Associations between markers of social functioning and depression and quality-of-life among head and neck cancer survivors: findings from the HN5000 study


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Linda Sharp1, Liya Lu1, Laura-Jane Watson2, Sam Harding3, Joanne Patterson4
1Newcastle University, 2South Tyneside and Sunderland NHS Foundation Trust, 3North Bristol NHS Trust, 4University of Liverpool

Abstract

Background

Social functioning is a person’s ability to engage effectively in social interactions, maintain interpersonal relationships, and conduct everyday activities independently. The side-effects of head and neck cancer (HNC) and its treatment can adversely impact survivors’ social functioning. We investigated associations between markers of social functioning (trouble with social eating and social contact) and depression and quality-of-life (QoL) among HNC survivors.

Method

Twelve-month follow-up data for HNC survivors from Head and Neck 5000 was used. Trouble with social eating and social contact were measured using items from EORTC QLQ-H&N35 and QOL using EORTC QLQ-C30; responses were converted into a score of 0-100, with a higher score equalling more trouble with social contact/eating or better QOL.  A HADS subscale score of ≥8 was considered significant depression.  Associations between tertiles of trouble with social eating and social contact and depression and QoL were assessed using multivariable logistic and linear regression, respectively.

Results

Of 2,561 survivors, 23% had significant depression.  Mean scores were: QOL, 68.9 (sd 22.4); trouble with social eating, 24.7 (sd=29.1); trouble with social contact, 11.9 (sd=20.2).  For trouble with social eating, after confounder adjustment, those in the intermediate and highest tertiles (ie more problems) had significantly increased risk of depression (intermediate: OR=4.5, 95%CI 3.19-6.45; high: OR=21.8, 15.17-31.18) and significantly lower QOL (intermediate:β=-9.0, 95%CI -10.47 to -7.03; high: β=-24.8, -26.80 to -22.88).  Results were similar for trouble with social contact: risk of depression increased, and QOL decreased, was trouble with social contact increased.

Conclusion

We found strong and significant associations between markers of social functioning and depression and QOL.  More effective interventions addressing social eating and contact are required.  These may help survivors regain their independence, reduce levels of isolation and loneliness, reduce depression, and improve QOL outcomes generally.

Impact statement

These findings highlight the need for – and potential benefit of - interventions to support social functioning among head and neck cancer survivors.