Objectives: Head and Neck Cancer (HNC) patients suffer highest treatment related morbidities. Nearly all patients experience some degree of treatment related fear. This study aims to evaluate the relationship between fear of treatment and treatment outcomes following radiation therapy +/- chemotherapy in HNC patients
Materials and Methods: This prospective survey study included 48 newly diagnosed HNC patients. Surveys such as Brief Worry Scale, intrusive thoughts subscale and pain scales were administered at the time of diagnosis and end of treatment (6weeks) along with questions related to fear and dysphagia.
Results: Majority of the patients were Caucasian males (77.1%), mean age of 62.6 years (SD=12.3 years) with modal tumor stage 2 receiving 61.3gy of radiation (SD=9.42gy). Statistical significant correlations with fear and (a) uncertainty about the future (r=0.689, p=0.00), (b)Intrusive thoughts subscale (r=0.589, p=0.00), (c) anxiety about cancer treatment (r=0.746, p= 0.00) prior to treatment were observed. Significant differences in means at baseline and end of treatment for uncertainty about the future (t = 3.188, p = 0.003); concern about cancer treatment (t = 2.278, p = 0.029) and intrusive thoughts subscale (t = 1.993, p = 0.05) were revealed. A statistically significant difference between groups in route of food administration i.e. via mouth or via tube with uncertainty about the future (F (2,32) = 4.241, p = 0.023); fearful about treatment (F (2,32) = 4.207, p = 0.023); anxiety (F (2,34) = 6.204, p = 0.005) and intrusive thoughts at baseline (F (2,32) = 4.471, p = 0.019) were identified. Post hoc analysis revealed patients consuming food via mouth were significantly less fearful as compared to those feeding via tube. Differences in means for low levels of self-help adherence with higher levels of intense pain were reported (F (2,34) =3.424, p=0.029). Regression analysis revealed for every one unit increase in fear of treatment on the visual analogue scale, predicted adherence to self-help behaviors increases by 0.092 units after controlling for worry, weight and route of food consumption at follow up.
Conclusion: Results suggest higher fear and pain was associated with lower adherence to self-help behaviors and modifications in diet leading to poor quality of life in HNC patients. Our findings indicate that high levels of fear prior to radiation therapy were related to swallowing deficits and poorer treatment outcomes in these patients. Future research should look at influence of social support and self-efficacy to self-help behaviors in this population.