[Quality of life stress in patients with large tumors of the mouth. 3: Indications for preoperative assessment of individual coping capacity].
A three-part empirical study investigated in detail the effects of illness and therapy on patients with large tumors of the oral cavity (n = 50). Part 1 compared the limitations of quality of life (LQL) of these patients with those of patients after total laryngectomy (n = 34) and with a group of patients "without cancer" (n = 40). Part 2 dealt with the individual coping strategies applied by the patients. The aim of this third part was to evaluate those biopsychosocial variables which could serve preoperatively in determining whether a planned surgical intervention could benefit the patient's quality of life. For this purpose a dependent variable ("subjective burden of illness and therapy") was defined as the weighted sum of 9 scores (including "duration of survival" and LQL). 51 variables (19 medical, 7 demographic and many psychological) were chosen as potentially explanatory variables. 7 of the 8 exploratory variables correlating most strongly with the dependent variable had an emotional content: depressive personality, intensified preoperative anxiety and depression, emotional indifference, reinforced control of emotions, reservation and compulsiveness. The somatic variables with the highest correlations to the dependent variable were "more pronounced preoperative dysfunction" (4th place) and "extent of primary tumor" (9th place). The findings suggested that the primary reason for a delay (postponement of the first medical consultation) often resulting in a poorer prognosis is not the growth of the tumor in the meantime but the fact that the delay represents an existing resignation. This resignation and the reduced self-esteem generally underlying it would then be concomitant causes of poorer courses of the illness. The opportunities for the surgeon to support the patient's self-esteem are discussed.
Kollbrunner
J
J
Universitätsklinik für HNO, Hals-Kiefer- und Gesichtschirurgie, Inselspital, CH-3010 Bern, Schweiz. juerg.kollbrunner@insel.ch
Zbären
P
P
Quack
K
K
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D017281:Cost of Illness; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000523:psychology; D009062:Mouth Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D009367:Neoplasm Staging; D010552:Personality Assessment; D011183:Postoperative Complications / Q000523:psychology; D011788:Quality of Life; D012803:Sick Role