title: Identifying appearance-related concerns in routine follow-up clinics following treatment for oral and oropharyngeal cancer.
abstract: Facial disfigurement can be a consequence of treatment for oral or oropharyngeal cancer. Patients' concerns about appearance and the impact this has on quality of life are very important, but are often not recognised in a busy outpatient clinic. We aimed to assess concerns about appearance using the University of Washington Quality of Life questionnaire version 4 (UW-QoL) and the Patient Concerns Inventory (PCI), a self-administered questionnaire that allows patients to choose what they would like to discuss in their consultation. Prospective data were collected from 204 patients who attended routine follow-up clinics from August 2007 to mid-July 2009. Fifty-seven percent were male, 68% had cancer of the oral cavity, 78% had clinical T1-T2 tumours, 19% had node positive tumours, 44% had had radiotherapy since diagnosis, and 48% had had free-flap reconstructive surgery. They all completed the questionnaires using touch-screen computer technology at 454 clinic appointments. Appearance was raised on the inventory at 9% (42/454) of clinics, and at 10% (47/454) it was indicated as a serious problem on the UW-QoL questionnaire. Concerns about appearance were raised on the inventory or were shown to be a serious problem on the UW-QoL in 14% (64/454) of patients. The main factors associated with those who reported concerns about appearance were age (younger patients), sex (female), T stage (III and IV), and site (oropharynx). Patients who choose concerns about appearance for discussion on the UW-QoL questionnaire and not on the PCI risk being missed if only the PCI is completed. Both tools compliment the screening of patients who have problems with facial disfigurement; failure to identify them can have serious clinical and psychosocial implications.
authors.affiliation: Foundation Dentist Year 1, 303-305 Mill Lane, St. Helens, WA9 4EU Merseyside, UK. aflexen@tiscali.co.uk
authors.forename: J
authors.initials: J
authors.lastname: Flexen
authors.forename: N
authors.initials: N
authors.lastname: Ghazali
authors.forename: D
authors.initials: D
authors.lastname: Lowe
authors.forename: S N
authors.initials: SN
authors.lastname: Rogers
mesh_terms: D000367:Age Factors; D000368:Aged; D001828:Body Image; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000523:psychology* / Q000601:surgery; D009367:Neoplasm Staging; D019647:Oral Surgical Procedures / Q000523:psychology*; D009959:Oropharyngeal Neoplasms / Q000523:psychology* / Q000601:surgery; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000523:psychology*; D012189:Retrospective Studies; D012737:Sex Factors; D012944:Social Support; D011795:Surveys and Questionnaires