Depression in head and neck cancer patients can be attributed to the tumours caused by such cancers as they are more likely to be obvious than many other cancers. Furthermore, the ‘head and neck’ region houses most of the senses and functional capacity of the human body. It is also an area of great aesthetic value. Therefore, head and neck cancer rehabilitation is greatly desired to help the patient enjoy a decent lifestyle.

Common causes of depression in head and neck cancer patients

  1. A change in body image affects most patients emotionally and psychologically. As a result, some patients refuse conventional cancer treatment because they wish to preserve and maintain their looks (e.g. fear of hair-loss, disfigurement of the body etc.) while others defer treatment for cultural and religious beliefs such as compliance with certain customs or folklore, and the desire for child-bearing.
  2. When we talk about acceptance of illness, we are also talking about self-acceptance and the integration of an after-treatment image that we must feel good about, or that is at least bearable. Examples of an after-treatment image include wearing a wig or hat, having a trachea-tube, a major dissection etc which make patients feel ‘strange’ about themselves and thus avoid any forms of socialising. Patients with mild to severe hearing loss, whether temporary or permanent, will be shy to communicate with others. Some patients with swallowing difficulties may take longer to eat. To avoid embarrassment, they prefer to dine alone.
  3. Intimacy might be a real issue for some. This is partly due to physical and emotional stressors. Some couples do not sleep together for practical reasons like being worried about waking up early to run errands, or keeping their spouse awake by sounds of heavy breathing and occasional odour from mouth dryness, accumulation of phlegm or regurgitation due to their upper respiratory or digestive disorder. Consistent care and management helps to minimise many of these concerns.
  4. Unemployment is another concern. Although patients may be given a clean bill of health, they may not be able to find a job. This is particularly true for semi-skilled and non-skilled workers. Very often, having good family support helps. This can be in the form of temporary role-reversal between spouses, negotiating a temporary care arrangement or short-term financial help. Many patients are reluctant to ask their relatives for help for fear of rejection. This can limit their potential resources which may also affect their quality of care and livelihood.

Overcoming depression in head and neck cancer patients

Generally, for those with good family support, the psychosocial issues may centre on expectations of care (especially between the spouse and their extended family), motivational issues, anxieties and denial of the patient. For some, brief counselling and emotional support from a professional may help.

Acceptance of the cancer diagnosis, the treatment and most importantly of the patient himself/herself, is gradual and is seldom complete. Patients need to understand their illness to make sense of, and find personal meaning for, their cancer experience. This will enable them to move on with their lives, learn to develop an interdependent relationship and not a one-sided dependent relationship. They need to feel that they are useful and are contributing towards their family and society. It is important for them to have a sense of self-mastery and be in control of the things that are within their means.