ORIGINAL ARTICLE PREDICTORS OF EMOTIONAL DISTRESS IN PATIENTS WITH HEAD AND NECK CANCER Susanne Singer, PhD, 1 Oliver Krauß, PhD, 2 Judith Keszte, MSc, 1 Gregor Siegl, BA, 1 Kirsten Papsdorf, MD, 3 Ettore Severi, MSc, 4 Johann Hauss, MD, 5 Susanne Briest, MD, 6 Andreas Dietz, MD, 7 Elmar Bra ¨hler, PhD, 1 Rolf-Dieter Kortmann, MD 3 1 Departments of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany. E-mail: Susanne.singer@medizin.uni-leipzig.de 2 Park-Krankenhaus Leipzig-Su ¨ dost, Leipzig, Germany 3 Department of Radiation–Oncology, University of Leipzig, Leipzig, Germany 4 Health Protection Agency, South East Regional Office, London, United Kingdom 5 Department of Surgery, University of Leipzig, Leipzig, Germany 6 Department of Gynecology, University of Leipzig, Leipzig, Germany 7 Department of Laryngo-Rhino-Otology, University of Leipzig, Leipzig, Germany Accepted 26 October 2010 Published online 11 March 2011 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/hed.21702 Abstract: Background. Patients with head and neck cancer are known to be more commonly emotionally distressed than patients with other tumors. This study investigates reasons for this difference. Methods. Patients in this prospective cohort study included those with head and neck cancer (n ¼ 113) and those with other cancers (n ¼ 1690). The Hospital Anxiety and Depres- sion Scale, measuring emotional distress, along with additional questions regarding emotional support wished and provided were administered. Results. Patients with head and neck tumors were 1.5-fold (at the time of admission), 1.2-fold (before discharge), and 2.7- fold (half a year after admission) more frequently distressed than the other patients with cancer. This association was con- founded by perceived social support and sociodemographic factors. Patients with head and neck cancer expressed less frequently the wish for and received less support by psycho- oncologists. Conclusions. Emotional distress is more common in patients with head and neck tumors; this is largely a result of the psychosocial context the patients live in, especially the amount of social support received. V V C 2011 Wiley Periodicals, Inc. Head Neck 34: 180–187, 2012 Keywords: social support; needs assessment; psychology; head and neck neoplasms; quality of life Because neoplasms are potential life-threatening dis- eases, patients are often severely distressed during acute oncologic treatment 1,2 and later on. 3,4 The haz- ard of being depressed in patients with cancer has been shown to be 3.55-fold higher in newly diagnosed patients with cancer compared with healthy persons, 4 controlled for confounders; with this rate they are more often affected than, for example, patients with stroke, heart disease, or diabetes. Patients with head and neck cancer suffer more frequently from mental health conditions and psycho- logical distress than other patients with cancer. 5–9 Currently, we do not know whether this stems from specific risk factors for head and neck neoplasms, such as alcohol consumption 10,11 and specific working conditions, 12 or stems from socioeconomic factors. 13 However, Kugaya et al 6 and Richardson et al 14 have previously shown that the educational level is not related to the emotional distress in patients with head and neck cancer. It could also be that the tumor itself, its location 15 or stage, 6,16 is a relevant factor influencing the men- tal health of the patients. Moreover, the treatment side effects involving facial disfigurement, impaired ingestion, breathing, and communication have an impact on quality of life even years after the initial diagnosis. 17–22 Therefore, the treatment could be a decisive factor for the mental health of the patients as well. With this study, we aimed to investigate reasons for the increased emotional burden of patients with head and neck tumors at a radiation oncology depart- ment before and after the treatment. PATIENTS AND METHODS Design. Over a period of 2 years, all patients admit- ted to the Leipzig University Hospital for diagnosis or treatment of cancer at the surgery, gynecology, radia- tion-oncology, or urology department were eligible for this study. Additional inclusion criteria were: age 18 Correspondence to: S. Singer Contract grant sponsor: German Federal Ministry of Education and Research; contract grant number: 01ZZ0106. V V C 2011 Wiley Periodicals, Inc. 180 Distress in Patients with Head and Neck Cancer HEAD & NECK—DOI 10.1002/hed February 2012