Psychosocial issues in Head & Neck Cancers

By: Gilbert Fan,
      Manager,
      Dept of Psychosocial Oncology, NCC

Tumours of the head and neck are likely to be more obvious than many other cancers. The ‘head and neck’ houses most of the senses and functional capacity of the human body. It is also an area of great aesthetic value. Therefore, any rehabilitation effort is greatly desired to help the patient recover and lead a decent lifestyle. A patient’s success in rehabilitation is dependent on any recurrent physical and emotional issues, motivational factors and any other on-going distress.

A change in body image affects many patients emotionally and psychologically. As a result, some patients refuse conventional medical treatments because they wish to preserve and maintain their looks (eg. fear of hair-loss, disfigurement of the body etc) and others defer treatments for cultural and religious beliefs such as to comply with certain customs / folklores, and the desire for child bearing.

When we talk about acceptance of illness, we are also talking about self-acceptance and the integration of an after-treatment image that we must feel good about or at least is bearable. Examples of after-treatment image include wearing a wig or hat, having a trachea-tube, a major dissection etc which make patients feel ‘strange’ about themselves and thus avoid any forms of socialising. Patients with mild to severe hearing loss, whether temporary or permanent, will be shy to communicate with others. Some patients with swallowing difficulties may take longer to eat. To avoid embarrassment, they prefer to dine alone.

Intimacy might be a real issue for some. This is partly due to physical and emotional stressors. Some couples do not sleep together for practical reasons like worried about having to wake up early to run errands or keeping their spouse awake by sounds of heavy breathing and occasional odour from mouth dryness, accumulation of phlegm or regurgitation due to their upper respiratory or digestive disorder. Consistent care and management helps to minimize many of these concerns.

Unemployment is another concern. Although patients might be given a clean bill of health , many still could not find a job. This is particularly true for the semi-skilled and non-skilled workers. Very often, having good family support helps a great deal. This can be in the form of temporary role-reversal between spouses, negotiating a temporary care arrangement or short-term financial help. Many patients are reluctant to ask their relatives for help for fear of rejection. This can limit their potential resources which may also affect their quality of care and livelihood.

Generally, for those with good family support, the psychosocial issues may center on expectations of care (especially between spouse and their extended family), motivational issues,anxieties and denial of the patient. For some, brief counselling and emotional support from a professional helps.

Acceptance of the diagnosis, the treatment and most importantly of him/herself is gradual and is seldom complete. Patients need to understand their illness to make sense and find personal meaning to their cancer experience. This will enable them to move on with their lives. Learn to develop an interdependent relationship and not a one-sided dependent relationship. They need to feel that they are useful and are contributing towards their family and society. It is important for them to have a sense of self-mastery and be in control of the things that they still can.