Symptoms of anxiety and depression are increased in patients with head and neck cancer (HNC) who experience symptoms of dysphagia, according to researchers from the University of Pittsburgh and the University of Pittsburgh Medical Center (UPMC). These findings were published in Oncology Nursing Forum.

For this cross-sectional analysis, 228 survivors of head and neck cancer were recruited between October 2018 and January 2020. Participants completed questionnaires that assessed for outcomes such as swallowing dysfunction and symptoms of anxiety and depression.

Patient-reported symptoms of dysphagia were measured with the 10-item Eating Assessment Tool (EAT-10), which assessed issues such as difficulties with consistencies, food sticking, coughing, and swallowing-related weight loss. Participants also completed the Generalized Anxiety Disorder-7 (GAD-7) to assess for recent symptoms of anxiety and the Patient Health Questionnaire-8 (PHQ-8) to assess for recent symptoms of depression.

Continue Reading

Patients who self-reported symptoms of dysphagia were also more likely to report symptoms of anxiety and depression. Overall, 23% of the participants reported symptoms of anxiety and 29% reported symptoms of depression. “When comparing anxiety and depression levels in survivors who reported symptoms of dysphagia versus those who did not, statistical analysis showed a substantial positive correlation between increased swallowing dysfunction and more severe symptoms of anxiety and depression,” the researchers reported.

The study was limited by its cross-sectional nature, and a causal association between patient-reported symptoms of dysphagia and psychological distress cannot be inferred by these data. Self-report questionnaires are intended to screen for certain symptoms, not diagnose conditions. Lastly, the patients were selected from one clinic and were racially homogenous.

“By expanding knowledge of this association, oncology nursing practice can be improved by implementing additional screening for depression and anxiety in survivors reporting swallowing dysfunction,” explained the researchers. This is especially important, given the knowledge that anxiety, depression, and suicide rates are higher in the HNC community. Oncology nurses should be aware of this and feel empowered to provide resources to their patients to help them pursue interventions.

“Future studies can be conducted regarding which method of intervention is best for addressing mental health in HNC survivors,” the researchers concluded.


Eastburn K, Lyu L, Harrison C, et al. Association between patient-reported symptoms of dysphagia and psychological distress in head and neck cancer survivors. Oncol Nurs Forum. 49(1), 81-89. doi:10.1188/22.ONF.81-89