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

Psycho-oncology Co-operative Research Group, The University of Sydney, Sydney, NSW, Australia.
Supportive Care in Cancer (Impact Factor: 2.36). 03/2011; 19(7):871-81. DOI: 10.1007/s00520-011-1119-7
Source: PubMed


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.
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.
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.
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.

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    • "However, compared with cancers such as breast and prostate cancer, H&N cancer has not received widespread attention, nor have H&N cancer patients had ready access to tailored psychosocial interventions or support groups. The authors of a review of interventions designed specifically for H&N cancer patients described some evidence of benefit due to psychoeducational initiatives [20]; however, few robust studies in this population have been conducted to date. In the United Kingdom, pilot testing of a psychoeducational intervention for patients during treatment demonstrated improvement in patient knowledge and body image [21]. "
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    ABSTRACT: Background: Few cancers pose greater challenges than head and neck (H&N) cancer. Residual effects following treatment include body image changes, pain, fatigue and difficulties with appetite, swallowing and speech. Depression is a common comorbidity. There is limited evidence about ways to assist patients to achieve optimal adjustment after completion of treatment. In this study, we aim to examine the effectiveness and feasibility of a model of survivorship care to improve the quality of life of patients who have completed treatment for H&N cancer. Methods/design: This is a preliminary study in which 120 patients will be recruited. A prospective randomised controlled trial of the H&N Cancer Survivor Self-management Care Plan (HNCP) involving pre- and post-intervention assessments will be used. Consecutive patients who have completed a defined treatment protocol for H&N cancer will be recruited from two large cancer services and randomly allocated to one of three study arms: (1) usual care, (2) information in the form of a written resource or (3) the HNCP delivered by an oncology nurse who has participated in manual-based training and skill development in patient self-management support. The trained nurses will meet patients in a face-to-face interview lasting up to 60 minutes to develop an individualised HNCP, based on principles of chronic disease self-management. Participants will be assessed at baseline, 3 and 6 months. The primary outcome measure is quality of life. The secondary outcome measures include mood, self-efficacy and health-care utilisation. The feasibility of implementing this intervention in routine clinical care will be assessed through semistructured interviews with participating nurses, managers and administrators. Interviews with patients who received the HNCP will explore their perceptions of the HNCP, including factors that assisted them in achieving behavioural change. Discussion: In this study, we aim to improve the quality of life of a patient population with unique needs by means of a tailored self-management care plan developed upon completion of treatment. Delivery of the intervention by trained oncology nurses is likely to be acceptable to patients and, if successful, will be a model of care that can be implemented for diverse patient populations. Trial registration: ACTRN12613000542796 (registered on 15 May 2013).
    Trials 05/2014; 15(1):191. DOI:10.1186/1745-6215-15-191 · 1.73 Impact Factor
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    • "Distress management may be achieved by different strategies. Luckett et al. [20] "
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    ABSTRACT: Conclusion: Distress and to some extent health-related quality of life (HRQoL) in head and neck squamous cell carcinoma (HNSCC) patients was found to be stable during follow-up. About one-third of the distress and HRQoL variances were accounted for in the present investigation with one-third from T stage, one-third directly from neuroticism and one-third from neuroticism via choice of coping response. In addition, choice of coping response predicted directly 5% of the HRQoL variance. Objective: To investigate the stability of distress and HRQoL as related to neuroticism and choice of coping response in HNSCC patients during a follow-up period of 4 years. Methods: We determined distress by the general health questionnaire (GHQ), HRQoL, personality by the Eysenck Personality Questionnaire (EPQ) and choice of coping response. All patients younger than 78 years with new HNSCC in Western Norway in the period 1992-2001 following successful treatment were interviewed. We determined GHQ and EORTC QLQ C30/H&N35 a second time after 4 years. Results: The GHQ scores were stable, whereas the HRQoL sum scores declined slightly (p < 0.001). The GHQ and the HRQoL scores were predicted by neuroticism, avoidant coping pattern, T stage and smoking history, but primarily H&N-specific HRQoL was predicted by treatment-derived factors.
    Acta oto-laryngologica 11/2012; 133(2). DOI:10.3109/00016489.2012.720032 · 1.10 Impact Factor
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    • "Limited well-controlled studies existed in the study of non-ulcer dyspepsia, multiple sclerosis, physical disability following traumatic injury, non-epileptic seizures, postconcussion syndrome, chronic obstructive pulmonary disease, hypertension, Type II diabetes, and burning mouth syndrome (e.g., Soo et al. 2004; Thomas et al. 2006; Baker et al. 2007; Ismail et al. 2004). However, cancer was studied more rigorously and with more robust methodological attention, indicating small to medium effect sizes of individual CBT as compared to patient education only in gynecological and head/neck cancers (Zimmermann and Heinrichs 2006; Luckett et al. 2011), on secondary outcomes such as quality of life, psychological distress (i.e., depression and anxiety), and pain. "
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    ABSTRACT: Cognitive behavioral therapy (CBT) refers to a popular therapeutic approach that has been applied to a variety of problems. The goal of this review was to provide a comprehensive survey of meta-analyses examining the efficacy of CBT. We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.
    Cognitive Therapy and Research 10/2012; 36(5):427-440. DOI:10.1007/s10608-012-9476-1 · 1.70 Impact Factor
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