Factors associated with shame and stigma among head and neck cancer patients: a cross-sectional study.

PURPOSE: Head and neck cancer (HNC) patients often suffer from shame and stigma due to treatment limitations or due to societal factors. The purpose of this study was to assess perceived body image, depression, physical and psychosocial function, and self-stigma, as well as to identify factors that predicted shame and stigma in patients with HNC. METHODS: This cross-sectional study recruited 178 HNC patients from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed for patient reported outcomes using the Body Image Scale (BIS), the Hospital Anxiety and Depression Scale-Depression Subscale (HADS-Depression Subscale), the University of Washington Quality of Life Scale (UW-QOL) version 4.0, and the Shame and Stigma Scale (SSS). Data were analyzed by descriptive analysis, Pearson's product-moment correlation, and multiple regression. RESULTS: The two top-ranked subscales of shame and stigma were: "speech and social concerns" and "regret". Shame and stigma were positively correlated with a longer time since completion of treatment, more body image concerns, and higher levels of depression. They were negatively correlated with being male and having lower physical function. Multiple regression analysis showed that female gender, a longer time since completing treatment, higher levels of body image concern, greater depression, and less physical function predicted greater shame and stigma. These factors explained 74.7% of the variance in shame and stigma. CONCLUSION: Patients' body image concerns, depression, time since completing treatment, and physical function are associated with shame and stigma. Oncology nurses should assess and record psychological status, provide available resources, and refer appropriate HNC patients to counselling.

Dose-response association of metformin use and risk of age-related macular degeneration among patients with type 2 diabetes mellitus: a population-based study.

Background: Recent studies have demonstrated that patients with type 2 diabetes mellitus (T2DM) who receive metformin have a decreased risk of developing age-related macular degeneration (AMD). However, other studies have also suggested that metformin may increase the risk of AMD development. Therefore, this study investigated the association between treatment with metformin and the risk of AMD in patients with T2DM by using Taiwan' National Health Insurance Research Database. Methods: Patients who received a diagnosis of new-onset T2DM between 2002 and 2013 were enrolled in this study. The patients were divided into patients treated and not treated with metformin to evaluate the risk of AMD after 5 years of follow-up. The logistic regression was used to estimate the risk of AMD associated with the intensity of treatment with metformin. Result: A total of 7 517 patients (103.16 patients per 10,000 people) developed AMD in 5 years after DM diagnosis. After adjusting for the relevant variables, patients with T2DM treated with <5 defined daily dose (DDD)/month of metformin had a lower risk of AMD (odds ratios [OR]: 0.93; 95% confidence interval [CI]: 0.88 0.99). Patients treated with >25 DDD/month of metformin had a higher risk of AMD (OR: 1.39; 95% CI: 1.08-1.78). Conclusion: Metformin use may be associated with a risk of AMD among patients with T2DM in a dose-dependent association manner, with the greater benefit at lower DDD/month. However, higher DDD/month exhibited an increased risk of AMD.

Effects of a return to work program on the health and barriers to returning to work in head and neck cancer patients: A randomized controlled trial.

Objective: The aim of the study was to evaluate the effects of a return to work (RTW) program on perceived health status, barriers to returning to work, fear of cancer progression, social support, physical function, and psychosocial function in head and neck cancer (HNC) patients. Methods: A randomized controlled trial with repeated measures was conducted. The 70 HNC patients were randomly assigned into two groups: 35 in the experimental group (RTW) and 35 in the control group (usual care). Patients were assessed at four time points: baseline (T0) (6 months after completing treatment), and then at 9-, 12-, and 15-months (T1, T2, and T3, respectively) after completing treatment. Patients completed a self-reported questionnaire, including measures of perceived health status, barriers to returning to work, fear of cancer progression, social support, physical function, and psychosocial function. Results: Patients in the experimental group had significantly greater perceived health status and better psychosocial function compared to those in the control group. Compared to T0, at T4, participants in both groups had significantly lower levels of barriers to returning to work, fear of cancer progression, social support, and higher levels of physical function. Conclusions: The RTW program effectively improved perceived health status and psychosocial function in HNC patients. Survivorship care should include a transitional return-to-work program to help patients transition back to work. Trial registration: NCT04322695.

The HSP40 family chaperone isoform DNAJB6b prevents neuronal cells from tau aggregation.

BACKGROUND: Alzheimer's disease (AD) is the most common neurodegenerative disorder with clinical presentations of progressive cognitive and memory deterioration. The pathologic hallmarks of AD include tau neurofibrillary tangles and amyloid plaque depositions in the hippocampus and associated neocortex. The neuronal aggregated tau observed in AD cells suggests that the protein folding problem is a major cause of AD. J-domain-containing proteins (JDPs) are the largest family of cochaperones, which play a vital role in specifying and directing HSP70 chaperone functions. JDPs bind substrates and deliver them to HSP70. The association of JDP and HSP70 opens the substrate-binding domain of HSP70 to help the loading of the clients. However, in the initial HSP70 cycle, which JDP delivers tau to the HSP70 system in neuronal cells remains unclear. RESULTS: We screened the requirement of a diverse panel of JDPs for preventing tau aggregation in the human neuroblastoma cell line SH-SY5Y by a filter retardation method. Interestingly, knockdown of DNAJB6, one of the JDPs, displayed tau aggregation and overexpression of DNAJB6b, one of the isoforms generated from the DNAJB6 gene by alternative splicing, reduced tau aggregation. Further, the tau bimolecular fluorescence complementation assay confirmed the DNAJB6b-dependent tau clearance. The co-immunoprecipitation and the proximity ligation assay demonstrated the protein-protein interaction between tau and the chaperone-cochaperone complex. The J-domain of DNAJB6b was critical for preventing tau aggregation. Moreover, reduced DNAJB6 expression and increased tau aggregation were detected in an age-dependent manner in immunohistochemical analysis of the hippocampus tissues of a mouse model of tau pathology. CONCLUSIONS: In summary, downregulation of DNAJB6b increases the insoluble form of tau, while overexpression of DNAJB6b reduces tau aggregation. Moreover, DNAJB6b associates with tau. Therefore, this study reveals that DNAJB6b is a direct sensor for its client tau in the HSP70 folding system in neuronal cells, thus helping to prevent AD.

Effects of a Nurse-led Survivorship Care Program on the Health and Resilience of Primary Caregivers of Patients With Advanced Head and Neck Cancer: A Randomized Controlled Trial.

OBJECTIVES: The present study aimed to evaluate the effects of a nurse-led survivorship care program (SCP) on emotional distress, social support, physical health, mental health, and resilience in primary caregivers of patients with advanced head and neck cancer. DATA SOURCES: A randomized controlled trial was conducted. One hundred patient-primary caregiver dyads were randomized into the nurse-led SCP group (experimental) or the usual care group (control). Participants completed a self-reported questionnaire, including measures of emotional distress, social support, physical health, mental health, and resilience. After 6 months, the experimental group reported a significant improvement in emotional distress, social support, physical health, mental health, and resilience. Compared with the control group, measures of emotional distress, physical health, overall resilience, and the resilience aspects of equanimity and perseverance improved in the experimental group. CONCLUSION: An SCP may feasibly help alleviate emotional distress, improve social support, increase physical and mental health, and strengthen resilience in the primary caregivers of patients with head and neck cancer. Health care providers should encourage primary caregivers to join an SCP. IMPLICATIONS FOR NURSING PRACTICE: The nurse-led SCP can be applied before patients complete treatment, which may increase the positive effect on physical health and adaptation.

PbABCG1 and PbABCG2 transporters are required for the emission of floral monoterpenes in Phalaenopsis bellina.

Terrestrial plants emit volatiles into the atmosphere to attract both pollinators and the enemies of herbivores, for defense. Phalaenopsis bellina is a scented orchid species in which the main scent components are monoterpenes, including linalool and geraniol, and their derivatives. Here, we investigated whether ABC transporters are involved in floral scent emission. We carried out whole-genome identification of ABC transporter-related genes using four floral transcriptomics libraries of P. bellina. We identified 86 ABC subfamily G genes related to terpenoid transport. After comparing the gene expression patterns of P. bellina with that of Phalaenopsis aphrodite subsp. formosana, a scentless species, followed by gene-to-gene correlation analysis, PbABCG1 and PbABCG2 were selected. The temporal expression of both PbABCG1 and PbABCG2 was highly correlated with that of the key enzyme PbGDPS and the major transcription factor PbbHLH4 in monoterpene biosynthesis, with optimal expression on day 5 post-anthesis. Spatial gene expression analysis showed that PbABCG1 was highly expressed in sepals, whereas PbABCG2 was expressed in the lip. Subcellular localization with a GFP fusion protein revealed that both PbABCG1 and PbABCG2 are cytoplasmic membrane proteins. Co-downregulation of PbABCG1 and PbABCG2 using both double-strand RNA interference and tobacco rattle virus-based gene silencing led to a significant decrease in monoterpene emission, accompanied by an increase in the internal monoterpene pools. Furthermore, ectopic expression of PbABCG1 and PbABCG2 in an ABC16- mutant yeast strain rescued its tolerance to geraniol. Altogether, our results indicate that PbABCG1 and PbABCG2 play substantial roles in monoterpene transport/emission in P. bellina floral scent.

Factors Facilitating or Creating Barriers to Returning to Work in Head and Neck Cancer Patients Within the First 6 Months After Treatment.

Head and neck cancer (HNC) patients who are unable to return to work after completing treatment might face financial loss and reduced self-esteem. The aim of this study was to identify factors influencing a return to work in HNC cancer patients in the first 6 months after treatment. This cross-sectional study examined HNC patients who completed treatment from the outpatient radiation department of a single cancer center in northern Taiwan. Patients were assessed according to psychological distress, patient-perceived health status, barriers to returning to work, and facilitators of returning to work. Of the 106 HNC patients surveyed, 54.7% successfully returned to work. Barriers to returning to work included poor self-perception of health, greater psychological distress, and age ≥50 years. Patients who had higher psychological distress, returned to work after start of the pandemic, or received reconstruction surgery were less likely to experience a positive environment facilitating a return to work.

Dose-Response Association of Metformin with Parkinson's Disease Odds in Type 2 Diabetes Mellitus.

Background. Studies have demonstrated that patients with diabetes mellitus who receive metformin have a lower risk of developing Parkinson's disease (PD). However, studies have also suggested that metformin may increase the risk of PD. In this study, we investigated whether metformin use was associated with the risk of PD in type 2 diabetes mellitus (T2DM). Methods. In this population-based cross-sectional study, patients with T2DM diagnosed between 2001 and 2018 were enrolled. We categorized these patients as metformin users or nonusers. Participants below 50 years old were excluded. Two models were employed to evaluate the associations of metformin exposure and use intensity with PD after 3 and 5 years of follow-up. Results. Patients with T2DM who received <300 cumulative defined daily doses (cDDD) of metformin and those with metformin use intensity of <10 DDD/month had respective odds ratios (ORs) for PD of 0.88 (95% confidence interval [CI] = 0.83−0.94) and 0.87 (95% CI = 0.81−0.93) in a 3-year follow-up. In a 5-year follow-up, such patients had respective ORs for PD of 0.94 (95% CI = 0.90−0.98) and 0.93 (95% CI = 0.89−0.98). Patients with T2DM who received ≥300 cDDD of metformin or used metformin with intensity of ≥10 DDD/month experienced no neuroprotective effects after 3 or 5 years. Conclusions. Metformin was associated with PD odds in T2DM in a dose−response association manner. Patients who received low dosage and intensity of metformin use were associated with lower odds of PD, while higher dosage and intensity of metformin use had no neuroprotective effect.

Factors influencing family function in spousal caregivers of head and neck cancer patients within 6 months posttreatment.

PURPOSE: Spousal caregiving of head and neck cancer (HNC) patients challenges relationship quality and may negatively impact family function. Our purpose was to identify factors associated with family dysfunction in spousal caregivers (SCs) of HNC patients within the first 6 months after treatment. We explored whether patient or SC characteristics differ by level of family dysfunction. METHODS: We conducted a cross-sectional study of HNC patient-SC dyads in Taiwan from July 2020 to January 2022 using patient-reported outcomes. Patients were assessed using a set of structured questionnaires to measure performance status, demographic and clinical characteristics, physical function, and social-emotional function. SCs were measured on their hardiness, coping styles, spousal relationship, quality of life, and family function. RESULTS: Of the 132 dyads surveyed, 62.1% of SCs reported a functional family, 34.8% reported a moderately dysfunctional family, and 3.0% reported a highly dysfunctional family. Patient factors associated with family dysfunction (highly dysfunctional or moderately dysfunctional) included lower family annual income and worse social-emotional function. Associated SC factors were lower hardiness, less use of active coping, and worse spousal relationships. CONCLUSIONS: Lower family annual income, less patient social-emotional function, less SC hardiness, less SC active coping, and worse SC perceived spousal relationship were associated with perceived family dysfunction. Providing patient-SC dyads with sufficient social resources and problem-solving training may help them positively cope with cancer and enhance family function.

Factors impacting posttraumatic growth in head-and-neck cancer patients with oncologic emergencies.

PURPOSE: To identify factors associated with posttraumatic growth (PTG) of head-and-neck cancer squamous cancer (HNC) patients with oncologic emergencies (OE) within the first six months post-treatment. METHODS: We conducted a cross-sectional study of HNC patients in Taiwan from May 2019 to April 2021 using patient-reported outcomes. Patients were assessed for symptom distress, anxiety, fear of recurrence (FCR), and PTG. Multiple regression analysis was conducted to identify factors associated with PTG. The independent-samples t-test was used to compare PTG and its five specific domains in patients with low FCR, high FCR, low anxiety, and high anxiety. RESULTS: Of the 114 patients surveyed, 46.5% reported little-to-no PTG, and 53.5% had moderate-to-high PTG. Greater PTG was associated with greater FCR, longer time since OE, less anxiety, having a cancer recurrence, and greater educational attainment. These factors explained 38.6% of the variance in PTG. CONCLUSION: A notable proportion of HNC patients with OE-reported PTG but almost half-reported little-to-no PTG. PTG occurred most in the domain of appreciation of life. The study results also suggest that training patients in coping skills and inviting them to group growth experiences can help them increase PTG and cope with cancer-related psychological threats related to OE.

Risk of Non-Hodgkin Lymphoma among Patients with Hepatitis B Virus and Hepatitis C Virus in Taiwan: A Nationwide Cohort Study.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are associated with an increased risk of developing non-Hodgkin lymphoma (NHL); however, adequate data corroborating these associations are lacking. Therefore, a study based on the national database was performed to investigate the correlation between HBV and HCV with NHL in Taiwan. This research was a retrospective cohort study using a nationally representative database established by the Health and Welfare Data Science Center of the Ministry of Health and Welfare, Taiwan. The participants were patients with HBV and HCV, analyzed using the propensity score matching method. The study results indicated that the incidence rate of NHL (0.13%) was significantly higher than that in patients from the general population. After controlling related variables, the hazard ratio (HR) of the incidence of NHL in patients with hepatitis was 2.37 (95% CI, 1.93-2.91). Furthermore, the incidence of NHL in patients with HBV was significantly higher than in patients from the general population (HR, 2.49; 95% CI, 1.94-3.19). The incidence of NHL in patients with HCV was significantly higher than in patients from the general population (HR, 2.36; 95% CI, 1.73-3.22). This study indicated that HBV and HCV significantly increase the risk of NHL.

Comparison of physical and psychosocial function post-treatment among oral cancer patients with low-to-moderate and high nicotine dependence.

PURPOSE: After suddenly stopping smoking after an initial oral cancer (OC) diagnosis, patients may restart smoking and nicotine dependence. This study sought to identify factors associated with high nicotine dependence in OC patients who restarted smoking post-treatment. DESIGN: A cross-sectional study. METHODS: A group of 220 OC patients who restarted smoking post-treatment were recruited from the outpatient radiation department of a single cancer center in northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed for nicotine and smoking dependence, physical activity and function, socio-emotional function, social support, and depression. RESULTS: Among patients who restarted smoking after treatment for OC, 75.9% reported low-to-moderate dependence on smoking, while 24.1% reported high nicotine dependence. Factors associated with high nicotine dependence included higher incidence of smoking per day, greater dependence on smoking, less physical activity per week, and poorer social-emotional function. Those highly dependent on nicotine were younger, unmarried, had less education, and had begun smoking earlier than those with low-to-moderate nicotine dependence. CONCLUSIONS: The amount of smoking per day, greater smoking behavioral dependence, less physical activity per week, and worse social-emotional function affected high nicotine dependence. CLINICAL RELEVANCE: Smoking cessation training and counseling for OC patients may help them better control their use of tobacco after treatment.

Trajectories of resilience and related factors in primary caregivers of patients with advanced head and neck cancer: A longitudinal cohort study.

PURPOSE: Primary caregivers (PC) of patients with advanced head and neck cancer (HNC) report stress during caregiving time post-treatment. We sought to identify the trajectories of resilience from initial completion of treatment to 1-year post-treatment in PC of patients with advanced HNC and to determine the factors associated with trajectories of resilience. DESIGN: In this prospective cohort study with convenience sampling, patient-PC dyads were recruited from a medical center in northern Taiwan between August 2015 and July 2020. METHODS: We recruited 120 patient-PC dyads and followed up at treatment completion and 1, 6, and 12 months post-treatment. Generalized estimating equation analysis was performed to identified factors related to resilience. FINDINGS: PCs' overall resilience increased from initial completion of treatment to peak at 1-year post-treatment. Patient factors associated with greater overall resilience included older age, higher performance status, and shorter time since cancer diagnosis; PC factors included reporting more social support, better physical health, and better mental health. CONCLUSIONS: PC mental health was the most important factor in the resilience trajectory of patients with advanced HNC cancer. CLINICAL RELEVANCE: Quantifying the relevant factors of trajectories of resilience will help to identify vulnerable PCs and guide survivorship care in the early stages of the post-treatment period.

[The Nutritional Assessment and Management of Patients With Gastrointestinal Cancer].

The gastrointestinal dysfunction and nutrient malabsorption associated with gastrointestinal tumors and related treatments may result in malnutrition in gastrointestinal (GI) cancer patients. Malnutrition has been associated with decreased treatment tolerance, poor quality of life, and increased mortality in this patient population. In this article, the relevant literature is reviewed and the factors, assessment tools, and management strategies related to malnutrition are summarized. In clinical care, healthcare providers should conduct early assessments of nutritional status and provide individualization nutritional counselling to promote treatment that effectively prolongs patient survival. This article may be used by nurses as a reference in caring for GI cancer patients.

Body mass index and self-care behaviors related to oral health-related quality of life in patients with oral squamous cell carcinoma within three months posttreatment.

PURPOSE: Oral dysfunction is a common adverse event of treatment and may affect oral health-related quality of life (OHRQoL). This study aimed to identify factors associated with OHRQoL in patients with oral squamous cell carcinoma (OSCC) within the first three months posttreatment. METHODS: This cross-sectional study examined OSCC patients who received treatment from the outpatient radiation department of a single cancer center in northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed using the Self-Care Behaviors Scale (SCB), Oral Health Impact Profile (OHIP), and Karnofsky Performance Status (KPS) questionnaires. RESULTS: Among 148 OSCC patients, 11.5% reported being underweight and 70.3% reported normal weight. The most common self-care factors associated with adverse effects were decreased appetite and fatigue. Psychological disability, functional limitation, and physical pain were the most negative OHRQoL factors. Poor OHRQoL was associated with more severe adverse effects after self-care behaviors, using feeding tubes during treatment, and having BMI less than 25, which together explained 33.5% of the variance in OHRQoL. CONCLUSIONS: The severity of adverse effects after self-care behaviors and using feeding tubes during treatment strongly influenced overall OHRQoL and seven specific dimensions of OHRQoL.

Association between multidisciplinary team care and the completion of treatment for oral squamous cell carcinoma: A cohort population-based study.

OBJECTIVES: This study investigates the relationship between multidisciplinary team care (MDTC) and patient completion of their treatment regimen for oral squamous cell carcinoma (OSCC). METHODS: We conducted a retrospective cohort study in patients diagnosed with OSCC in Taiwan from 1 January 2016 to 30 June 2018 using a linked cancer registry database. RESULTS: Of the 969 OSCC MDTC patients in the study cohort, 6.3% reported incomplete treatment, with 1.3% interrupting ongoing treatment and 5.0% terminating definitive treatment. Patients who had advanced-stage disease, experienced primary cancer recurrence or a secondary cancer, or were treated with surgery combined with chemotherapy, radiotherapy or chemoradiotherapy were more likely to terminate treatment before completion. The major reasons for interruption of ongoing treatment included 'patient or their family considered the patient to be in poor physical condition' and 'difficulty enduring physical discomfort caused by treatment'. The major reason for termination of definitive treatment was 'patient or their families or friends experienced negative treatment effects and worried about the side-effects of treatment'. CONCLUSION: Advanced-stage cancer, recurrence or secondary cancer, and surgery combined with chemotherapy, radiotherapy or chemoradiotherapy negatively affected treatment completion. MDTC allows for shared decision-making to determine the optimal treatment.

Factors Associated With Resilience Among Primary Caregivers of Patients With Advanced Cancer Within the First 6 Months Post-Treatment in Taiwan: A Cross-Sectional Study.

PURPOSE: To identify factors associated with resilience in primary caregivers of patients with advanced oral cavity cancer within the first 6 months post-treatment. DESIGN: A cross-sectional study. METHODS: We recruited patient-primary caregiver dyads from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed using a set of structured questionnaires to measure performance status and demographic and clinical characteristics. Primary caregivers were measured in their social support, resilience, and care characteristics. RESULTS: Of the 148 dyads surveyed, 33.8% of primary caregivers reported moderately low to moderate resilience, and 61.5% reported low resilience. Greater resilience of primary caregivers was associated with the primary caregiver factors of younger age, lower educational level, and more affectionate social support; and greater resilience was associated with the patient factors of better performance status and older age. These factors explained 40.4% of the variance in resilience. CONCLUSIONS: Patients' performance status and primary caregivers' affectionate social support strongly influence overall resilience and each domain of resilience. CLINICAL RELEVANCE: Providing primary caregivers with sufficient social resources and a support group can help them cope with the demands of caregiving for loved ones with oral cavity cancer.

Factors impacting on discordance with treatment plan in head and neck cancer patients: a retrospective, population-based cohort study.

PURPOSE: The aims of this study were to identify the factors and reasons impacting discordance with the treatment plan in head and neck cancer (HNC) patients and compare the differences between the concordance group and the discordance group. METHODS: This secondary analysis was conducted from population-based data from Taiwan collected from January 1, 2016, to June 30, 2018. Logistic regression analysis was used to identify the factors related to discordance with the treatment plan. RESULTS: We examined 1095 HNC patients, 12.1% of whom were discordant with treatment. Patients with advanced cancer stage, old age, and treatment plans of best supportive care (BSC) or surgery combined with radiation (RT), chemotherapy (CT), or chemoradiation (CCRT) were more likely to have discordance with their treatment plan. Of the 133 patients who were discordant with their treatment plan, the top reasons were as follows: "patients or their family considered patients' poor physical condition (chronic disease or unstable systemic disease), difficulty in enduring any condition likely to cause physical discomfort from disease treatment," "inconvenient transportation," and "disease progression." CONCLUSIONS: Patients' cancer stage, age, and types of treatment plans recommended significantly influenced discordance with treatment plan. Poor physical condition was the major reason for discordance with the treatment plan. Patients in the concordance group were significantly more likely than those in the discordance group to be younger than 65 years, have less advanced cancer stage, and be recommended to receive surgery rather than any other regimen. Multidisciplinary team care can help patients make positive decisions about treatment.

Impact of physical and psychosocial dysfunction on return to work in survivors of oral cavity cancer.

OBJECTIVE: To compare the levels of social support, physical function, and social-emotional function between oral cavity cancer survivors who did or did not resume work 6 months or longer after treatment completion. METHODS: This cross-sectional study examined survivors of oral cavity cancer who were treated at the outpatient radiation department of a medical center in Northern Taiwan. Questionnaires were used to collect data regarding perceived social support, physical function, social-emotional function, and return to work status after treatment. Logistic regression was conducted to determine factors related to returning to work. RESULTS: We examined 174 survivors of oral cavity cancer, 55.2% of whom returned to work after treatment. Relative to survivors who returned to work, those who did not return to work reported needing greater tangible social support, having fewer positive social interactions, having poorer physical function, and having poorer social-emotional function. Multivariable analysis indicated that younger age (OR = 0.864, P < .05), higher family income (OR = 10.835, P < .05), sufficient tangible social support (OR = 0.943, P < .05), positive social interaction (OR = 1.025, P < .05), and better physical function (OR = 1.062, P < .05) were significantly associated with the return to work. CONCLUSIONS: Survivors of oral cavity cancer who did not return to work had worse physical and social-emotional function and required more tangible social support and positive social interactions. Providing occupational rehabilitation and counseling for oral cavity cancer survivors may help them return to work.

Factors influencing body image in posttreatment oral cavity cancer patients.

OBJECTIVE: The purpose of this study of posttreatment oral cavity cancer (OCC) patients was to identify factors associated with self-reported overall body image, perceived attractiveness, and dissatisfaction with body appearance. METHODS: This cross-sectional study recruited patients with OCC from the outpatient radiation department of a single cancer center in Northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed using the Hospital Anxiety and Depression Scale (HADS), the Liebowitz Social Anxiety Scale (LSAS), the University of Washington Quality of Life Scale (UW-QOL), and the Body Image Scale (BIS). RESULTS: A total of 168 patients were included in this current study, 76 females and 92 males. Negative overall body image was associated with greater degree of depression, greater fear of social interactions, poorer social-emotional function, receipt of surgery, female gender, and greater avoidance of social interaction; these factors explained 49.0% of the variance in this outcome measure. Poor perceived attractiveness was associated with greater depression, greater fear of social interaction, and receipt of surgery; these factors explained 25.4% of the variance in this outcome measure. Dissatisfaction with body appearance was associated with poor social-emotional function, greater fear of social interaction, receipt of reconstruction, advanced cancer stage, and female gender; these factors explained 52.2% of the variance in this outcome measure. CONCLUSIONS: This study of posttreatment OCC patients indicated that depression and fear of social interaction strongly influenced overall body image, perceived attractiveness, and dissatisfaction with body appearance.