Two-Thirds of Oral Cancer Patients in China Show Cognitive Impairment on Screening

More than two-thirds of patients treated for oral cancer in a large Chinese hospital screened positive for cognitive impairment, and those with the poorest scores were also the most likely to report anxiety, depression, and a diminished quality of life. That is the central finding of a cross-sectional study published in Supportive Care in Cancer, which offers one of the most detailed snapshots to date of how thinking problems, mood disturbances, and daily wellbeing intertwine in this under-studied cancer population. The results arrive at a moment when oncologists worldwide are increasingly recognizing that cancer’s toll extends far beyond the tumor itself, reaching into memory, attention, and executive function in ways that can quietly erode a patient’s ability to work, socialize, and manage their own care.

The research team, led by investigators at Changde Hospital of Xiangya School of Medicine, Central South University, together with colleagues at Hunan Provincial People’s Hospital, recruited 567 patients with oral cancer at a tertiary hospital in Changde, in China’s Hunan Province. Data were collected over a one-month window, from June 15 to July 15, 2023, using an online questionnaire that combined demographic and clinical information with four standardized instruments. The design was deliberately pragmatic: rather than relying on lengthy neuropsychological batteries that are impractical in busy oncology clinics, the team deployed brief, validated screening tools that could, in principle, be folded into routine care.

At the heart of the cognitive assessment was the Montreal Cognitive Assessment, or MoCA, a 30-point instrument widely used to detect mild cognitive impairment across domains including attention, executive function, language, abstraction, delayed recall, and orientation. The patients’ mean score was 19.25, with a standard deviation of 6.49; after adjusting for education level, a standard practice because MoCA performance is sensitive to years of schooling, the mean rose only slightly to 19.55. Applying the conventional cut-off of a score below 24, the researchers classified 67.40 percent of participants as screening-positive for cognitive impairment. For a cancer type in which cognitive function has rarely been systematically measured, the sheer scale of that figure is striking, and it suggests that subtle or not-so-subtle deficits in thinking may be the norm rather than the exception in this population.

Several factors unique to oral cancer could plausibly contribute to such deficits. The disease and its treatment frequently involve surgery to the jaw, tongue, and surrounding structures, often followed by reconstruction with free flaps, radiation therapy, and chemotherapy. Patients commonly face chronic pain, disrupted sleep, nutritional compromise, and difficulty speaking and eating, all of which can burden cognition. Many patients are also older, and some carry risk factors such as heavy tobacco and alcohol use that independently affect the brain. Prior research cited by the authors, including work on postoperative cognitive dysfunction and on cancer-related cognitive impairment in breast, ovarian, cervical, and hematologic malignancies, has established that cognitive decline is a recognized complication across many tumor types, but head and neck cancers have received comparatively little attention in this literature.

To probe the psychological dimension, the team used Zung’s Self-Rating Anxiety Scale and Self-Rating Depression Scale, self-report instruments that quantify the severity of anxious and depressive symptoms. Quality of life was measured with the University of Washington Quality of Life Questionnaire, a head-and-neck-specific instrument covering physical, social, and emotional domains such as pain, swallowing, chewing, speech, mood, and anxiety. The statistical architecture of the study rested on two complementary approaches: Spearman correlation analysis to map the strength and direction of associations between continuous variables, and multivariable logistic regression to identify which factors independently predicted screening-positive cognitive impairment while adjusting for confounders.

The correlation results painted a coherent picture. Higher quality-of-life scores were negatively correlated with anxiety scores, with a Spearman coefficient of −0.2009, and with depression scores, at −0.2055, both statistically significant at the p < 0.01 level. Conversely, quality of life was positively correlated with education-adjusted MoCA scores, with a coefficient of 0.2027, also significant at p < 0.01. In plain terms, patients who thought more clearly reported better daily functioning, and those burdened by anxiety or depression reported worse. The effect sizes are modest, as is typical for correlations in behavioral research, but their consistency across three separate pairings strengthens the case that these dimensions of patient experience are genuinely linked rather than artifacts of measurement.

The multivariable logistic regression sharpened the story further. Older age emerged as a positive predictor of screening-positive cognitive impairment, an expected result given the well-documented association between aging and cognitive decline. More notably, higher anxiety scores and higher depression scores each independently predicted a positive cognitive screen, while higher quality-of-life scores were negatively associated with it. All of these associations reached statistical significance at p < 0.05. The directionality, however, remains an open question. Cross-sectional designs capture a single moment in time, so the data cannot determine whether psychological distress drives cognitive impairment, whether cognitive difficulties breed anxiety and depression, or whether a third factor, such as disease severity or treatment intensity, underlies all of them simultaneously.

That ambiguity is precisely why the authors call for longitudinal studies to clarify the temporal relationships among cognitive impairment, psychological symptoms, and quality of life. Such work matters clinically. If anxiety and depression accelerate cognitive decline, treating mood disorders early could protect the brain; if cognitive impairment fuels distress, then cognitive rehabilitation and support might lift mood as well. Either way, the study’s practical recommendation is clear: cognitive and psychological screening should be incorporated into routine clinical care for patients with oral cancer. Because the MoCA takes roughly ten minutes to administer, and the self-rating scales are even quicker, the barrier to implementation is low, particularly in settings where patients already complete online questionnaires before appointments.

The study’s context within China adds another layer of significance. Oral cancer imposes a heavy and inequitable global burden, with incidence and outcomes varying sharply across countries, and prior Chinese studies have documented substantial rates of anxiety and depressive symptoms among newly diagnosed oral cancer patients. Yet cognitive screening has not been standard practice in Chinese oncology wards, and the MoCA has only recently been validated extensively in middle-aged and older Chinese populations. By demonstrating that two out of three patients in a real-world hospital sample fall below the impairment threshold, the study provides local evidence that could inform screening policies in Chinese hospitals and, by extension, in other regions where head and neck cancer care is delivered with limited psychological support infrastructure.

Caveats remain. The single-center, cross-sectional design limits generalizability, and self-selected participation in an online survey may have skewed the sample toward patients with better digital access or greater engagement with their care. The MoCA is a screening tool, not a diagnostic instrument, so a positive screen flags probable impairment rather than confirming a clinical diagnosis. Still, the convergence of findings, a very high prevalence of positive screens, consistent correlations linking cognition, mood, and quality of life, and independent predictors that align with biological plausibility, makes a compelling case that the mind deserves a place alongside the mouth in oral cancer care. For patients already coping with the physical demands of surgery and reconstruction, recognizing and addressing cognitive and psychological burden could meaningfully change what survivorship looks like.

Subject of Research: Cognitive impairment, anxiety, depression, and quality of life in patients with oral cancer in China

Article Title: Associations between MoCA screening-positive cognitive impairment, anxiety, depression, and quality of life in patients with oral cancer: a cross-sectional study in China

Article References: Shi, Z., Wang, H., Guo, Y., Chen, L., Zhang, X., Shen, J., & Tong, L. (2026). Associations between MoCA screening-positive cognitive impairment, anxiety, depression, and quality of life in patients with oral cancer: a cross-sectional study in China. Supportive Care in Cancer, 34(10), Article 975. https://doi.org/10.1007/s00520-026-11225-5

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11225-5

Keywords: oral cancer, cognitive impairment, MoCA, anxiety, depression, quality of life, cross-sectional study, cancer screening, psychological distress, head and neck cancer, supportive care, China