Cancer and changes in facial appearance: A meta-ethnography of qualitative studies

Management of nasal vestibule carcinomas: recommendations by the Oncological Committee of the Italian Society of Otorhinolaryngology - Head and Neck Surgery

Objective

Squamous cell carcinoma of the nasal vestibule (NV SCC) is a head and neck malignancy for which there is no established consensus on most aspects of clinical management. The purpose of this document is to give updated recommendations that incorporate recent evidence on its clinical characteristics and the high efficacy of brachytherapy as primary treatment modality.

Methods

A working group consisting of the members of the Scientific Committee for Oncology and Reconstructive Surgery of the Italian Society of Otorhinolaryngology Head and Neck Surgery and radiation oncologists expert in brachytherapy was formed to achieve a consensus.

Results

Consensus was reached on a set of recommendations, proposing a refined anatomical definition of the nasal vestibule, a novel T staging system of the NV SCC, and brachytherapy as standard of care, with a new method for catheter implantation.

Conclusions

The Committee emphasises the critical role of an accurate classification in clinical practice and encourages further research to validate the novel staging system and further improve treatment strategies. Where appropriate, it is recommended that patients be referred to centres with specific experience in brachytherapy for NV SCC.

Quality of life and psychological evaluation of patients after anaplastology

A comprehensive questionnaire with 43 questions was designed to evaluate quality of life, based on rehabilitation with a facial prosthesis. Each patient's psychological situation was assessed using the validated questionnaire and associated scales. Different patient groups were compared with each other in terms of questionnaire scores and general data. In total, 76 patients with a prosthesis of the orbit, nose, or ear, or a combination thereof, were included. There was a highly significant difference in overall satisfaction with defect reconstruction via a prosthesis of the ear compared with the orbit and nose (F(3) = 6.511, p = 0.001). Patients with congenital defects showed a significantly higher level of general satisfaction compared with patients with acquired defects (F(2) = 5.795, p = 0.001). Patients who returned to work were significantly more satisfied with their quality of life (T(57) = 2.626, p = 0.011). With regard to improvements to the state-of-the-art prostheses, the majority of patients suggested better retention, more durable colors, make-up possibilities, less noticeable margins, softer materials, and a movable orbital prosthesis. Within the limitations of the study it seems that facial epitheses improved mental wellbeing and increased quality of life among patients with facial defects. Multiple factors, such as type of facial defect, location of residence, and education can have a potential influence on the quality of life of affected patients. However, further studies are needed, since the psychological and social challenges remain.

Towards a better understanding of the social stigma of facial difference

Facial difference (FD) is not only an individual experience; it is inherently social, reflecting interactions between social norms and individual attitudes. Often FD is stigmatized. In this paper, we employ a widely used stigma framework, namely the social stigma framework put forth by Pryor and Reeder (2011), to unpack the stigma of FD. This framework posits that there are four forms of stigma: public stigma, self-stigma, stigma by association, and structural stigma. We first discuss the social and psychological literature on FD as it pertains to these various forms of stigma. We then describe coping approaches for FD stigma. Lastly, we delineate evidence-based methods for addressing the various forms of FD stigma, such that future efforts can more effectively tackle the stigma of facial difference.

Burnout or Fade Away; experiences of health professionals caring for patients with head and neck cancer

PURPOSE

The oncology workforce has been found to have high risk of burnout; however, limited research has explored the experiences of health professionals working with head and neck cancer patients. The objective of this qualitative study was to explore the experiences of health professionals who work directly with patients diagnosed with head and neck cancers, with a focus on work-life balance, mental health and wellbeing.

METHOD

A total of 21 in-depth semi-structured interviews were conducted with health professionals including radiation oncologists, medical oncologists, nurses, and associated medical and allied health professionals. A qualitative research approach based on social constructionist theory was used. Thematic analysis was used to identify and code themes.

RESULTS

Five main themes emerged: 1. Conscientiousness; 2. Empathy; 3. Challenges; 4. Coping; and 5. Burnout or Fade Away. Challenges included sub-themes of Time & Resource Constraints, Work-Life Imbalance, Patients with Complex Needs, and Lack of Self-Care.

CONCLUSION

It is vital to the sustainability of head and neck oncology services that this highly skilled workforce is retained. The development of interventions that will reduce the risk of burnout and improve retention and capacity of health professionals may include advanced communication skills training, trauma sensitivity training, self-compassion and stress management skills.