Psychological Effect of Facial and Neck Surgery Flashcards
when does the number of cases of head and neck cancer begin to increase and then decrease
age 35
age 70 start to decline in men
age 70 slower increase in women
when does the number of cases of head and neck cancer begin to increase and then decrease
age 35
age 70 start to decline in men
age 70 slower increase in women
when does the number of cases of head and neck cancer begin to increase and then decrease
age 35
age 70 start to decline in men
age 70 slower increase in women
how have the different age groups (male) changed over the year
1993-2017
80+ gradual decrease
50-80 increase over time
how have the different age groups (female) changed over the years
1993-2017
explain why this trend
50+ increase over time
history of increase in smoking rates of that particular age group entering the 60s
which country in the uk has the highest incidence of head and neck cancer
scotland
who is affected worse m/f
men
maybe because men smoke tobacco/ drink alcohol more
is cancer a chronic disease
a chronic disease lasts 3 months or more and may get worse
BUT very treatable and curable
what happens after treatment of HandN c
recovery (from disease AND treatment)
prevention (lifestyle changes, pharmacological)
surveillance and continued screening
management of consequences of cancer and cancer treatment.
-physiological (breathing, chewing, taste), psych, social
is there a risk of recurrence after treatment
in there 1st year there is a risk for head and neck, then decreases
-due to cancer type and treatment
give some examples of:
1. Disfigurement
2. Dysfunction
- Cheek Resection, forehead flap, laryngectomy, orbital exenteration, nasal amputation
- Loss of smell, unilateral hearing loss, speech impairment, aphonia, loss of vision, impaired salivary control.
what are the 4 psychological factors related to h/n cancer
- Health- related QofL
- Psychological distress
- Facial Appearance
- Fear of Cancer recurrence
what does QofL comprise
physical health
psych state
independence
social relationships
occupation and finance
personal beliefs
values
how does QofL changer during treatment and after
dips during treatment, return 12-18 months after treatment
what are key issues in head and neck cancer in relation to QofL
comorbidity and disability
self-care
pain (chronic)
speech
eating and swallowing
breathing
financial/ work
fam/ friend impact
how do you measure QofL?
why measure?
questionnaires
interviews
measure so that we can:
evaluate treatment outcomes
identify patient priorities, values, expectations
development of interventions and support
describe the trend of anxiety post treatment
what scale do we use
right after treatment- high
but then significant drop 1 month after
gradual decrease with some fluctuations
not much higher than general population
HOSPITAL ANCIETY + DEPRESSION SCALE
describe the trend of depression post treatment
what scale do we use
lowest just after treatment
sharp increase 2-3 months after WHY pain and functional deficit at its worst
then some decline
but still higher than general population
what are the 3 aspects to consider when thinking of appearance changes after treatment
CONTEXT OF DISEASE
-survival
-relationship with the disease
-care team
CONTEXT OF SOCIAL WORLD
-other’s positive reactions
-other’s negative reactions
CONTEXT OF THE SELF
-self under attack
-self-to-self rating
-self in the world
-rebuilding the self
intrusive questions, rude, ignored, isolated (feel responsibility to hide away)
feel ugly, shame, unattractive
disgust, concern for recurrence
shock, emotional journey
what are the psychological consequences of disfigurement
increase anxiety and depression rates
lower self esteem
negative body image and self-perceptions
difficulties forming relationships
negative reactions from others
stigma/discimintation
why might severe facial deformities be less of a psychological burden tan mild ones
can anticipate reactions
less predictable reactions with milder as take a while to notice
what is the psychology of cosmetic/plastic surgery
some studies- approx 50% have mental disorders
mood disorders (depression, anxiety, bipolar)
eating disorders (anorexia nervosa, bulimia nervosa)
neurodevelopmental disorders ADD/ADHD
trauma (PTSD, physical sex abuse, social estrangement)
OCD (body dysmorphic disorder)
psychotic disorders (monosymptomatic hypochondriacal psychosis)
how can you assess appearance concerns
communication skills
seek out family, carers, close friends opinion
validate concerns by considering how it impacts on behaviours (how many situs do they avoid)
specialist assessment (clinical psychologist, liaison psychiatrist
what is FCR
fear, worry, concern relating to the possibility that cancer may recur or progress
if heightened impact QofL
increased med use and service utilisation
35% patients have significant levels of FCR
discuss common sense model of ilnness
STAGE 1 INTERPRETATION
-illness representation
-emotional response
STAGE 2 COPING
STAGE 3 APPRAISAL
what can you use to manage
AFTER intervention
Mini-AFTERc
what do carers do posttreatment
retain structure to daily life
assisst with meds, treatments
practical and mobility support
emotional support
family interactoins not alwats suportive
how is carer distress affected
care distress can be higher than patients
feel need to stya positive- oprress feelings
less informed not at meetings about treatment/ progress
can predict carer distress from patient distress
family are also clients of care
