Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. National Cancer Institute (2010) Head and neck cancer. http://www.cancer.gov/cancertopics/types/head-and-neck. Accessed 19th Sept 2010.

  2. Bofetta P, Hashibe M, La Vecchia C, Zatonski W, Rehm J (2006) The burden of cancer attributable to alcohol drinking. Int J Cancer 119:884–887

    Article  Google Scholar 

  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 88:542–549

    Article  PubMed  CAS  Google Scholar 

  4. IOM (Institute of Medicine) (2009) State of the USA health indicators: letter report. The National Academies Press, Washington

    Google Scholar 

  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 46:588–598

    Article  PubMed  CAS  Google Scholar 

  6. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho Oncol 10(1):19–28

    Article  CAS  Google Scholar 

  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):303–319

    Article  PubMed  CAS  Google Scholar 

  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):440–454

    Article  PubMed  CAS  Google Scholar 

  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):843–868

    Article  PubMed  CAS  Google Scholar 

  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):251–267

    Article  PubMed  Google Scholar 

  11. Callahan C (2004) Facial disfigurement and sense of self in head and neck cancer. Soc Work Health Care 40(2):73–87

    Article  PubMed  Google Scholar 

  12. Frampton M (2001) Psychological distress in patients with head and neck cancer: review. Br J Oral Maxillofac Surg 39(1):67–70

    Article  PubMed  CAS  Google Scholar 

  13. Haman KL (2008) Psychologic distress and head and neck cancer: part 1–review of the literature.[see comment]. J Support Oncol 6(4):155–163

    PubMed  Google Scholar 

  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):119–126

    Article  CAS  Google Scholar 

  15. Humphris GM, Ozakinci G (2006) Psychological responses and support needs of patients following head and neck cancer. Int J Surg 4:37–44

    Article  PubMed  Google Scholar 

  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):187–193

    Article  PubMed  Google Scholar 

  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–S51

    PubMed  Google Scholar 

  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):1050–1062

    PubMed  CAS  Google Scholar 

  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):13–34

    Article  PubMed  Google Scholar 

  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):123–136

    Article  PubMed  Google Scholar 

  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):214–230

    Article  PubMed  Google Scholar 

  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):434–441

    Article  PubMed  Google Scholar 

  23. National Comprehensive Cancer Network (NCCN) (1999) NCCN practice guidelines for the management of psychosocial distress. Oncology 13:113–147

    Google Scholar 

  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):427–436

    Article  PubMed  Google Scholar 

  25. Owen C, Watkinson JC, Pracy P, Glaholm J (2001) The psychosocial impact of head and neck cancer. Clin Otolaryngol Allied Sci 26(5):351–356

    Article  PubMed  CAS  Google Scholar 

  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):558–584

    PubMed  Google Scholar 

  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):372–390

    Article  PubMed  CAS  Google 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, Sydney

    Google 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, Hillsdale

    Google Scholar 

  32. Bailey JJ (2001) Development of a multi-modal psychological intervention as adjunctive therapy for smoking-related cancers. Dissertation, University of Memphis, US

  33. Feldman JE, Baker KH (1988) The psychodynamics of prolonged treatment in a patient with cancer of the hypopharynx. Cancer Nurs 11(6):362–367

    Article  PubMed  CAS  Google Scholar 

  34. Clarke A (2001) Resourcing and training head and neck cancer nurse specialists to deliver a social rehabilitation programme to patients. Dissertation, City University

  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):576–584

    Article  PubMed  Google Scholar 

  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):507–516

    Article  PubMed  CAS  Google Scholar 

  37. Katz MR, Irish JC, Devins GM (2004) Development and pilot testing of a psychoeducational intervention for oral cancer patients. Psycho Oncol 13(9):642–653

    Article  Google Scholar 

  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):379–388

    Article  PubMed  Google Scholar 

  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):482–485

    Article  CAS  Google Scholar 

  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):88–96

    Article  PubMed  Google Scholar 

  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):538–544

    Article  PubMed  CAS  Google Scholar 

  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):501–509

    Article  PubMed  CAS  Google Scholar 

  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):2203–2208

    Article  Google Scholar 

  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):405–410

    Article  PubMed  Google Scholar 

  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):225–239

    Article  PubMed  Google Scholar 

  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):83–89

    Article  PubMed  Google Scholar 

  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):261–270

    Article  PubMed  Google Scholar 

  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):3169–3176

    Article  PubMed  Google Scholar 

  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):425–428

    Article  PubMed  Google Scholar 

  50. Katz MR, Kopek N, Waldron J, Devins GM, Tomlinson G (2004) Screening for depression in head and neck cancer. Psycho Oncol 13(4):269–280

    Article  Google Scholar 

  51. Center for Epidemiologic Studies (1971) Center for Epidemiologic Studies Depression Scale (CES-D). National Institute of Mental Health, Rockville

    Google Scholar 

  52. Ullrich de Muynck R, Ullrich R (1977) Der Unsicherheitsfragebogen. Testmanual und Anleitung fur den Therapeuten (Section III). Pfeiffer, Munich

    Google Scholar 

  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 85:365–376

    Article  PubMed  CAS  Google Scholar 

  54. Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67(6):361–370

    Article  PubMed  CAS  Google Scholar 

  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):802–808

    Article  PubMed  CAS  Google Scholar 

  56. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA (1983) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists, Palo Alto

    Google Scholar 

  57. Bradburn N (1969) The Structure of Psychological Well-Being. Aldine, Chicago

    Google Scholar 

  58. Atkinson T (1977) Is Satisfaction a good measure of the perceived quality of life? Annual Meeting of the American Statistical Association, Chicago, Illinois

  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):521–529

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We wish to acknowledge the support of the Psycho-oncology Co-operative Research Group (PoCoG), which provided the opportunity for the authors to collaborate on this review.

Conflict of interest

No organisation sponsored this research. No primary data were collected. The authors agree to allow the journal to review data subjected to secondary analysis in this article if requested.

Author information

Authors and Affiliations

  1. Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia

    T. Luckett & N. M. Rankin

  2. Improving Palliative Care through Clinical Trials (ImPaCCT) South Western Sydney Clinical School, Faculty of Medicine,, University of NSW (UNSW), Sydney, NSW, Australia

    T. Luckett

  3. Psycho-oncology Service, Calvary Mater Hospital, Newcastle, NSW, Australia

    B. Britton & K. Clover

  4. Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW, Australia

    B. Britton & K. Clover

  5. Health research consultant, Bulli, NSW, Australia

    N. M. Rankin

  6. Department of Palliative Care, Braeside Hospital, Locked Bag 82, Wetherill Park, NSW, 2164, Australia

    T. Luckett

Authors
  1. T. Luckett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Britton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Clover
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. M. Rankin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Luckett.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Luckett, T., Britton, B., Clover, K. et al. Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature. Support Care Cancer 19, 871–881 (2011). https://doi.org/10.1007/s00520-011-1119-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-011-1119-7

Keywords

Search

Navigation