Analysis of psychological distress in elderly patients with head and neck cancer receiving radiotherapy
Bao Ruizhi, Yi Junlin, Liu Qingfeng, Chen Xuesong, Wu Runye, Huang Xiaodong, Wang Kai, Qu Yuan, Zhang Shiping, Luo Jingwei, Xiao Jianping, Zhang Ye
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Abstract：Objective To evaluate the psychological pain of patients with head and neck cancer aged ≥60 years old before and after intensity-modulated radiotherapy (IMRT). Methods Distress Thermometer (DT)(Chinese version) was used to investigate the degree and problems of psychological pain before and after IMRT for 85 elderly patients with head and neck cancer. The results before and after IMRT were compared by paired t-test. Relevant factors were identified by Logistic regression analysis. Results The median age in the cohort was 66 years old (60-85 years old). The incidence rates of psychological pain were 73% and 87% before and after IMRT (P<0.001). The corresponding incidence rates of severe distress were 6% and 34%(P<0.001). The main distress problems before IMRT were memory loss/attention deficit, worry, oral pain, economic problems, stress, sleep problems, and dry nose. The significantly-increased distress problems after IMRT were oral pain, constipation, eating, nausea, and dry nose. Logistic regression analysis showed gender (OR=5.520, 95%CI 1.437-21.212, P=0.013), pre-treatment PG-SGA score (OR=1.220, 95%CI 1.048-1.421, P=0.010) and medical insurance (OR=0.230, 95%CI 0.053-0.995, P=0.049) were the relevant factors of the severe psychological distress before IMRT. Occupation (OR=2.286, 95%CI 1.291-4.050, P=0.005) and medical insurance (OR=0.089, 95%CI 0.029-0.276, P<0.001) were the relevant factors of severe psychological distress after IMRT. Conclusion The incidence rate of distress is high in elderly patients with head and neck cancer before IMRT, which can be aggravated after IMRT, primarily the treatment-related physical pain problems.
Bao Ruizhi,Yi Junlin,Liu Qingfeng et al. Analysis of psychological distress in elderly patients with head and neck cancer receiving radiotherapy[J]. Chinese Journal of Radiation Oncology, 2021, 30(2): 109-113.
[1] Howell D, Olsen K:Distress-the 6th vital sign[J]. Curr Oncol, 2011, 18(2):208-210. DOI:10.3747/co.v18i5.790. [2] Pandey M, Devi N, Ramdas K, et al. Higher distress relates to poor quality of life in patients with head and neck cancer[J]. Int J Oral Maxillofac Surg, 2009, 38(9):955-959. DOI:10.1016/j.ijom.2009.04.004. [3] Williams C. Psychosocial distress and distress screening in multidisciplinary head and neck cancer treatment[J]. Otolaryngol Clin N Am, 2017, 50(4):807-823. DOI:10.1016/j.otc.2017.04.002. [4] Thomas BC, Thomas I, Nandamohan V, et al. Screening for distress can predict loss of follow-up and treatment in cancer patients:results of development and validation of the distress inventory for cancer version 2[J]. Psychooncology, 2009, 18(5):524-533. DOI:10.1002/pon.1422. [5] Chen AM, Hsu S, Felix C, et al. Effect of psychosocial distress on outcome for head and neck cancer patients undergoing radiation[J]. Laryngosocpe, 2018, 128(3):641-645. DOI:10.1002/lary.26751. [6] Buchmann L, Conlee J, Hunt J, et al. Psychosocial distress is prevalent in head and neck cancer patients[J]. Laryngoscope, 2013, 123(6):1424-1429. DOI:10.1002/lary.23886. [7] Badr H, Gupta V, Sikora A, et al. Psychosocial distress in patients and caregivers over the course of radiotherapy for head and neck cancer[J]. Oral Oncol, 2014, 50(10):1005-1011. DOI:10.1016/j.oraloncology.2014.07.003. [8] Krebber AMH, Jansen F, Cuijpers P, et al. Screening for psychosocial distress in follow-up care to identify head and neck cancer patients with untreated distress[J]. Support Care Cancer, 2016, 24(6):2541-2548. DOI:10.1007/s00520-015-3053-6. [9] Williams C. Psychosocial distress and distress screening in multidisciplinary head and neck cancer treatment[J]. Otolaryngol Clin N Am, 2017, 50(4):807-823. DOI:10.1016/j.otc.2017.04.002. [10] Ghazali N, Roe B, Lowe D, et al. Screening for distress using the distress thermometer and the university of Washington quality of life in post-treatment head and neck cancer survivors[J]. Eur Arch Otorhinolaryngol, 2017, 274(5):2253-2260. DOI:10.1007/s00405-017-4474-2. [11] Patil V, Noronha V, Joshi A, et al. Distress management in patients with head and neck cancer before start of palliative chemotherapy:a practical approach[J]. J Global Oncol, 2018, 4(1):1-10. DOI:10.1200/JGO.17.00044. [12] Zheng B, Du PX, Yi TW, et al. Effects of two translated phrases of distress thermometer on screening distress in Chinese cancer patients:a comparative study[J]. J Clin Nur, 2019, 28(5-6):828-835. DOI:10.1111/jocn.14678. [13] Jacobsen PB,Donovan KA,Trask PC,et al. Screening for psychologic distress in ambulatory cancer patients[J]. Cancer, 2005, 103(7):1494-1502. DOI:10.1002/cncr.20940. [14] Holland JC,Andersen B,Breitbart WS. NCCN clinical practice guide-lines in oncology:distress management[J]. J Natl Compr Canc Netw, 2013, 11(2):190-209. DOI:10.6004/jnccn.2013.0027. [15] 张叶宁,张海伟,宋丽莉,等. 心理痛苦温度计在中国癌症患者心理痛苦筛查中的应用[J]. 中国心理卫生杂志, 2010, 46(6):897-902. DOI:10.3969/j.issn.1000-6729.2010.12.004. Zhang YN, Zhang HW, Song LL, et al. Application of the NCCN distress therometer in chinese cancer patients[J]. Chin J Ment Heal, 2010, 46(6):897-902. DOI:10.3969/j.issn.1000-6729.2010.12.004. [16] Yi JL, Huang XD, Xu ZG, et al. Phase Ⅲ randomized trial of preoperative concurrent chemoradiotherapy versus preoperative radiotherapy for patients with locally advanced head and neck squamous cell carcinoma[J]. Oncotarget, 2017, 8(27):44842-44850. DOI:10.18632/oncotarget.15107. [17] Chen AM, Jennelle RL, Grady V, et al. Prospective study of psychosocial distress among patients undergoing radiotherapy for head and neck cancer[J]. Int J Radiat Oncol Biol Phys, 2009, 73(1):187-193. DOI:10.1016/j.ijrobp.2008.04.010. [18] Meeker CR, Wong YN, Egleston BL, et al. Distress and financial distress in adults with cancer:an age-based analysis[J]. J Natl Compr Canc Netw, 2017, 15(10):1224-1233. DOI:10.6004/jnccn.2017.0161. [19] Dauphin S, Jansen L, Burghgraeve TD, et al. Long-term distress in older patients with cancer:a longitudinal cohort study[J]. BJGP Open, 2019, 3(3):bjgpopen19X101658. DOI:10.3399/bjgpopen19X101658. [20] Renovanz M, Hickmann AK, Nadji-Ohl M, et al. Health-related quality of life and distress in elderly vs. younger patients with high-grade glioma-results of a multicenter study[J]. Support Care Cancer, 2020, 28(11):5165-5175. DOI:10.1007/s00520-020-05354-8. [21] Mitchell AJ. Screening for cancer-related distress:when is implementation successful and when is it unsuccessful?[J]. Acta Oncol, 2013, 52(2):216-224. DOI:10.3109/0284186X.2012.745949. [22] Duffy SA, Ronis DL, Valenstein M, et al. A tailored smoking, alcohol, and depression intervention for head and neck cancer patients[J]. Cancer Epidemiol Biomark Prev, 2006, 15(11):2203-2208. DOI:10.1158/1055-9965. EPI-05-0880. [23] Zhang Y, Chen L, Hu GQ, et al. Gemcitabine and cisplatin induction chemotherapy in nasopharyngeal carcinoma[J]. N Eng J Med, 2019, 381(12):1124-1135. DOI:10.1056/NEJMoa1905287. [24] Ang KK, Zhang Q, Rosenthal DI, et al. Randomized phase Ⅲ trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage Ⅲ to IV head and neck carcinoma:RTOG 0522[J]. J Clin Oncol, 2014, 32(27):2940-2950. DOI:10.1200/JCO.2013.53.5633. [25] Nguyen NP, Frank C, Moltz CC, et al. Impact of dysphagia on quality of life after treatment of head-and-neck cancer[J]. Int J Radiat Oncol Biol Phys, 2005, 61(3):772-778. DOI:10.1016/j.ijrobp.2004.06.017. [26] Chen ml, Chen MC, Yu CT. Depressive symptoms during the first chemotherapy cycle predict mortality in patients with advanced non-small cell lung cancer[J]. Support Care Cancer, 2011, 19(11):1705-1711. DOI:10.1007/s00520-010-1005-8. [27] Matud MP, Garcia MC. Psychological distress and social functioning in elderly Spanish people:a gender analysis[J]. Int J Environ Res Public Health, 2019, 16(3):341. DOI:10.3390/ijerph16030341. [28] Gosak M, Gradisar K, Kozjek NR, et al. Psychological distress and nutritional status in head and neck cancer patients:a pilot study[J]. Eur Arch Otorhiolaryngol, 2020, 277(4):1211-1217. DOI:10.1007/s00405-020-05798-y.
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