Patterns of stress coping and depression among patients with head and neck cancer: A Japanese cross-sectional study

Objective Patients with head and neck cancer (HNC) experience many stressful problems with breathing, eating, swallowing, and/or speaking. The aim of this study was to (1) identify the clusters of HNC patients based on their stress coping strategies, and (2) evaluate the differences in clinical data and depression between the identified HNC patients' coping clusters. Methods We conducted a single-center, cross-sectional study with self-completed questionnaires for patients with HNC between April and August 2013. We measured stress coping (an abbreviated version of the COPE Inventory: Brief COPE) and depression (the Japanese version of the Beck Depression Inventory-II: BDI-II). Results Of the 116 patients who completed all the questionnaires, 81 (69.8%) participants were 60-79 years old and 105 (90.5%) were men. Cluster analysis based on the standardized z score of Brief COPE showed that patients were classified into three clusters, labeled "dependent coping," "problem-focused coping," and "resigned coping." The ANOVA revealed that depression (BDI score) was significantly higher in the dependent-coping cluster compared to the problem-focused coping. Conclusions This study indicates that patients with a dependent-coping pattern may account for the largest HNC population, and are likely to suffer from depression. Dependent-coping includes smoking, drinking, seeking support, or engaging self-distraction. In the future, we should develop psychological intervention programs focused on coping strategies and enhancement of the support system for patients with HNC.