Prevalence and associated factors of psychological distress among patients with oral cancer in the selected tertiary care institutes in Sri Lanka: a combined cross-sectional and case-control study.

Introduction: Oral cancer represents the most prevalent malignancy among Sri Lankan males. This aggressive disease is associated with significant psychological distress, driven by disfigurement and impairments of vital functions.While the detrimental impact of psychological distress on patients with oral cancer is well documented, its prevalence and associated determinants remain underexplored in the Sri Lankan context. This study aims to evaluate the prevalence and identify the factors associated with psychological distress in a selected cohort of patients with oral cancer in Sri Lanka.

Methods: A hospital-based cross-sectional study was conducted among 355 patients with oral cancer to determine the prevalence of psychological distress. Additionally, a nested case-control study comprising 140 patients per group was carried out to evaluate the factors associated with psychological distress. Multivariate logistic regression analysis was performed to identify significant associated factors of psychological distress.

Results: The prevalence of psychological distress among patients with oral cancer was 31.0% (95% CI=27.8-35.3%). Being <50 years of age (adjusted OR (AOR)=1.2, 95% CI=0.7-1.7, p=0.006), having pain (AOR=44.7, 95% CI=34-53.21, p=0.001), late stages of cancer at the diagnosis (AOR=10.7, 95% CI=1.07-28.78, p=0.04), being worried about basic functional disabilities (AOR=11.4, 95% CI=10.3-14.8, p=0.006) and the two psychological factors- ("Other people about me more than I do"; AOR=5, 95% CI=2.8-6.9) and ("I feel very about what has happened to me"; AOR=12.1, 95% CI=6.8-15.4)-emerged as significant independent factors that were associated with increased risk of psychological distress among patients with oral cancer.

Conclusion: Approximately one-third of patients with oral cancer in the selected tertiary care hospitals were found to experience psychological distress, highlighting its high prevalence in this population. The identification of key factors associated with psychological distress provides valuable insights for the development of targeted intervention strategies aimed at mitigating psychological morbidity among patients with oral cancer.