D'Souza, V., Blouin, E., Zeitouni, A., Muller, K., & Allison, P.J. (2013). An investigation of the effect of tailored information on symptoms of anxiety and depression in head and neck cancer patients. Oral Oncology, 9, 431–437.

To investigate if providing tailored information to patients with advanced head and neck cancer decreases patients' symptoms of anxiety and depression

Patients at one study site received the intervention, and patients at another study site did not receive the intervention and were treated as a control group. The tailored information used was a multimedia tool that included a patient booklet; interactive computer software; computer animation describing cancer spread, staging, and surgical procedures; and a take-home DVD. The purpose of the packet was to educate patients about diagnostic and adjuvant procedures, nutrition, and speech and swallowing practice. Another component was a database. The database could receive and store patient input and could print information that could be given to the patient. The intervention was provided at the hospital by a nurse who was available to address patients' questions and concerns. The control intervention was usual care provided by a nurse practitioner who provided verbal information and pamphlets and met with some patients in an ad hoc manner. Data were collected at baseline. Outcomes were assessed at three months and six months.

• The study reported on a sample of 96 patients.
• Mean patient age was 59.8 years. The age range was 19–87 years.
• The sample was 75% male and 25% female.
• All patients had stage III or IV primary or recurrent head and neck cancer.
• Most patients received combination radiation and chemotherapy.
• The education level of the groups varied significantly, with patients in the control group having a much higher level of education.
• About half of the sample was employed.

• Multisite 
• Setting not specified
• Montréal, Canada

Active antitumor treatment

Nonrandomized controlled trial

• Distress Thermometer
• Hospital Anxiety and Depression Scale (HADS)

Over time, anxiety was lower in the intervention group (p = 0.001), and there was a significant group-by-time effect (p = 0.025). Anxiety did not decline in the control group over time. Over time, depression declined in both groups (p = 0.001), and there were no group differences in depression. Findings were grouped by low, borderline, and high anxiety levels according to HADS results. In the low-anxiety group, patients reported lower levels of anxiety over time than did controls (p = 0.003). In the borderline group, there were no significant differences between study groups. Among those who had clinical levels of anxiety at baseline, patients had lower levels of anxiety at three months (p = 0.014) and six months (p = 0.005). Among those with clinical depression in the control group, depression initially increased at three months and then decreased toward baseline,

Findings demonstrate that the providing information can have an effect on anxiety. It cannot be determined if the nature of the multimodal intervention was a critical factor or whether providing information in any form would be helpful, since there was no random patient assignment and patients in the control group received information in an inconsistent, ad hoc manner.

• The study had a small sample size, with fewer than 100 participants.
• The study had baseline sample and group differences of import.
• The study had a risk of bias due to no control group, no blinding, no random assignment, and no appropriate attentional control condition.
• Baseline data were obtained after the intervention was given.

Findings suggest that providing information to patients may help reduce patients' anxiety but not their symptoms of depression. This study used a package of information; such a package may be a practical means of ensuring that the information patients receive is consistent. Multiple limitations in this study prevent the drawing of firm conclusions about the effectiveness of the method studied.