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Background <p>Oral cancer remains a significant public health challenge in India, largely driven by substance use such as tobacco and alcohol. This study examines patterns of substance use among oral cancer patients and their associations with quality of life (QoL) and psychological well-being, while exploring implications for counseling and rehabilitation.</p> Aims and Objectives <p>The primary aim was to assess the prevalence and patterns of substance use in oral cancer patients and their correlations with QoL and psychological distress. Secondary objectives included evaluating longitudinal changes in these outcomes and the efficacy of motivational interviewing (MI) in reducing substance use and improving well-being.</p> Methods <p>A prospective cohort study was conducted on 150 oral cancer patients (aged 20–80 years) at a tertiary care center in North India from March 2022 to January 2024. Substance use patterns were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Psychological well-being was evaluated with the Depression, Anxiety, and Stress Scale-21 (DASS-21), and QoL using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&amp;N35). A subset of 50 patients, randomly allocated from the cohort, received MI for substance cessation. Assessments were performed at baseline, 2 weeks, 1 month, and 6 months post-treatment. Statistical analyses included chi-square tests, ANOVA, and regression models adjusted for age, stage, treatment modality, and baseline ASSIST scores.</p> Results <p>Tobacco use was prevalent in 82% of patients (smokeless: 58%, smoked: 24%), with alcohol co-use in 45%. High substance use correlated with elevated DASS-21 scores (depression: mean 14.2 ± 4.1, anxiety: 12.8 ± 3.9, stress: 15.6 ± 4.5 at baseline) and reduced QoL (EORTC mean: 50.0 ± 10.5). Over time (baseline vs. 6 months), depression and stress increased (<i>p</i> &lt; 0.001), while anxiety decreased (<i>p</i> &lt; 0.01). Substance-dependent patients showed 25% lower QoL scores (β=-0.32, <i>p</i> &lt; 0.001) and higher psychological distress (OR = 2.1, 95% CI: 1.4–3.2), with stronger effects in advanced stages (III/IV: OR = 2.8, <i>p</i> &lt; 0.001) and combined treatments (OR = 2.4, <i>p</i> &lt; 0.01). Patients receiving MI showed a 30% reduction in ASSIST scores (<i>p</i> &lt; 0.01) and had better QoL scores at 6 months (<i>p</i> &lt; 0.05) compared to controls.</p> Conclusion <p>Substance use exacerbates psychological distress and impairs QoL in oral cancer patients, particularly in advanced stages and multimodal treatments. Counseling interventions, such as MI, demonstrate potential to reduce substance use and enhance recovery, underscoring the need for integrated rehabilitation programs.</p>

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Pattern of Substance Use and Their Impact on Quality of Life and Psychological Well-Being in Oral Cancer Patients: Implications for Counseling and Post-treatment Rehabilitation

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Abhijeet Kamble,
  • Rangila Ram,
  • Manish Sahore,
  • Narotam Ghezta

摘要

Background

Oral cancer remains a significant public health challenge in India, largely driven by substance use such as tobacco and alcohol. This study examines patterns of substance use among oral cancer patients and their associations with quality of life (QoL) and psychological well-being, while exploring implications for counseling and rehabilitation.

Aims and Objectives

The primary aim was to assess the prevalence and patterns of substance use in oral cancer patients and their correlations with QoL and psychological distress. Secondary objectives included evaluating longitudinal changes in these outcomes and the efficacy of motivational interviewing (MI) in reducing substance use and improving well-being.

Methods

A prospective cohort study was conducted on 150 oral cancer patients (aged 20–80 years) at a tertiary care center in North India from March 2022 to January 2024. Substance use patterns were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Psychological well-being was evaluated with the Depression, Anxiety, and Stress Scale-21 (DASS-21), and QoL using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC QLQ-H&N35). A subset of 50 patients, randomly allocated from the cohort, received MI for substance cessation. Assessments were performed at baseline, 2 weeks, 1 month, and 6 months post-treatment. Statistical analyses included chi-square tests, ANOVA, and regression models adjusted for age, stage, treatment modality, and baseline ASSIST scores.

Results

Tobacco use was prevalent in 82% of patients (smokeless: 58%, smoked: 24%), with alcohol co-use in 45%. High substance use correlated with elevated DASS-21 scores (depression: mean 14.2 ± 4.1, anxiety: 12.8 ± 3.9, stress: 15.6 ± 4.5 at baseline) and reduced QoL (EORTC mean: 50.0 ± 10.5). Over time (baseline vs. 6 months), depression and stress increased (p < 0.001), while anxiety decreased (p < 0.01). Substance-dependent patients showed 25% lower QoL scores (β=-0.32, p < 0.001) and higher psychological distress (OR = 2.1, 95% CI: 1.4–3.2), with stronger effects in advanced stages (III/IV: OR = 2.8, p < 0.001) and combined treatments (OR = 2.4, p < 0.01). Patients receiving MI showed a 30% reduction in ASSIST scores (p < 0.01) and had better QoL scores at 6 months (p < 0.05) compared to controls.

Conclusion

Substance use exacerbates psychological distress and impairs QoL in oral cancer patients, particularly in advanced stages and multimodal treatments. Counseling interventions, such as MI, demonstrate potential to reduce substance use and enhance recovery, underscoring the need for integrated rehabilitation programs.