Course of psychiatric comorbidity and utilization of mental health care after laryngeal cancer: a prospective cohort study.

Abstract

In a German multi-center prospective cohort study, we wanted to assess the course of psychiatric comorbidity, utilization of mental health care and psychosocial care needs in laryngeal cancer patients during the first year after partial laryngectomy (PRL). Structured interviews with patients were conducted before surgery, 1week (1 w), 3months (3m) and 1year (12m) after PRL. Psychiatric comorbidity was assessed using the Structured Clinical Interview for DSM-IV (SCID). Psychosocial care needs and utilization of mental health care were evaluated with standardized face-to-face interviews. In 176 patients, psychiatric disorders were prevalent in 11% (1 w), 15% (3m) and 14% (12m), respectively, of which 4% (12m) underwent psychiatric treatment or psychotherapy. Two percent had acute, 15% emerging and 6% chronic psychiatric comorbidity. Chronically mental ill patients were more frequently younger than 65years (p=0.026), female (p=0.045) and experienced more often a need for psychological counseling (p≤0.001). One year after surgery, 27% of the comorbid psychiatric patients expressed a need for additional psychological counseling. Alcohol-related disorders were diagnosed in 3% (1 w), 3% (3m) and 8% (12m), respectively. Only one of these patients received psychological treatment, while 14% expressed a need for psychological counseling and 7% for additional medical consultations. The non-treatment of alcohol-related disorders measured in our sample indicates a major problem since continued alcohol consumption in laryngeal cancer patients is associated with reduced global quality of life, increased functional impairments and reduced overall survival. Screening instruments integrated into acute care are necessary to detect harmful drinking behavior.