Appearance concerns and psychosocial adjustment following head and neck cancer: A cross-sectional study and nine-month follow-up

Abstract

Psychosocial difficulties have been reported in head and neck cancer (HNC) patients, yet only few studies have assessed the impact of altered appearance following HNC treatment using theoretically selected measures of appearance-related distress. This study investigated appearance-related adjustment following HNC, and demographic and socio-cognitive predictors of adjustment. HNC patients (n = 49) completed baseline questionnaires and a nine-month postal follow-up (n = 20). Participants showed considerable variation in appearance-related adjustment, with females reporting higher levels of appearance-related distress (derriford appearance scale [DAS-24]) than females in the general population and male HNC survivors. Depression scores on the hospital anxiety and depression scale were higher than UK norms whilst anxiety was similar to UK norms. There were no significant differences between baseline and follow-up data. Fear of negative evaluation (a central feature of social anxiety) was a significant predictor of appearance-related adjustment at baseline, whilst dispositional optimism was a significant predictor of appearance-related adjustment at baseline and follow-up. Qualitative responses showed themes of appearance and disability, and coping strategies. Findings suggest that appearance-related adjustment post-HNC varies considerably and psychosocial services working with HNC patients should consider this broad pattern of response. Future research to examine the role of socio-cognitive predictors of appearance-related adjustment could progress development of effective psychological interventions.

Keywords:

• oncology
• head and neck cancer
• psychosocial adjustment
• appearance

Acknowledgements

The authors would like to acknowledge the ARC Advisory Committee, in particular, Olivia Giles, Pam Warren and Luke Wiseman for their input into the research programme. The authors also wish to acknowledge the contribution made to this research by clinical staff from the hospital clinics who supported recruitment to the research programme and all those who took part. In particular, we would like to thank Mr Westin and Mr Smith (Sheffield Teaching Hospitals), and Mr Bem, Mr Worrall and Mr McCaul (Bradford Teaching Hospitals).

Funding

Funding for the study was provided by the Healing Foundation in association with the Welton Foundation and the Worshipful Company of Tin Plate Workers. The funders were not involved in the design, data collection, analysis or interpretation of data, or the writing of the report.