Year of Publication

2013

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Public Health

Department

Gerontology

First Advisor

Dr. Graham Rowles

Second Advisor

Dr. John Watkins

Abstract

Diagnosis of head and neck squamous cell carcinoma (HNSCC) presents a multifarious problem. Late stage diagnosis, uncertainty regarding appropriate clinical treatment, as well as the high potential for disfigurement and functional loss resulting in diminished quality of life, contributes to anxiety, stress, fear, and uncertainty throughout the cancer treatment experience. This qualitative study sought to explore the cancer treatment experience of adults with newly diagnosed HNSCC, including laryngeal, esophageal, and oral cancers. Study participants were recruited from the University of Kentucky Ear Nose and Throat Clinic in Lexington KY. Participants agreed to be interviewed after receipt of their cancer diagnosis and again after completion of their cancer treatment. Socio-emotional Selectivity Theory, and Leventhal’s Self-Regulation Model provided the theoretical foundation for exploring the ongoing emotional, psychological, and physical aspects of the cancer experience while also recognizing the role of age and time perception. Forty-one patients completed two in depth semi- structured interviews. Transcripts were coded for key themes. Findings indicated that HNSCC in older patients is often preceded by lifelong alcohol, tobacco, and substance use. Despite frequent interaction with health and substance abuse treatment professionals, very few patients had prior knowledge of HNSCC risk or had been screened for these cancers. Experience with addiction treatment programs and perceptions of time seem to influence cancer treatment experience. The following themes were identified: (1) dynamic time perspectives including taking time, making time, junk time and time out; (2) recovery vs. cure from disease; (3) the role of reconciliation, hope, self-inventory, reflection, and spirituality in navigating the cancer experience; (4) the role of healing vs. cure; and (5) patient's moving forward to a life after cancer. Findings from this investigation suggest that patients with a history of lifelong substance use could benefit from earlier detection and improved awareness and knowledge of HNSCC risk. Findings can be applied to improve access to cancer screening through addiction and cessation programs, reduce lags in diagnosis, improve prognosis and contribute to the development of clinical tools. Additionally, the intersection of advancing chronological age, comorbidity, and perception of time warrants further investigation.

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