Fatemeh Moslemi1, Nazanin Rahbanian2, Elham Abbaszadeh3, Behjat Kalantari4 and Maryam Alsadat Hashemipour5*
1Postgraduate Student of Pediatric Dentistry, Department of Pediatric Dentistry, Dental School, Kerman of University of Medical Sciences, Kerman, Iran
2General Dentist, Private Practice, Kerman, Iran
3Assistant Professor of Oral Medicine, Department of Oral Medicine, Dental School, Kerman of University of Medical Sciences, Kerman, Iran
4Assistant Professor of Oncology, Department of Oncology, Medical School, Kerman of University of Medical Sciences, Kerman, Iran
5Professor of Oral Medicine, Department of Oral Medicine, Dental School, Kerman of University of Medical Sciences, Kerman, Iran
*Corresponding Author: Maryam Alsadat Hashemipour, Professor of Oral Medicine, Department of Oral Medicine, Dental School, Kerman of University of Medical Sciences, Kerman, Iran.
Received: April 15, 2021; Published: May 24, 2021
Introduction: Many people, having been diagnosed with cancer, experience high levels of inability and frustration while coping with this disease in individual and familial lives. To return to their normal lives, these patients need help to cope with the disease and meet their various needs. Coping with cancer refers to a set of attitudes and practices that one adopts to preserve health, well-being, happiness, and to overcome the stresses from cancer. This study aimed to investigate coping with cancer in patients with head and neck cancers in Kerman and Isfahan using the Cancer Coping Questionnaire.
Materials and Methods: The studied population was patients presenting to the Oncology Ward of Shafa and Bahonar Hospitals in Kerman and Omid Hospital in Isfahan in 2019 - 2020. The questionnaire was provided by a senior student to the patients in a quiet environment. A questionnaire consisting of several parts was used to collect data. The demographic questionnaire included age, type of treatment, stage of illness, marital status, level of education, economic status and lifestyle. The Cancer Coping Questionnaire consists of 22 items with two subscales of personal and interpersonal. In this study, descriptive statistics, i.e., percentage and frequency, mean and standard deviation, t-tests, ANOVA and SPSS21 statistical software was applied.
Results: 164 people participated in this study, 85 were men and 79 were women. The mean age of the participants was 40.3 ± 5.12 years. The mean coping score by participants was 37.99 ± 12.2. Considering that this variable can range from 22 to 88, one would conclude that the coping rate of the people with head and neck cancer was at a low level. The study of the relationship between age, coping and disease duration suggested that there was no significant relationship between age and coping level (P = 0.662).
Also, there was no significant relationship between the duration of the disease and the mean score from the questionnaire (P = 0.156). The coping of people undergoing chemotherapy was greater than that in surgery (P = 0.024), but it was no different from surgery with chemotherapy (P = 0.442).
The results suggested that there was no significant relationship between coping, gender, marital status and level of education (P = 0.901, P = 0.494, P = 0.275, P = 0.556, respectively).
Conclusion: This study reaffirmed that coping in people with head and neck cancer was generally low. Also, a low average score was obtained in the personal and interpersonal dimensions. Individuals' incomes may create differences in the extent of their coping, as increasing age reduces planning and deviated thinking in individuals. To sum, as the duration of the disease increases, the amount of coping increases.
Keywords: Coping; Cancer; Patients; Head; Neck
Head and neck cancers are the sixth most common cancers in the human body. The prevalence of head and neck cancers is reported to be between 5 and 50% across the world, with South Asia and Southern Europe having the highest prevalence rates [1].
In the meantime, head and neck cancers are mostly prevalent in such countries as France, Brazil, India and South America [2]. Approximately 36,500 new cases are reported each year, as 11,000 people die from cancer in the United States alone [2]. In Australia, the prevalence of this cancer amounts to 12.3 and is seen as the fifth most common cancer [3,4].
Nasopharyngeal carcinoma, forming the major tumor of the nose and throat areas, is less prevalent in the United States, but more prevalent in the Chinese population. Nasal cavity and paranasal sinuses cancers account for 2% of the newly diagnosed cancers. Included in the pharyngeal cancers is the supraglottis cancer making up about 95% of pharyngeal cancers [5,6]. In general, when speaking head and neck cancers, it is meant the upper digestive and respiratory tract including the paranasal sinuses, nasal cavity, oral pharyngeal, oral cavity, hypopharynx, larynx, esophagus, and cervical region. The most common carcinoma in this area is squamous epithelial cell carcinoma [7].
Head and neck carcinomas, such as skin cancers and intracranial tumors account for 5% of all cancers in men and 2% of all cancers in women [7].
The age of development of this type of cancer is usually around 60 to 70. Eighty percent of SCC tumors and another 20 percent include such rare cancers as the salivary glands, thyroid, and sarcomas [7].
Smoking is an important cause of cancer. Alcohol consumption directly affects the epithelial cells of the oral mucosa, increasing its permeability, while at the same time causing dehydration. There is some evidence suggesting the direct effect of alcohol on genes. Dysfunctional uptake of nutrients, P53, vitamins, and impaired liver function are other carcinogens produced by alcohol [7].
Head and neck cancers are treated differently depending on the cancer stage. For some reasons, most patients with head and neck cancer experience delayed examinations, which makes treatment difficult. Treatment options include a combination of surgery, radiotherapy and chemotherapy. Palliative care is often key in advanced stages of the disease [8].
Complications of treatment increase pain and discomfort in patients with head and neck cancer. The most common complaints of patients include pain, dry mouth, sticky saliva, nutritional problems and difficulty speaking, among others [9]. Also, organ removal due to extended surgery to control the disease can cause psychological stress and physical pains in patients. Other problems include economic problems, job problems and adverse effects disrupt the family life [10,11].
Many people, having been diagnosed with cancer, experience high levels of inability and frustration while coping with this disease in individual and familial lives [12]. To return to their normal lives, these patients need help to cope with the disease and meet their various needs [13].
Coping with cancer refers to a set of attitudes and practices that one adopts to preserve health, well-being, happiness, and to overcome the stresses from cancer [14].
Those cancer patients who are not resistant to stress get frustrated, become unable to focus on problems, and cannot make the right decisions, they do not have a plan for the right lifestyle, are pessimistic about their lives, have no control over their own destiny, and do not play an active role in how to form their own lives. Their feedback and practical conducts are irrational and are unable to meet the challenges facing their lives. These complications leave such a profound and lasting effect on the patient's psyche that a recollection of bitter memories of the past even after years could cause anxiety for them, affecting their coping abilities [15].
Coping with the stressful event of cancer is a dynamic process. For Lazarus and Folkman, cancer can engender a variety of responses, including two types of problem-oriented and emotion-oriented coping styles [16,17].
Problem-oriented coping is indicative of a problem-oriented and purposeful effort to solve the problem, reorganize the problem, or attempt to change the situation. This strategy focuses on engaging with the problem in a systematic and orderly manner. The most important of these strategies include confrontational coping, active efforts to change the present situation, seeking social support, and deliberate efforts to resolve the situation. Emotion-oriented coping refers to self-oriented reactions aimed at reducing stress, rather than solving a rational problem. New reactions include emotional responses. Negative emotion reactions include emotional expressions in the form of isolation, repression and quitting the subject [15]. Since studies conducted in Iran on the prevalence of head and neck cancers suggests an increase in the prevalence of this type of cancer [18] and that no study has been conducted in this field in Iran so far, this study aimed to investigate coping with cancer in patients with head and neck cancers in Kerman and Isfahan using the Cancer Coping Questionnaire.
This research was descriptive-analytical. The studied population was patients presenting to the Oncology Ward of Shafa and Bahonar Hospitals in Kerman and Omid Hospital in Isfahan in 2019 - 2020. The cancers studied included all head and neck cancers except for the skin, eye and brain cancers included in the study according to the oncologist examination. Inclusion criteria were going through chemotherapy or surgery, no cancer in other parts of the body, not having any known mental illness and no use of psychiatric drugs. Exclusion criteria were the occurrence of any stressful event for the patient or first-degree members of the patient's family in the past 6 months.
Also, illiterate people were excluded from the study. Before the study began, verbal consent was obtained from all patients and then the Cancer Coping Questionnaire. The questionnaire was provided by a senior student to the patients in a quiet environment. The objective of this study was explained to each person and a questionnaire was provided to them if accepted. In the meantime, all people were assured as to the confidentiality of the information in the questionnaire and the data were examined only from a statistical point of view.
A questionnaire consisting of several parts was used to collect data. The demographic questionnaire included age, type of treatment, stage of illness, marital status, level of education, economic status and lifestyle. The Cancer Coping Questionnaire consists of 22 items with two subscales of personal and interpersonal. Personal subscale is a subset including items 1 to 14 discussing questions pertaining to coping (items 2,6, 7, 12), positive focus (items 1, 9, 14), planning questions (items 5, 13, 10) and deviated thinking (items 3, 4, 8). Interpersonal subscale items also include questions 15 to 22. This scale was scored on a 4-point Likert scale, including nothing (score 1), low (2), medium (3) and high (4). The questionnaire scores vary between 22 and 88. Higher scores indicate greater coping strategies.
In this study, descriptive statistics, i.e. percentage and frequency, mean and standard deviation, t-tests and ANOVA tests to measure the relationship between demographic variables and coping with cancer, as well as Pearson correlation coefficient and stepwise multiple linear regression to measure the relationship between coping with cancer and the stated independent variables were used. For statistical analysis, SPSS21 statistical software was applied. Moreover, this research was registered with an ethics code of IR.KMU.REC.1398.449 at the ethics committee�����