Late-Effect Symptoms, Tobacco and Alcohol Use, and Demoralization in Head and Neck Cancer Survivors

Abstract

Worldwide, head and neck cancers are the sixth most common type of cancer and comprise the ninth most common forms of cancer in the United States. Estimates of U.S. adults diagnosed with head and neck cancer in 2017 exceeded 53,000. Head and neck cancers are located in areas of the body associated with essential life functions, which are key to one’s quality of life. Depending on the location and stage of the tumor, current standard treatments for head and neck cancer include surgery, radiation, chemotherapy, or a combination of the aforementioned. These treatments may result in multiple late-effect physiological symptoms such as dry mouth, mouth sores, swallowing difficulties, pain, and fatigue. Late-effect symptoms cause physical and psychosocial distress and may be exacerbated by tobacco and alcohol use. Head and neck cancer survivors experience some of the highest rates of major depressive disorders. Demoralization is a psychological syndrome observed in patients with serious illness. It may be experienced as feelings of helplessness, hopelessness, loss of meaning and purpose in life and expressed as an inability to cope. Head and neck cancer survivors are at least two times more likely to commit suicide as compared to the general U.S. population. A descriptive correlational design, supported by the theory of unpleasant symptoms, was used to examine the occurrence and relationship of late-effect physical symptoms such as but not limited to xerostomia, mucositis, dysphagia, pain and fatigue, tobacco and alcohol use, and demoralization among head and neck cancer survivors. Descriptive statistics were reported for the occurrence and intensity of late-effect physical and life interference symptoms, tobacco and alcohol use, and demoralization. A hierarchical multiple regression was completed to explain the relationship between demoralization, late-effect physical symptoms, and tobacco and alcohol use. This study found when controlling for age, a relationship between life interference (general activity, mood, work including work around the house, relations with other people, walking, and enjoyment of life) and demoralization, the dependent variable. Variables representing situational factors (tobacco and alcohol use), were not significant in the model, nor were the physiological factors of late-effect physical symptoms. Further research and exploration regarding identification of demoralization in head and neck cancer survivors and its relationship to life interference could prove useful in identifying patients who may be experiencing distress. Furthermore, this identification could help support those who have a lower quality of life in survivorship and may promote referrals to appropriate supportive resources.