Question

To assess the effectiveness of psychosocial interventions to improve quality of life and psychosocial well being for adult patients with head and neck cancer.

Relevance to nursing care

Internationally, it is recommended that patients with a cancer diagnosis have a systematic psychological assessment at key points of their treatment journey and have access to psychosocial support. Patients with head and neck cancer are known to have specific psychosocial needs due to the location of their disease and the impact of the treatment.

Assessment and interventions to support psychosocial issues are recognized as important; however, there exists limited knowledge to support this in clinical practice. Nurses are most often present with adult patients with head and neck cancer and need to understand optimal support for these patients.

Study characteristics

Participants included adult patients (aged 18 years or older) who had any type or stage of head and neck cancer [1]. The interventions of interest were any psychosocial intervention that involved a supportive relationship between a trained helper (e.g. nurse or psychologist) and individuals diagnosed with head and neck cancer. Psychosocial interventions were defined as providing solutions to the challenges individuals may encounter to their psychosocial well being. Interventions had to fit with four key classifications of psychosocial interventions: psycho-educational, psychotherapy (individual), cognitive behavioural training and supportive and group interventions. Duration or frequency of intervention was not specified and control groups were those who had not received the psychosocial intervention or those who received standard care.

The primary outcome of interest was quality of life, as measured by an established and/or validated tool. This included the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30. The secondary outcome measures included anxiety, depression, coping, social functioning, self-esteem, self-efficacy, body image, locus of control, adjustment/adaptation, life satisfaction, satisfaction with the intervention and fear of recurrence.

Seven randomized controlled trials, totalling 542 participants, were included. The mean number of participants was 77. Included studies varied widely on risk of bias, interventions used and outcome measures reported. A meta-analysis was conducted on three studies for quality of life.

There was no evidence to suggest that psychosocial intervention promotes global quality of life for patients with head and neck cancer at the end of the intervention when compared to standard care. Three studies measured the effects of interventions to alleviate anxiety and four studies reported on the effects of interventions to relieve depression. No significant differences were found when results were pooled in these two outcomes when compared with standard care.

Implications for nursing care

The findings of this review suggest insufficient evidence to refute or support the effectiveness of psychosocial intervention for patients with head and neck cancer.

It is important for nurses to screen patients at greatest risk of psychosocial difficulties at key junctures of the cancer journey as recommended in National Institute for Health and Care Excellence and international guidelines.

Implications for research

Further research needs to be targeted at patients who demonstrate distress and use validated outcome measures such as the EORTC which can measure quality of life.

Reference