Psychological Effect of Face and Neck Surgery Flashcards
Describe some statistics surrounding head and neck cancer for the UK
Growing incidence with age
Men more affected than women
Name the psychological factors related to head and neck cancer
Health-related quality of life: evaluate using questionnaire/interview
Psychological distress (anxiety and depression)
Facial appearance
Fear of cancer recurrence
What are the important issues for head and neck cancer patients that affect their quality of life?
Many physiological, psychological and social factors:
Comorbidity and disability
Self-care
Pain
Speech
Eating and swallowing
Breathing
Financially and work
Impact on family and friends
Therefore, it is important to identify the patient’s priorities, outcomes and expectations so you can tailor intervention and support to fit their needs.
What are the components of appearance changes in head and neck cancer?
In the context of the disease (usually refers to earlier on in the diagnosis/disease course):
Survival is paramount (changes to appearance were necessary for survival)
Relationship with disease (eg. emotional journey, concern/denial/shock/fear/anxiety/disgust/relief)
Care team (important to how patients deal psychologically with facial changes)
In the context of the social world:
Others’ positive reactions (praise and reassurance from clinicians and people close to them)
Others’ negative reactions (things like intrusive questions, awkward silences, comments from close family/friends that can be perceived as rejection)
In the context of sense of self (self-image and identity):
Self under attack (feeling like they have lost their sense of self)
Self-to-self rating (comparative emotional language related to disgust and shame)
Self in the world (evaluate themselves more negatively compared to others)
Rebuilding self (internal struggle to return to old self, build new identities, pride of sign of survivorship)
What are ways you can assess appearance concerns in your patient?
Communication skills: careful and sensitive questioning to gauge level of difficulty that appearance concerns may have for the patient
Seek out family/carers’/close friend’s opinions of possible patient concerns.
Appearance and body image concerns can be validated by observing how it impacts on patient behaviour (eg. Avoiding social situations).
Seek specialist assessment if necessary (psychiatry/psychology).
What is the relevance of fear of cancer recurrence in patients with head and neck cancer?
Sustained or heightened fear can impact on patient quality of life and exacerbate anxiety and depression
Linked to increased medication use and service utilisation
Describe the Common-Sense Model of Illness in relation to head and neck cancer
Fear of cancer recurrence can be evaluated using this model.
Stage 1: interpretation
Stimulus: something to make the patient think of cancer recurrence (eg. A pain)
They will relate this back to illness representations that they are familiar with during their treatment
This will elicit an emotional response
Stage 2: coping
Engagement with coping strategies to regulate/manage that concern or fear
Adaptive or maladaptive
Common with cancer patients is ‘checking behaviour’ for signs of recurrence (maladaptive – anxiety regulator)
Stage 3: appraisal
Feedback loop
Has this behaviour helped the patient return to a sense of normality/equilibrium?
What are the roles of carers’ in patient treatment and recovery?
Maintain the structure of daily life
Assist with meds, treatments and adherence to medical recommendations
Practical and mobility support
Emotional support
Family interactions are complex and not always supportive
What is the importance of involving carers’ in patient after care in cancer treatment
Carers’ distress can be higher than patient’s in FCR
Patient distress can predict carer distress
Remember that the family, not the patient alone, are clients of care
