[Psychological aspects of treatment of patients with head and neck cancer]. / Psychologiczne aspekty leczenia chorych z nowotworami glowy i szyi.

One of the basic components that describe treatment success in contemporary oncology is patients' quality of life (QL) depending on specificity of the disease, treatment method, side effect of treatment, the medical prognosis and patient expectations. In reality, the QL is determined by the difference between patients' expectations and the actual health condition. The bigger the difference, the worse the evaluation of QL. Solving the crises, stress situation and starting life in a new way are strictly connected with the reshaping of personality and formation of adequate skills. It means it is necessary to create a new "picture of oneself", "self image" appropriate to the actual health condition and find the optimum way of activating personality protecting system (defence mechanisms). This task is not easy to realise; it is often necessary to introduce the psychotherapy to make it work. The main aim of defence mechanisms is the reduction of fear and other negative emotions, typical for oncological patients. However, the immature and poor defence system of "ego" can, at the same time, protect the personality unity and result in harmful behaviours. But when the "new self image" is made real, the newly learnt personality defence mechanisms are more mature, the patient becomes able to fight with the disease, is able to face the reality, which constitutes the main factor in the increase of QL assessment. To estimate the influence of psychotherapy on QL of head and neck cancer patients we have planned the introduction of psychological intervention (meetings of therapeutic groups).

[The quality of life in head and neck cancer patients: description of randomized examination formula based on standardized questionnaires EORTC QLQ C-30, EORTC QTQ-H-N35 and Kiel Questionnaire]. / Jakosc zycia u chorych z nowotworami glowy i szyi--wstep do randomizowanych badan opartych na standaryzowanych kwestionariuszach EORTC QLQ C-30, EORTC QLQ-H&N35 i Kwestionariuszu Kilonskim.

The notion of quality of life (QL) was first introduced in the US in the 50-ies. This notion is much broader then health, it is a personal, subjective feeling of well-being that comes from actual, widely-meant life experiences. The QL is not a measurable value, however, it may be assessed by means of appropriate indices. In the contemporary holistic attitude to a patient, in modern oncology, QL has become a parameter of equal importance to other values characterizing the treatment success, as important as numbers describing e.g. mean survival, disease free survival, or neoplasm controlled survival. Head and neck neoplasms bring about deterioration of the basic functions of the organism such as: breathing, swallowing, speaking and senses: hearing, taste and smell. Application of treatment may intensify pain, dyspnea, hoarseness or cause any kind of discomfort. It influences directly the patients' family and social life. Comparison of QL of patients treated for larynx, tongue, tonsill, glands, and paranasal sinuses neoplasms depending on localisation of primary foci, advancement of the disease, the applied treatment and its radicality, age, sex, place of living (town/country), and educational level. Correlation between the subjectively assessed QL and the objectively evaluated condition of the patient is measured. In ENT Dept. K. Marcinkowski University of Medical Sciences 46 patients were examined from May to September 2000. EORTC QLQ C-30, EORTC QLQ-Head and Neck and HAD scale were used. Kiel Questionnaire was introduced in September. The main reason for introducing it was the fact, that surgery is the method of choice in the treatment of head and neck malignancies in our Dept. The team composed of a psychologist and an ENT doctor has been working together on objective assessment of each patient. The QL assessment may be of practical importance when trying to improve the model of health care in cases of oncological patients. This knowledge enables us to learn how the accompanying side effects of therapy influence the QL of our patients, and how these problems may be overcome by proper education, advice, and support provided by the qualified staff. The authors are evaluating the QL in the period of 2, 6 months and 1 year after surgery in patients not supported psychologically. Our goal, in the future, is to introduce the psychological treatment, i.e. repetitive meetings in small groups, conducted by a psychologist. We have contacted 4 major ENT centers in Poland in order to coordinate the research on detailed assessment of QL in Head and Neck Cancer Patients in Poland. The results will be presented in the further publications.