Oct 27

An exploratory study into HNC patients’ perceptions of their appearance

Every now and again we are fortunate enough to have an opportunity to under take a piece of research in an area that we are passionate about. For a number of years, I’ve been interested in how the treatment of head and neck cancer (HNC) affects a patient’s perceptions about their appearance. As part of my recent MSc in Health Psychology with the University of West of England, I was required to undertake a small research project and decided to scope an exploratory study into this topic. My supervisor Dr Tim Moss suggested that I include an investigation of the concept of ‘positivity’ (also refered to as posttraumatic growth).  The project has now been completed and written up.  Below is a copy of the abstract and if you are interested a PDF will be available in the near future.

The extent of Patients’ Positivity, Appearance Adjustment and Quality of Life following treatment for Head and Neck Cancer: An exploratory study

Background: Facial disfigurement is considered to be one of the most distressing aspects of head and neck cancer (HNC) and its treatment, but it has been the focus of little systematic study.  However there is a growing body of literature supporting the suggestion that such a stressful event may be a catalyst for positive psychosocial changes.  To date there are no existing studies looking at the relationship between quality of life (QoL), sense of appearance and positivity in this patient group.

Aim: To investigate how HNC affect patients’ QoL, sense of appearance and positivity.

Method: A Questionnaire battery containing the Medical Outcomes Short Form 12 (SF-12), Derriford Appearance Scale (DAS24) and Silver Lining Questionnaire (SLQ) was sent to 1,571 patients treated by the Maxillofacial Department in 2009.  The same measures with the inclusion of the University of Washington QoL Questionnaire (UoW), were posted to 299 HNC patients.  The study compares the Maxillofacial patients and HNC patients with reference data and explores associations with clinical factors.

Results: Reasons for non-completion of the questionnaires was given by a 118 patients.  Two hundred and thirty nine (15%) of the Maxillofacial patients and one hundred and thirty two (44%) of the HNC patients returned questionnaires.

The HNC patients had reported less distress and dysfunction related to appearance than age and gender matched norms.  They had similar QoL to other reported HNC patients, but worse than an age matched norm group.  Tumour stage was the only demographic to reveal a difference in relation to appearance.  The HNC patients also reported having a greater sense of positivity than the maxillofacial group and a similar level to previous data collected on lung cancer patients.

The complexity of the patient cohort has introduced many confounding variables, and the number of completed questionnaires was insufficient to identify the significance factors related to the data obtained on the measures.  Although there are indications that age and cancer staging may be particularly important.

Conclusions: The data collected in this study suggests that appearance issues are of less concern to HNC patients than the general population, and that they appear to be more positive, but further research is needed to investigate individual differences allowing for all the confounding variables.  Allowing for the lack of significant findings, we posit some hypotheses that would merit further investigation.  We also suggests that a follow up study, using the same validated questionnaires, over an extended patient group and longitudinally, may be able to identify significant co-variables. This may in turn inform the provision of support and information for patients to aid them in their difficult time.