YBJOM-4230; No. of Pages 5
ARTICLE IN PRESS Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx–xxx
Quality of life, psychological wellbeing and treatment needs of trauma and head and neck cancer patients Farah Shiraz a,1 , Emmylou Rahtz a,2 , Kamaldeep Bhui a , Iain Hutchison b , Ania Korszun a,∗ a
Centre for Psychiatry, Old Anatomy Building, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, United Kingdom b Bart’s Health NHS Trust, 59 Bartholomew Close, St. Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, United Kingdom Accepted 26 March 2014
Abstract There is increasing evidence that patients treated for trauma or cancer of the head and neck may go on to experience psychological distress. We aimed to measure the impact of this on their quality of life (QoL) and to explore their willingness to be referred for psychological support. A total of 96 patients with facial injuries and 124 with cancer of the head and neck completed a self-reported questionnaire to identify psychological distress (Hospital Anxiety and Depression Scale (HADS) and the Acute Stress Disorder (ASD) Scale), quality of life (WHOQoL-BREF), satisfaction with treatment, and willingness to accept psychological support. Thirty-nine percent of patients showed high levels of depressive symptoms and 43% reported high levels of anxiety; 43% in the trauma group and 12% in the cancer group had high ASD scores. Patients with high scores on the HADS reported poorer QoL, and 40% of those with high levels of psychological distress were willing to consider psychological support. Despite the fact that patients report high levels of satisfaction with their medical and surgical care, many have psychological problems and have needs that are not being met. A large proportion would use psychological support services. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Psychological; Quality of life; Head and neck cancer; Facial trauma; Depression; Anxiety; Psychological distress
Introduction Despite considerable advances in surgical restoration, which have resulted in improvements in cosmetic appearance, function, and survival after treatment for injuries and cancer of the head and neck, less attention has been given to patients’ overall quality of life (QoL) and their psychological needs
∗ Corresponding author: [email protected] (Professor Korszun). Fax: +44 020 7882 5728. E-mail addresses: [email protected] (F. Shiraz), [email protected] (E. Rahtz), [email protected] (K. Bhui), [email protected] (I. Hutchison). 1 Tel.: +44 20 7882 2045; fax: +44 20 7882 5728. 2 Joint first author.
Ania
after treatment. Studies report a wide range in the proportion of patients who have serious psychological problems. Rogers et al. found that after 3–4 years, at least one in 10 patients who had had operations for cancer of the head and neck with no recurrence, was anxious or depressed.1 Similar studies have shown that anxiety levels were highest at diagnosis, while depression was most common during treatment.2 A cross-sectional study from Taiwan of patients with various stages of head and neck cancer found that 33% had clinically significant levels of depression,3 and a UK study reported a 22% incidence of anxiety and depression.4 In an assessment, UK researchers found that patients with facial injuries had an increased risk of depression (odds ratio (OR) 9.2) and, to a lesser extent, anxiety (OR 2.68), when compared with a control group who were undergoing elective oral and maxillofacial operations.5 They
http://dx.doi.org/10.1016/j.bjoms.2014.03.019 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Shiraz F, et al. Quality of life, psychological wellbeing and treatment needs of trauma and head and neck cancer patients. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2014.03.019
YBJOM-4230; No. of Pages 5
2
ARTICLE IN PRESS F. Shiraz et al. / British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx–xxx
also found that women were more likely to suffer negative psychological consequences. Another study found that 30% experienced depression or anxiety at baseline and one year later, which suggests that these reactions are not transient.6 Acute stress disorder (ASD) is a common outcome after traumatic events, including injury or diagnosis with cancer, and comprises distressing symptoms of intrusive reminders and anxiety about the event. High levels of acute stress are reported in patients with facial injuries and they are often accompanied by symptoms of depression.7 We know of little research that has included the diverse black and ethnic minority population in the UK. Studies on the coping styles of different ethnic groups of cancer patients in Britain reported that British Asian patients were more likely to disbelieve their diagnosis than those who were white (48% British Asian; 31% white British), and that denial was strongly associated with anxiety and depression.8 South Asian patients also had a more fatalistic attitude towards their diagnosis than white patients.8 Clearly, to develop future interventions that aim to improve the wellbeing of oral and maxillofacial patients, such findings raise questions that require further investigation. Little is known about the willingness of these patients to seek psychological support. We aimed to examine levels of psychological distress (depression, anxiety, and symptoms of acute stress) in oral and maxillofacial patients based in everyday clinical settings, and to explore their willingness to be referred for psychological support. It is clinically useful to recognise psychological problems, as they can potentially be treated, and interventions can ameliorate dysfunction and improve QoL.
Patients and methods Sample Over a 3-month period (January 2012 to March 2012) we invited all patients attending oral and maxillofacial (OMF) outpatient trauma clinics at the Royal London Hospital and outpatient head and neck cancer clinics at St Bartholomew’s Hospital, London, to complete questionnaires. This was part of a clinical effectiveness audit registered with the Clinical Effectiveness Unit for Barts Health NHS Trust (approved 8/12/11). Two research psychologists, who were supervised by a consultant oral and maxillofacial surgeon and a consultant psychiatrist, collected the data. Patients aged over 18 years were included, and those who did not speak English, or had psychotic symptoms or impaired cognitive function, were excluded.
Table 1 Patients’ details. Data are number (%). Outpatient clinic
Sex Male Female Age (years) 18-35 36-65 66+ Not given Ethnicity White Asian Black Other Not given
Trauma (n = 96)
Head and neck cancer (n = 124)
83 (87) 13 (14)
76 (61) 48 (39)
57 (59) 33 (34) 4 (4) 2 (2)
16 (13) 64 (52) 43 (35) 1 (
ARTICLE IN PRESS Available online at www.sciencedirect.com
British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx–xxx
Quality of life, psychological wellbeing and treatment needs of trauma and head and neck cancer patients Farah Shiraz a,1 , Emmylou Rahtz a,2 , Kamaldeep Bhui a , Iain Hutchison b , Ania Korszun a,∗ a
Centre for Psychiatry, Old Anatomy Building, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, United Kingdom b Bart’s Health NHS Trust, 59 Bartholomew Close, St. Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, United Kingdom Accepted 26 March 2014
Abstract There is increasing evidence that patients treated for trauma or cancer of the head and neck may go on to experience psychological distress. We aimed to measure the impact of this on their quality of life (QoL) and to explore their willingness to be referred for psychological support. A total of 96 patients with facial injuries and 124 with cancer of the head and neck completed a self-reported questionnaire to identify psychological distress (Hospital Anxiety and Depression Scale (HADS) and the Acute Stress Disorder (ASD) Scale), quality of life (WHOQoL-BREF), satisfaction with treatment, and willingness to accept psychological support. Thirty-nine percent of patients showed high levels of depressive symptoms and 43% reported high levels of anxiety; 43% in the trauma group and 12% in the cancer group had high ASD scores. Patients with high scores on the HADS reported poorer QoL, and 40% of those with high levels of psychological distress were willing to consider psychological support. Despite the fact that patients report high levels of satisfaction with their medical and surgical care, many have psychological problems and have needs that are not being met. A large proportion would use psychological support services. © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Keywords: Psychological; Quality of life; Head and neck cancer; Facial trauma; Depression; Anxiety; Psychological distress
Introduction Despite considerable advances in surgical restoration, which have resulted in improvements in cosmetic appearance, function, and survival after treatment for injuries and cancer of the head and neck, less attention has been given to patients’ overall quality of life (QoL) and their psychological needs
∗ Corresponding author: [email protected] (Professor Korszun). Fax: +44 020 7882 5728. E-mail addresses: [email protected] (F. Shiraz), [email protected] (E. Rahtz), [email protected] (K. Bhui), [email protected] (I. Hutchison). 1 Tel.: +44 20 7882 2045; fax: +44 20 7882 5728. 2 Joint first author.
Ania
after treatment. Studies report a wide range in the proportion of patients who have serious psychological problems. Rogers et al. found that after 3–4 years, at least one in 10 patients who had had operations for cancer of the head and neck with no recurrence, was anxious or depressed.1 Similar studies have shown that anxiety levels were highest at diagnosis, while depression was most common during treatment.2 A cross-sectional study from Taiwan of patients with various stages of head and neck cancer found that 33% had clinically significant levels of depression,3 and a UK study reported a 22% incidence of anxiety and depression.4 In an assessment, UK researchers found that patients with facial injuries had an increased risk of depression (odds ratio (OR) 9.2) and, to a lesser extent, anxiety (OR 2.68), when compared with a control group who were undergoing elective oral and maxillofacial operations.5 They
http://dx.doi.org/10.1016/j.bjoms.2014.03.019 0266-4356/© 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Shiraz F, et al. Quality of life, psychological wellbeing and treatment needs of trauma and head and neck cancer patients. Br J Oral Maxillofac Surg (2014), http://dx.doi.org/10.1016/j.bjoms.2014.03.019
YBJOM-4230; No. of Pages 5
2
ARTICLE IN PRESS F. Shiraz et al. / British Journal of Oral and Maxillofacial Surgery xxx (2014) xxx–xxx
also found that women were more likely to suffer negative psychological consequences. Another study found that 30% experienced depression or anxiety at baseline and one year later, which suggests that these reactions are not transient.6 Acute stress disorder (ASD) is a common outcome after traumatic events, including injury or diagnosis with cancer, and comprises distressing symptoms of intrusive reminders and anxiety about the event. High levels of acute stress are reported in patients with facial injuries and they are often accompanied by symptoms of depression.7 We know of little research that has included the diverse black and ethnic minority population in the UK. Studies on the coping styles of different ethnic groups of cancer patients in Britain reported that British Asian patients were more likely to disbelieve their diagnosis than those who were white (48% British Asian; 31% white British), and that denial was strongly associated with anxiety and depression.8 South Asian patients also had a more fatalistic attitude towards their diagnosis than white patients.8 Clearly, to develop future interventions that aim to improve the wellbeing of oral and maxillofacial patients, such findings raise questions that require further investigation. Little is known about the willingness of these patients to seek psychological support. We aimed to examine levels of psychological distress (depression, anxiety, and symptoms of acute stress) in oral and maxillofacial patients based in everyday clinical settings, and to explore their willingness to be referred for psychological support. It is clinically useful to recognise psychological problems, as they can potentially be treated, and interventions can ameliorate dysfunction and improve QoL.
Patients and methods Sample Over a 3-month period (January 2012 to March 2012) we invited all patients attending oral and maxillofacial (OMF) outpatient trauma clinics at the Royal London Hospital and outpatient head and neck cancer clinics at St Bartholomew’s Hospital, London, to complete questionnaires. This was part of a clinical effectiveness audit registered with the Clinical Effectiveness Unit for Barts Health NHS Trust (approved 8/12/11). Two research psychologists, who were supervised by a consultant oral and maxillofacial surgeon and a consultant psychiatrist, collected the data. Patients aged over 18 years were included, and those who did not speak English, or had psychotic symptoms or impaired cognitive function, were excluded.
Table 1 Patients’ details. Data are number (%). Outpatient clinic
Sex Male Female Age (years) 18-35 36-65 66+ Not given Ethnicity White Asian Black Other Not given
Trauma (n = 96)
Head and neck cancer (n = 124)
83 (87) 13 (14)
76 (61) 48 (39)
57 (59) 33 (34) 4 (4) 2 (2)
16 (13) 64 (52) 43 (35) 1 (
