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Quality of life during early radiotherapy in patients with head and neck cancer and pain
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
2017 (English)In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 10, p. 1697-1704Article in journal (Refereed) Published
Abstract [en]

Background: Patients with head and neck cancer (HNC) have a potentially severe diagnosis and often suffer from tumor-related pain as well as from adverse side effects of treatment such as radiotherapy (RT). Knowledge about quality of life (QoL) during early RT in this group is limited and should be assessed in relation to diagnosis and treatment. Purpose: The purpose of this cross-sectional study was to identify potential factors that may influence QoL in patients with HNC during the early stages of RT (no later than two weeks of ongoing RT). We hypothesized that pain intensity, pain interference, catastrophizing, and mood disturbances are associated with QoL during early RT. Patients and methods: In this study, 54 patients (53% of eligible patients) diagnosed with HNC were consecutively recruited from the regular flow to the Pain and Rehabilitation Center at Linkoping University. The patients completed self-reported questionnaires on sociodemo-graphics, pain intensity, pain interference, anxiety, depression, pain catastrophizing, and QoL. Results: The patients in this study scored high for QoL, low for pain intensity, and low for pain interference. The patients reported minor depressive symptoms and anxiety symptoms. Regression analyses showed that pain intensity and depressive symptoms negatively influenced QoL. Conclusion: No later than two weeks of RT, pain intensity and depression negatively influenced QoL in patients with HNC. Early screening for pain and depression in a targeted preventive strategy might maintain QoL during the course of the RT for patients with HNC. This assumption needs to be further investigated.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD , 2017. Vol. 10, p. 1697-1704
Keywords [en]
pain; quality of life; head and neck cancer; radiotherapy; cross-sectional study
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:liu:diva-139653DOI: 10.2147/JPR.S138113ISI: 000405597700005PubMedID: 28761374OAI: oai:DiVA.org:liu-139653DiVA, id: diva2:1133677
Available from: 2017-08-16 Created: 2017-08-16 Last updated: 2018-05-02
In thesis
1. Impact of Pain and Evaluation of Education and Self-Care in Patients with Head and Neck Cancer
Open this publication in new window or tab >>Impact of Pain and Evaluation of Education and Self-Care in Patients with Head and Neck Cancer
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

It is not unusual for patients with head and neck cancer (HNC) to suffer from both tumor and treatment-related pain that is difficult to alleviate despite individualized pharmacological treatment.

The presence of concomitant various dimensions of pain in patients during the often difficult period following radiotherapy (RT) has not been elucidated. Several aspects concerning the importance of relatives for HNC patients have been addressed. However, little attention has been given to how relatives perceive patients with HNC pain and it is important to further elucidate this sparsely studied topic. Knowledge about health-related quality of life (HR-QoL) in this patient group during early RT is limited and needs to be assessed in relation to diagnosis and treatment. Self-care (SC) refers to what patients do on their own to achieve, maintain, and promote optimal health and may help reduce pain for several pain conditions. The impact of patient education and SC on pain and other common HNC symptoms need further clarification.

The aims of this thesis were:

  1. to describe experiences and perceptions of pain in patients with HNC shortly after RT
  2. to describe how relatives perceived the patient’s situation, especially concerning pain, and how they experienced their own situation
  3. to identify factors that impact HR-QoL during early RT
  4. to develop effective pain management strategies, maintain activities of daily living, and promote HR-QoL in patients with HNC undergoing RT using patient education and SC instruction.

In paper I patients with HNC described existential pain – expressed as fear of death, meaninglessness and guilt – already during and shortly after RT. Physical pain, psychological distress and social withdrawal played a significant role. Patients with HNC who were treated with RT should also proactively be offered treatment for the various dimensions of pain.

In paper II relatives described their mental stress in response to a challenging situation that required their active support to help ease the patient's difficult condition. The interviews with relatives also revealed a lack of personal knowledge and frustration over the inability to participate in patient care, as well as inadequate support from the healthcare system. Early interventions from the healthcare system on behalf of the relatives may be necessary to meet these needs.

In Paper III regression models revealed that pain intensity and symptoms of depression adversely affected HR-QoL in patients with HNC during early RT. Customized prehabilitation programs aimed at preventing pain and symptoms of depression could help preserve good HR-QoL.

Paper IV assessed individual patient education and SC initiatives that resulted in a tendency for lower pain intensity during a portion of RT. One way to potentially enhance the benefits of education and SC could be to improve for example patient motivation and self-efficacy, as well as to optimize supportive efforts from caregivers.

In conclusion, by identifying factors that can impact HR-QoL and evaluating the effect of patient education and SC, this thesis contributes to knowledge on perceived pain and the patient’s situation during and shortly after RT in patients with HNC and their relatives. This thesis points to the need for evaluation and further development of patient education and effective SC strategies for pain in patients with HNC undergoing RT, as well as for development and evaluation of support strategies for patients with pain and their families during and after RT.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 102
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1616
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-147288 (URN)10.3384/diss.diva-147288 (DOI)9789176853313 (ISBN)
Public defence
2018-05-25, Berzeliussalen, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Note

Korrigeringar är gjorda i den elektroniska versionen utifrån publicerad erratalista / The corrections in the published errata list are implemented in the electronic version.

Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2018-04-16Bibliographically approved

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Dragioti, Elena

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