Assessing Functional Status and Social Support in the Head and Neck Cancer Patients

Abstract

Purpose: The current study, which was a descriptive study to determine the functional status of and the social support perceived by head and neck cancer patients.

Materials and Methods: The current study, which was conducted in the medical oncology and radiation oncology polyclinics of the Ankara Oncology Training and Research Hospital. The sample of the study consisted of 145 patients. The data in the study were collected utilizing the introductory characteristics questionnaire, Functional Living Scale (cancer), and the Cancer Patient Social Support Scale.

Results: At the conclusion of the study, it was determined that mean functional living scale scores of head and neck cancer patients was low and the mean scores of the social support scale were high. It was determined that the social support perceived by patients and the functional living and of patients was influenced by gender, marital status, income status, status of receiving information, period of diagnosis, stage of disease, treatment, surgical treatment, time of the most recent surgical treatment, and the existence of other chronic diseases.

Conclusions: The relationship between the sub dimensions of the functional living scale and the sub-dimensions of the social support scale were positively significant.

Keywords: Head and neck cancer; Functional status; Social support

Introduction

Head and neck cancers include the paranasal sinuses, nasal cavity, oral cavity, pharynx, and larynx epithelial cell cancers and they comprise approximately 6% of all cancers [1]. The most frequently observed type is squamous cell carcinoma. Squamous cell head and neck cancers rank seventh in terms of mortality due to cancer. Every year worldwide, 400,000 cases of oral cavity and pharynx cancers and 160,000 larynx cancer cases occur and approximately 300,000 of these result in mortality [1-3]. According to the cancer incidence data of the Ministry of Health Cancer Control Department, larynx cancer ranks sixth in Turkey with a 4% incidence rate in terms of incidence among males [4]. Even though head and neck cancers rank lower compared to other cancers in terms of incidence, the anatomic and functional properties of the localization are of particular importance due to the physical, psychological, and social problems created by the impact of disease and treatment [5-7]. Head and neck cancer patients suffer from a broad range of problems that have multiple effects on the functional life of individuals [6,8,9]. A decrease in physical capacity due to reasons such as pain, fatigue, loss of function in the shoulder, and impact on health status cause individuals to experience difficulty when performing their daily living activities [5,10,11]. Impact on body image occurring due to changes in the physical appearance of patients has an adverse impact on the psychological well-being of individuals and causes psychological problems such as depression and loss of self-esteem [5,12]. In the study conducted by Campbell et al. (2000), problems such as difficulty swallowing, speech problems, and difficulties in physical activities could be observed at a high rate in patients in the advanced stage of the disease and the quality of life these patients was low [13]. Problems experienced in communicating due to changes in speech function and difficulties in adapting to functional changes, increased the level of anxiety of individuals [14]. In the study of Rosenthal et al. (2009), 18% of head and neck cancer patients were symptomatic prior to therapy [15]. This subset of patients reported moderate levels of pain, fatigue, sleep disturbance, feeling sad, and emotional distress. A decrease in social activities and problems such as social isolation, prevent the ability of patients to fulfil their social and professional roles [6,7,16]. Such difficulties that have been experienced have caused head and neck cancer patients to require greater social support. Some studies state that social support is beneficial for cancer patients and there is a positive relationship between the emotional support from family members and the degree of physical and psychological adaptation to cancer [17-19]. In patients with head and neck cancer, social support and its role in psychosocial well-being is important. Some studies state that adequate social support has benefits for patients with head and neck cancer in coping with the symptoms, decreasing anxiety and depression, and by preventing social isolation, it provides benefits for ensuring that the relationship between the individual with society is maintained [20-23]. While in the past, the only measurable outcome was tumour control and survival, today, quality of life has become increasingly important, especially in oncology. In recent years, the purpose in the treatment of the disease is not limited to only the remedy of the disease, but also focuses on the outcomes being within acceptable limits in functional and aesthetic terms and sustaining quality of life [6,24]. Thus, in addition to the evaluation of treatment methods, tumour response, and general survival period in head and neck cancer patients, the evaluation of the impact of cancer and cancer treatment on the individual’s functional, psychological, and social health is also important [5,6,7,24]. There are a limited number of studies in Turkey evaluating the functional status and social support of head and neck cancer patients. It is considered that the result of this study will contribute to the care planning for the enhancement of functional living and the determination of initiatives that will highlight the functionality of the family in the field of social support.

Methods

Design, Participants and setting

The study was conducted in the medical and radiation oncology polyclinics of the Oncology Education and Research Hospital with the largest capacity affiliated with the Ministry of Health in Ankara. To calculate the sample size, the NCSS-PASS (Number Cruncher Statistical System- Power Analysis and Sample Size) 2007 program was utilized. According to the results of the conducted population mean significance test, the sample size for the Functional Living Scale application was determined to be 145 and it was also determined to be 107 for the Cancer Patient Social Support Scale application. The study sample size was determined as 145.

Participants

Individuals that accepted to participate in the study were aware of their cancer diagnosis, and were 18 years old and over were included in the study. Patients included in the sample were accessed when they consulted the medical oncology polyclinics and the radiation oncology polyclinic. After patients were provided with information on the study, the data collection form was implemented.

Ethical considerations of the research

Permission was obtained from the Ankara Second Clinical Studies Ethics Board for the study and the Directorate of Oncology Education and Research Hospital, where the study was to be conducted, and verbal informed consent was obtained from the study participants.

Data Collection

Data in the study was collected through the questionnaire to determine the defining characteristics of head and neck cancer patients, Functional Living Index (cancer), and the Cancer Patient Social Support Scale. The defining characteristics of the questionnaire consisted of two different sections. In the first section, there were questions regarding the socio-demographic information of the patients (age, gender, marital status, educational status, location of residence, income status, status of receiving assistance, and knowledge) and in the second section there were questions regarding the disease (diagnosis, stage, time of diagnosis, treatment, status of whether or not undergoing operation, treatment duration, completion period of treatment, and presence of another disease). The Functional Living Index (Cancer) was developed in 1984 by H. Schipper, J. Clinch, A. McMurray, and M. Levitt. The scale, which used for the purpose of determining the functional status of patients, consists of 22 questions and 5 dimensions, including physical functions, psychological functions, general well-being, social functions, and gastrointestinal symptoms. The reliability and validity of the scale in Turkey were testedin 2005 by Akdemir and Bektas. High scores indicate that functional status and life quality were very good [25]. In this study the Cronbach’s alpha coefficient for the total scale score was 0.92. The Cancer Patient Social Support Scale is a five point Likert grading scale to determine the type and level of social support patients consider to be receiving from their families. It was developed by Eylen, and its validity and reliability in Turkey were testedin 2001. High scores in the Cancer Patient Social Support Scale indicated that social support provided by families as perceived by cancer patients was high [26]. In this study, Cronbach’s alpha coefficient for the total perceived social support was 0.91.

Ethical considerations of the research

Permission was obtained from the Ankara Second Clinical Studies Ethics Board for the study and the Directorate of Oncology Education and Research Hospital, where the study was to be conducted, and verbal informed consent was obtained from the study participants.

Data analysis

The evaluation of data and statistics were performed utilizing the Statistical Package for the Social Sciences (SPSS) 15.0. Percentile ratios were utilized to evaluate the defining characteristics of the patients. In the distribution of the scores obtained from the Functional Living Index and Cancer Patient Social Support Scale, the mean, minimum, and maximum values were utilized. In the statistical evaluation of the mean scores of the introductory characteristics of patients, Functional Living Index (cancer)sub-dimensions, and the Cancer Patient Social Support Scale sub-dimensions the independent sample t-test, Kruskal Wallis test, variance analysis test, and Mann-Whitney U-test were utilized. A correlation analysis was conducted to examine the level of significance of the relationship between the patient’s Functional Living Index sub-dimensions and Cancer Patient Social Support Scale sub-dimensions. The level of significance in the statistical evaluation was accepted to be p<0.05.

Results

Defining characteristic of patients

The average age of patients in the study was 54.41±14.9 years. Of the participants in the study, 68.3% were male, 77.8% were married, and 37.9% were primary school graduates. Ninety-three point one percent of patients stated that they required the help they received from close family and when asked, the patients received help from their spouses (35.8%), children (33.1%), relatives and friends (15.2%), and parents (9%). Sixty-four point eight percent of patients stated that they received information regarding the disease or treatment. Thirty-seven point two percent of patients included in the study were diagnosed with larynx, 24.1% with pharynx, 19.4% with oral cavity, and 19.3% with other head and neck cancers. Forty-two point eight percent of patients stated that their diagnosis period was less than 3 months, 43.4% stated that they were in stage II of the disease, and 42.1% in stage III of the disease. Sixty percent of patients included in the study underwent radiotherapy and 26.9% underwent chemotherapy together with radiotherapy. Thirty-five percent of the patients received radiotherapy for 21-27 days and the final radiotherapy period for 61.5% was 2-4 months. Forty-five point seven percent of patients received two doses of chemotherapy and the last date of chemotherapy was less than one month for 57.5% of the patients. Forty-nine point seven percent of patients underwent surgery and the last date of surgery for 56.3% of the patients was less than three months. Thirty-five point nine percent of patients in the study did not have chronic diseases. It was determined that the functional status of head and neck cancer patients was poor and their total Functional Living Score averages were 88.24±19.8. It was determined that the average scores of patients regarding physical functions, psychological functions, general well-being, social functions, and gastrointestinal symptoms were low. Total perceived social support of head and neck cancer patients was above average(132.7±14.82); when each sub-scale is evaluated separately; the average security support subscale scores of patients were higher than other sub-scale average scores, and average information support subscale scores were lower.

The Introductory characteristics of the relationship between functional living and social support

In the study, the physical and psychological function scores, gastrointestinal symptoms, and mean total functional living scores of female patients were significantly low. In addition to only mean information support scores being statistically significant, mean social support scores were lower compared to male patients. The perceived social support in patients aged 65 and over was significantly low. The physical function and gastrointestinal symptom mean scores of single patients were significantly high. The trust support and perceived social support scores of widowed patients were significantly low. As the level of education increased, trust support, emotional support, and perceived social support scores increased significantly. The physical function, psychological function, social function, general well-being, total functional living scores, and the perceived social support of patients with a low level of income were lower (Table 1). The functional living means scores and social support mean scores of patients with advanced disease were lower. The gastrointestinal symptoms, total functional living mean scores, information support, and total mean perceived social support scores of patients with a diagnosis period of 7–12 months were low. The functional living areas and information support mean scores of patients that have undergone surgical operations and whose recent surgery was 7-12 months prior were low. The physical function, psychological function, and total functional living mean scores of patients with another chronic disease were lower. The psychological functions and perceived social support levels of informed patients with information were significantly high. The diagnoses of patients, number of chemotherapy days, number of radiotherapy days, final radiotherapy, and period of receiving chemotherapy had an influence on functional living and perceived social support (Table 1). Each functional living scale sub-dimension of head and neck cancer patients have a relationship at a significant level with each social support scale sub-dimensions (p<0.01). As the social support of head and neck cancer patients increases, their functional status improves (Table 2).