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William F. Connell School of Nursing

Easing the burden of neuropsychiatric symptoms

by corinne steinbrenner

Depression, anxiety, impaired cognition, and other neuropsychiatric symptoms frequently afflict patients undergoing treatment for head and neck cancer as well as their caregivers and families, Assistant Professor Stewart Bond and colleagues at the Vanderbilt University Medical Center found in a pilot study published in Cancer Nursing.

The researchers surveyed 23 family caregivers of patients with head and neck cancer. They asked them to identify neuropsychiatric symptoms they observed in the patient, rate each symptom’s severity, and gauge their own distress. Each caregiver pointed to at least one symptom, and the group identified an average of 7.5 symptoms per patient. The most common were trouble with appetite and eating, altered nighttime behaviors, depression or dysphoria, anxiety, irritability, and agitation or aggression. Coping with these symptoms—particularly with irritability, agitation or aggression, and difficulty eating—caused measurable caregiver distress.

The prevalence of neuropsychiatric symptoms among head and neck cancer patients could lead them to disrupt their treatment or neglect their rehabilitation, the researchers noted. It could also affect patients’ abilities to care for themselves, increasing the burden on caregivers and straining family relationships. With this in mind, the study authors recommend that clinicians take steps to assuage these outcomes, informing patients and their caregivers about possible neuropsychiatric symptoms before treatment begins so they can develop coping strategies. They also advise clinicians to monitor symptoms before, during, and after treatment, and if necessary manage them with appropriate drugs and psychological support.