Department of Surgery, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan.
Department of Community Health Sciences, Aga Khan University Hospital, Stadium Road, Karachi, 74800, Pakistan.
BMC Cancer. 2021 Aug 3;21(1):888. doi: 10.1186/s12885-021-08624-8.
The study aimed to assess resilience and its associated factors in head and neck cancer patients, post-treatment in a low middle income country (LMIC) such as Pakistan.
An analytical cross-sectional study was conducted from November 2019 to May 2020 among head and neck cancer patients aged at least 18 years at the largest private tertiary care hospital, in Karachi, Pakistan. Information regarding their resilience scores was collected through Wagnild and Young's Resilience scale that comprises of 14 items (RS-14). Moreover, depression and anxiety were also assessed via Hospital Anxiety and Depression Scale (HADS) and social support was assessed by Enriched Social Support Instrument (ESSI).
The data was analyzed by linear regression modeling. Unadjusted and adjusted beta coefficients with 95% CI were reported. A total of 250 head and neck cancer patients were recruited, 79% of them were males. Mean age of the patients was 51.59 years with 93% having high social support and only 8% having severe depression and 3% having severe anxiety. After adjusting for the covariates in multivariable analysis resilience was associated with severe depression (- 17[- 20.98,-12.93]) or borderline depression (- 4[- 8.41,-0.39]), severe anxiety (- 11 [- 17.88,-4.18]), low social support (- 6[- 9.62,-1.71]), having family members of > 6 in the household (- 2[- 4.31,-0.29), smokeless tobacco users post- treatment (10[5.79, 14.45]), and those who underwent tracheotomy (- 4[- 7.67,-0.21]). There was a significant interaction between education and role in the family (decision maker).
In Pakistan, a South Asian LMIC, collectivist culture prevails, family ties are greatly promoted thus resilience and social support is highly prevalent in head and neck cancer patients resulting in lower prevalence of depression and anxiety. Our study highlights that higher resilience is prevalent among small families less than six members, as the welfare of the individual is prioritized over multiple needs of the family. Formal Education and role in household/decision making power are effect modifiers in our study, demonstrating its protective effect on the mental health of head and neck cancer patients. High resilience scores were reported among current smokeless tobacco users as compared to quitters post treatment. Resilience-building interventions should be formulated to aid head and neck cancer patients to cope with the disease and its sequel.
本研究旨在评估中低收入国家（如巴基斯坦）头颈部癌症患者治疗后的韧性及其相关因素。
2019 年 11 月至 2020 年 5 月期间，在巴基斯坦卡拉奇最大的私立三级保健医院，对至少 18 岁的头颈部癌症患者进行了一项分析性横断面研究。通过 Wagnild 和 Young 的韧性量表（包含 14 个项目的 RS-14）收集有关其韧性评分的信息。此外，还通过医院焦虑和抑郁量表（HADS）评估抑郁和焦虑，通过丰富社会支持量表（ESSI）评估社会支持。
通过线性回归建模对数据进行分析。报告了未经调整和调整后的β系数及其 95%置信区间。共招募了 250 名头颈部癌症患者，其中 79%为男性。患者的平均年龄为 51.59 岁，93%具有较高的社会支持，只有 8%有严重抑郁，3%有严重焦虑。在多变量分析中调整协变量后，韧性与严重抑郁（-17[-20.98，-12.93]）或边缘性抑郁（-4[-8.41，-0.39]）、严重焦虑（-11[-17.88，-4.18]）、低社会支持（-6[-9.62，-1.71]）、家庭中成员数大于 6（-2[-4.31，-0.29]）、治疗后使用无烟烟草（10[5.79，14.45]）以及行气管切开术（-4[-7.67，-0.21]）有关。教育和家庭角色（决策者）之间存在显著的交互作用。
在南亚的中低收入国家巴基斯坦，集体主义文化盛行，家庭关系得到极大的促进，因此头颈部癌症患者的韧性和社会支持度很高，导致抑郁和焦虑的发生率较低。我们的研究表明，家庭成员少于 6 人的小家庭中，较高的韧性更为普遍，因为个人的福利优先于家庭的多种需求。在我们的研究中，正规教育和家庭/决策制定角色是效应修饰因子，表明其对头颈部癌症患者心理健康具有保护作用。与治疗后戒烟者相比，目前使用无烟烟草者的韧性评分较高。应制定增强韧性的干预措施，以帮助头颈部癌症患者应对疾病及其后果。
