Assessment of fatigue, depression and self-esteem among patients undergoing treatment for head and neck cancer.

Purpose: Head and neck cancers (HNC) are one of the most common forms of cancer in India. Patients with this condition often suffers from distressing symptoms of fatigue, depression and poor self-esteem. The exact cause of these symptoms, as to whether disease or other determinants induced or whether treatment induced needs to be established. To assess fatigability, depression and self-esteem among HNC study group before start, during and in the post radiation period and to find out the determinants of these parameters.

Materials and methods: Seventy newly diagnosed HNC patients and equivalent number of age and gender matched controls were interviewed using standardized questionnaires, before start of chemo-radiotherapy (CCRT). Study group were interviewed again in the 4th week and post completion of CCRT in the 7th week.

Results: Mean age of study group was 55.1± 11.3 years. Three fourth of them 52(74.3%) were males. Majority of them 26(37.1%) had oral cancer. Base line fatigue (p<0.001) and depression scores (p<0.001) were significantly more while self-esteem scores (p=0.004) was significantly less among study group compared to controls before onset of radiation. The mean fatigue and depression scores was found to significantly increase (p<0.001) while self-esteem scores was found to significantly deteriorate (p<0.001) over the course of CCRT among these patients. There was significant positive correlation (p<0.001) between fatigue and depression scores and negative correlation (p<0.001) of these parameters with self-esteem scores before, during and after CCRT. There was no association between age and gender of study group with any of these parameters. Multivariate analysis showed that baseline fatigue was significant probably due to cancer (p<0.001) and depression after completion of entire course of CCRT was significantly influenced by baseline depression levels (p=0.011).

Conclusion: Fatigue and depression need to be periodically screened for among HNC study group on CCRT so as to initiate prompt remedial measures for its alleviation.