Psychological Factors Related to Treatment Outcomes in Head and Neck Cancer

Antti A Mäkitie; Rasheed Omobolaji Alabi; Laura Pulkki-Råback; Alhadi Almangush; Jonathan J Beitler; Nabil F Saba; Primož Strojan; Robert Takes; Orlando Guntinas-Lichius; Alfio Ferlito

doi:10.1007/s12325-024-02945-3

Psychological Factors Related to Treatment Outcomes in Head and Neck Cancer

Adv Ther. 2024 Sep;41(9):3489-3519. doi: 10.1007/s12325-024-02945-3. Epub 2024 Aug 7.

Authors

Antti A Mäkitie^{1

2

3}, Rasheed Omobolaji Alabi^{4

5}, Laura Pulkki-Råback⁶, Alhadi Almangush^{4

7

8}, Jonathan J Beitler^{9

10}, Nabil F Saba¹¹, Primož Strojan¹², Robert Takes¹³, Orlando Guntinas-Lichius¹⁴, Alfio Ferlito¹⁵

Affiliations

¹ Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O.Box 263, 00029 HUS, Helsinki, Finland. antti.makitie@helsinki.fi.
² Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland. antti.makitie@helsinki.fi.
³ Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden. antti.makitie@helsinki.fi.
⁴ Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland.
⁵ Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland.
⁶ Department of Psychology, University of Helsinki, Helsinki, Finland.
⁷ Department of Pathology, University of Helsinki, Helsinki, Finland.
⁸ Institute of Biomedicine, Pathology, University of Turku, Turku, Finland.
⁹ Harold Alfond Center for Cancer Care, Maine General Hospital, Augusta, ME, USA.
¹⁰ Dept of Radiation Oncology, John J. Cochran Veterans Hospital, St. Louis, MO, USA.
¹¹ Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, 30322, USA.
¹² Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
¹³ Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
¹⁴ Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
¹⁵ Coordinator of the International Head and Neck Scientific Group, Padua, Italy.

Abstract

Background: Patients with head and neck cancer (HNC) often demonstrate stress, distress, anxiety, depression, and are at risk for suicide. These affect their quality of life (QoL) but less attention has been given to psychological variables that may impact response to treatment.

Objectives: This study aims to systematically review publications during 2013-2023 to collate evidence on the effects of psychological variables on HNC treatment outcomes.

Methods: We searched Ovid Medline, PubMed, Scopus, and Web of Science for articles that examined psychological factors related to treatment outcomes in patients with HNC.

Results: There were 29 studies (5 before treatment, 2 during, 17 after, and 5 covering the whole management trajectory) including 362,766 patients. The psychological factors were either behavioral (adjustment and coping strategy, unrealistic ideas, self-blame), cognitive (elevated risk of psychiatric co-comorbidity), or emotional (distress, depression, anxiety, nervousness, and fear of disfigurement and complications). It was found that there was a relationship between depression and decreased survival in patients with HNC. Pretreatment pain was an independent predictor of decreased survival in a large sample of patients. The distress level was approximately 54%, emotional problems ranged between 10 and 44%, while financial difficulties were identified in 54% of the patients. Sixty-nine percent of patients were reported to have used at least one cost-coping strategy within 6 months after treatment initiation. During post-treatment period, depression increased from 15% at the baseline to 29%, while the fear of recurrence was found among at least 35% of patients.

Discussion and conclusion: Several psychological factors predict QoL and survival among HNC survivors. Distress encompasses depression and anxiety, and physical burden from HNC diagnosis and treatment. Routine screening and early interventions that target distress could improve HNC survivors' QoL. A systematic and standardized measurement approach for QoL is warranted to homogenize these findings and to understand the underlying relationships.

Keywords: Distress; Head and neck cancer; Psychology; Stress; Systematic review.

Publication types

Systematic Review

MeSH terms

Adaptation, Psychological*
Anxiety / etiology
Anxiety / psychology
Depression / etiology
Depression / psychology
Head and Neck Neoplasms* / psychology
Head and Neck Neoplasms* / therapy
Humans
Quality of Life*
Stress, Psychological / psychology
Treatment Outcome