Utilization of Psychosocial Oncology Services by Oral Cancer Patients

Objectives: Oral cancer, a subcategory of head and neck cancer (HNC), presents challenges including psychological distress, functional limitations, and reduced quality of life. In North America, it accounts for over half of HNC cases and deaths. Psychological distress affects 20–60% of HNC patients, including oral cancer patients, who face a high suicide risk. Despite guidelines recommending routine distress screening, little is known about the use of psychosocial oncology services (POS) for these patients. This study examines POS referral rates, responses, changes over time, and barriers to service utilization.
Methods: A retrospective cross-sectional study was conducted at a major tertiary care facility in Montreal, Canada. Patients diagnosed with oral cancer between 2016 and 2023 were identified. Data from electronic health records included demographic, linguistic, behavioural, and clinical characteristics. Statistical analyses used descriptive statistics, comparison tests, and logistic regression to identify factors associated with POS referral and utilization.
Results: We identified 389 oral cancer patients during the study period, with only 56 (14%) referred to POS—much lower than expected given distress prevalence. POS users averaged 73.2 years (SD = 15.9) compared to 70.9 years (SD = 14.9) for non-users. Women made up 50% of users and 51.1% of non-users, while 71.9% of the sample was French-speaking. Notably, 26.8% of users were current smokers versus 13.8% of non-users, and former smokers were more likely non-users (30%) than users (21.4%). These results suggest demographic and behavioural factors influence POS access.
Conclusions: This study is among the first to explore barriers to POS utilization specifically for oral cancer patients in Quebec, addressing an overlooked aspect of cancer care. Findings will inform healthcare providers and policymakers by identifying critical gaps in service delivery, guiding interventions to improve access to POS, and ultimately improving the quality of psychosocial support for this patient population.