Physical and psychosocial correlates of head and neck cancer: a review of the literature.

This article reviews recent literature on the physical and psychosocial correlates of head and neck cancer, with a focus on quality-of-life issues, rehabilitation outcomes, and changes in the literature from the previous decade. These studies have shown that head and neck cancer has an enormous impact on the quality of life of patients. The most important physical symptoms are speech problems, dry mouth and throat, and swallowing problems. Pain is also frequently reported. Disturbances in psychosocial functioning and psychological distress are reported by a considerable number of patients; worry, anxiety, mood disorder, fatigue, and depression are the main symptoms. Cancer of the head and neck has a negative effect on social, recreational, and sexual functioning. Despite a growing number of longitudinal studies, little is known about the rehabilitation outcomes over a longer period of time. Future research is necessary to form a consensus about the further development and use of specific instruments to study patients with cancer of the head and neck, to conduct more prospective studies, and to develop programs that are aimed at maximizing rehabilitation outcomes and evaluate these programs with randomized designs.

Psychosocial correlates of cancer relapse and survival: a literature review.

This article reviews literature on the psychosocial correlates of cancer relapse and survival from 1979 through 1995. The factors studied were structured according to a theoretical model of coping with cancer. Reviewed studies have shown that factors most frequently evaluated were depression, anxiety, hopelessness/helplessness, hostility, marital status and social involvement. Mainly inconsistent results were found. The strongest evidence for a relationship between psychosocial variables and prognosis was found for social involvement/social support; in 7 of 15 studies a positive relationship was demonstrated, while no negative associations were found. Coping styles e.g., fighting spirit and stoic acceptance, and severe/stressful life events were found to have no conclusive influence on the length of survival. Important determinants of the coping model, such as uncertainty and information given by the specialist were not studied as possible predictors of survival and/or relapse free period. Among the factors that showed no correlation at all was multidimensional health locus of control. For the inconsistent findings, a considerable number of methodologic shortcomings with respect to study design, sample size, measure and statistical analysis are enumerated.

Assessments of trust in intimate relationships and the self-perception process.

Assessments of trust in intimate relationships are often based on perceptions of a partner's behaviors; however, people's own actions, increased self-awareness, and individual differences (e.g., exchange or communal orientation) may also affect their trust in their partners. Communally or exchange-oriented members of heterosexual dating couples, students in a U.S. university, displayed either trusting or irrelevant behaviors under conditions of increased self-awareness. They then completed measures of interpersonal trust. The participants' trusting behaviors significantly determined their level of trust; heightened self-awareness and a communal orientation further enhanced the participants' trust in their partners.

Psychosocial and physical correlates of survival and recurrence in patients with head and neck carcinoma: results of a 6-year longitudinal study.

BACKGROUND: Studies that have examined correlations between psychosocial factors and survival in cancer patients do not permit any definitive conclusions. To the authors' knowledge, to date no study has examined the relation between medical as well as quality of life variables and survival in head and neck carcinoma patients. The current study focused on the complex interactions among psychosocial, medical, behavioral, and demographic variables as they relate to prognosis in these patients. METHODS: A total of 133 consecutive head and neck carcinoma patients were included in a prospective study at pretreatment. In addition to clinical variables, psychosocial and physical functioning was assessed by means of a self-report questionnaire. RESULTS: During the observation period 57 patients died whereas 76 were still alive at 6 years after treatment. Results of the multivariate survival analysis indicated that patients without head and neck metastasis had a better prognosis than patients with positive cervical lymph nodes. Pretreatment smoking showed a negative correlation with overall survival. Patients who were more physically self-efficacious (i.e., higher perceived physical abilities) were more likely to survive and less likely to develop a recurrence. In addition, patients who expressed intense psychosocial complaints prior to treatment had a better prognosis than had those who did not express such negative feelings. CONCLUSIONS: The current findings linking physical self-efficacy and prognosis are promising, but clinical trials are necessary to examine the direct and indirect mediational pathways of the variables that underlie physical efficacy and influence survival and recurrence. Also, the negative correlation between pretreatment smoking and survival suggests a need for increased efforts to address smoking in newly diagnosed patients.

Values of hypercompetitive and personal development competitive individuals.

The value systems of hypercompetitive and personal development competitive individuals were examined in a sample of university undergraduates. As expected, people higher in hypercompetitiveness and in personal development competitiveness were both more likely to endorse values related to self-contained individualism such as achievement, hedonism, and a striving for an exciting and challenging life, but only hypercompetitives endorsed the value of power and control over others. Moreover, the data indicated that people higher in personal development competitiveness were more prone to endorse values related to ensembled individualism. In particular, they strongly endorsed values associated with social concern, that is, with caring about the well-being of others and with treating them with respect and as equals, whereas hypercompetitives expressed a lack of such concern. Discussion centered on the socialization process and how it can foster the development of different competitive orientations.

Construction of a personal development competitive attitude scale.

Theory development and research in the area of psychologically healthy competition has been impeded by the lack of a psychometrically sound instrument. Four studies were conducted as part of a research program designed to remedy this deficiency by constructing an individual difference measure of general personal development competitive attitude with satisfactory psychometric properties. In Studies 1 and 2, a 15-item scale was derived primarily through item-total correlational analysis; it demonstrated satisfactory internal and test-retest reliabilities. Studies 3 and 4 were concerned with establishing the construct validity of the scale. Both Studies 3 and 4 showed the scale's discriminant validity through its lack of association with hypercompetitiveness. In addition, its construct validity was seen in its negative association with neurosis and its positive links with personal and social self-esteem and optimal psychological health. Also, as expected, personal development competitiveness was positively correlated with needs for affiliation, whereas hypercompetitiveness was unrelated to affiliation needs. Although hypercompetitive individuals were more aggressive, dominant, and exhibitionistic, this was not the case for personal development competitors.

Rehabilitation outcomes of long-term survivors treated for head and neck cancer.

BACKGROUND: Little is known about the rehabilitation outcomes of long-term survivors following treatment for head and neck cancer. There are, for example, no studies on physical and psychosocial rehabilitation outcomes of T1 glottic larynx carcinoma, despite the fact that these form the majority of head and neck cancer sites. Thus, this investigation afforded a unique opportunity for examining similarities and differences among T1 glottic larynx patients, laryngectomy patients, and those who had surgery for cancer of the oral cavity and/or oropharynx along a variety of physical and psychosocial dimensions. METHODS: To describe the impact of these three types of head and neck cancer and their treatment on the physical and psychosocial functioning of long-term survivors, a self-report questionnaire was completed by 110 patients treated between 2 and 6 years previously in a major cancer center. RESULTS: Data indicate that a higher percentage of patients treated with laryngectomy or commando procedures still experience severe psychosocial distress between 2 and 6 years after their last treatment than do patients treated with radiotherapy for a T1 carcinoma of the glottic larynx. Psychosocial and physical complaints are still reported by many laryngectomy patients, apparently the result of problems in effective communication with others. Many commando procedure patients experience problems with respect to food intake, and with disfigurement and its consequences. T1 larynx patients mainly experience a considerable number of physical complaints. The greater the time that had elapsed since treatment, the fewer the psychosocial problems associated with head and neck tumors. Open discussion of the illness in the family, social support, and perceptions of adequate information from the specialist are the most important predictors of positive rehabilitation outcomes. CONCLUSIONS: This study indicates that T1 larynx patients report many physical complaints even though several years had elapsed since treatment. Also, laryngectomy patients may need psychosocial guidance for a longer posttreatment period and that health care personnel must involve the partner as much as possible in all communications. Commando procedure patients in particular feel hindered by their disfigurement and its consequences. Future research with respect to validation of the specific head and neck modules is needed.

Personality correlates of the Hypercompetitive Attitude Scale: validity tests of Horney's theory of neurosis.

This study focused on assessing the concurrent validity of Horney's ideas about the personalities of hypercompetitive individuals based on her theory of neurosis. One hundred and sixty university men and women provided data by responding to a test battery of personality inventories containing measures of hypercompetitive attitudes and several theoretically relevant constructs. The results strongly support Horney's contentions. Stepwise multiple regression analysis indicated that hypercompetitive individuals were high in narcissism, Type E orientation, and several aspects of sensation seeking. The discussion centered on hypercompetitiveness as a mental health problem in American society and on the scale's utility in the diagnosis of the problem and in the assessment of therapeutic change in clients.

Assessment of the full content of physique stereotypes with a free-response format.

A major limitation of physique stereotyping research is that American subjects have used a restricted set of traits provided by the experimenter to evaluate endomorphs, mesomorphs, and ectomorphs. A free-response procedure was used in Study 1 to identify the full domain of traits associated with each physique. Although many of the traits identified were similar to those used in previous research, a number of new trait dimensions were uncovered. In Study 2, the large number of traits generated with the free-response format was reduced by combining synonyms. This new set of traits was placed in semantic differential format and given to a new sample of subjects to evaluate. The results paralleled those of the first study with the exception that ectomorphs were seen more favorably. This discrepancy, as well as the fact that raters listed trait antonyms within each of the three major physiques in Study 1, suggests the possibility of unique subtypes within the global stereotypes. Examples of these subtypes are proposed.

Social perceptions of male and female extreme mesomorphs.

In this study, male and female university students in the United States were exposed to mesomorphic or nonmesomorphic stimuli as reflected by photographs of either male body builders and non-body builders or female body builders and non-body builders. Then they were asked to attribute various personality traits and sex-role behaviors to them. Subjects, irrespective of their sex, perceived male and female body builders as possessing more traditionally masculine and less traditionally feminine personality characteristics than male and female non-body builders. Also, male and female body builders were seen as possessing less socially desirable traits than non-body builders. As predicted, female body builders were perceived generally as being more likely to engage in traditionally masculine sex-role behaviors in their dating and marriage relationships than female non-body builders. Contrary to expectation, however, male body builders were not perceived as more likely to engage in higher levels of masculine sex-role behaviors than male non-body builders.

Relationship between physical attractiveness, physical effectiveness, and self-esteem: a cross-sectional analysis among adolescents.

In the present study, the relative contributions of physical attractiveness and physical effectiveness to the self-esteem were examined among four different grade-levels of adolescents (mean ages; 12.5, 14.6, 16.3, 18.3 years old). Overall, both attractiveness and effectiveness were significantly related to the self-esteem of males and females. In contrast to previous research, attractiveness and effectiveness did not appear to be differentially important to the self-esteem of males and females and consistent patterns were evident across the different grade-levels. These results are believed to reflect changes occurring in sex-role expectations and socialization.

Judging speech communication effectiveness in oral cancer patients.

An experiment was conducted to assess the effects of different types of sentences and recording methods on naive judges' evaluations of the speech communication effectiveness of four patients who had undergone surgery for oral cancer. As expected, judges understood patients better if they read meaningful rather than meaningless sentences and if their speech was evaluated under video rather than audio conditions. However, these general findings were qualified because of the powerful influence of individual differences among patients. For example, whereas the intelligibility of three of the patients increased under the audio condition if the sentences being read were meaningful, one patient was poorly understood no matter what type of sentence he read under the same condition. The results suggested that the identification of the unique personality characteristics of patients that are related to their intelligibility merits serious consideration by both researchers and rehabilitation clinicians.

Psychosocial aspects of head and neck cancer--a review of the literature.

This study is a systematic analysis of the literature on psychosocial aspects in head and neck cancer patients. Patients with head and neck cancer experience a variety of physical as well as psychosocial problems. Physical problems include swallowing or chewing, speech and physical appearance. Psychosocial problems include anxiety, depression, loss of self-esteem and uncertainty about the future. Because of these problems, isolation from friends typically occurs, re-employment is difficult, and there are social and sexual tensions within families. Information and support by professionals, partners and/or fellow patients are related to positive rehabilitation outcomes such as the acquisition of speech, increases in constructive social functioning and decreases in depression.