Evaluation of a randomized clinical trial of a psychoeducational intervention on long-term quality of life, negative affect, progression and survival in head and neck cancer patients.

摘要

The relationship between psychological and physiological factors that impact health is an important consideration for daily life, illness prevention, treatment, and recovery in cancer patients. Psychological functioning may impact overall immune functioning, which may affect efficacy of cancer treatment and disease outcomes. Unfortunately, how psychological variables and quality of life during treatment may impact progression or survival has not been systematically studied. There is a growing body of research suggesting that psychological factors are important predictors of quality of life among cancer survivors. The purpose of the present study was to evaluate the effects of a randomized clinical trial of a psychoeducational intervention and to understand the effects of psychological variables and quality of life on progression and survival in patients with head and neck cancer. Patients (N=91) receiving treatment for head and neck cancer at the University of Pittsburgh Medical Center were randomized to the intervention group (n=51) or the information control group (n=40). Data collection included psychological and health behavior variables at the time of the intervention, and at one month, six months and 12 months following completion of the intervention. Medical chart information was collected including recurrence and survival information up to five years following initial treatment. Patients with head and neck cancers who had higher levels of baseline depression, anxiety, and distress and received the intervention did not differ on their levels of depression, anxiety, and subjective distress compared to an information control group. Quality of life did not significantly change after the intervention, and there were no differences between the intervention group and the control group. Patients with head and neck cancer who received the intervention and were smokers at baseline, did not show a reduction in smoking behaviors compared to smokers in the usual care control group. The survival rate was higher than expected in the present study, and the proposed models could not be analyzed. However, exploratory Kaplan Meier and Cox regression analyses were conducted. Exploratory Cox regression analysis showed that baseline levels of depression, anxiety, distress and quality of life did not predict recurrence and survival times within the first five years following initial diagnosis and treatment. However, cancer stage was predictive of survival and weekly tobacco and alcohol use was predictive of progression. Understanding the long-term effects of psychological variables and quality of life among cancer patients undergoing treatment can improve our understanding of how a patient's overall psychological health may impact progression and survival.