Body image and quality of life after head and neck cancer surgery

OBJECTIVES: The purpose of this paper is to describe the process of body image reintegration as it relates to quality of life in the surgical head and neck cancer patient. MATERIALS AND METHODS: To illustrate the course of body image reintegration after head and neck cancer surgery, the results of two major studies are presented. In the first study, a cohort sample of 75 adults about to undergo disfigurative surgery for head and neck cancer was examined to determine levels of anxiety before and after the procedure. The State Trait Anxiety Inventory was administered before and after surgery on postoperative days 4 through 6. In the large study, from which the cohort sample was derived, 117 adults about to undergo disfigurative surgery were investigated to determine the relationship between coping with surgical disfigurement/dysfunction and length of hospital stay. The Ways of Coping Checklist was administered before surgery. Disfigurement/dysfunction as measured by the Disfigurement/Dysfunction Scale, and postoperative coping behaviors as measured by the Coping Behaviors Score were accounted for in both samples. Self-care and resocialization behaviors were observed and measured on postoperative days 4 through 6. RESULTS: In the cohort study, anticipation of disfigurative facial surgery was associated with extremely high levels of anxiety. In the large sample, coping effectiveness was diminished. The degree of surgical deficit ranged from mild to severe disfigurement and dysfunction. Preoperative coping effectiveness predicted postoperative coping behavior. It was concluded that body image reintegration was characterized by self-care, resocialization and reduced anxiety. Further, that these components, when taken together, constitute assimilation of the surgical defect into self. CONCLUSION: Body image reintegration is critical to subsequent quality of life after head and neck cancer surgery. When disfigurement/dysfunction is associated with treatment, quality of life may be profoundly and adversely affected. Findings from the studies presented indicate a significant correlation between postoperative self-care and reduction in level of anxiety. The implications of this finding are important to care during the early period after surgery and to long-term follow-up after hospital discharge.