Depression and Predictors in Taiwanese Survivors with Oral Cancer

  • Published : 2013.08.30


Background: Depression is a comorbid disabling problem and potentially affects patient likelihood of survival. The aims of this study were to recognize the characteristics of depression and investigate associated predictor factors in patients with oral cancers. Methods: A cross-sectional and correlational design was used to collect data for this study conducted in northern Taiwan. A set of questionnaires was used to measure depression, symptom distress, performance status, social support, and demographic and disease-related information. Logistic regression was conducted to determine important factors predicting depression. Results: A total of 132 oral cancer patients participated in this study. Of these, 18.2% were identified as depression cases. The patient average performance status score was 90 or higher. Patients reported mild-to-moderate levels of symptom distress. The majority of social support was from families. Religious belief, alcohol use, symptom distress, and social support from family were found to be important factors predicting depression. Patients with religious belief with alcohol use reported greater symptom distress, and those with lower levels of social support from families were significantly more likely to develop depression. Conclusions: Clinicians should assess patient emotional status and manage symptoms in a timely manner to enhance coping abilities. Supportive care provides assurance during the acute survivor phase.


  1. American Cancer Society (2012). Cancer statistics 2010 [Online], Available: [2013, May 1].
  2. Breslau N, Peterson EL, Schultz LR, et al (1998). Major depression and stages of smoking: a longitudinal investigation. Arch Gen Psychiatry, 55, 161-6.
  3. Canadian Cancer Society (2012). Supportive care: surviving cancer [Online], Available: [2013, May 1].
  4. Carpenter KM, Fowler JM, Maxwell GL, et al (2010). Direct and buffering effects of social support among gynecologic cancer survivors. Ann Behav Med, 39, 79-90.
  5. Chen SC, Lai YH, Cheng SY, et al (2011). Psychometric testing of the Chinese-version cancer needs questionnaire short form head and neck cancer-specific version in oral cavity cancer patients. Support Care Cancer, 19, 647-56.
  6. Chen SC, Lai YH, Liao CT, et al (2010). Changes of symptom and depression in oral cavity cancer patients receiving radiation therapy. Oral Oncol, 46, 509-13.
  7. Chen SC, Lai YH, Liao, CT, et al (2013). Supportive care needs in newly diagnosed oral cavity cancer patients receiving radiation therapy. Psychooncology, 22, 1220-8.
  8. Chen YJ, Chang JTC, Liao CT, et al (2008). Head and neck cancer in the betel quid chewing area: recent advances in molecular carcinogenesis. Cancer Sci, 99, 1507-14.
  9. Cohen S, Hoberman H (1983). Positive events and social supports as buffers of life change stress. J Appl Soc Psychol, 13, 99-125.
  10. Delgado-Guay M, Parsons HA, Li Z, et al (2009). Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Support Care Cancer, 17, 573-9.
  11. Deno M, Tashiro M, Miyashita M, et al (2012). The mediating effects of social support and self-efficacy on the relationship between social distress and emotional distress in head and neck cancer outpatients with facial disfigurement. Psychooncology, 21, 144-52.
  12. Derogatis LR, Morrow GR, Fetting J, et al (1983).The prevalence of psychiatric disorders among cancer patients. JAMA, 249, 751-57.
  13. Evans DL, Charney DS, Lewis L. et al (2005). Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry, 58, 175-89.
  14. Fisch M (2004). Treatment of depression in cancer. J Natl Cancer Inst Monogr, 32, 105-11.
  15. Haisfield-Wolfe ME, McGuire DB, Soeken K, et al (2009). Geiger-Brown J, De Forge BR. Prevalence and correlates of depression among patients with head and neck cancer: a systematic review of implications for research. Oncol Nurs Forum, 36, E107-25.
  16. Hasin DS, Grant BF (2002). Major depression in 6,050 former drinker: association with past alcohol dependence. Arch Gen Psychiatry, 59, 794-800.
  17. Henriksson MM, Isometsa ET, Hietanen PS, et al (1995). Mental disorders in cancer suicides. J Affect Disord, 36, 11-20.
  18. Holt CL, Oster RA, Clay KS, et al (2011). Religiosity and physical and emotional functioning among African American and White colorectal and lung cancer patients. J Psychosoc Oncol, 29, 372-93.
  19. International Agency for Research on Cancer (2004). Betel-quid and areca-nut chewing and some areca-nut-derived nitrosamines. IARC Monographs, 85, 1-349.
  20. Kandasamy A, Chaturvedi SK, Desai G (2011). Spirituality, distress, depression, anxiety, and quality of life in patients with advanced cancer. Indian J Cancer, 48, 55-9.
  21. Karnofsky DA, Abelmann WH, Craver LF, et al (1948). The use of the nitrogen mustards in the palliative treatment of carcinoma with particular reference to bronchogenic. Cancer, 1, 634-56.<634::AID-CNCR2820010410>3.0.CO;2-L
  22. Keith O, Winifred B (1985). A social-cognitive theory of depression in reaction to life events. Psychological Review, 92, 372-88.
  23. Ko YC, Huang YL, Lee CH, et al (1995). Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. J Oral Pathol Med, 24, 450-3.
  24. Ko YC, Chiang TA, Chang SJ, et al (1992). Prevalence of betel quid chewing habit in Taiwan and related socio-demographic factors. J Oral Pathot Med, 21, 261-4.
  25. Liao MN, Chen SC, Chen SC, et al (2012). Changes and predictors of unmet supportive care needs in Taiwanese women with newly diagnosed breast cancer. Oncol Nurs Forum, 39, 380-9.
  26. Lin SY (2002). Perceived stress, coping behaviors and social support of caregivers of the ventilator dependents. Unpublished master's thesis. National Yang-Ming University, Taipei, Taiwan.
  27. Lloyd-Williams M, Dennis M, Taylor F (2004). A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med, 18, 558-63.
  28. McCorkle R, Young K (1987). Development of symptom distress scale. Cancer Nurs, 1, 373-8.
  29. Morse DE, Psoter WJ, Baek LS, et al (2012). Smoking and drinking in relation to depressive symptoms among persons with oral cancer or oral epithelial dysplasia. Head Neck, 32, 578-87.
  30. National Cancer Institute (2012). Survivorship [Online], Available: [2013, May 1].
  31. Nelson C, Jacobson CM, Weinberger MI, et al (2009). The role of spirituality in the relationship between religiosity and depression in prostate cancer patients. Ann Behav Med, 38, 105-14.
  32. Pinar G, Okdem S, Buyukgonenc L, et al (2012). Ayhan A. The relationship between social support and the level of anxiety, depression, and quality of life of Turkish women with gynecologic cancer. Cancer Nurs, 35, 229-35.
  33. Rajandram RK, Ho SM, Samman N, et al (2011). Interaction of hope and optimism with anxiety and depression in a specific group of cancer survivors: a preliminary study. BMC Research Notes, 4, 519.
  34. Rutkowska M, Gerber H, Nowak R, et al (2007). Depression in patients with oral or facial malignancy. Med Sci, 4, 392-95.
  35. Salvo N, Zeng L, Zhang L, et al (2012). Frequency of reporting and predictive factors for anxiety and depression in patients with advanced cancer. Clin Oncol (R Coll Radiol), 24, 139-48.
  36. Shah JP, Gil Z (2009). Current concepts in management of oral cancer - Surgery. Oral Oncol, 45, 394-401.
  37. Singer S, Krauß O, Keszte J, et al (2012). Predictors of emotional distress in patients with head and neck cancer. Head Neck, 34, 180-87.
  38. Spiegel D, Giese-Davis J (2003). Depression and cancer: mechanisms and disease progression. Biol Psychiatry, 54, 269-82.
  39. Taiwan cancer registry (2012). 2008 annual report [Online], Available: [2013, May 1].
  40. Teunissen SC, de Graeff A, Voest EE, et al (2007). Are anxiety and depressed mood related to physical symptom burden? A study in hospitalized advanced cancer patients. Palliat Med, 21, 341-6.
  41. Thomas BC, Devi N, Sarita GB et al (2005). Reliability and validity of the Malayalam hospital anxiety and depression scale (HADS) in cancer patients. Indian J Med Res, 122, 395-99.
  42. Thornton LK, Baker AL, Lewin TJ, et al (2012). Reasons for substance use among people with mental disorders. Addict Behav, 37, 427-34.
  43. Tsai KY, Su CC, Lin YY, Chung JA et al (2009). Quantification of betel quid chewing and cigarette smoking in oral cancer patients. Community Dent Oral Epidemiol, 37, 555-61.
  44. Zigmond AS, Snaith RP (1983). The hospital anxiety and depression scale. Acta Psychiatr Scand, 67, 361-70.

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