journal club presentation in maxillofacial surgery

1. Presented by- Dr. Abhijeet Kamble
2nd Year PG
Dept of Maxillofacial and Oral Surgery
Government Dental College, Shimla

2. 1. About the Journal
2. Abstract
3. Introduction
4. Material and Methods
5. Results
6. Discussion
7. Review of Literature
8. References

3. Prospective evaluation of psychological burden
in patients with oral cancer
K. Kumar a, S. Kumar a,f , D. Mehrotra a,∗, S.C. Tiwari b, V. Kumar c, S. Khandpur d, R.C. Dwivedi e

4. • British Journal Of Oral and Maxillofacial Surgery
• Peer reviewed journal
• Open access PubMed Indexed Journal
• Impact factor – 3.192
• Published by – Elsevier Inc.
• Volume – 61
• Issue – 2
• Year of publication - 198

5. • Purpose : The purpose of this study therefore was to evaluate depression, anxiety, and stress
in patients with oral cancer using the short version of the Depression Anxiety and Stress Scale
(DASS-21),12 and to compare DASS-21 with HADS (Hospital Anxiety and Depression Scale).
• Method : A total of 111 patients were enrolled and 75 of them completed the questionnaires
at diagnosis, one month after treatment, and three months after discharge. Scores were high
for stress at diagnosis, and for depression at the other time points, but were low for anxiety
at all three.
• Results : The results of Friedman’s ANOVA showed that mean ranks for depression and stress
were significant (p < 0.05). Scores for depression and stress rose significantly between
diagnosis and three months after operation, but those for anxiety (which had increased
between diagnosis and operation p > 0.05), were stable three months postoperatively. .
• Conclusion :The DASS-21 was a useful method of evaluating stress. Correlation of the results
from the two questionnaires showed a strongly positive association. We therefore recommend
psychological intervention to improve overall outcome.

6.  Oral cancer is the sixth most common cancer worldwide and the second most common in
Southeast Asia. In India, an increase in the use of tobacco has considerably increased its
incidence.Treatment depends on the stage of the disease, but diagnosis is often late, and this
affects both recovery and survival.When first diagnosed, patients experience several physical,
mental, emotional, and social difficulties, and the effects of the treatment on daily activities
such as chewing, swallowing, and speech, can cause depression, anxiety, and stress, which
must be treated to enable patients to cope.
 Many studies have reported the difficulties patients face7 and several have focused on anxiety
and depression,but to our knowledge few have looked at potential anxiety or stress. Patients
who are stressed typically find it difficult to relax, and are irritable, tense, and agitated.
Various analytical studies have reported a correlation among stress, depression, and anxiety,
but few if any data about all three concurrently.

7.  We studied patients who were treated at the Department of Oral and Maxillofacial Surgery
and Oncology at the North India Medical University between 2013 and 2016. Those with
histopathologically confirmed oral squamous cell carcinoma (SCC), who were 18 years and
above, and able to read and write in English or Hindi, were included. Those who had a history
of mental illness, or had psychological treatment for a mental illness, were excluded. Of the
111 patients who were enrolled, 17 did not attend, 11 refused, and eight had died, so 75
were included They each completed the DASS-21 and HADS at three different time points
during their treatment: at the time of diagnosis (after histopathological confirmation and
before treatment), one month after operation, and three months after discharge. Data were
assessed by only one rater, a psychologist (KK), to reduce problems with inter-rater reliability

8. Questionnaires
DASS-21 (Depression, Anxiety, and Stress Scale) To evaluate depression,
anxiety, and stress, we used the DASS-21, a shorter version of the DASS-42, in
both the Hindi and English languages.12 Each of the three domains includes
seven items, which are scored from 0 (does not apply to me at all) to 3
(applies to me very much, or most of the time). Scores for each domain are
added to give the total.

9.  At the time of diagnosis, age affected the incidence of
depression but not that of anxiety and stress (Table 2).
Table 3 shows that when diagnosed, the depression
scores of those aged between 30 and 60 differed
significantly from those who were over 60.

10.  Studies on depression and anxiety among patients with oral cancer, tend not to evaluate
stress together with depression and anxiety. Initially, psychological burden was measured only
in terms of anxiety and depression, and “stress”, which focused on difficulty in relaxing,
impatience, tension, agitation and irritability, was added later. Selye defined it as “the non-
specific response of the body to any demand for change” and described it as being “the rate
of wear and tear on the body.
 Anxiety was almost stable, but stress increased. Studies have indicated a close affinity
between the two,15 and some of the symptoms of stress such as chronic arousal, tension,
fatigue, worry, nervousness, discouragement, shortness of temper, fidgetiness, interrupted
sleep, avoidance, and irritability, overlap with those of anxiety. These findings could be a
reason for the difference between our results and those of previous studies

11.  To combat the disease, patients’ psychological needs must be addressed together with their
physical needs, not only during, but also after, treatment. To identify those who need
support, the DASS-21 is particularly useful because it also assesses stress.