
  4. 4.
    Goldenberg D, Lee J, Koch WM et al (2004) Habitual risk factors for head and neck cancer. Otolaryngol Head and Neck Surg 131(6):986–993CrossRefGoogle Scholar
  5. 5.
    Goldenberg D, Golz A, Joachims HZ (2003) The beverage maté: a risk factor for cancer of the head and neck. Head Neck 25(7):595–601CrossRefPubMedGoogle Scholar
  6. 6.
    Yu MC, Yuan JM (2006) Nasopharyngeal cancer. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer Epidemiology and Prevention, 3rd edn. Oxford, New YorkGoogle Scholar
  7. 7.
    Yu MC, Yuan JM (2002) Epidemiology of nasopharyngeal carcinoma. Semin Cancer Biol 12(6):421–429CrossRefPubMedGoogle Scholar
  8. 8.
    Olshan AF (2006) Cancer of the Larynx. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer Epidemiology and Prevention, 3rd edn. Oxford, New YorkGoogle Scholar
  9. 9.
    Blot WJ, McLaughlin JK, Winn DM et al (1988) Smoking and drinking in relation to oral and pharyngeal cancer. Can Res 48(11):3282–3287Google Scholar
  10. 10.
    Howren MB, Christensen AJ, Karnell LH, Funk GF (2013) Psychological factors associated with head and neck cancer treatment and survivorship: evidence and opportunities for behavioral medicine. J Consult Clin Psychol 81(2):299–317CrossRefPubMedGoogle Scholar
  11. 11.
    Chaturvedi AK, Engels EA, Anderson WF, Gillison ML (2008) Incidence trends for human papillomavirus-related and–unrelated oral squamous cell carcinomas in the United States. J Clin Oncol 26:612–619. CrossRefPubMedGoogle Scholar
  12. 12.
    Gillison ML, D’Souza G, Westra W et al (2008) Distinct risk factor profiles for human papillomavirus type 16-positive and human papillomavirus type 16-negative head and neck cancers. J Nat Cancer Inst 100:407–420. CrossRefPubMedGoogle Scholar
  13. 13.
    D’Souza G, Kreimer AR, Viscidi R et al (2007) Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med 356:1944–1956CrossRefPubMedGoogle Scholar
  14. 14.
    Blomberg M, Nielsen A, Munk C, Kjaer SK (2011) Trends in head and neck cancer incidence in Denmark, 1978–2007; focus on human papillomavirus associated sites. Int J Cancer 129:733–741. CrossRefPubMedGoogle Scholar
  15. 15.
    D’Souza G, Agrawal Y, Halpern J, Bodison S, Gillison ML (2009) Oral sexual behaviors associated with prevalent oral human papillomavirus infection. J Infect Dis 199:1263–1269. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Sherman AC, Simonton S (2010) Advances in quality of life research among head and neck cancer patients. Curr Oncol Rep 12:208–215CrossRefPubMedGoogle Scholar
  17. 17.
    Moore KA, Ford PJ, Farah CS (2014) Support needs and quality of life in oral cancer: a systematic review. Int J Dental Hygiene 12:36–47CrossRefGoogle Scholar
  18. 18.
    Devins GM, Payne AYM, Lebel S, Mah S, Lee K, Irish J, Ronin GM (2013) The burden of stress in head and neck cancer. Psycho-Oncology 22(3):668–676
  19. 19.
    Ronis DL, Duffy SA, Fowler KE, Khan MJ, Terrell JE (2008) Changes in quality of life over 1 year in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg J 134(3):241–248. CrossRefGoogle Scholar
  20. 20.
    Kallay E, Degi L, Vineze A (2007) Dysfuntional attitudes, depression and quality of life in a sample of Romanian Hungarian cancer patients. J Cogn Behav Psychol 7(1):97–108Google Scholar
  21. 21.
    de Leeuw J et al (2001) Prediction of depression 6 months to 3 years after treatment of head and neck cancer. Head Neck 23(10):882–898CrossRefGoogle Scholar
  22. 22.
    Haisfield-Wolfe ME, McGuire DB, Soeken K, Geiger-Brown J, De Forge BR (2009) Prevalence and correlates of depression among patients with head and neck cancer; a systematic review of implications for research. Oncol Nurs Forum 34(2):180–187Google Scholar
  23. 23.
    Karnell LH et al (2006) Persistent posttreatment depressive symptoms in patients with head and neck cancer. Head Neck 28(5):453–461CrossRefPubMedGoogle Scholar
  24. 24.
    Sehlen S et al (2003) Depressive symptoms during and after radiotherapy for head and neck cancer. Head Neck 25(12):1004–1018CrossRefPubMedGoogle Scholar
  25. 25.
    Singer S et al (2012) Predictors of emotional distress in patients with head and neck cancer. Head Neck 34(2):180–187CrossRefPubMedGoogle Scholar
  26. 26.
    Lydiatt WM, Moran J, Burke WJ (2009) A review of depression in the head and neck cancer patient. Clin Adv Hematol Oncol 7:397–403PubMedGoogle Scholar
  27. 27.
    DiMatteo MR, Lepper HD, Croghan TW (2000) 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 160:2101–2107. CrossRefPubMedGoogle Scholar
  28. 28.
    Howren MB, Christensen AJ, Karnell LH, Funk GF (2010) Health-related quality of life in head and neck cancer survivors: impact of pretreatment depressive symptoms. Health Psychol 29:65–71. CrossRefPubMedGoogle Scholar
  29. 29.
    Spiegel D, Giese-Davis J (2003) Depression and cancer: mechanisms and disease progression. Biol Psychiat 54:269–282CrossRefPubMedGoogle Scholar
  30. 30.
    Nielson K, Pollard A, Boonzaier A, Corry J, Castle D, Smith D, Trauer T, Couper J (2013) A longitudinal study of distress (depression and anxiety) up to 18 months after radiotherapy for head and neck cancer. Psycho-Oncology 22:1843–1848CrossRefGoogle Scholar
  31. 31.
    Zeller J (2006) High suicide risk found for patients with head and neck cancer. J Am Med Assoc 296(14):1716–1717CrossRefGoogle Scholar
  32. 32.
    Callahan C (2005) Facial disfigurement and sense of self in head and neck cancer. Soc Work Health Care 40:73–87. CrossRefGoogle Scholar
  33. 33.
    Clarke A (1999) Psychosocial aspects of facial disfigurement: problems, management, and the role of a lay-led organization. Psychol Health Med 4:127–142. CrossRefGoogle Scholar
  34. 34.
    Fingeret MC, Yuan Y, Urbauer D, Weston J, Nipomnick S, Weber R (2012) The nature and extent of body image concerns among surgically treated patients with head and neck cancer. Psycho-Oncology 21:836–844. CrossRefPubMedGoogle Scholar
  35. 35.
    Lebel S, Castonguay M, Mackness G, Irish J, Bezjak A, Devins G M (2011) The psychosocial impact of stigma in people with head and neck or lung cancer. Psycho-Oncology. Advance online publication. doi:
  36. 36.
    Koch R, Wittekindt C, Altendorf-Hofmann A, Singer S, Guntinas-Lichius O (2015) Employment pathways and work-related issues in head and neck cancer survivors. Head & Neck. April 2015; 585–593. doi:
  37. 37.
    Loscalzo M, Clark K, Dillehunt J, Rinehart R, Strowbridge R, Smith D (2010) Support Screen: a model for improving patient outcomes at your fingertips. J Nat Compr Cent Netw 8:496–504CrossRefGoogle Scholar
  38. 38.
    Kennedy V, Smolinski KM, Colón Y, Zabora J (2015) Educating and training professional social workers in Psycho-Oncology. In Holland, JC et al (eds) Psycho-Oncology, 3rd edn. Oxford, New York, pp 689–694Google Scholar
  39. 39.
    Semple C, Parahoo K, Norman A, McCaughan E, Humphris G, Mills M (2013) Psychosocial interventions for patients with head and neck cancer. Cochrane Database Syst Rev 7:1–59. Google Scholar
  40. 40.
    Britton B et al (2012) Baseline depression predicts malnutrition in head and neck cancer patients undergoing radiotherapy. Support Care Cancer 20(2):335–342CrossRefPubMedGoogle Scholar
  41. 41.
    Hawton K, van Heeringen K (2009) Suicide. Lancet 373(1):1372–1381CrossRefPubMedGoogle Scholar
  42. 42.
    Massie M, Popkin, M (1998) Depressive disorders. In Holland JC (ed) Psycho-Oncology. Oxford, New YorkGoogle Scholar
  43. 43.
    Newport D, Nemeroff C (1998) Assessment and treatment of depression in the cancer patient. J Psychosom Res 45:215–237CrossRefPubMedGoogle Scholar
  44. 44.
    Pirl W, Roth A (1999) Diagnosis and treatment of depression in cancer patients. Oncology 9:1293–1306Google Scholar
  45. 45.
    Andersen BL (2002) Biobehavioral outcomes following psychological interventions for cancer patients. J Consult Clin Psychol 70(3):590–610CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Rehse B, Pukrop R (2003) Effects of psychosocial interventions on quality of life in adult cancer patients: meta analysis of 37 published controlled outcome studies. Patient Educ Couns 50(2):179–186CrossRefPubMedGoogle Scholar
  47. 47.
    Faller H, Schuler M, Richard M, Heckl U, Weis J, Kuffner R (2013) 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 31(6):782–793CrossRefPubMedGoogle Scholar
  48. 48.
    Andersen BL, Farrar WB, Golden-Kreutz DM et al (2004) Psychological, behavioral, and immune changes after a psychological intervention: a clinical trial. J Clin Oncol 22(17):3570–3580CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH (2010) An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 4(2):87–100CrossRefPubMedGoogle Scholar
  50. 50.
    Richardson JL, Marks G, Johnson CA et al (1987) Path model of multidimensional compliance with cancer therapy. Health Psychol 6(3):183–207CrossRefPubMedGoogle Scholar
  51. 51.
    McGregor BA, Antoni MH (2009) Psychological intervention and health outcomes among women treated for breast cancer: a review of stress pathways and biological mediators. Brain Behav Immun 23(2):159–166CrossRefPubMedGoogle Scholar
  52. 52.
    Andersen BL, Dorfman CS, Godiwala N (2015) Cognitive and behavioral interventions. In Holland JC (eds) Psycho-Oncology, 3rd edn. Oxford, New York, pp 449–457Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.City of HopeDuarteUSA

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