The nature and content of rumination for head and neck cancer survivors

"Women's experiences of head and neck cancer: an interpretative phenomenological analysis"

PURPOSE

Head and neck cancers (HNCs) are predominantly studied in men. This study aimed to explore women's experiences of HNC.

METHODS

The study was based on the secondary analysis of interviews conducted by using the life story methodology with patients who underwent surgery for HNC. We selected seven particularly rich interviews regarding the experience of cancer and first conducted a thematic analysis to identify key patterns in the data. We then applied interpretative phenomenological analysis (IPA) to explore in depth how participants made sense of their experiences.

RESULTS

Key themes were identified across different phases of the illness journey, including diagnosis, treatment, post-treatment, recurrence, and future projection. A major challenge was diagnostic wandering, as many women did not fit the typical head and neck cancer (HNC) profile-typically a man who consumes alcohol and tobacco. Identity loss was a central issue, with themes of reclaiming one's body post-surgery and the loss of feminine symbolism (infertility, hair loss, self-recognition). Coping strategies varied: some sought social support and aimed to return to work, while others viewed surgery as essential for recovery.

CONCLUSION

These findings highlight the need for personalized support tailored to women's specific needs and challenges.

IMPLICATIONS FOR CANCER SURVIVORS

This study emphasize the importance of providing personalized support that closely aligns with the needs of female head and neck cancer survivors. It is crucial to consider their subjectivity, recognizing that each experience is unique, to better assist them in overcoming adversity. Tailoring care to their individual realities will more effectively address their emotional and physical difficulties.

Individual Rumination in Adult Cancer Care: A Concept Analysis

OBJECTIVE

To conceptualize rumination in adult cancer care.

METHODS

Walker and Avant's concept analysis method was used to examine rumination in adults with cancer. A systematic search was conducted across psychology, nursing, medicine, and public health disciplines in PsycINFO, PubMed, Web of Science, CINAHL, and Scopus databases from their inception to April 2024. Additional records were identified by manually searching reference lists of relevant studies.

RESULTS

Analysis of 50 articles identified rumination's three defining attributes (intrusions, brooding, instrumentality), antecedents (cancer-related adversity, pre-existing susceptibilities), and consequences (psychophysiological functioning impairments, long-term adaptation). Key features included trait-state duality, internal variability, external cyclicality, and high emotional correlation.

CONCLUSIONS

This concept analysis establishes a preliminary conceptual model of rumination in adult cancer care, integrating its attributes, antecedents, and consequences. The model offers insights into rumination mechanisms, highlighting its complexity and variability, and may inform the development of targeted interventions and theoretical development for cancer population. Further research is needed to validate the model and explore its clinical applications.

IMPLICATIONS FOR NURSING PRACTICE

Understanding rumination in adult cancer care helps nurses identify and support at-risk patients. By recognizing key signs, nurses can implement targeted interventions to improve patients' emotional and psychological well-being, ultimately enhancing their long-term adaptation and quality of life.

People, places, systems and society:A qualitative exploration of socio-cultural factors in head and neck cancer survivorship

PURPOSE

People living with head and neck cancer (HNC) often endure permanent and life changing adverse effects of treatment and reduced health-related quality of life. Study of post-traumatic growth (PTG), is gaining traction to understand why some people living with cancer have better psychosocial outcomes than others. Current theoretical models on PTG point to the importance of 'socio-cultural influences' but do not provide insight into how such socio-cultural factors influence survivorship outcomes. This research aimed to illuminate pathways to PTG following HNC by exploring socio-cultural factors in experiences of living with, and moving on from, HNC.

METHOD

Semi-structured interviews with people living with HNC (up to 5 years post-treatment) on experiences of diagnosis, treatment and recovery. Qualitative framework analysis using the environmental factors codes from the International Classification of Functioning, Disability and Health (ICF) HNC core set.

RESULTS

20 people living with HNC were interviewed (11 male, 9 female; aged 46-83 years). Four inter-related themes described socio-cultural factors that influence (positively and/or negatively) the experience of living with HNC: (1) people and places; (2) healthcare systems and support services; (3) societal attitudes to cancer; (4) work and finances.

CONCLUSION

Support from family, friends and healthcare professionals, as well as societal attitudes, financial and work security and personal experiences all appear to contribute to an individuals' ability to navigate the HNC experience. These findings could inform development of interventions targeting the socio-cultural factors in the lives of people living with HNC, particularly for those at risk for poorer psycho-social outcomes.