[Quality of life stress in patients with larger tumors of the mouth. A descriptive study of psychosocial effects of illness and primary surgery therapy in 3 parts--1: Quantity and quality of life].

Up to about 40 years ago, the therapy of large tumors of the oral cavity often resulted in severe disfigurement and dysfunctions. Modern resection and reconstruction techniques now enable tumors of this type to be removed in such a way that virtually normal eating and speech functions are restored and traces of the extensive surgery are barely noticeable in many patients. After rehabilitation, most of these patients seem objectively to have a high quality of life, but it is less clear whether their subjective experience is the same. In a three-part empirical study the "limitations of quality of life" (LQL) of 50 patients with large tumors of the oral cavity were investigated at four points of time: preoperatively as well as 1, 4 and 12 months postoperatively. Our self constructed questionnaire for LQL includes 241 questions covering 19 fields of limitation. The results were compared with those of a group of patients after total laryngectomy (n = 34) and a group of patients "without cancer" (n = 40). One year after surgery the limitations of quality of life of patients with large tumors of the oral cavity are still large but seem less so than those of patients after total laryngectomy. However, objectively marginal problems such as a change of body image through a minor disfigurement, slightly indistinct articulation, or a prolonged period of accustomization to dentures are experienced as a severe strain by many patients. The apparent hypersensitivity of many patients to minor discomfort is seen as an effect of the demands made by modern society for fast, subtle adaptive processes. The second part of the study deals with the coping strategies applied by patients, and the third part is focused on a search for variables which could serve as preoperative indicators of the individual ability to bear the burden of illness and therapy.