Psychosocial Distress of Head Neck Cancer (HNC) Patients Receiving Radiotherapy: A Systematic Review

Document Type : Systematic Review and Meta-analysis


1 Department of Medical-Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India.

2 Department of Radiotherapy & Oncology, Kasturba Medical College & Kasturba Hospital Manipal, Manipal Academy of Higher Education, Manipal, India.

3 Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, India.

4 Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India.


Background: Head and Neck Cancer (HNC) patients are at increased risk of psychosocial distress compared with patients with other forms of cancer. Various symptoms of the disease and side effects of treatment are attributing factors for distress. This systematic review aimed to identify the prevalence of psychosocial distress among HNC patients receiving radiotherapy. Methods: The following search engines from 2000-2021 were searched: PubMed, CINAHL, Cochrane, Web of Science, ProQuest, Scopus, and Embase. Citation checking and extensive reference checking were also conducted. Cross-sectional, longitudinal, cohort, exploratory and prospective, repeated measure studies published in English were included. Newcastle Ottawa Scale assessed the quality, and the data were extracted on a validated data extraction form. Results: Out of 782 articles, eleven records met the eligibility criteria, including 776 HNC patients receiving radiotherapy. Data were synthesized and summarized descriptively as measurements were not homogenous. Prevalence estimates of depression or depressive symptoms were calculated. Outcomes were measured with various measuring tools and reported in frequency, percentage, mean, and standard deviation in various studies. All studies reported depression ranging from 9.8% to 83.8%, and pooled estimated prevalence of depression among HNC patients receiving radiotherapy is 63% (95% CI 42-83) with significant heterogeneity (I2= 97.66%; p<0.001). An increase in the trend is observed along with treatment progression. Another three studies reported anxiety along with depression. Physical symptoms, body image, low social support, fatigue specific radiotherapy regimens were the predictive factors of depression. Conclusion: HNC patients are psychosocially distressed during radiotherapy, and the distress is steadily increased during the therapy. The predictive factors could serve as potential areas of intervention and supportive therapy during radiotherapy.


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