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Nurse-led psychosocial interventions in follow-up care for head and neck cancer patients

Ingeborg van der Meulen

Introduction: Head and neck cancer and its treatment frequently results in long-term physical problems, such as dry mouth, difficulty eating, impaired speech and/or altered shoulder function. In part because of these persisting problems, head and neck cancer patients are prone to deteriorated psychosocial wellbeing. The objective of this thesis was to evaluate three nurse-led psychosocial interventions, which vary by intensity and content, for head and neck cancer patients aimed at improving psychosocial wellbeing in the years after completion of cancer treatment. Research projects: The Nurse Cancer and After Intervention (NUCAI) was combined with the standard 2-montly medical follow-up. Patients received six counseling sessions of 45-60 minutes during one year given by a trained nurse in the outpatient clinic. A two-arm randomized controlled trial was conducted in 205 head and neck cancer patients. The NUCAI was effective in reducing depressive symptoms and increasing health-related quality of life one year after cancer treatment, and for some variables even up to two years. The decrease in depressive symptoms was even stronger in the group of patients with raised levels of depressive symptoms at baseline. A secondary analysis of the NUCAI study showed that head and neck cancer patients who were married/living together, had low scores for global quality of life, and emotional or social functioning at baseline benefited more from the NUCAI than patients who were single or with high scores for global quality of life and emotional or social functioning. These variables can guide the decision making which patient might benefit from a psychosocial intervention to combat depressive symptoms. To explore if a less intensive intervention also has a positive effect the Distress and Problem List + (DT&PL+) intervention was evaluated in a two-arm RCT including 110 head and neck cancer patients. Patients received three to four sessions of 20 minutes during 1 year given by a trained nurse in the outpatient clinic combined with standard medical care. The intervention seemed feasible in clinical practice and participants were satisfied with nurses’ care. No effect was found in reducing depressive symptoms or improving health-related quality of life at 6 or 12 months after study inclusion. The educational intervention comprised a discharge interview of 30 minutes given by a nurse on the ward the day before discharge. In a quasi-experimental study 48 patients participated but no effects could be shown on the informational needs or the level of satisfaction with information. Discussion: Screening for psychosocial distress in cancer patients is upcoming in the Netherlands. However, it seems that the goal of screening, i.e., improving psychosocial wellbeing of cancer patients, is not met by screening and possibility for referral alone. Additional immediate psychosocial care with a more personalized and active approach, as was provided with the NUCAI and DT&PL+ intervention, seems to be needed. Future research should focus on specific interventions tailored to sub-groups of patients with different levels of psychosocial problems to provide effective psychosocial care in the follow-up period.

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