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Original Article

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
Korean Journal of Adult Nursing 2016;28(2):148-155.
Published online: April 30, 2016

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: January 26, 2016   • Accepted: April 18, 2016

Copyright © 2016 Korean Society of Adult Nursing

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.

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  • 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.
  • Key Words: Head and neck neoplasms; Symptom; Depression; Anxiety
Figure 1.
Occurrence of depressive and anxiety symptoms in moderate to severe symptoms.
kjan-28-148f1.jpg
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)
Female 16 (13.9)
Spouse Yes 97 (84.4)
No 18 (15.6)
Religion Yes 76 (66.1)
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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    • A Systematic Review on the Effects of Prophylactic Swallowing Exercise in Patients with Head and Neck Cancer Undergoing Radiotherapy
      Hyeongmin Byun
      The Korean Journal of Rehabilitation Nursing.2024; 27(1): 1.     CrossRef

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    Symptom Severity according to the Presence of Depressive and Anxiety Symptoms among Patients with Head and Neck Cancer
    Korean J Adult Nurs. 2016;28(2):148-155.   Published online April 30, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.2.148
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    • Citation for the content below
    Symptom Severity according to the Presence of Depressive and Anxiety Symptoms among Patients with Head and Neck Cancer
    Korean J Adult Nurs. 2016;28(2):148-155.   Published online April 30, 2016
    DOI: https://doi.org/10.7475/kjan.2016.28.2.148
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    Symptom Severity according to the Presence of Depressive and Anxiety Symptoms among Patients with Head and Neck Cancer
    Image
    Figure 1. Occurrence of depressive and anxiety symptoms in moderate to severe symptoms.

    Figure 1.

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

    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)
    Female 16 (13.9)
    Spouse Yes 97 (84.4)
    No 18 (15.6)
    Religion Yes 76 (66.1)
    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.

    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
    Table 1. Demographic and Disease-related Characteristics of the Participants (N=115)

    Multiple response.

    Table 2. Symptom Severity according to the Presence of Depressive and Anxiety Symptoms (N=115)

    Table 1.

    Table 2.

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