Screening for distress, related problems and perceived need for psycho-oncological support in head and neck squamous cell carcinoma (HNSCC) patients: a retrospective cohort study

Effect of meditation and relaxation therapy on preoperative anxiety and stress in oral squamous cell carcinoma patients scheduled for oral and maxillofacial surgery: An experimental study

Context

The diagnosis of oral squamous cell carcinoma [OSCC] and its treatment phase is emotionally demanding for the patient and challenging for the surgeon. The induction of stress and anxiety is unavoidable in these patients. It becomes very important for the patient to have psychological as well as physical stability during this treatment phase. Various studies have reported the beneficial effect of meditation along with relaxation therapy on healthy individuals but the beneficial effect of meditation and relaxation therapy [MRT] to reduce stress and anxiety preoperatively in OSCC patients has not been reported in scientific literature.

Aim

The aim of this study was to study the effect of MRT on preoperative anxiety and stress in OSCC patients undergoing for oral and maxillofacial surgery.

Settings and Design

An experimental, parallel study design was carried out with randomization of patients into experimental[25] and control group[25] with allocation ratio 1:1 in 50 patients diagnosed with OSCC [stage II or III] scheduled for oral and maxillofacial surgery with general anesthesia.

Materials and Methods

The biopsy which was the prerequisite for the diagnosis was taken. Twenty-one days before surgery in experimental group, patients were oriented about meditation and relaxation exercises. The reorientation of MRT was done from the day of admission twice a day till the day of surgery. Physiological parameters for stress and anxiety like heart rate [HR], blood pressure [BP], pulse rate [PR], and respiratory rate [RR] were evaluated on 1st day of MRT at 9 am and on the day of surgery. The serum cortisol which was quantitative parameter for stress was evaluated 1st day of MRT at 9 am fasting and on the day of surgery. The qualitative analysis for anxiety was done preoperatively using visual analog scale on the 1st day before MRT and compared with the values on the day of surgery after MRT at a specific time.

Statistical Analysis

Paired t-test analysis was used intragroup whereas unpaired t-test was used intergroup between experimental and control groups with significance at P = 0.05 and highly significant at P = 0.0001.

Results

The serum cortisol was significantly less in the experimental group over control group with t = 7.04 and P = 0.0001. The systolic and diastolic BP, pulse rate, respiratory rate, and anxiety in the experimental group reported significantly less rate compared to the control group with t = 5.66, t = 22.2, t = 11.93, t = 27.71, and P = 0.0001.

Conclusion

In our study, MRT in the form of Sukhasana, Anulom Vilom, Omkar chanting, and Shavasana for 30 min twice daily has shown positive effect to reduce stress and anxiety. The serum cortisol as a quantitative parameter has been effectively evaluated in this benchmark study.

Effects of DSM-5 Betel-Quid-Related Symptoms, Pathological Behaviors, and Use Disorder on Oral Squamous Cell Carcinoma Risk

Simple Summary

This is the first study using psychometrics to investigate the association of the DSM-5 betel-quid (BQ)-related symptoms, pathological behaviors, and BQ use disorder (BUD) severity with the risk of oral squamous cell carcinoma (OSCC). This study presents data demonstrating that the symptoms of unsuccessful cutdown of BQ consumption, neglecting major roles, social or interpersonal problems, abandoning or limiting activities, hazardous use, and continued use despite awareness of the dangers were associated with the risk of OSCC. Pathological behavior of risky BQ use enhanced OSCC risk in chewers with moderate-to-severe BUD. BQ chewing is a major risk factor for oral cavity cancers; however, the risk can be mitigated by reducing pathological use. Our study indicates that targeting BUD and establishing a BUD-based strategy is a promising new direction for the prevention of OSCC.

Abstract

The neuroactive alkaloids in betel quid (BQ) can induce BQ addiction. We conducted a case–control study to investigate the effects of BQ-associated DSM-5 symptoms, pathological behaviors, and BQ use disorder (BUD) on oral squamous cell carcinoma (OSCC) risk. A total of 233 patients with newly diagnosed and histopathologically confirmed OSCC and 301 sex- and age-matched controls were included. BQ-related DSM-5 symptoms in the 12 months prior to disease onset were used to measure psychiatric characteristics and BUD. Compared with nonchewers, chewers with the symptoms of unsuccessful cutdown of BQ consumption, neglecting major roles, social or interpersonal problems, abandoning or limiting activities, hazardous use, and continued use despite the awareness of the dangers had a 54.8-, 49.3-, 49.9-, 40.4-, 86.2-, and 42.9-fold higher risk of developing OSCC, respectively. Mild-to-moderate and severe BUD were, respectively, associated with a 8.2–8.5- and 42.3-fold higher OSCC risk, compared with BQ nonuse. Risky BQ use of pathological behavior was associated with a 12.5-fold higher OSCC risk in chewers with no BUD or mild BUD and a 65.0-fold higher risk in chewers with moderate-to-severe BUD (p for risk heterogeneity between the two BUD groups, 0.041). In conclusion, BQ-associated DSM-5 symptoms, pathological behaviors, and BUD severity are associated with the impact of BQ chewing on OSCC development. The pathological behavior of risky BQ use enhances OSCC risk in chewers with moderate-to-severe BUD. Preventing BUD in new BQ users and treating BUD in chewers who already have the disorder are two priorities in areas where BQ chewing is prevalent.

Screening for Distress and Health Outcomes in Head and Neck Cancer

Head and neck cancers (HNC) have higher rates of emotional distress than other cancer types and the general population. This paper compares the prevalence of emotional distress in HNC across various distress screening measures and examines whether significant distress or distress screening are associated with cancer-related survival. A retrospective observational cohort design was employed, with data collected from the Distress Assessment and Response Tool (DART) and linkages to administrative databases from 2010 to 2016. Descriptive and prevalence data were reported using multiple concurrently administered distress tools, including the Patient Health Questionaire-9 (PHQ-9), Generalized Anxiety Disorders-7 (GAD-7), Edmonton Symptom Assessment Scale-revised (ESAS-r), and MD Anderson Symptom Index-Head and Neck module (MDASI-HN). Across measures, 7.8 to 28.1% of the sample reported clinically significant emotional distress, with PHQ-9 and GAD-7 identifying lowest prevalence of moderate/severe distress, and the ultrashort distress screens within ESAS-r and MDASI-HN performing equivalently. Cox hazards models were used in univariate and multivariate survival analyses. ESAS depression (≥4), but not anxiety, was associated with increased risk of cancer-related mortality and patient completion of DART was associated with greater cancer-related survival. The findings underscore the importance of implementing routine distress screening for HNC populations and the utility of ultra-brief screening measures.

Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer

Head and neck squamous cell carcinoma (HNSCC) is the most common cancer involving the mucosal surfaces of the head and neck and is associated with a number of etiological factors, including cigarette smoking, alcohol and betel nut consumption and exposure to high-risk human papillomavirus. The risk of HNSCC increases with age, peaking in the seventh and eighth decade, but this varies by anatomical and histological subtype. While several advancements have been made in the treatment of head and neck cancer (HNC) in recent decades, undertaking curative treatment still subjects the majority of HNSCC patients to substantial treatment-related toxicity requiring patients to tolerate a gamut of physical, psychological, and emotional demands on their reserves. In conjunction with other patient-related factors, clinicians involved in treating patients with HNSCC may incorporate advancing chronological age into their decision-making process when determining treatment recommendations. While advancing chronological age may be associated with increased concerns regarding physical treatment tolerability, clinicians may also be concerned about heightened vulnerability in various health and wellbeing outcomes. The available literature, however, does not provide evidence of this vulnerability in patients with advancing age, and, in many instances, older patients self-report greater resilience compared to their younger counterparts. While this data is reassuring it is limited by selection bias and heterogeneity in trial and study design and the absence of a consistent definition of the elderly patient with HNSCC. This narrative review article also includes a review of the measures used to assess HRQL, psychosocial outcomes and unmet needs in elderly or older patients with HNSCC.