Symptom Severity according to the Presence of Depressive and Anxiety Symptoms among Patients with Head and Neck Cancer

Hyun-Joo Kim; Ok-Hee Cho; Yang-Sook Yoo

doi:10.7469/kjan.2016.28.2.148

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Kim, Cho, and Yoo: Symptom Severity according to the Presence of Depressive and Anxiety Symptoms among Patients with Head and Neck Cancer

Original Article

Korean J Adult Nurs 2016;28(2):148-155.

Published online: April 2016

DOI: https://doi.org/10.7469/kjan.2016.28.2.148

Symptom Severity according to the Presence of Depressive and Anxiety Symptoms among Patients with Head and Neck Cancer

Hyun-Joo Kim¹, Ok-Hee Cho², Yang-Sook Yoo²

^¹Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul

^²College of Nursing and Health, Kongju National University, Gongju

^³College of Nursing, The Catholic University of Korea, Seoul, Korea

Corresponding author: Yoo, Yang-Sook College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Secho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-7411, Fax: +82-2-2258-7772, E-mail: ysyoo@catholic.ac.kr

Received 26 January 20166 April 2016 Accepted 18 April 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to compare symptom severity and the impact of presence of depressive and/or anxiety symptoms among patients with head and neck cancer (HNC).

Methods

One hundred and fifteen patients diagnosed with HNC completed two questionnaires: Hospital Anxiety and Depression Scale (HADS) and the M. D. Anderson Symptom Inventory-Head and Neck Cancer (MDASI-HN).

Results

Of the total sample, 55.6% reported depressive symptoms and 33% reported anxiety symptoms. Patients who reported either depressive or anxiety symptoms also had significantly more severe symptoms. The most severe symptom was dry mouth. Participants who were depressed reported that interference in the enjoyment of life due to symptoms was the most distressing whereas participants with anxiety reported symptom interference in work was of most concern. Of patients reporting moderate to severe symptoms, more than 60% reported depressive symptoms. Of patients reporting moderate to severe feelings of being distress and feeling sad, more than 70% reported anxiety symptoms.

Conclusion

Patients with HNC reporting moderate to severe symptoms also report depressive and/or anxiety symptoms. The results suggest the need to develop an integrated nursing intervention of both physical and emotional symptoms for patients with HNC.

Keywords: Head and neck neoplasms, Symptom, Depression, Anxiety

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Figure 1.

Occurrence of depressive and anxiety symptoms in moderate to severe symptoms.

Table 1.

Demographic and Disease-related Characteristics of the Participants (N=115)

Characteristics	Categories	n (%) or M±SD
Age (year)		56.6±11.1
Gender	Male	99 (86.1)
Gender	Female	16 (13.9)
Spouse	Yes	97 (84.4)
Spouse	No	18 (15.6)
Religion	Yes	76 (66.1)
Religion	No	39 (33.9)
Education	≤Middle school	26 (22.6)
	High school	50 (43.5)
	≥College	39 (33.9)
Occupation	Disabled due to illness	36 (31.3)
	Employed	44 (38.3)
	Unemployed	35 (30.4)
Monthly income (10,000 won)	≤150	25 (21.7)
	151~350	60 (52.2)
	≥351	30 (26.1)
Cancer site	Nasopharynx, larynx,	47 (40.8)
	pharynx
	Tonsil	26 (22.6)
	Oral cavity, tongue,	24 (20.9)
	salivary gland
	Nasal cavity, paranasal	14 (12.2)
	sinuses
	Other	4 (3.5)
Cancer stage	I	11 (9.6)
	II	7 (6.1)
	III	31 (26.9)
	IV	66 (57.4)
Period since diagnosis (month)	≤6	50 (43.5)
	7~12	20 (17.4)
	13~24	11 (9.6)
	25~90	34 (29.5)
Treatment type^†	Operation (Yes)	62 (53.9)
	Radiation therapy (Yes)	91 (79.1)
	Chemotherapy (Yes)	96 (83.5)
	Symptomatic	8 (7.0)
	management (Yes)
Karnofsky performance status (%)		89.3±10.9

^† Multiple response.

Table 2.

Symptom Severity according to the Presence of Depressive and Anxiety Symptoms (N=115)

Symptom	Depressive symptoms		p	Anxiety symptoms		p
	Yes (n=64)	No (n=51)		Yes (n=38)	No (n=77)
	M±SD	M±SD		M±SD	M±SD
Core items
Pain Fatigue	3.33±3.04 5.00±2.54	1.78±2.80 2.84±2.28	.006 ＜.001	4.10±3.31 5.62±2.52	2.03±2.73 3.30±2.40	.002 ＜.001
Nausea Disturbed sleep	2.47±2.84 4.13±3.28	1.41±2.10 2.24±2.62	.024 ＜.001	3.10±3.23 5.05±3.56	1.56±2.15 2.48±2.56	.022 ＜.001
Feeling of being distressed Shortness of breath	4.42±3.01 2.37±2.43	1.49±1.85 1.14±1.28	＜.001 ＜.001	5.50±3.13 2.59±2.64	1.99±2.08 1.48±1.81	＜.001 .026
Difficulty remembering Lack of appetite	3.59±2.67 4.46±3.18	1.73±1.96 2.24±2.62	＜.001 ＜.001	3.59±2.56 5.05±3.15	2.32±2.41 2.68±2.82	.008 ＜.001
Feeling drowsy Having a dry mouth	3.98±2.65 5.52±3.11	2.98±2.61 3.80±3.04	.044 .004	4.29±2.89 5.83±3.10	3.30±2.59 4.22±3.11	.170 .010
Feeling sad Vomiting	4.00±3.06 1.33±2.06	1.02±1.66 0.94±2.06	＜.001 .319	5.38±2.88 1.71±2.11	1.43±2.03 0.88±1.96	＜.001 .042
Numbness or tingling	3.09±2.68	1.76±2.08	.004	3.68±2.78	1.83±2.08	＜.001
Head and neck cancer specific items
Problem with oral mucus	2.97±3.31	2.25±3.11	.241	3.39±3.43	2.27±3.06	.073
Difficulty swallowing or chewing Choking or coughing	4.98±3.76 3.28±2.83	2.67±3.36 1.48±1.95	＜.001 ＜.001	4.79±3.82 3.48±2.88	3.49±3.67 2.08±2.45	.060 .017
Difficulty with voice or speech Skin pain/burning/rash	4.14±3.57 1.95±2.73	1.88±2.78 0.90±1.43	＜.001 .010	4.54±3.89 2.18±2.82	2.44±2.96 1.12±1.88	.005 .035
Constipation Problem with tasting food	3.02±3.32 4.95±3.40	2.33±2.75 2.98±3.17	.241 .002	3.71±3.45 4.56±3.51	2.27±2.83 3.81±3.42	.029 .225
Mouth/Throat sores Problem with teeth or gum	3.43±3.30 4.27±3.44	1.59±2.80 2.49±3.09	.002 .005	3.53±3.52 4.52±3.61	2.21±3.00 2.92±3.17	.047 .012
Interference items
General activity Mood	5.69±3.07 5.36±2.75	2.63±2.73 2.29±2.23	＜.001 ＜.001	6.34±2.82 6.29±2.36	3.35±3.06 2.91±2.60	＜.001 ＜.001
Work Relations with others	5.89±3.26 5.91±3.18	2.43±2.45 2.51±2.56	＜.001 ＜.001	6.93±2.69 6.64±2.85	3.05±2.93 3.19±2.99	＜.001 ＜.001
Walking ability Enjoyment of life	4.63±2.99 6.23±2.92	1.96±2.21 2.33±2.26	＜.001 ＜.001	5.43±2.81 6.67±2.56	2.48±2.60 3.38±3.05	＜.001 ＜.001

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