Psychological state and body image disturbance in head and neck cancer patients: Prevalence and determinants

Table 1 Assessment of anxiety disorders in head and neck cancer patients

HADS-A (points)	Anxiety degree	n (%)
0-7	Normal	75 (75.00)
8-10	Mild	19 (19.00)
11-14	Moderate	6 (6.00)
15-21	Severe	0 (0.00)
Total	5.62 ± 2.89

HADS-A: Hospital Anxiety and Depression Scale-Anxiety.

Table 2 Measurement of depressive conditions in head and neck cancer patients

HADS-D (points)	Degree of depression	n (%)
0-7	Normal	70 (70.00)
8-10	Mild	24 (24.00)
11-14	Moderate	5 (5.00)
15-21	Severe	1 (1.00)
Total	5.00 (3.00, 8.00)

HADS-D: Hospital Anxiety and Depression Scale-Depression.

Table 3 Assessment of body image disturbance in head and neck cancer cases

BIS (points)	Scoring range	Score
Affective	0-12	6.44 ± 2.32
Cognitive	0-12	7.00 (5.00, 8.00)
Behavioral	0-6	3.00 (2.00, 4.00)
Global	0-30	16.00 (14.00, 18.00)
Mild distress	0-10	1 (1.00)
Moderate distress	11-20	90 (90.00)
Severe distress	21-30	9 (9.00)

BIS: Body Image Scale.

Table 4 Association between anxiety/depressive symptoms and body image distress in head and neck cancer patients

Correlation analysis	HADS-A (points)	HADS-D (points)
Affective (points)	r = 0.206, P = 0.040	r = 0.370, P < 0.001
Cognitive (points)	r = 0.445, P < 0.001	r = 0.344, P < 0.001
Behavioral (points)	r = 0.364, P < 0.001	r = 0.418, P < 0.001
Global BIS score (points)	r = 0.308, P = 0.002	r = 0.388, P < 0.001

HADS-A: Hospital Anxiety and Depression Scale-Anxiety; HADS-D: Hospital Anxiety and Depression Scale-Depression; BIS: Body Image Scale.

Table 5 Univariate evaluation of body image disturbance in head and neck cancer patients

Variable	BIS < 15 points (n = 37)	BIS ≥ 15 points (n = 63)	χ2	P value
Age (years)			1.401	0.237
< 60	25 (67.57)	35 (55.56)
≥ 60	12 (32.43)	28 (44.44)
Sex			7.665	0.006
Male	27 (72.97)	28 (44.44)
Female	10 (27.03)	35 (55.56)
Educational attainment			0.059	0.809
Below senior high school	22 (59.46)	39 (61.90)
Senior high school or above	15 (40.54)	24 (38.10)
Disease progression stage			7.111	0.008
I-II	17 (45.95)	13 (20.63)
III-IV	20 (54.05)	50 (79.37)
Primary tumor site			1.158	0.560
Oral cavity	18 (48.65)	27 (42.86)
Oropharynx	7 (18.92)	18 (28.57)
Larynx	12 (32.43)	18 (28.57)
Multimodal treatment			4.927	0.026
No	33 (89.19)	44 (69.84)
Yes	4 (10.81)	19 (30.16)
Unemployment			7.565	0.006
No	15 (40.54)	10 (15.87)
Yes	22 (59.46)	53 (84.13)
HADS-A (points)			4.133	0.042
< 8	32 (86.49)	43 (68.25)
≥ 8	5 (13.51)	20 (31.75)
HADS-D (points)			5.313	0.021
< 8	31 (83.78)	39 (61.90)
≥ 8	6 (16.22)	24 (38.10)

HADS-A: Hospital Anxiety and Depression Scale-Anxiety; HADS-D: Hospital Anxiety and Depression Scale-Depression; BIS: Body Image Scale.

Table 6 Multivariate modeling of body image disturbance in head and neck cancer patients

Variable	B	SE	Wald	P value	OR	95%CI
Sex	1.650	0.562	8.613	0.003	5.206	1.730-15.666
Disease progression stage	1.462	0.582	6.310	0.012	4.316	1.379-13.508
Multimodal treatment	1.907	0.753	6.416	0.011	6.730	1.539-29.427
Unemployment	1.242	0.610	4.142	0.042	3.461	1.047-11.444
HADS-A (points)	1.394	0.665	4.398	0.036	4.031	1.095-14.831
HADS-D (points)	1.306	0.633	4.249	0.039	3.690	1.066-12.767

HADS-A: Hospital Anxiety and Depression Scale-Anxiety; HADS-D: Hospital Anxiety and Depression Scale-Depression; CI: Confidence interval.