Introduction

Oral cancer (also referred to as mouth cancer) is a disease where malignancies develop in the tissues of the mouth. This includes the lips, tongue, cheeks, and throat. There are multiple types of oral cancers including (but not limited to):

• Squamous cell carcinoma
• Salivary gland carcinomas
• Lymphomas
• Mucosal melanoma
• Sarcomas 

The impact of oral cancer manifests in physical changes, such as mouth sores, mouth pain, earache, difficulty chewing and swallowing etc. Facing the challenges of oral cancer, individuals will often be affected by the emotional impact of the disease, stigma, social perception, body image issues, and possible financial concerns. In this article, we will explore how oral cancer can affect your mental health and wellbeing, and ways to find support and treatment. 

Understanding oral cancer

Causes and risk factors

The risk of developing oral cancers is increased by factors, such as tobacco and alcohol usage. Other risk factors that can increase your risk of oral cancer include:

• Human papillomavirus (HPV) infection
• Prolonged sun exposure
• Gender
• Genetics 

According to a 2022 study, smoking can triple the risk of oral cancer, with the length of time that a person has smoked increasing their cancer risk.¹ The American Cancer Society also states that HPV DNA is found in two-thirds of oropharyngeal cancer cases.

Common symptoms and early detection

Symptoms of oral cancer are varied but most commonly include: 

• Persistent mouth sores
• Red or white patches in the mouth
• Bleeding from the mouth
• Difficulty with/painful swallowing
• Changes in speech
• Unexplained weight loss

Early detection is crucial for successful treatment, as it can allow the cancer to be stopped before it has spread. If the treatment can be implemented at an early stage, the five-year survival rate is above 80%. However, if oral cancer spreads to the lymph nodes then the survival rate drops below 20%.² 

Although there are no routine oral cancer screening tests, regular inspection of the oral cavity, and routine check-ups with a dentist or a doctor, can maximise the chances of noticing changes. Special lights and dyes, such as fluorescent lights and toluidine blue, can be used by healthcare professionals to see potential changes.

Oral cancer can be detected based on the symptoms that an individual is presenting with, accompanied by potential risk factors. Once oral cancer is suspected, a physician may perform a physical examination (head, neck, and general) and request further investigations. These might include:

• HPV testing
• Endoscopy
• X-ray
• CT scan
• Biopsies

Treatment options 

There are a multitude of treatment options for oral cancer which depend on the type and staging, but they mainly involve:

• Surgery
• Radiation therapy
• Chemotherapy 

For early-stage oral cancers, surgery and radiotherapy are the most common treatment methods. These might be recommended individually or in combination. More advanced oral cancer may require chemotherapy and other forms of management.² 

Mental health implications

Being diagnosed with any disease can cause fear and anxiety. A diagnosis of any cancer can often bring about emotional distress. This can include depression and uncertainty due to the nature of the term “cancer” and its potential implications. 

Coping with the emotional burden of the diagnosis and treatment can significantly challenge your mental health. A 2021 study showed that patients diagnosed with oral cancer showed high severity of depression before and even after their treatments, highlighting the need to consider mental health in cancer management.³

Individuals who have been diagnosed with oral cancer may also have mental health stress due to the societal stigma associated with the disease. This is especially connected to risk factors, such as tobacco usage and HPV. Negative perceptions and misunderstandings about oral cancer can contribute to feeling isolated on top of the psychological burden of being diagnosed with the disease. 

Impact of treatment on mental health

Though treatment is designed to improve outcomes for the individual, it can also lead to mental health difficulties. 

Oral cancer treatments can alter someone’s physical appearance and impact daily functions (e.g., speech or eating). Chemotherapy works by weakening the body to kill the cancer cells, which can result in side effects, such as:

• General frailty
• Pain
• Fatigue
• Nausea
• Weight and hair loss 

These physical changes can influence body image and self-esteem-related issues. Depending on the course of the cancer, treatments can be prolonged which can gradually impact your daily routine and further contribute to feelings of frustration, sadness, or helplessness.

Some individuals with oral cancer have been shown to have Post Traumatic Stress Disorder (PTSD)-related symptoms prior to surgical treatment. On top of this, survivors sometimes experience deterioration in the quality of sleep and have high levels of anxiety and depression.^4,5

Furthermore, there are considerations that extend beyond the treatment phase, as survivors may grapple with long-term psychological effects, fear of recurrence, and adjustments to a new change. The fear of recurrence can be the biggest worry for survivors, with a 2020 study showing that nearly a third of survivor patients feel concerned about this.⁶

Support systems

Integrating psychological support, counselling services, and educational resources into the management plan can help individuals and their carers navigate the emotional challenges associated with oral cancer.

Support systems have a vital role for any individual diagnosed with an illness including oral cancer. A strong support network, often comprised of family, friends, others who are facing similar challenges, and healthcare professionals, can provide outlets for emotional expression. Along with this, a combined support system fosters a sense of understanding, empathy, and unity. 

Role of healthcare professionals

Individuals should be provided with a platform/opportunity to seek counselling services. Participation in these services allows you to share your experiences, exchange coping strategies, and find solace. 

Healthcare professionals can provide up-to-date and factual information regarding the disease and its progress to the patient, family and friends. Knowledgeable support systems can enable informed decisions and dispel misinformation that can induce anxiety and stress.

A 2023 research published by the British Medical Journal showed that psychosocial support provided to patients and their relatives leads to improvements in anxiety, distress, and depression.⁷

Importance of family and social support

Family and social support play an important role in the overall well-being and coping mechanisms of both individuals facing oral cancer and survivors. Attending medical appointments with the individual allows family members to stay informed about the treatment plan, ask essential questions, clear doubts, and provide an additional layer of support during consultations. Furthermore, providing practical assistance, such as meal preparation, transportation to medical appointments, and household chores, helps ease the challenges that can be faced. 

Social support, including friends, colleagues, and community networks, contributes to stronger mental health by providing a network of support and preventing feelings of isolation. Regular interactions with friends and social groups create a sense of normalcy, alleviating potential loneliness, and can allow the sharing of coping mechanisms.

Joining cancer support groups provides individuals with the opportunity to connect with others who share similar experiences. Peer support fosters a sense of camaraderie and gives a chance to exchange insights. If positive news/a breakthrough has occurred, a support system can also celebrate milestones, acknowledging resilience and progress while providing a sense of accomplishment and hope.

A 2022 study showed that support provided by different sources, such as friends, family and a partner led to a reduction of the symptoms that patients experienced.⁸

Integration of mental health services into oral cancer care

The integration of mental health services into oral cancer care is fundamental for addressing the psychological and emotional issues associated with oral cancer. Education from healthcare professionals on the disease, treatment, and side effects can be a broad way to alleviate fears and anxiety.

Implementation of routine mental health screenings and assessments as part of evaluation can help identify existing mental health concerns or ones that may arise later and allow for timely intervention. 

Providing crisis intervention services for acute mental health challenges can prevent severe consequences. Having mental health professionals readily available can assist in managing immediate emotional challenges and preventing escalation.

Prevention and awareness

Providing up-to-date information and education, through campaigns, posters, and social media can help raise awareness about the risk factors associated with oral cancer, including tobacco and alcohol use, human papillomavirus (HPV) infection, and prolonged sun exposure. Furthermore, encouragement can be given to reduce these risk factors and promote regular health check-ups with doctors and dentists. 

As there should be awareness of oral cancer, there should be awareness of the mental health consequences associated with oral cancer. During these campaigns, a perspective on mental health should also be included, to provide education about early detection, general awareness, and treatment. 

Summary

Oral cancer is a disease that has significant physical health challenges while also significantly impacting mental well-being. A diagnosis of oral cancer can evoke emotional distress, anxiety, and fear. This is often exacerbated by societal stigma and potential changes in appearance or function, which can reduce your overall quality of life.

Integrating mental health services into oral cancer care is crucial to addressing the complex emotional challenges individuals face. Recognition of the intersection between oral cancer and mental health emphasises the need for a multidisciplinary approach to care by both the public and healthcare providers.