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

Psychological Factors Related to Treatment Outcomes in Head and Neck Cancer

Antti A Mäkitie  1   2   3 , Rasheed Omobolaji Alabi  4   5 , Laura Pulkki-Råback  6 , Alhadi Almangush  4   7   8 , Jonathan J Beitler  9   10 , Nabil F Saba  11 , Primož Strojan  12 , Robert Takes  13 , Orlando Guntinas-Lichius  14 , Alfio Ferlito  15
Affiliations

Psychological Factors Related to Treatment Outcomes in Head and Neck Cancer

Antti A Mäkitie et al. Adv Ther. 2024 Sep.

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.

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Conflict of interest statement

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 is an Editorial Board member of Oncology and Therapy. Alfio Ferlito was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions.

Figures

Fig. 1
Fig. 1
PRISMA flow chart
See this image and copyright information in PMC

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