Head And Neck Cancer And Mental Health

Overview

One of the most prevalent cancers in the world, head and neck cancer (HNC) affects parts of the body like the mouth, throat, and voice box, which are used in regular activities. Although there are treatments to combat the cancer, they can have adverse side effects that affect a patient's appearance, speech, etc, which can have a significant negative influence on their mental health. These changes, along with the fear of cancer recurrence, cause anxiety, depression, and loneliness in many patients.¹

Patients with HNC frequently face mental health challenges such as anxiety, depression, and social withdrawal, exacerbated by physical changes, communication difficulties, and the ongoing fear of recurrence. Addressing the mental health of HNC patients is crucial for their overall recovery and quality of life. Through a holistic approach to care, including both physical and emotional support, patients can navigate the challenges of their cancer journey more effectively.²

Understanding head and neck cancers

The term "head and neck cancer" describes a class of cancers that originate in the salivary glands, voice box, throat, and mouth. 90% of head and neck cancers start in squamous cells. Squamous cells line the inside of the head and neck, including the mouth, nose, and throat. A lump beneath the skin of the cheek or neck is often an early sign of many cancers. This may occur if a lymph node has been affected by cancer. The type of cancer you have decides the course of treatment you need.¹

Doctors will perform tests to determine the type of cancer present. It may be head and neck cancer or a cancer that has metastasised from another region of the body. Even if a stomach cancer spreads to a neck lymph node, it will still be considered stomach cancer. Additionally, it doesn’t include cancers of the brain, eyes, thyroid, oesophagus, or skin.

This type of cancer is common—it's the sixth most common cancer globally, with about 650,000 new cases and 350,000 deaths each year.¹

What causes head and neck cancer?

The main factors that increase the risk of developing HNC the most are:^3,4

• Tobacco use: The number one cause. Smoking or chewing tobacco—and even exposure to secondhand smoke—is linked to 70–80% of cases
• Alcohol: Heavy drinking raises the risk. Combined with tobacco use, the danger multiplies
• HPV (Human Papillomavirus): Especially HPV-16, this virus spreads through sexual contact and is increasingly linked to throat and tonsil cancers, particularly in younger people
• Chemical exposure: Long-term exposure to wood dust, paint fumes, asbestos, or industrial chemicals can increase risk
• Weak immune system: Illnesses or medications that weaken immunity make it harder for the body to fight off abnormal cell growth
• Poor oral hygiene: Gum disease, poor dental care, and betel nut chewing (common in parts of Asia) can raise the risk of mouth cancer
• Other risk factors account for a smaller proportion of head and neck cancers. These risk factors include:²
  • Having a sibling, parent, or child with head and neck cancer (perhaps due to similar lifestyle factors)
  • Inheriting a disorder (such as Fanconi anaemia or Li-Fraumeni syndrome) associated with head and neck cancer
  • Experiencing glandular fever, another name for Epstein-Barr virus

How are these cancers classified?

Head and neck cancers are categorised by location, cell type, and stage:^3,4

Location

• Oral cavity: Lips, tongue, gums, and inside the mouth
• Larynx: The voice box
• Pharynx: The throat, including the nasopharynx (upper), oropharynx (middle), and hypopharynx (lower)
• Other areas: Salivary glands, nasal cavity, and sinuses

Cell type

• Squamous Cell Carcinoma (HNSCC) is the most common type, forming in the mouth and throat lining
• Others include adenocarcinomas (salivary glands) and mesenchymal tumours (soft tissue and sinuses)

Stage (TNM System)

The cancer stage describes its size and whether it has metastasised.

• T (Tumour): Shows how big the primary tumour is. Generally, the larger the number, the deeper the cancer has penetrated the tissue
• N (Nodes): Indicates whether the cancer has spread to lymph nodes in the area. N0 indicates that the cancer has not spread to the lymph nodes; the higher the number, the more nodes are impacted or the more cancer is present within the nodes
• M (Metastasis): Suggests whether the cancer has spread to other body parts. M0 indicates that the cancer has not spread, while M1 indicates metastasis

Common symptoms to watch for

Signs vary depending on where the cancer starts, but common symptoms include:^3,5

• A lump or swelling in the neck, jaw, or mouth
• Mouth sores that don’t heal
• Pain, numbness, or weakness in the face
• Difficulty swallowing or opening the mouth
• Voice changes, slurred speech, or noisy breathing
• Persistent sore throat or ear pain
• Red or white patches in the mouth
• Unexplained bleeding, bad breath, or fatigue

Diagnosis and treatment

Diagnosing head and neck cancer begins with a physical exam. It may involve imaging tests, namely CT scans, MRIs, or ultrasounds, along with endoscopy and biopsy to confirm the presence of cancer. Additional tests, such as HPV and genetic testing, improve diagnostic accuracy. Treatment depends on the cancer type and stage and includes surgery to remove tumours, radiation, chemotherapy, targeted therapies (like cetuximab), and immunotherapy (such as pembrolizumab).^3,5 

A supportive care team assists with speech, swallowing, and recovery. Cancer treatments can lead to visible changes in the face, causing swelling or disfigurement, which may affect a person’s appearance and consequently their self-esteem. Speech and voice can change, especially if the throat or voice box is affected, and swallowing may become difficult. These challenges can be frustrating, but speech and swallowing therapy can help patients adapt and improve their quality of life over time.^2,3

Mental health challenges faced by HNC patients 

Being diagnosed with head and neck cancer can take a serious toll on a person’s mental health. Beyond the physical pain and treatment side effects, patients often face emotional struggles that are just as challenging.

Emotional struggles post-diagnosis

Patients commonly experience anxiety and depression, often worrying about their health, future, and the impacts of treatment. The fear of cancer recurrence and uncertainty surrounding treatment outcomes also persist, affecting mental well-being.

Physical appearance changes

Surgical and radiation treatments can cause swelling, scarring, and loss of facial features, which significantly impact a patient’s appearance. These changes often lead to self-consciousness and withdrawal, harming self-esteem and emotional health.

Challenges with communication and eating

Patients may have difficulties speaking or using their voice, making communication challenging. Additionally, swallowing problems complicate basic functions like eating and drinking, leading to frustration and further emotional strain.

Isolation and social withdrawal

Due to changes in appearance and difficulty with communication, many patients withdraw from social situations. This isolation heightens the risk of loneliness and depression, as patients may feel misunderstood or embarrassed.

Survivor’s guilt and ongoing fear

Some patients experience survivor’s guilt, feeling distressed about surviving, while others might not. There is also an ongoing fear of the cancer returning, which keeps them anxious and uncertain long after treatment ends.

Additional stressors

Frequent medical appointments can be mentally exhausting, while the financial burden of treatment and ongoing care adds stress. Furthermore, changes in family roles due to illness often create emotional strain for both patients and their loved ones.

Mental health support and interventions

Managing the mental health of head and neck cancer patients is important for their overall recovery. Emotional challenges such as stress, anxiety, and depression are common during treatment, so mental health support is key to improving mental health.^2,6

Psychological therapies

• Cognitive Behavioural Therapy (CBT): Helps patients change negative thoughts and reduce anxiety and depression, teaching ways to handle stress^2,6
• Acceptance and Commitment Therapy (ACT): Encourages patients to accept difficult emotions and focus on living in line with their values, even while facing cancer^2,6

Medications

• Antidepressants: Help manage feelings of sadness or depression during treatment⁷
• Anxiolytics: Reduce anxiety and help with fear or stress related to the illness⁷

Other supports include mindfulness, support groups, smoking cessation programs, and caregiver support. Training healthcare workers to communicate effectively improves the overall experience for patients and caregivers. These combined approaches support mental well-being throughout the cancer journey.

Catching signs of emotional stress early is important when supporting people with head and neck cancer. Everyone's needs are different, so the kind of help they get should be personalised. It's also important to ensure support is accessible and free from obstacles such as a lack of awareness or fear of judgment. The main goal should be for patients to feel better physically, emotionally, socially, and even spiritually, improving their overall quality of life. Support shouldn’t stop after treatment ends—regular check-ins and ongoing care are key to helping patients manage lasting emotional struggles and maintain a good quality of life.⁷

The way forward

Head and neck cancer care has advanced technologically, surgically, and treatment-wise in the past decade, leading to more personalised and precise care. In time, we expect further tailored approaches, less invasive surgeries, and new targeted therapies to improve patient outcomes and experiences. The COVID-19 pandemic has also fast-tracked telemedicine use and shared decision-making, which will play a bigger role in the future. As we move forward, our focus will remain on providing compassionate, high-quality and multidisciplinary care to enhance and personalise every patient’s journey.⁸

Summary

In conclusion, technological changes, surgical methods, and available treatments have led to impressive progress in managing head and neck cancers in recent years. Although these advancements have improved patient care, they also point out the need to address the psychological issues that frequently follow a cancer diagnosis. Patients' well-being can be severely impacted by emotional challenges, physical changes, and issues with eating and communicating. To guarantee that patients not only survive but also flourish throughout their cancer journey, it is crucial to offer comprehensive support, which includes counselling, medications, and long-term care. In the future, telemedicine, minimally invasive procedures, and customised service will be crucial in enhancing the patient experience.