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Implementing a cognitive behavioral intervention for patients with head and neck cancer

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Abstract

Purpose

Sequelae of and therapies for head and neck cancers (HNC) are associated with physical and functional impairment as well as increased levels of psychological distress post treatment. Given the impact of HNC and treatment on functioning (i.e., eating and talking), health-related quality of life (HRQOL) is a significant area of survivorship concern within this population. Although prior research indicates that the incidence of anxiety and depression ranges from 15 to 50%, to date, there is a paucity of research on specific psychosocial interventions related to HNC treatment and completed studies have been limited by infrequent use of a randomized design and provision of non-standardized psychosocial interventions. This study aimed to address these gaps and utilize a brief cognitive behavioral intervention (CBI) to improve (1) self-efficacy for coping with cancer, (2) depressive symptoms, (3) other psychological symptoms, and (4) HRQOL among patients with HNC.

Methods

In an effort to conduct a randomized clinical trial of those undergoing treatment for HNC, eighty-eight patients were assigned to receive either a standardized CBI or usual psychological care (N = 47 and 41, respectively) with a 1-year follow-up. The means of all variables for both groups, adjusted for baseline, were visually compared at 3, 6, and 12 months post treatment.

Results

As has been a challenge in other longitudinal HNC studies, a high degree of attrition occurred, with a loss of 35 patients from the CBI group and 29 from the usual care group. Despite the high attrition, analysis of existing data indicated that the effect of CBI was discernable among the patients who completed the course of the study. Of the 38 comparisons, 34 showed that the CBI group had the favorable outcome. Important considerations for implementation of a structured psychotherapy intervention during active cancer treatment with multiple barriers including communication challenges and practical limitations were realized.

Conclusions

The impact of HNC treatment can be particularly distressing as it often results in functional impairment and markedly changed activities of daily living among survivors. However, engaging in therapeutic methods to cope and manage distress during treatment can influence QOL and mood into the survivorship phase.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to express appreciation for the collaborating medical providers who assisted with this study and the care of patients. Finally, thank you to the patients who gave their time during a period of great hardship.

Funding

This study was funded by a New Investigator internal grant from the Research Funding Committee of Loyola University Medical Center.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Neurosciences, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA

    Sarah Thilges & Patricia Mumby

  2. Department of Public Health Sciences, Loyola University, 2160 South First Avenue, Maywood, IL, 60153, USA

    James Sinacore

  3. Department of Hematology and Oncology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA

    Joseph Clark & Cheryl Czerlanis

Authors
  1. Sarah Thilges
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  2. Patricia Mumby
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  5. Cheryl Czerlanis
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Drs. Thilges, Mumby, Clark, and Czerlanis and analysis was performed by Dr. James Sinacore. The first draft of the manuscript was written by Dr. Sarah Thilges and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sarah Thilges.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Loyola University Medical Center on 3/16/2011.

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Informed consent was obtained from all individual participants included in the study.

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N/A.

Competing interests

The authors declare no competing interests.

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Thilges, S., Mumby, P., Sinacore, J. et al. Implementing a cognitive behavioral intervention for patients with head and neck cancer. Support Care Cancer 31, 476 (2023). https://doi.org/10.1007/s00520-023-07948-4

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