Computerized prospective screening for high levels of emotional distress in head and neck cancer patients and referral rate to psychosocial care

Oral Oncol. 2009 Oct;45(10):e129-33. doi: 10.1016/j.oraloncology.2009.01.012. Epub 2009 Apr 9.


To investigate prospectively the prevalence of high levels of emotional distress and referral rate to psychosocial care in head and neck cancer (HNSCC) patients. Fifty-five consecutive newly diagnosed HNSCC patients were asked to complete the hospital anxiety and depression scale (HADS) and the EORTC QLQ-C30 and H&N35 quality of life questionnaires on a touch screen computer-assisted data collection system on their first visit and during follow-up visit. Sociodemographic, clinical, and quality of life parameters were compared to a high level of distress (HADS score >15). Number of patients with a high level of distress were compared to referral rates to psychosocial care as retrieved from patient hospital files. At time of diagnosis, 18% (10/55) of the patients had a high level of distress (related to tumor stage and site, and global quality of life and social eating) versus 25% (14/55) at follow-up (related to a variety of quality of life parameters). Low levels of distress at baseline or follow-up was noted in 64%; 18% had normal scores at baseline and developed distress at follow-up; 11% had high levels at baseline and returned to normal scores at follow-up, and 7% had persistent distress from baseline to follow-up. No patients were referred to psychosocial care at time of diagnosis. At follow-up visit 21% (3/14) were referred, all patients who developed a high level of distress after initial diagnosis. High level of emotional distress is common and few patients are referred to psychosocial care. Development of a stepped care model (including careful monitoring by using a touch screen computer system) may meet the potentially unmet needs of HNC patients and contribute improving cancer care.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology*
  • Data Collection / methods
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology*
  • Female
  • Head and Neck Neoplasms / psychology*
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Quality of Life
  • Referral and Consultation / statistics & numerical data
  • Risk Factors
  • Social Support
  • Stress, Psychological / diagnosis
  • Stress, Psychological / epidemiology*
  • Surveys and Questionnaires