Posttraumatische Reifung und Lebensqualität bei Patienten mit Plattenepithelkarzinomen im Kopf-Hals-Bereich – Eine retrospektive Analyse

Abstract

Trauma can also lead to positive outcomes such as posttraumatic growth. Therefore a lot of studies about posttraumatic growth in correlation exist with different trauma types. Severe illness like cancer is one reason for possible positive psychological change. This study aims to assess posttraumatic growth and health related quality of life in patients with a primary oral squamous cell carcinoma. Thirty patients have been treated at the Clinic for Oral, Jaw and Face Surgery at University of Göttingen between 2011 and 2012 and were enrolled in this study. Routinely the University of Washington Quality of Life (UW-QOL). Questionnaire was handed out to them pre-operatively and in intervals of post-operative recalls. For assessing the posttraumatic growth the PTGI (Posttraumatic Growth Inventory) Questionnaire designed by Tedeschi and Calhoun was used. The design of this study is a retrospective analysis of the existing data. Repeated- measures- ANOVA was used to test the significance of changes in PTG from 30 to 360 days. Followed by paired test of each moment of time. The Analysis of possible influences like gender, age, civil status or religion, was realized with t-test for independent samples. Furthermore there was a statistical evaluation of the pre- and post-op Quality of Life (QOL), as well as the description of different influence quantities. From n=30 50% dropped out of the cohort due to a lack of compliance. Fifteen patients filled out the questionnaires frequently and entirely. Two of these patients died one year after surgery. The global analysis showed that there is significant chance in posttraumatic growth in dependency of the time (p<0,001). The presentation of the results describes an anticlimax. There is a decrease in PTR from 30 days to 360 post-op. Survivors reported higher scores right after the diagnosis which degreases over the time after the diagnosis. The global analysis of each subscale showed that four of the five subscales have a statistic relevant chance from 30 to 360 days (p<0,05). The results of the paired analysis was mixed. Only for one subscale (“Personal Relationships”) was a significant trend for every moment of time (p<0,05). Only gender showed a significant relation to one of the subscale “New Possibilities (p=0,02). Patients at the age of 60 and younger estimated there new possibilities to be better, than patients over 60 years. There was also a significant outcome for religious patients and “Personal Relationships” (p=0,04). Health related quality of life also showed significant relation to time. Chronical sequence reported poorer quality post-operatively. Physical function: “Chewing” presented the largest increase from pre-operatively to time after surgery (p=0,005). The global analysis showed also significant results for “Swallow” (p=0,045), “Speech” (p=0,030) and “Taste” (p=0,032). Social-emotional function: “Shoulder” was tested with a significant result of p=0,004. No significant relation between age, religion and family status was shown. There is a slight tendency of women reporting better quality of life in the aftermath of surgery (p=0,05). The development of quality of life was tested in connection to different oral reconstructions. Therefore the cohort was classified in different cancer stages. Because of the reduced sample size results are not being tested for significance. Free flap versus local reconstruction showed that free flap reconstruction was associated with poorer quality of life. When testing the correlation between posttraumatic growth and quality of life, the results did not support the presumption that higher posttraumatic growth correlates with poorer quality of life. There is a negative correlation, showing a decreasing PTR when having poorer quality of life. The analysis has a small sample size. Patients with oral-cell-carcinoma suffer a high mortality rate and often suffer low quality of life, thus it makes studies hard to conduct. Findings indicate the existance of posttraumatic growth after the diagnosis. There should be further studies to investigate how treatment is projecting on quality of life and how the psychological well being can be positively influenced.