Psychological distress and nutritional status in head and neck cancer patients: a pilot study

Abstract

Purpose To determine whether the psychological state of patients with head and neck cancer (HCN) is associated with their nutritional status. Methods In 40 patients with locally advanced HNC treated with definitive or adjuvant (chemo)radiotherapy, psychological and nutritional status were assessed before treatment, at its completion and 3 months' post-therapy. Psychosocial distress was measured using the Hospital Anxiety and Depression Scale questionnaire (HADS-A, HADS-D), whereas the nutritional status was evaluated using standard methods (Nutritional Risk Screening Tool 2002, anthropometric data, dynamometry and laboratory tests) and with a bioelectrical impedance analysis parameter phase angle (PA). Results Before treatment, more patients were screened positive for anxiety than at treatment completion (p = 0.037) or 3 months' post-therapy (p = 0.083). Depression prevalence was non-significantly higher at the end and after therapy. Compared to the baseline, more cachectic patients and a reduction of PA values were found at successive assessments. Anxiety was more often recorded among malnourished/cachectic patients (assessment 1, p = 0.017; assessment 2, p = 0.020) who were also found more frequently depressed (assessment 2, p = 0.045; assessment 3, p = 0.023). Significantly higher PA values were measured in patients without distress determined at 3 months' post-therapy by the HADS-A (p = 0.027). Conclusion The association between the psychological and nutritional status found in this pilot study and the options for intervention warrants further clarification in a larger prospective trial.

Relation Between Malnutrition and the Presence of Symptoms of Anxiety and Depression in Hospitalized Cancer Patients

“…We found an association between presenting anxious and depression symptomatology and malnutrition in hospitalized oncologic patients. Previous studies also point towards this association [27][28][29][30][31][32]. Chabowski et al found that the deterioration in nutritional status is associated with a signi cant worsening in terms of depression, anxiety, and pain.…”

“…[28]. Gosak et al found a signi cant correlation between nutritional status and HADS scores, with more distressed patients found in the malnourished/cachectic subgroups [29]. Santos et al found the presence of depression in 52.9% elderly malnourished patients undergoing treatment for cancer [33].…”

Identifying Patient-Reported Outcome Measures (PROMs) for Routine Surveillance of Physical and Emotional Symptoms in Head and Neck Cancer Populations: A Systematic Review

“…Variability in rates of depression were noted and ranged from 2% to 84% due to differential timing of assessments, different scales, and different threshold values. For example, across different studies, depression was evaluated using any of the following instruments: Hospital Anxiety and Depression Scale (HADS) [16][17][18][19][20][21][22][23][24][25]35,36], the Beck Depression Inventory (BDI) [26][27][28], the short-form of the Geriatric Depression Scale (GDS-SF) [29], the Neuropsychiatric Inventory Questionnaire (NPI-Q) [30], the Research Diagnostic Criteria Schedule for Affective Disorders and Schizophrenia (RDC SADS) [31], the University of Washington Quality of Life Mood scale (UWQOL-mood) [32], and the Patient Health Questionaire-8 (PHQ-8) [4]. Chen et al [16] evaluated the prevalence of depression over time using the HADS-D (cut-off score of ≥8) and the BDI (cut-off score ≥ 14) and reported a 13% difference in the number of patients with depression as identified by the HADS-D and the BDI at pre-treatment, a 5% difference in prevalence during treatment, and a 12% difference post-treatment between instruments.…”

“…Twenty studies reported on prevalence of anxiety in HNC [4,[16][17][18][19][20][21][22][23]25,30,33,[35][36][37][42][43][44][45][46]. Sample sizes ranged from 23 patients to 229 patients and prevalence rates ranged from 1% to 97.5%.…”

Toxicities Caused by Head and Neck Cancer Treatments and Their Influence on the Development of Malnutrition: Review of the Literature

“…Malnutrition in patients with HNC is linked with signs of psychological distress, and includes adjusting to physical changes that may impact body image, such as rapid weight loss, or the impact of changes to the social meaning of eating [ 84 ]. Compared to other cancer types, patients with HNC have the highest prevalence of psychological distress, with a associations found between nutritional status, dietary intake and psychological status [ 85 , 86 ]. However, additional factors also contribute to psychological distress in this population, in particular anxiety in one-third of the population, and depression, experienced by 15–50% of patients [ 87 ].…”