Worldwide there are more than 500,000 new cases of head and neck cancer annually, making it the 5^th most common cancer.  A diagnosis of head and neck cancer has a significant psychosocial impact and interventions have been developed to help patients cope with the emotional and social impact of the condition. The aim of this review was to assess the effectiveness of psychosocial interventions for adults with head and neck cancer.

Searches were conducted in the Cochrane Ear, Nose and Throat (ENT) Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, PubMed; Embase; CINAHL; PsycINFO; LILACS; KoreaMed; IndMed; PakMediNet; CABAbstracts; Web of Science; BIOSIS Previews; ClinicalTrials.gov; IC-TRP; National Cancer Institute Trials database; Cancer Research UK trials database and Google.  Randomised and quasi-randomised controlled studies of psychosocial interventions for adults with head and neck cancer were selected. Studies had to assess outcomes using a validated quality of life or psychological distress measure, or both. Data was abstracted by two reviewers independently and risk of bias assessed.

• 7 randomised controlled trials involving 542 participants were included.
• Only 1 trial was considered to be at low risk of bias, 3 at high risk the remainder being unclear.
• From these studies, there was no evidence to suggest that psychosocial intervention promotes global quality of life for patients with head and neck cancer at end of intervention (MD 1.23, 95% CI -5.82 to 8.27) as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). This quality of life tool includes five functional scales, namely cognitive, physical, emotional, social and role. There was no evidence to demonstrate that psychosocial intervention provides an immediate or medium-term improvement on any of these five functional scales.
• From the data available,
  • There was no significant change in levels of anxiety (SMD -0.09, 95% CI -0.40 to 0.23) or
  • Depression following intervention (SMD -0.03, 95% CI -0.24 to 0.19).

From a practice perspective the authors concluded:-

This review suggests that currently there is insufficient evidence to refute or support the effectiveness of psychosocial interventions for patients with head and neck cancer. This review was also unable to provide any evidence to support any specific type of psychosocial intervention for patients treated with head and neck cancer, in relation to theoretical perspective, duration, setting, mode of delivery or intensity.

Comment

The authors highlight that the included studies had a variation in the focus of the intervention from preparation for the post surgical changes to dealing with fear of recurrences. There were also variations in the outcomes measures used, with 5 out of 7 dealing with quality of life (and not all using the same measures), 3 studies considering anxiety and 4 depression.  THe range outcomes used and the different focus of the interventions and the small number of studies there were identified led the authors to recommend that:-

Future research should be targeted at patients who screen positive for distress and use validated outcome measures, such as the EORTC scale, as a measure of quality of life. These studies should implement interventions that are theoretically derived. Other shortcomings should be addressed in future studies, including using power calculations that may encourage multi-centred collaboration to ensure adequate sample sizes are recruited.

Links

Semple C, Parahoo K, Norman A, McCaughan E, Humphris G, Mills M. Psychosocial interventions for patients with head and neck cancer. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD009441. DOI: 10.1002/14651858.CD009441.pub2.