The Psychological Effect of Antimicrobial Resistance in Patients with Oral Squamous Cell Carcinoma (OSCC)

Shilan Farhad Mamand; Hardi Abdulqader Hasan; Akam Fareeq Saber; Mardin Fareeq Saber; Jihad Haji Saleh; Radhwan Saifadin Sabah; Sima siyamand hussein; Suha Saeed Azeez

doi:10.64048/y96cn554

Authors

Shilan Farhad Mamand Department of Medical Microbiology, College of Science, Knowledge University, Kirkuk Road, 44001 Erbil, Iraq Author https://orcid.org/0000-0002-0270-4402
Hardi Abdulqader Hasan Staff Nurse, Nanakali Cancer Hospital, Erbil, Iraq Author https://orcid.org/0009-0009-3286-3824
Akam Fareeq Saber Department of Dentistry, Tishk International University, Erbil, Iraq Author https://orcid.org/0009-0009-1748-1983
Mardin Fareeq Saber Independent Researcher, Erbil, Iraq Author https://orcid.org/0009-0001-5482-1408
Jihad Haji Saleh Department of Biology, Harran university, Şanlıurfa, Turkey Author https://orcid.org/0000-0002-9676-873X
Radhwan Saifadin Sabah College of Nursing, Hawler Medical University Erbil, Iraq Author https://orcid.org/0009-0009-6782-071X
Sima siyamand hussein Department of Nursing, Shaqlawa Technical College, Erbil Polytechnic University, Erbil, Iraq Author https://orcid.org/0009-0000-1508-4671
Suha Saeed Azeez Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq Author https://orcid.org/0000-0001-8532-8387

DOI:

https://doi.org/10.64048/y96cn554

Keywords:

Antimicrobial Resistance, Oral Squamous Cell Carcinoma, Psychological Burdens, Mental Health Interventions, Psychosocial Impact

Abstract

Background and Aim: Oral squamous cell carcinoma (OSCC) is a common form of head and neck cancer, and the emergence of antimicrobial resistance (AMR) has made its treatment increasingly challenging. AMR contributes to treatment failures, increased morbidity, and reduced survival rates among OSCC patients. Beyond these clinical impacts, this review aims to evaluate the psychological burdens associated with AMR in OSCC and to explore the effectiveness of mental health interventions tailored to these patients.

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, APA PsycINFO, CINAHL, Cochrane Library, and Web of Science. To ensure a thorough examination of the topic, the review focused on the intersection of AMR, OSCC, and mental health interventions, with studies published from March 2001 to August 2024 being considered.

Results: A total of 62 studies were reviewed, revealing that AMR in OSCC significantly exacerbates psychological burdens such as anxiety, depression, and social isolation. Interventions like mindfulness-based interventions (MBIs), cognitive-behavioral therapy (CBT), and acceptance and commitment therapy (ACT) were identified as effective in reducing psychological distress and improving quality of life.

Conclusion: The results indicate that AMR significantly worsens the psychological well-being of OSCC patients. Healthcare providers and policymakers are recommended to integrate mental health support into standard cancer care, enhance training on the psychological impact of AMR, and address barriers to mental health services. Future research should focus on developing and evaluating innovative mental health interventions and strategies to mitigate the impact of AMR on OSCC patients.

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References

AHMED, S. K., HUSSEIN, S., QURBANI, K., IBRAHIM, R. H., FAREEQ, A., MAHMOOD, K. A. & MOHAMED, M. G. 2024a. Antimicrobial resistance: Impacts, challenges, and future prospects. Journal of Medicine, Surgery, and Public Health, 2, 100081. https://doi.org/10.1016/j.glmedi.2024.100081

AHMED, S. M., SABER, A. F., NAIF, A. A., HAMAD, A. H., AHMED, S. K., ABDULLAH, A. Y., QURBANI, K. & HUSSEIN, S. 2024b. Exploring Young Adults' Reluctance to Engage With Psychiatric Hospitals in Erbil, Iraq: Identifying Barriers to Psychiatric Care. Cureus, 16. https://doi.org/10.7759/cureus.62164

AHMED, S. M., SABER, A. F., NAIF, A. A., HAMAD, A. H., AHMED, S. K., ABDULLAH, A. Y., QURBANI, K., HUSSEIN, S. & NAIF, A. 2024c. Exploring young adults' reluctance to engage with psychiatric hospitals in Erbil, Iraq: identifying barriers to psychiatric care. Cureus, 16. https://doi.org/10.7759/cureus.62164

AJITHAKUMARI, G. & HEMAVATHY, V. 2022. Caregivers Burnout Syndrome: Support Yourself While Caring For A Loved One. Cardiometry, 965-969. https://doi.org/10.18137/cardiometry.2022.24.965969

AL SUWYED, A. S., AL ZOMAN, K. H., ROBERT, A. A., AL-NOWAISER, A. M., ALABDELY, M. H. & AL MUBARAK, S. 2021. The silent epidemic of common oral diseases among the Arab population: An emerging health problem. Journal of Family Medicine and Primary Care, 10, 2768-2774. https://doi.org/10.4103/jfmpc.jfmpc_323_21

AYOB, A. Z. & RAMASAMY, T. S. 2018. Cancer stem cells as key drivers of tumour progression. Journal of biomedical science, 25, 1-18. https://doi.org/10.1186/s12929-018-0426-4

BACHMANN, A. S., ZAUNBAUER, A. C., TOLKE, A. M., SINIATCHKIN, M., KLUCK, C., WILTFANG, J. & HERTRAMPF, K. 2018. Well-being and quality of life among oral cancer patients–Psychological vulnerability and coping responses upon entering initial treatment. Journal of Cranio-Maxillofacial Surgery, 46, 1637-1644. https://doi.org/10.1016/j.jcms.2018.05.042

BARRETT, K., O’CONNOR, M. & MCHUGH, L. 2019. A systematic review of values-based psychometric tools within acceptance and commitment therapy (ACT). The Psychological Record, 69, 457-485. https://doi.org/10.1007/s40732-019-00352-7

BAUMEISTER, R. F. & LEARY, M. R. 1997. Writing narrative literature reviews. Review of general psychology, 1, 311-320. https://doi.org/10.1037//1089-2680.1.3.311

BORELLA, P., BARGELLINI, A., MARCHEGIANO, P., VECCHI, E. & MARCHESI, I. 2016. Narrative review. Ann Ig, 28, 98-108.

BROOKS, L., NARVEKAR, U., MCDONALD, A. & MULLANY, P. 2022. Prevalence of antibiotic resistance genes in the oral cavity and mobile genetic elements that disseminate antimicrobial resistance: A systematic review. Molecular Oral Microbiology, 37, 133-153. https://doi.org/10.1111/omi.12375

BUGSHAN, A. & FAROOQ, I. 2020. Oral squamous cell carcinoma: metastasis, potentially associated malignant disorders, etiology and recent advancements in diagnosis. F1000Research, 9. https://doi.org/10.12688/f1000research.22941.1

CAPOTE-MORENO, A., BRABYN, P., MUÑOZ-GUERRA, M., SASTRE-PÉREZ, J., ESCORIAL-HERNANDEZ, V., RODRÍGUEZ-CAMPO, F., GARCÍA, T. & NAVAL-GÍAS, L. 2020. Oral squamous cell carcinoma: epidemiological study and risk factor assessment based on a 39-year series. International journal of oral and maxillofacial surgery, 49, 1525-1534. https://doi.org/10.1016/j.ijom.2020.03.009

CARLSON, L. E., WALLER, A. & MITCHELL, A. J. 2012. Screening for distress and unmet needs in patients with cancer: review and recommendations. Journal of Clinical Oncology, 30, 1160-1177. https://doi.org/10.1200/JCO.2011.39.5509

CARRERA, P. M., KANTARJIAN, H. M. & BLINDER, V. S. 2018. The financial burden and distress of patients with cancer: understanding and stepping‐up action on the financial toxicity of cancer treatment. CA: a cancer journal for clinicians, 68, 153-165. https://doi.org/10.3322/caac.21443

CHOU, H.-C., LIN, H.-W., YANG, J.-H., LIN, P.-Y., CHENG, S.-J., WU, Y.-H. & KUO, Y.-S. 2019. Clinical outcomes of oral cancer patients who survive for more than 5 years in Taiwan. Journal of the Formosan Medical Association, 118, 1616-1622. https://doi.org/10.1016/j.jfma.2019.07.022

CILLESSEN, L., JOHANNSEN, M., SPECKENS, A. E. & ZACHARIAE, R. 2019. Mindfulness‐based interventions for psychological and physical health outcomes in cancer patients and survivors: a systematic review and meta‐analysis of randomized controlled trials. Psycho‐oncology, 28, 2257-2269. https://doi.org/10.1002/pon.5214

CIVILOTTI, C., ACQUADRO MARAN, D., SANTAGATA, F., VARETTO, A. & STANIZZO, M. R. 2020. The use of the Distress Thermometer and the Hospital Anxiety and Depression Scale for screening of anxiety and depression in Italian women newly diagnosed with breast cancer. Supportive Care in Cancer, 28, 4997-5004. https://doi.org/10.1007/s00520-020-05343-x

COMBES, G., DAMERY, S., SEIN, K., ALLEN, K., NICHOLAS, J. & BAHARANI, J. 2019. Distress in patients with end-stage renal disease: staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support. PloS one, 14, e0225269. https://doi.org/10.1371/journal.pone.0225269

COMPEN, F., BISSELING, E., SCHELLEKENS, M., DONDERS, R., CARLSON, L., VAN DER LEE, M. & SPECKENS, A. 2018. Face-to-face and internet-based mindfulness-based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer: a multicenter randomized controlled trial. Journal of Clinical Oncology, 36, 2413-2421. https://doi.org/10.1200/JCO.2017.76.5669

COQUE, T. M., CANTÓN, R., PÉREZ-COBAS, A. E., FERNÁNDEZ-DE-BOBADILLA, M. D. & BAQUERO, F. 2023. Antimicrobial resistance in the global health network: known unknowns and challenges for efficient responses in the 21st century. Microorganisms, 11, 1050. https://doi.org/10.3390/microorganisms11041050

CURRAN, L., SHARPE, L. & BUTOW, P. 2017. Anxiety in the context of cancer: a systematic review and development of an integrated model. Clinical psychology review, 56, 40-54. https://doi.org/10.1016/j.cpr.2017.06.003

DESHIELDS, T. L., KAPLAN, J. & RYNAR, L. Z. 2022. Psychological Approaches to Cancer Care, Hogrefe Publishing GmbH. https://doi.org/10.1027/00511-000

DHINGRA, S., RAHMAN, N. A. A., PEILE, E., RAHMAN, M., SARTELLI, M., HASSALI, M. A., ISLAM, T., ISLAM, S. & HAQUE, M. 2020. Microbial resistance movements: an overview of global public health threats posed by antimicrobial resistance, and how best to counter. Frontiers in Public Health, 8, 535668. https://doi.org/10.3389/fpubh.2020.535668

DI STEFANO, M., POLIZZI, A., SANTONOCITO, S., ROMANO, A., LOMBARDI, T. & ISOLA, G. 2022. Impact of oral microbiome in periodontal health and periodontitis: a critical review on prevention and treatment. International journal of molecular sciences, 23, 5142. https://doi.org/10.3390/ijms23095142

EWA SZUMACHER, M., YVONNE ANGWENYI, M., CLEMENT GWEDE PHD, M. & BRANSON, D. 2019. 2019 International Cancer Education Conference. Journal of Cancer Education, 34, S1-S58.

FAREEQ, A., AHMED, S. K., HUSSEIN, S. & QURBANI, K. 2024. Artificial intelligence-assisted nursing interventions in psychiatry for oral cancer patients: A concise narrative review. Oral Oncology Reports, 100343. https://doi.org/10.1016/j.oor.2024.100343

FAREEQ SABER, A., MASIH, S., KARIMIRAD, M. R., SHARIFI, F. & MANOOKIAN, A. 2024. The relationship between internet addiction, sleep quality, and psycho‐social problems among secondary school students in Erbil, 2023–2024. Public Health Nursing, 41, 933-942. https://doi.org/10.1111/phn.13353

GRANEK, L., NAKASH, O., ARIAD, S., SHAPIRA, S. & BEN-DAVID, M. Strategies and Barriers in Addressing Mental Health and Suicidality in Patients With Cancer. Oncology nursing forum, 2019. https://doi.org/10.1188/19.ONF.561-571

GRANEK, L., NAKASH, O., BEN‐DAVID, M., SHAPIRA, S. & ARIAD, S. 2018. Oncologists', nurses', and social workers' strategies and barriers to identifying suicide risk in cancer patients. Psycho‐Oncology, 27, 148-154. https://doi.org/10.1002/pon.4481

GREER, J. A., JACKSON, V. A., MEIER, D. E. & TEMEL, J. S. 2013. Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA: a cancer journal for clinicians, 63, 349-363. https://doi.org/10.3322/caac.21192

HAMAD, A. H., TAHER, D. H., NAIF, A. A., OMAR, I. F., MANOOKIAN, A., SABER, A. F., AHMED, S. K., HUSSEIN, S. & NAIF, A. 2024. Assessment of anxiety, stress, and depression among COVID-19 survivors after 40 months in the Kurdistan region of Iraq: an online cross-sectional study. Cureus, 16. https://doi.org/10.7759/cureus.63739

HAQUE, M., MCKIMM, J., GODMAN, B., ABU BAKAR, M. & SARTELLI, M. 2019. Initiatives to reduce postoperative surgical site infections of the head and neck cancer surgery with a special emphasis on developing countries. Expert review of anticancer therapy, 19, 81-92. https://doi.org/10.1080/14737140.2019.1544497

HASAN, H. A., SABER, A. F. & NASRABADI, A. N. 2025. Knowledge and Attitude of Emergency Nurses Regarding Work‐Related Legal Issues in Erbil Hospitals: A Cross‐Sectional Study, 2023–2024. Health Science Reports, 8, e70496. https://doi.org/10.1002/hsr2.70496

HOLLAND, J. C. 2018. Psycho‐oncology: Overview, obstacles and opportunities. Psycho‐oncology, 27, 1364-1376. https://doi.org/10.1002/pon.4692

IRFAN, M., DELGADO, R. Z. R. & FRIAS-LOPEZ, J. 2020. The oral microbiome and cancer. Frontiers in immunology, 11, 591088. https://doi.org/10.3389/fimmu.2020.591088

IRWIN, K. E., HENDERSON, D. C., KNIGHT, H. P. & PIRL, W. F. 2014. Cancer care for individuals with schizophrenia. Cancer, 120, 323-334. https://doi.org/10.1002/cncr.28431

KAPSE-MISTRY, S., GOVENDER, T., SRIVASTAVA, R. & YERGERI, M. 2014. Nanodrug delivery in reversing multidrug resistance in cancer cells. Frontiers in pharmacology, 5, 159. https://doi.org/10.3389/fphar.2014.00159

KARPIŃSKI, T. M. 2019. Role of oral microbiota in cancer development. Microorganisms, 7, 20. https://doi.org/10.3390/microorganisms7010020

KHATTAK, M. I., KHAN, M., KHATTAK, S. I., KHAN, Z., HAQ, Z. U. & SADDKI, N. 2021. The experiences of oral cancer patients: A narrative review. Malaysian Journal of Public Health Medicine, 21, 168-177. https://doi.org/10.37268/mjphm/vol.21/no.2/art.902

KUMAR, A. R., DEVAN, A. R., NAIR, B., VINOD, B. S. & NATH, L. R. 2021. Harnessing the immune system against cancer: current immunotherapy approaches and therapeutic targets. Molecular biology reports, 1-21. https://doi.org/10.1007/s11033-021-06752-9

KUMAR, K., KUMAR, S., MEHROTRA, D., TIWARI, S., KUMAR, V., KHANDPUR, S. & DWIVEDI, R. 2018. Prospective evaluation of psychological burden in patients with oral cancer. British Journal of Oral and Maxillofacial Surgery, 56, 918-924. https://doi.org/10.1016/j.bjoms.2018.09.004

KUMAR, S. A., INDU, S., GAUTAMI, D. & VARRUCHI, S. 2020. Oral squamous cell carcinoma (OSCC) in humans: Etiological Factors, diagnostic and therapeutic relevance. Research Journal of Biotechnology Vol, 15, 10.

LAZAR, V., DITU, L.-M., PIRCALABIORU, G. G., GHEORGHE, I., CURUTIU, C., HOLBAN, A. M., PICU, A., PETCU, L. & CHIFIRIUC, M. C. 2018. Aspects of gut microbiota and immune system interactions in infectious diseases, immunopathology, and cancer. Frontiers in immunology, 9, 1830. https://doi.org/10.3389/fimmu.2018.01830

LEIJDESDORFF, S., KLAASSEN, R., WAIRATA, D.-J., ROSEMA, S., VAN AMELSVOORT, T. & POPMA, A. 2021. Barriers and facilitators on the pathway to mental health care among 12-25 year olds. International journal of qualitative studies on health and well-being, 16, 1963110. https://doi.org/10.1080/17482631.2021.1963110

LESHO, E. P. & LAGUIO-VILA, M. The slow-motion catastrophe of antimicrobial resistance and practical interventions for all prescribers. Mayo Clinic Proceedings, 2019. Elsevier, 1040-1047. https://doi.org/10.1016/j.mayocp.2018.11.005

LEVIT, L., BALOGH, E., NASS, S. & GANZ, P. A. 2013. The Workforce Caring for Patients with Cancer. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. National Academies Press (US). https://doi.org/10.17226/18359

LI, Q., HU, Y., ZHOU, X., LIU, S., HAN, Q. & CHENG, L. 2020. Role of oral bacteria in the development of oral squamous cell carcinoma. Cancers, 12, 2797. https://doi.org/10.3390/cancers12102797

LIN, L.-Y., LIN, L.-H., TZENG, G.-L., HUANG, Y.-H., TAI, J.-F., CHEN, Y.-L., WU, C.-J., CHEN, P.-H., LIN, P.-C. & HUNG, P.-L. 2022. Effects of mindfulness-based therapy for cancer patients: A systematic review and meta-analysis. Journal of Clinical Psychology in Medical Settings, 29, 432-445. https://doi.org/10.1007/s10880-022-09862-z

LITTLEJOHN, A., CHARITONOS, K. & KAATRAKOSKI, H. The role of professional learning in addressing global challenges: Tensions and innovations associated with AMR. Frontiers in Education, 2019. Frontiers Media SA, 112. https://doi.org/10.3389/feduc.2019.00112

LOWRENCE, R. C., SUBRAMANIAPILLAI, S. G., ULAGANATHAN, V. & NAGARAJAN, S. 2019. Tackling drug resistance with efflux pump inhibitors: from bacteria to cancerous cells. Critical reviews in microbiology, 45, 334-353. https://doi.org/10.1080/1040841X.2019.1607248

LU, Q., CHEN, L., SHIN, L. J., WANG, C., DAWKINS-MOULTIN, L., CHU, Q., LOH, A., YOUNG, L. & WANG, C. 2021. Improvement in quality of life and psychological well-being associated with a culturally based psychosocial intervention for Chinese American breast cancer survivors. Supportive Care in Cancer, 29, 4565-4573. https://doi.org/10.1007/s00520-020-05942-8

MAHALIK, K. S. 2019. The Lived Experience of Recovery Following Transoral Robotic Surgery (TORS) for Head and Neck Cancer. Duquesne University.

MAURA, J. & WEISMAN DE MAMANI, A. 2017. Mental health disparities, treatment engagement, and attrition among racial/ethnic minorities with severe mental illness: A review. Journal of clinical psychology in medical settings, 24, 187-210. https://doi.org/10.1007/s10880-017-9510-2

MCCRACKEN, L. M. & MORLEY, S. 2014. The psychological flexibility model: a basis for integration and progress in psychological approaches to chronic pain management. The Journal of Pain, 15, 221-234. https://doi.org/10.1016/j.jpain.2013.10.014

MCDOWELL, L., RISCHIN, D., GOUGH, K. & HENSON, C. 2022. Health-related quality of life, psychosocial distress and unmet needs in older patients with head and neck cancer. Frontiers in Oncology, 12, 834068. https://doi.org/10.3389/fonc.2022.834068

MEYER, J. E. & HARDER, J. 2007. Antimicrobial peptides in oral cancer. Current pharmaceutical design, 13, 3119-3130. https://doi.org/10.2174/138161207782110372

MICHAEL, A., MICHELE, C. & ELIAS, M. 2020. Challenges to tackling antimicrobial resistance economic and policy responses: economic and policy responses, OECD Publishing.

MINTZ, D. 2022. Psychodynamic psychopharmacology: caring for the treatment-resistant patient, American Psychiatric Pub. https://doi.org/10.1176/appi.books.9781615379064

MOORE, C. & EWA SZUMACHER, M. 2016. Late-Breaking Abstracts. cancer, 28.

MOORE, C. & EWA SZUMACHER, M. 2018. 2018 International Cancer Education Conference. Journal of Cancer Education, 33, S1-S48. https://doi.org/10.1007/s13187-018-1414-9

NAYAK, J. S., JAMES, T. T., MENARIA, S. & DHARGAVE, P. 2023. PP-07_141. Indian Journal of Palliative Care, 29, 106.

NOVIYANI, R., DUONG, K. N., NGO, N. T., KULARATNA, S., WIDATAMA, A. & SRINADI, I. G. A. M. 2024. Empirical antibiotics versus definitive antibiotics for Sepsis patients in Indonesia: A cost-effectiveness analysis. Journal of Applied Pharmaceutical Science. https://doi.org/10.7324/JAPS.2024.195834

ORZECHOWSKA, A., MARUSZEWSKA, P. & GAŁECKI, P. 2021. Cognitive behavioral therapy of patients with somatic symptoms—Diagnostic and therapeutic difficulties. Journal of Clinical Medicine, 10, 3159. https://doi.org/10.3390/jcm10143159

OZPISKIN, O. M., ZHANG, L. & LI, J. J. 2019. Immune targets in the tumor microenvironment treated by radiotherapy. Theranostics, 9, 1215. https://doi.org/10.7150/thno.32648

PACE-BALZAN, A., SHAW, R. J. & BUTTERWORTH, C. 2011. Oral rehabilitation following treatment for oral cancer. Periodontology 2000, 57. https://doi.org/10.1111/j.1600-0757.2011.00384.x

PARK, S., SATO, Y., TAKITA, Y., TAMURA, N., NINOMIYA, A., KOSUGI, T., SADO, M., NAKAGAWA, A., TAKAHASHI, M. & HAYASHIDA, T. 2020. Mindfulness-based cognitive therapy for psychological distress, fear of cancer recurrence, fatigue, spiritual well-being, and quality of life in patients with breast cancer—a randomized controlled trial. Journal of pain and symptom management, 60, 381-389. https://doi.org/10.1016/j.jpainsymman.2020.02.017

PEAT, C. M. 2013. Cognitive-behavioral therapy. Non-suicidal self-injury in eating disorders: Advancements in etiology and treatment. Springer. https://doi.org/10.1007/978-3-642-40107-7_7

PUCA, V., MARINACCI, B., PINTI, M., DI CINTIO, F., SINJARI, B., DI MARCANTONIO, M. C., MINCIONE, G., ACHARYA, T. R., KAUSHIK, N. K. & CHOI, E. H. 2024. Antimicrobial efficacy of direct air gas soft jet plasma for the in vitro reduction of oral bacterial biofilms. Scientific Reports, 14, 10882. https://doi.org/10.1038/s41598-024-61438-z

REID, G. J. & BROWN, J. B. 2008. Money, case complexity, and wait lists: Perspectives on problems and solutions at children’s mental health centers in Ontario. The journal of behavioral health services & research, 35, 334-346. https://doi.org/10.1007/s11414-008-9115-5

RENES, R. A. & AARTS, H. 2017. The sense of agency in health and well-being: Understanding the role of the minimal self in action-control. Routledge International Handbook of Self-Control in Health and Well-Being. Routledge. https://doi.org/10.4324/9781315648576-16

REWERSKA-JUŚKO, M. & REJDAK, K. Social stigma of patients suffering from COVID-19: challenges for health care system. Healthcare, 2022. MDPI, 292. https://doi.org/10.3390/healthcare10020292

SABER, A. F., ALI, A., HASAN, H. A., AHMED, S. K. & HUSSEIN, S. 2025a. Cognitive behavioral therapy for suicidal ideation: extending the stepped care model. Journal of Contemporary Psychotherapy, 55, 21-28. https://doi.org/10.1007/s10879-024-09639-5

SABER, A. F., HUSSEIN, S., AHMED, S. K. & MANOOKIAN, A. 2025b. Mindfulness Interventions in Managing Paranoia: A Scoping Review. BioMed Target Journal. https://doi.org/10.59786/bmtj.312

SALAM, M. A., AL-AMIN, M. Y., SALAM, M. T., PAWAR, J. S., AKHTER, N., RABAAN, A. A. & ALQUMBER, M. A. Antimicrobial resistance: a growing serious threat for global public health. Healthcare, 2023. MDPI, 1946. https://doi.org/10.20944/preprints202305.0555.v1

SANTACROCE, L., PASSARELLI, P. C., AZZOLINO, D., BOTTALICO, L., CHARITOS, I. A., CAZZOLLA, A. P., COLELLA, M., TOPI, S., GODOY, F. G. & D’ADDONA, A. 2023. Oral microbiota in human health and disease: A perspective. Experimental Biology and Medicine, 248, 1288-1301. https://doi.org/10.1177/15353702231187645

SCHELLEKENS, M. P., VAN DEN HURK, D. G., PRINS, J. B., MOLEMA, J., VAN DER DRIFT, M. A. & SPECKENS, A. E. 2016. The suitability of the Hospital Anxiety and Depression Scale, Distress Thermometer and other instruments to screen for psychiatric disorders in both lung cancer patients and their partners. Journal of affective disorders, 203, 176-183. https://doi.org/10.1016/j.jad.2016.05.044

SCOTT, S., GRUNFELD, E., MAIN, J. & MCGURK, M. 2006. Patient delay in oral cancer: a qualitative study of patients' experiences. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 15, 474-485. https://doi.org/10.1002/pon.976

SHOSHANI, A. & KANAT-MAYMON, Y. 2018. Involvement in care in pediatric cancer patients: implications for treatment compliance, mental health and health-related quality of life. Quality of Life Research, 27, 567-575. https://doi.org/10.1007/s11136-017-1744-9

SMITH-TURCHYN, J., MORGAN, A. & RICHARDSON, J. 2016. The effectiveness of group-based self-management programmes to improve physical and psychological outcomes in patients with cancer: a systematic review and meta-analysis of randomised controlled trials. Clinical Oncology, 28, 292-305. https://doi.org/10.1016/j.clon.2015.10.003

SPELTEN, E. R., HARDMAN, R. N., PIKE, K. E., YUEN, E. Y. & WILSON, C. 2021. Best practice in the implementation of telehealth-based supportive cancer care: Using research evidence and discipline-based guidance. Patient education and counseling, 104, 2682-2699. https://doi.org/10.1016/j.pec.2021.04.006

SPIVAK, E. S. & GREENLEE, S. B. 2023. Antimicrobial Stewardship: Where We’ve Come and Where We’re Going, An Issue of Infectious Disease Clinics of North America, E-Book, Elsevier Health Sciences. https://doi.org/10.1016/S0891-5520(23)00072-7

STOUT, R. A., BECKMAN, N. J., SHELBY, S. R. & LABOTT, S. M. 2013. Psychological issues in head and neck cancer. Head & Neck Cancer: Current Perspectives, Advances, and Challenges, 751-800. https://doi.org/10.1007/978-94-007-5827-8_25

TAJ, Z. & CHATTOPADHYAY, I. 2024. In Silico Prediction and Molecular Simulation of Antimicrobial peptide variants from Lactobacillus sp. Against Porphyromonas gingivalis and Fusobacterium nucleatum in oral squamous cell carcinoma. Peptide Science, e24348. https://doi.org/10.1002/pep2.24348

TANG, K. W. K., MILLAR, B. C. & MOORE, J. E. 2023. Antimicrobial resistance (AMR). British Journal of Biomedical Science, 80, 11387. https://doi.org/10.3389/bjbs.2023.11387

TANWAR, A. S. 2024. Microbiome and its role in shaping planetary health.

TAUBER, N. M., O’TOOLE, M. S., DINKEL, A., GALICA, J., HUMPHRIS, G., LEBEL, S., MAHEU, C., OZAKINCI, G., PRINS, J. & SHARPE, L. 2019. Effect of psychological intervention on fear of cancer recurrence: a systematic review and meta-analysis. Journal of clinical oncology, 37, 2899-2915. https://doi.org/10.1200/JCO.19.00572

TERRENI, M., TACCANI, M. & PREGNOLATO, M. 2021. New antibiotics for multidrug-resistant bacterial strains: latest research developments and future perspectives. Molecules, 26, 2671. https://doi.org/10.3390/molecules26092671

TOFTHAGEN, C. & MCMILLAN, S. C. 2010. Pain, neuropathic symptoms, and physical and mental well-being in persons with cancer. Cancer Nursing, 33, 437-444. https://doi.org/10.1097/NCC.0b013e3181e212b4

VALLATH, N. & SALINS, N. 2017. Holistic supportive care in oral cancer: principles and practice. Contemporary Oral Oncology: Rehabilitation and Supportive Care, 121-231. https://doi.org/10.1007/978-3-319-43857-3_5

WAGNER, C. D., DAS, L. T., BIGATTI, S. M. & STORNIOLO, A. M. 2011. Characterizing burden, caregiving benefits, and psychological distress of husbands of breast cancer patients during treatment and beyond. Cancer Nursing, 34, E21-E30. https://doi.org/10.1097/NCC.0b013e31820251f5

WALKER, E. R., CUMMINGS, J. R., HOCKENBERRY, J. M. & DRUSS, B. G. 2015. Insurance status, use of mental health services, and unmet need for mental health care in the United States. Psychiatric Services, 66, 578-584. https://doi.org/10.1176/appi.ps.201400248

WANG, R., ZHENG, X., SU, X., HUANG, X., LIU, H., GUO, Y. & GAO, J. 2023. The development of a Cancer Pain Belief Modification Program for patients with oral cancer in China: a feasibility study. BMC nursing, 22, 206. https://doi.org/10.1186/s12912-023-01372-z

WANG, Y., LIN, Y., CHEN, J., WANG, C., HU, R. & WU, Y. 2020. Effects of Internet-based psycho-educational interventions on mental health and quality of life among cancer patients: a systematic review and meta-analysis. Supportive Care in Cancer, 28, 2541-2552. https://doi.org/10.1007/s00520-020-05383-3

WESNER, A. C., GOMES, J. B., DETZEL, T., GUIMARÃES, L. S. & HELDT, E. 2015. Booster sessions after cognitive-behavioural group therapy for panic disorder: impact on resilience, coping, and quality of life. Behavioural and Cognitive Psychotherapy, 43, 513-525. https://doi.org/10.1017/S1352465814000289

WESTRA, H. A. & NOROUZIAN, N. 2018. Using motivational interviewing to manage process markers of ambivalence and resistance in cognitive behavioral therapy. Cognitive Therapy and Research, 42, 193-203. https://doi.org/10.1007/s10608-017-9857-6

YING, W. & LING, T. M. 2023. Understanding the Psychosocial Impact of Oral Squamous Cell Carcinoma (OSCC) on Patients. Journal of Advanced Analytics in Healthcare Management, 7, 132-151.