Abstract
Long-term survivors of head and neck cancer may suffer from psychological distress and reduced quality of life because of late side-effects of the treatment. In a follow-up study of patients randomised to two different radiation fractionating regimens, 204 patients filled in a mailed questionnaire 7-11 years after treatment. The questionnaire consisted of the General Health Questionnaire, 20-item version (GHQ-20), and the EORTC Core Quality of Life Questionnaire (EORTC QLQ-C30). There were no differences in psychological distress between patients receiving conventional radiotherapy and those receiving a slightly hypofractionated regimen. A high prevalence of psychological distress was found in both treatment groups (30% of 'cases' according to the GHQ-20), especially in patients with impaired cognitive or social function, or with pain. Clinicians need to be aware of this morbidity, and their ability to detect patients with psychological problems needs to be improved. The GHQ-20 can facilitate the communication process in a clinical setting. With an increased awareness of these problems and by using valid instruments for identification of patients at risk, the clinicians may intervene and help the patients to reduce their psychological distress.
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Selected References
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- Aaronson N. K., Ahmedzai S., Bergman B., Bullinger M., Cull A., Duez N. J., Filiberti A., Flechtner H., Fleishman S. B., de Haes J. C. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993 Mar 3;85(5):365–376. doi: 10.1093/jnci/85.5.365. [DOI] [PubMed] [Google Scholar]
- Bjordal K., Kaasa S., Mastekaasa A. Quality of life in patients treated for head and neck cancer: a follow-up study 7 to 11 years after radiotherapy. Int J Radiat Oncol Biol Phys. 1994 Mar 1;28(4):847–856. doi: 10.1016/0360-3016(94)90104-x. [DOI] [PubMed] [Google Scholar]
- Bjordal K., Kaasa S. Psychometric validation of the EORTC Core Quality of Life Questionnaire, 30-item version and a diagnosis-specific module for head and neck cancer patients. Acta Oncol. 1992;31(3):311–321. doi: 10.3109/02841869209108178. [DOI] [PubMed] [Google Scholar]
- Breitbart W., Holland J. Psychosocial aspects of head and neck cancer. Semin Oncol. 1988 Feb;15(1):61–69. [PubMed] [Google Scholar]
- Cleary P. D., Goldberg I. D., Kessler L. G., Nycz G. R. Screening for mental disorder among primary care patients. Usefulness of the General Health Questionnaire. Arch Gen Psychiatry. 1982 Jul;39(7):837–840. doi: 10.1001/archpsyc.1982.04290070065012. [DOI] [PubMed] [Google Scholar]
- Craig T. J., Comstock G. W., Geiser P. B. The quality of survival in breast cancer: a case-control comparison. Cancer. 1974 May;33(5):1451–1457. doi: 10.1002/1097-0142(197405)33:5<1451::aid-cncr2820330531>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
- David D. J., Barritt J. A. Psychosocial aspects of head and neck cancer surgery. Aust N Z J Surg. 1977 Oct;47(5):584–589. doi: 10.1111/j.1445-2197.1977.tb06588.x. [DOI] [PubMed] [Google Scholar]
- David D. J., Barritt J. A. Psychosocial implications of surgery for head and neck cancer. Clin Plast Surg. 1982 Jul;9(3):327–336. [PubMed] [Google Scholar]
- Derogatis L. R., Morrow G. R., Fetting J., Penman D., Piasetsky S., Schmale A. M., Henrichs M., Carnicke C. L., Jr The prevalence of psychiatric disorders among cancer patients. JAMA. 1983 Feb 11;249(6):751–757. doi: 10.1001/jama.249.6.751. [DOI] [PubMed] [Google Scholar]
- Drettner B., Ahlbom A. Quality of life and state of health for patients with cancer in the head and neck. Acta Otolaryngol. 1983 Sep-Oct;96(3-4):307–314. doi: 10.3109/00016488309132903. [DOI] [PubMed] [Google Scholar]
- Dropkin M. J. Coping with disfigurement and dysfunction after head and neck cancer surgery: a conceptual framework. Semin Oncol Nurs. 1989 Aug;5(3):213–219. doi: 10.1016/0749-2081(89)90095-8. [DOI] [PubMed] [Google Scholar]
- Finlay-Jones R. A., Burvill P. W. Contrasting demographic patterns of minor psychiatric morbidity in general practice and the community. Psychol Med. 1978 Aug;8(3):455–466. doi: 10.1017/s0033291700016135. [DOI] [PubMed] [Google Scholar]
- Fobair P., Hoppe R. T., Bloom J., Cox R., Varghese A., Spiegel D. Psychosocial problems among survivors of Hodgkin's disease. J Clin Oncol. 1986 May;4(5):805–814. doi: 10.1200/JCO.1986.4.5.805. [DOI] [PubMed] [Google Scholar]
- Goldberg D. The recognition of psychiatric illness by non-psychiatrists. Aust N Z J Psychiatry. 1984 Jun;18(2):128–133. doi: 10.3109/00048678409158781. [DOI] [PubMed] [Google Scholar]
- Gotay C. C., Moore T. D. Assessing quality of life in head and neck cancer. Qual Life Res. 1992 Feb;1(1):5–17. doi: 10.1007/BF00435431. [DOI] [PubMed] [Google Scholar]
- Kaasa S., Aass N., Mastekaasa A., Lund E., Fosså S. D. Psychosocial well-being in testicular cancer patients. Eur J Cancer. 1991;27(9):1091–1095. doi: 10.1016/0277-5379(91)90299-s. [DOI] [PubMed] [Google Scholar]
- Kaasa S., Malt U., Hagen S., Wist E., Moum T., Kvikstad A. Psychological distress in cancer patients with advanced disease. Radiother Oncol. 1993 Jun;27(3):193–197. doi: 10.1016/0167-8140(93)90073-h. [DOI] [PubMed] [Google Scholar]
- Kornblith A. B., Anderson J., Cella D. F., Tross S., Zuckerman E., Cherin E., Henderson E., Weiss R. B., Cooper M. R., Silver R. T. Hodgkin disease survivors at increased risk for problems in psychosocial adaptation. The Cancer and Leukemia Group B. Cancer. 1992 Oct 15;70(8):2214–2224. doi: 10.1002/1097-0142(19921015)70:8<2214::aid-cncr2820700833>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
- Maguire G. P., Tait A., Brooke M., Thomas C., Howat J. M., Sellwood R. A., Bush H. Psychiatric morbidity and physical toxicity associated with adjuvant chemotherapy after mastectomy. Br Med J. 1980 Nov 1;281(6249):1179–1180. doi: 10.1136/bmj.281.6249.1179. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morton R. P., Davies A. D., Baker J., Baker G. A., Stell P. M. Quality of life in treated head and neck cancer patients: a preliminary report. Clin Otolaryngol Allied Sci. 1984 Jun;9(3):181–185. doi: 10.1111/j.1365-2273.1984.tb01493.x. [DOI] [PubMed] [Google Scholar]
- Olson M. L., Shedd D. P. Disability and rehabilitation in head and neck cancer patients after treatment. Head Neck Surg. 1978 Sep-Oct;1(1):52–58. doi: 10.1002/hed.2890010108. [DOI] [PubMed] [Google Scholar]
- Olweny C. L., Juttner C. A., Rofe P., Barrow G., Esterman A., Waltham R., Abdi E., Chesterman H., Seshadri R., Sage E. Long-term effects of cancer treatment and consequences of cure: cancer survivors enjoy quality of life similar to their neighbours. Eur J Cancer. 1993;29A(6):826–830. doi: 10.1016/s0959-8049(05)80418-6. [DOI] [PubMed] [Google Scholar]
- Razavi D., Delvaux N., Farvacques C., Robaye E. Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatry. 1990 Jan;156:79–83. doi: 10.1192/bjp.156.1.79. [DOI] [PubMed] [Google Scholar]
- Sprangers M. A., Cull A., Bjordal K., Groenvold M., Aaronson N. K. The European Organization for Research and Treatment of Cancer. Approach to quality of life assessment: guidelines for developing questionnaire modules. EORTC Study Group on Quality of Life. Qual Life Res. 1993 Aug;2(4):287–295. doi: 10.1007/BF00434800. [DOI] [PubMed] [Google Scholar]
- Turesson I., Notter G. The influence of fraction size in radiotherapy on the late normal tissue reaction--II: Comparison of the effects of daily and twice-a-week fractionation on human skin. Int J Radiat Oncol Biol Phys. 1984 May;10(5):599–606. doi: 10.1016/0360-3016(84)90290-6. [DOI] [PubMed] [Google Scholar]
- Van Dongen-Melman J. E., Sanders-Woudstra J. A. Psychosocial aspects of childhood cancer: a review of the literature. J Child Psychol Psychiatry. 1986 Mar;27(2):145–180. [PubMed] [Google Scholar]
