The psychological effect of facial and neck surgery Flashcards
What is the trend for head and neck cancer in the UK?
Increase in rate with increase in age
Low rates below 35 and pick up after that peaking about about 70’s in men then declining and constantly increasing in females until death
Males have consistently higher rates than females
Where in the UK has the highest incidence rate in the UK?
Scotland has the highest incidence rate in the UK
Is cancer a chronic disease ?
Chronic disease last 3 month or more and may get worse
Many cancers (including H&N) are very treatable and “curable”
Treatment regimes can be lengthy and mixture of surgery and ongoing adjuvant treatments (chemotherapy, radiotherapy)
Following treatment there is;
- Recovery (both disease and treatments)
- Prevention (change in lifestyle or pharmacological treatments)
- Surveillance and continued screening
- Management of the consequences of cancer and cancer treatment
- Physiological, psychological and social consequences
- Risk of recurrence quite high in 1st year but then falls due to cancer type and treatments
What is the disfigurement and dysfunction chart used in relation to head and neck cancer?
Split up into Minor, Moderate and Severe for both disfigurement and dysfunction
What are the psychological factors related to head and neck cancer?
1). Health-related Quality of Life
2). Psychological distress (anxiety + depression)
3). Facial appearance
4). Fear of cancer recurrence
What does quality of life comprise of and how may this be affected in head and neck cancer?
Quality of life comprises;
- physical health and functioning
- psychological state
- level of independence
- social relationships
- occupation and finance
- personal beliefs
Key issues in head and neck cancer;
- comorbidity and disability
- self-care
- pain
- speech
- eating and swallowing
- breathing
- financial and work (take extensive periods away from work)
- impact on family and friends
How can we measure the quality of life and why do we do it?
Why do we measure QoL?
- evaluating treatment outcomes
- identifying patients priorities, values and expectations
- development of interventions and support
How to measure QoL;
- Questionnaires or interviews - no gold standard
E.g European Organisation for Research and Treatment of cancer
Might be cancer free but with significant disability - is that a good outcome for the patient?
For some patients quality of life means more than being cancer free
Info allows us to develop structures to better support them
How may face and neck post surgery patients respond in terms of anxiety ?
Not too much higher than general population
How may face and neck post surgery patients respond in terms of depression ?
Lowest point immediately following treatment then sharp rise 2-3 months on to do with where pain and functional deficit is at its worse
What appearance changes might someone experience head and neck cancer ?
Appearance changes and H&N cancer
In the context of the disease:
* Survival is paramount
* Relationship with the disease
* The care team
(Relief cancer gone, Disgust to post op changes)
In the context of the social world
* Others’ positive reactions
* Others’ negative reactions
(from care team, Intrusive questions, being ignored)
Context of the self:
* Self under attack
* Self-to-self rating
* Self in the world
* Rebuilding the self
(self image/identity and describing themselves)
What are the psychosocial consequences of disfigurement ?
- Higher rates of anxiety and depression
- Lower self esteem
- Negative body image and self-perceptions
- Difficulties forming relationships (friendships and relationships)
- Negative reactions from other
- Stigma and discrimination
- Severe facial deformities may be less of a psychological burden than those that are more mild (Reactions of other in mild are a lot less predicted where as in more severe more anticipated)
What is the psychology of cosmetic/plastic surgery?
Some studies suggest approx 50% have mental disorders
- Mood disorders (depression, anxiety, bipolar)
- Eating disorders (anorexia nervosa, bulimia nerves, compulsive eating)
- Neurodevelopment disorders (ADD/ADHD)
- Trauma (PTSD, physical and sexual abuse, social estrangement)
- Obsessive-compulsive disorders (Body dysmorphic disorder)
- Psychotic disorders (Monosymptomatic hypochondriacal psychosis)
How would you asses patient appearance concerns?
Communication skills – careful and sensitive questioning to gauge level of difficulty that appearance concerns may have for patient
Seek out family, carers or close friend’s opinions of possible patient concerns
Appearance and body image concerns can be validated by considering how it impacts on behaviour (avoidance of social situations)
Seek specialist assessment if necessary (clinical psychologist, liaison psychiatrist)
What is the “fear of cancer recurrence (FCR)?”
“fear, worry or concern relating to the possibility that cancer may recur or progress”
Sustained heightened FCR can impact on quality of life and exacerbate anxiety and depression
Linked to increased medication use and service utilisation
35% of head and neck cancer patients has significant levels of FCR, which was sustained longitudinally
How does the common sense model work in regards to these patients?
Stage 1 stimulus, pain which will make them think of illness representations i.e this is cancer coming back this triggers emotional response, anxiety etc then patient will engage if coping strategies to deal with that concern or fear (can be checking surgical sights to see a change - maladaptive - isnt beneficial) fed into appraisal to say have they been delt with for me to go back to normal or not?
How can the carer distress impact the patient and why might they be more distressed than the patient?
Carer distress can be higher than patients
Patient distress predicts carer distress
Family not the patient alone who are clients of care
Carer distress and far of reoccurrence is linked to patients
FoR - fear of reoccurrence
Carers aren’t always in meetings with medical team, can feel distress and worry
