Umeå universitets logga

umu.sePublikationer
Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Life after treatment for head and neck cancer
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
2022 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)Alternativ titel
Livet efter behandling för huvud- och halscancer (Svenska)
Abstract [en]

Background: Treatment for head and neck cancer (HNC) is often multimodal, including surgery, radiotherapy, and chemotherapy. The anatomic location of HNC and its treatments often affect vital functions such as swallowing and speech, but also physical appearance, leading to a risk for social withdrawal and nutritional difficulties that can affect the patient’s quality of life.

Aims: The general aims of this thesis were to describe the physical and social consequences for patients treated for HNC and to identify supportive needs in regaining a new everyday life including intimate relationships, return to work, and nutritional recovery.

Methods: Paper I (n = 131), objectives: to determine how patients with HNC experience changes in intimate relationships and to identify factors interfering with such relations. A semi-structured interview study was carried out on patients after treatment, and the analysis was inspired by the guidelines in constructive Grounded Theory. Paper II (n = 295), objective: to describe the frequency of patients’ returning to work after treatment for oropharyngeal cancer and to identify predictors and physical barriers (with a focus on pain, swallowing and speech difficulties, and physical appearance), that might interfere with the return-to-work process. A cross-sectional study using questionnaires was carried out 15 months after the diagnosis. Data were obtained from the Swedish Head and Neck Cancer Register. Paper III (n = 197), objective: to assess nutritional aspects and body weight in patients with HNC. A nutrition impact symptom-specific questionnaire for HNC was used to assess symptoms interfering with oral intake as well as interfering with body weight during the first year post-treatment. Paper IV (n = 21), objective: to examine how patients with HNC perceive life one year after treatment and how they experience health care. A semi-structured interview study was performed with an interview guide developed using concepts from the literature and clinical experience, and a thematic analysis approach was used.

Results: In Paper I most patients reported no major changes in intimate relationships at the end of treatment. In resuming intimate relationships, facilitating factors were stable relationships before treatment, engagement from others, and being open regarding the cancer, while detrimental factors were patronization and dis-engagement. This was summarised as “being open versus not sharing the cancer journey”. In Paper II, 15 months after diagnosis 84% of the patients who were working at the time for diagnosis had returned to work. Factors negatively associated with return to work were swallowing difficulties, problems talking on the telephone, and changed physical appearance. In Paper III, the post-treatment weight loss was related to the degree of symptoms and interference with oral intake, which also increased the risk for a body weight loss of ≥10% at 12 months after the end of treatment. In Paper IV, the patients were still suffering from side effects one year after treatment and from fear of recurrence, but they tried to live as they did before the cancer diagnosis. Even if most contacts with health care were experienced positively, patients lacked regular follow-ups regarding rehabilitation and contact with their contact nurse.

Conclusions: In Paper I, when resuming intimate relationships, the challenges were related to whether the patients were open or not about the disease. In Paper II, some remaining physical barriers were identified. A positive result from the study that can be reported to future patients is the high number of patients returning to work after treatment. In Paper III, both nutritional and clinical factors were shown to affect body weight, and a holistic approach is needed when addressing the patients’ nutritional needs. In Paper IV, despite the sequelae from treatment, the patients sought to live as they did before the diagnosis. This may disguise continuing needs, and by meeting the patients with engagement, the contact nurse-patient relation may uncover these needs and proper individualized support and rehabilitation can be offered.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet , 2022. , s. 57
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2191
Nyckelord [en]
head and neck cancer, intimate relationships, return to work, nutrition, contact nurse
Nationell ämneskategori
Cancer och onkologi Oto-rino-laryngologi
Forskningsämne
oto-rhino-laryngologi; onkologi
Identifikatorer
URN: urn:nbn:se:umu:diva-199315ISBN: 978-91-7855-857-5 (tryckt)ISBN: 978-91-7855-858-2 (digital)OAI: oai:DiVA.org:umu-199315DiVA, id: diva2:1695150
Disputation
2022-10-07, Föreläsningssalen ÖNH (målpunkt A82, plan 8), NUS, samt via Zoom, Umeå, 09:00 (Svenska)
Opponent
Handledare
Forskningsfinansiär
CancerfondenCancerforskningsfonden i NorrlandFamiljen Kamprads stiftelseAFA FörsäkringRegion VästerbottenTillgänglig från: 2022-09-16 Skapad: 2022-09-13 Senast uppdaterad: 2023-04-17Bibliografiskt granskad
Delarbeten
1. Changes in intimate relationships following treatment for head and neck cancer: a qualitative study
Öppna denna publikation i ny flik eller fönster >>Changes in intimate relationships following treatment for head and neck cancer: a qualitative study
Visa övriga...
2017 (Engelska)Ingår i: Journal of psychosocial oncology, ISSN 0734-7332, E-ISSN 1540-7586, Vol. 35, nr 5, s. 614-630Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The aim of this study was to determine how patients with head and neck cancer experience changes within their intimate relationships at the end of treatment and detect detrimental and facilitating factors in the process of resuming intimate relationships. Interviews were conducted with 131 patients. A core category – "Being open vs. not sharing the cancer journey" – emerged from the patients' narratives and was based on the experiences of engagement/disengagement, openess/fear, and patronising attitudes/sharing the burden. The findings point to the necessity of patients being open about the disease trajectory and might be understood in the light of theories about potential changes in identity and self-concept.

Ort, förlag, år, upplaga, sidor
Routledge, 2017
Nyckelord
Head and neck cancer, intimate relationships, patients experience, social support, qualitative study
Nationell ämneskategori
Socialt arbete Cancer och onkologi
Identifikatorer
urn:nbn:se:umu:diva-135348 (URN)10.1080/07347332.2017.1339224 (DOI)000413909300007 ()28605311 (PubMedID)2-s2.0-85027846387 (Scopus ID)
Anmärkning

Acknowledgement of funding: This study was sponsored by the Swedish Cancer Society, Lions Cancer Research Foundation at Umeå University, the Swedish Laryng Foundation, and the Cancer Research Foundation of Northern Sweden.

Tillgänglig från: 2017-05-24 Skapad: 2017-05-24 Senast uppdaterad: 2023-03-23Bibliografiskt granskad
2. Return to work after oropharyngeal cancer treatment: Highlighting a growing working-age population
Öppna denna publikation i ny flik eller fönster >>Return to work after oropharyngeal cancer treatment: Highlighting a growing working-age population
Visa övriga...
2020 (Engelska)Ingår i: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 42, nr 8, s. 1893-1901Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: To describe the frequency of patients returning to work after treatment for oropharyngeal cancer and to identify predictors and physical barriers that might interfere with the return to work process.

Methods: Cross‐sectional study including 295 patients. Data were collected regarding work/sick leave situation at 1 month before diagnosis and 15 months after diagnosis. The situation before diagnosis was retrospectively recalled by the patients. Two subscales and two single items from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire‐H&N35 were used. Data were analyzed with multivariate logistic regression.

Results: Fifteen months after diagnosis, 212 patients (72%) were working. To be working 15 months after diagnosis was associated with working before diagnosis. Swallowing difficulties, problems talking on the telephone, and physical appearance were negatively associated with returning to work.

Conclusions: The large number of individuals returning to work is encouraging for patients diagnosed with oropharyngeal cancer.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2020
Nyckelord
head and neck cancer, oropharyngeal cancer, quality of life, return to work, side effects
Nationell ämneskategori
Oto-rino-laryngologi
Identifikatorer
urn:nbn:se:umu:diva-168892 (URN)10.1002/hed.26123 (DOI)000515220300001 ()32092226 (PubMedID)2-s2.0-85088174470 (Scopus ID)
Anmärkning

On behalf of the Swedish Head and Neck Cancer Register (SweHNCR)

Tillgänglig från: 2020-03-19 Skapad: 2020-03-19 Senast uppdaterad: 2023-04-17Bibliografiskt granskad
3. Addressing symptoms that affect patients’ eating according to the Head and Neck Patient Symptom Checklist©
Öppna denna publikation i ny flik eller fönster >>Addressing symptoms that affect patients’ eating according to the Head and Neck Patient Symptom Checklist©
Visa övriga...
2022 (Engelska)Ingår i: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 30, s. 6163-6173Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: The purpose of this prospective study was to assess which nutritional impact symptoms (NIS) interfere with oral intake in patients with head and neck cancer (HNC) and how the symptoms interfere with body weight loss, up to 1 year after treatment.

Methods: This was a prospective study of 197 patients with HNC planned for treatment with curative intention. Body weight was measured before the start of treatment, at 7 weeks after the start of treatment, and at 6 and 12 months after completion of treatment. NIS and NIS interfering with oral intake at each follow-up were examined with the Head and Neck Patient Symptom Checklist© (HNSC©).

Results: At 7 weeks of follow-up, patients experienced the greatest symptom and interference burden, and 12 months after treatment the NIS scorings had not returned to baseline. One year after treatment, the highest scored NIS to interfere with oral intake was swallowing problems, chewing difficulties, and loss of appetite. At all 3 follow-ups, the total cumulative NIS and NIS interfering with oral intake were associated with body weight loss. Factors increasing the risk for a body weight loss of ≥ 10% at 12 months after treatment were pain, loss of appetite, feeling full, sore mouth, difficulty swallowing, taste changes, and dry mouth. Women scored higher than men in NIS and NIS interfering with oral intake. Furthermore, during the study period about half of the population had a body weight loss > 5%.

Conclusion: Because both nutritional and clinical factors may affect body weight, this study highlights the importance of a holistic approach when addressing the patients’ nutritional issues. Trial registration: ClinicalTrials.gov NCT03343236, date of registration: November 17, 2017.

Ort, förlag, år, upplaga, sidor
Springer-Verlag New York, 2022
Nyckelord
Body weight loss, Head and neck cancer, Head and Neck Patient Symptom Checklist©, Health-related quality of life, Nutritional impact symptoms
Nationell ämneskategori
Cancer och onkologi
Identifikatorer
urn:nbn:se:umu:diva-194350 (URN)10.1007/s00520-022-07038-x (DOI)000782736400001 ()35426524 (PubMedID)2-s2.0-85128213086 (Scopus ID)
Tillgänglig från: 2022-05-03 Skapad: 2022-05-03 Senast uppdaterad: 2022-09-13Bibliografiskt granskad
4. Perceptions of life and reflections of health care support one year after treatment for head and neck cancer
Öppna denna publikation i ny flik eller fönster >>Perceptions of life and reflections of health care support one year after treatment for head and neck cancer
Visa övriga...
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Hälsovetenskaper Cancer och onkologi
Identifikatorer
urn:nbn:se:umu:diva-199313 (URN)
Tillgänglig från: 2022-09-12 Skapad: 2022-09-12 Senast uppdaterad: 2023-04-17

Open Access i DiVA

fulltext(553 kB)173 nedladdningar
Filinformation
Filnamn FULLTEXT01.pdfFilstorlek 553 kBChecksumma SHA-512
5b49776f6fda6339eb2d1082b0beb2dbfb200975e9d040173c936114bc4f5b387d9667ebf208f510daad309ee3c35a1b0bda7518f7c34cb9dd0d1dccc914ef0a
Typ fulltextMimetyp application/pdf
spikblad(104 kB)72 nedladdningar
Filinformation
Filnamn SPIKBLAD01.pdfFilstorlek 104 kBChecksumma SHA-512
6f4fe392d5f8f3e1bf514ed0359e340116e231e0f036a3b669f3a368ef797ec368f3d863b2ed0ccf629825441a5fda47a748ac6054a2b5907dc735c35d96dda0
Typ spikbladMimetyp application/pdf

Person

Granström, Brith

Sök vidare i DiVA

Av författaren/redaktören
Granström, Brith
Av organisationen
Öron- näs- och halssjukdomar
Cancer och onkologiOto-rino-laryngologi

Sök vidare utanför DiVA

GoogleGoogle Scholar
Totalt: 173 nedladdningar
Antalet nedladdningar är summan av nedladdningar för alla fulltexter. Det kan inkludera t.ex tidigare versioner som nu inte längre är tillgängliga.

isbn
urn-nbn

Altmetricpoäng

isbn
urn-nbn
Totalt: 467 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf