Psychological Effect of Facial and Neck Surgery

Question 1

when does the number of cases of head and neck cancer begin to increase and then decrease

Answer 1

age 35
age 70 start to decline in men
age 70 slower increase in women

Question 1

when does the number of cases of head and neck cancer begin to increase and then decrease

Answer 1

age 35
age 70 start to decline in men
age 70 slower increase in women

Question 2

when does the number of cases of head and neck cancer begin to increase and then decrease

Answer 2

age 35
age 70 start to decline in men
age 70 slower increase in women

Question 3

how have the different age groups (male) changed over the year
1993-2017

Answer 3

80+ gradual decrease
50-80 increase over time

Question 4

how have the different age groups (female) changed over the years
1993-2017
explain why this trend

Answer 4

50+ increase over time
history of increase in smoking rates of that particular age group entering the 60s

Question 5

which country in the uk has the highest incidence of head and neck cancer

Answer 5

scotland

Question 6

who is affected worse m/f

Answer 6

men
maybe because men smoke tobacco/ drink alcohol more

Question 7

is cancer a chronic disease

Answer 7

a chronic disease lasts 3 months or more and may get worse
BUT very treatable and curable

Question 8

what happens after treatment of HandN c

Answer 8

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

Question 9

is there a risk of recurrence after treatment

Answer 9

in there 1st year there is a risk for head and neck, then decreases
-due to cancer type and treatment

Question 10

give some examples of:
1. Disfigurement
2. Dysfunction

Answer 10

1. Cheek Resection, forehead flap, laryngectomy, orbital exenteration, nasal amputation
2. Loss of smell, unilateral hearing loss, speech impairment, aphonia, loss of vision, impaired salivary control.

Question 11

what are the 4 psychological factors related to h/n cancer

Answer 11

1. Health- related QofL
2. Psychological distress
3. Facial Appearance
4. Fear of Cancer recurrence

Question 12

what does QofL comprise

Answer 12

physical health
psych state
independence
social relationships
occupation and finance
personal beliefs
values

Question 13

how does QofL changer during treatment and after

Answer 13

dips during treatment, return 12-18 months after treatment

Question 14

what are key issues in head and neck cancer in relation to QofL

Answer 14

comorbidity and disability
self-care
pain (chronic)
speech
eating and swallowing
breathing
financial/ work
fam/ friend impact

Question 15

how do you measure QofL?
why measure?

Answer 15

questionnaires
interviews

measure so that we can:
evaluate treatment outcomes
identify patient priorities, values, expectations
development of interventions and support

Question 16

describe the trend of anxiety post treatment
what scale do we use

Answer 16

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

Question 17

describe the trend of depression post treatment
what scale do we use

Answer 17

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

Question 18

what are the 3 aspects to consider when thinking of appearance changes after treatment

Answer 18

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

Question 19

what are the psychological consequences of disfigurement

Answer 19

increase anxiety and depression rates
lower self esteem
negative body image and self-perceptions
difficulties forming relationships
negative reactions from others
stigma/discimintation

Question 20

why might severe facial deformities be less of a psychological burden tan mild ones

Answer 20

can anticipate reactions
less predictable reactions with milder as take a while to notice

Question 21

what is the psychology of cosmetic/plastic surgery

Answer 21

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)

Question 22

how can you assess appearance concerns

Answer 22

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

Question 23

what is FCR

Answer 23

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

Question 24

discuss common sense model of ilnness

Answer 24

STAGE 1 INTERPRETATION

-illness representation
-emotional response

STAGE 2 COPING

STAGE 3 APPRAISAL

Question 25

what can you use to manage

Answer 25

AFTER intervention
Mini-AFTERc

Question 26

what do carers do posttreatment

Answer 26

retain structure to daily life
assisst with meds, treatments
practical and mobility support
emotional support
family interactoins not alwats suportive

Question 27

how is carer distress affected

Answer 27

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