| ObjectivesThis study aimed to investigate the current status of demoralization and posttraumatic growth(PTG)among individuals with head and neck cancer(HNC)and identify the relevant factors contributing to these outcomes.In addition,we aimed to examine the roles of internal and external resources(psychological resilience and social support)and symptom burden in patients’ stress levels,with the goal of providing healthcare professionals with evidence-based information for assessing the psychological outcomes of HNC patients and developing individualized care plans.MethodsThis study employed a cross-sectional research design and conducted survey evaluations on patients with HNC who sought treatment the radiation and chemotherapy department,otolaryngology department,head and neck surgery department,and oncology department of three tertiary hospitals in Lanzhou City from December 2021 to November 2022.Convenience sampling was used to select the participants.The research tools used in this study included a general information and disease information questionnaire,the MD Anderson Symptom Inventory(MDASI),the 10-item Connor-Davidson Resilience Scale(CD-RISC-10),the Perceived Social Support Scale(PSSS),the Short Demoralization Scale(DS-II),and the ChinesePosttraumatic Growth Inventory(C-PTGI).Data analysis was performed using SPSS26.0 and AMOS 28.0 software.The Wilcoxon rank sum test,Kruskal Wallis rank sum test,and univariate linear regression analysis were used to investigate the factors influencing the resilience and PTG of HNC patients and the differences in symptom burden levels between patients.Multiple linear regression analysis was used to evaluate the comprehensive effects of symptom burden,psychological resilience,and social support on patients’ resilience and PTG.Spearman correlation analysis and structural equation modeling were used to examine the correlations between variables and potential mediating links.Results1.General information and disease profile of HNC patientsThis study collected data from a total of 412 patients diagnosed with HNC.The average age of the patients was 48.66±12.16 years,with the majority being female(67.23% or 277 cases).Most patients lived in urban areas(73.30%),and only a small proportion lived alone(6.31%).Unmarried patients accounted for only 5.10%,and the vast majority of patients had children(93.45%).The overall educational level of patients was relatively high,with 69.18% of patients having an education level of technical secondary school/high school or above.Only 48.79% of patients were employed,with 70.63% of patients having an income of less than 5000 yuan.The vast majority of patients had medical insurance coverage(93.93%).Spouses were the main caregivers for patients(64.08%).Thyroid cancer was the most common type of cancer among head and neck cancer patients,accounting for 77.91%.More than half of the patients surveyed had been diagnosed for more than one year(56.06%).10.44% of patients experienced tumor metastasis,while 85.44% of patients received only surgery as a treatment.24.51% of patients had complications or comorbidities.2.The symptom burden,psychological resilience,social support,demoralization,and PTG status of patients with HNC.The study found that the symptom burden was moderate for patients with HNC,with a median score of 47 points and an average item score of 2.71±1.54.The average score of psychological resilience was 26.99±7.98,indicating a moderate level of resilience,with an average item score of 2.70±0.80.The average score of social support was 61.17±14.21,and “family support” was the most commonly reported type of support,followed by “other support” and “friend support”.The median score of demoralization was 11.00 points,with two dimensions,“meaning and purpose”,and“pain and coping ability”,having median scores of 4.00 points and 7.00 points,respectively.Additionally,more than half of the patients experienced moderate to severe demoralization.The median score of PTG was 61.50 points,with the lowest average score in the dimension of new possibilities and the highest in personal strength.3.Comparison of symptom burden levels among different types of HNC patientsAmong the patients with HNC who were interviewed,those with thyroid cancer had the greatest variation in symptom burden.On the other hand,salivary gland cancer patients had a lower overall burden of symptoms.Patients with nasal and paranasal sinus cancer had a higher overall symptom burden compared to those with thyroid and parathyroid cancer(P<0.01),oral cancer(P<0.01),and salivary gland cancer(P<0.01).4.Analysis of factors influencing the demoralization in HNC patientsThe findings of the univariate analysis indicated that several factors,including place of residence,living status,work situation,medical payment methods,disease classification,and comorbidities,impacted the demoralization level in patients with HNC.Additionally,the results of the univariate regression analysis revealed that symptom burden had a positive predictive effect on demoralization(β=0.497,P<0.001).In contrast,psychological resilience(β=-0.566,P<0.001)and social support(β=-0.429,P<0.001)were both negative predictive factors.According to the results of the hierarchical linear regression analysis,the risk of demoralization was higher among patients who lived alone(β=-0.077,P<0.05).The level of demoralization was lower among employed(β=-0.330,P<0.01),retired(β=-0.257,P<0.01),and jobless patients(β=-0.209,P<0.05)compared to those who were unemployed.Furthermore,the level of demoralization was higher among patients with oral cancer(β=-0.148,P<0.05)and nasopharyngeal and nasal sinus cancer(β=-0.170,P<0.01)compared to those with salivary gland cancer.There was a positive correlation between the level of demoralization and symptom burden among patients with HNC(β=0.277,P<0.001).In contrast,a negative correlation was found between demoralization and psychological resilience(β=-0.352,P<0.001)as well as social support(β=-0.196,P<0.001).5.Analysis of factors influencing PTG level in HNC patientsThe findings of the univariate analysis suggested that the place of residence,disease classification,and treatment method impacted the level of PTG in patients with HNC.Further analysis through single factor regression revealed that symptom burden negatively predicted PTG level(β=-0.305,P<0.001),while psychological resilience(β=0.739,P<0.001)and social support(β=0.599,P<0.001)positively predicted PTG level.Stratified linear regression analysis,after adjustment,demonstrated that psychological resilience(β=0.576,P<0.001)and social support(β=0.296,P<0.001)were positively correlated with the PTG level in patients with HNC.However,there was no statistically significant difference in the impact of symptom burden and other factors on PTG levels in patients with HNC.6.The impact of psychological resilience and social support on demoralization,PTG among patients with HNC.The findings of the structural equation model revealed that psychological resilience significantly predicted lower levels of demoralization(β=-0.405,P<0.001)and symptom burden(β=-0.367,P<0.001)among HNC while also positively correlating with higher levels of PTG(β=0.717,P<0.001).Furthermore,symptom burden partially mediated the relationship between psychological resilience and demoralization in these patients.Moreover,social support was a significant predictor of higher levels of PTG(β=0.289,P<0.001)and lower levels of demoralization(β=-0.176,P<0.001)in these patients.However,the mediating effect of symptom burden did not reach statistical significance.Conclusion1.HNC patients tended to experience high levels of demoralization,with over half of them classified as having moderate to severe levels.Additionally,their PTG level also needed to be improved.2.A supportive living environment,stable employment,minimal symptom burden,and strong psychological resilience and social support were crucial factors in preventing the development of demoralization in HNC patients.Patients with robust psychological resilience and social support were more likely to experience higher levels of PTG.3.Psychological resilience and social support have a positive impact on the level of PTG and a negative impact on the level of demoralization among HNC patients.Additionally,symptom burden partially mediated the relationship between psychological resilience and demoralization in these patients. |
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