Preoperative risk factors associated with peri-operative psychiatric diagnosis in oral cancer patients

Head and neck cancers (HNCs) are one of the commonest cancers in low- and middle-income countries. There is a paucity of data on comorbid psychiatric problems associated with HNCs. The present study is aimed at reporting the pattern of psychiatric caseness in HNC patients who were referred to specialist psycho-oncology service and also investigate the predictors of psychiatric caseness in oral cancer patients.

Case records of all patients with HNC referred to an integrated psycho-oncology service over 7 years (October 2011-December 2018) from a cancer hospital were analysed. All patients were assessed by a trained consultant psychiatrist and ICD-10 diagnoses were ascertained based on a clinical interview with the patients and family members. Associations of psychiatric caseness for consecutive oral cancer patients assessed by the psycho-oncology services over 2 years (January 2017-December 2018) were calculated by using univariate and multivariate statistical methods. Simple descriptive statistics of the referred patients were conducted, followed by logistic regression to find the associations of psychiatric caseness in oral cancer patients.

The psycho-oncology service assessed 771 HNC patients over 7 years. The commonest referrals were patients with oral cancer (75%, 558/771). For the years 2017-2018, 179 consecutive oral cancer patients were evaluated by the psycho-oncology service. Multivariate logistic regression analysis showed that being a woman (OR = 2.33; 95% CI = 1.02-5.32; p = 0.04); having worries about having pain in the post-operative period (OR = 2.55; 95% CI = 1.2-5.38; p = 0.01); worries about implications of the cancer and its treatment on the family (OR = 3.5; 95% CI = 1.19-10.57; p = 0.02); and longer duration of hospital stay period (OR = 1.08; 95% CI = 1.003-1.16; p = 0.04) were independently associated with psychiatric caseness even after controlling for confounders.

Specialist psycho-oncology services are important in the management of oral cancer patients and in addressing the mental health needs of this very vulnerable group of patients. A combination of psychoeducation, pragmatic psychological interventions and medications were used to treat these patients.