Oral Cancer Patients' Perspectives to Quality of Life: A Qualitative Study in the Context of Northern Thailand Medical and Cultural Systems

Objective: To determine oral cancer patients’ perspective on quality of life; to explore how medical systems work in the context of cultural systems in Northern Thailand.

Methods: A phenomenological study was conducted to make an understanding on oral cancer patient experiences and their perceptions on quality of life. Twelve oral cancer patients were recruited for in-depth, semi-structured interviews. The diverse experiences from patients who have been diagnosed with oral cancer from 2 months to 11 years were collected and the narratives were extracted, categorized, and analyzed into significance themes by using content analysis.

Results: Four themes emerged from the interviews including: (1) ability to cope with cancer under the supportive cultural medicine, (2) family support and social network, (3) accessibility and availability of medical care, and (4) acceptance of new identity. Patients’ health believes and values were attached firmly to cultural explanation of disease and expressed through health seeking behaviors. Biomedicine together with cultural medicine both played roles for oral cancer healing, as culture defined meaning of oral cancer and identified healing, thus, patients used pluralistic medicine to cure diseases and heal their illness.

Conclusions: The stigma of cancer is the unprepared-suffering caused by unclear factors. Patients believed Karma and curses were causes of cancer. Oral cancer patients need both biomedicine and cultural medicine to heal their organs, emotion, mind, and soul. Supports from social network, government health policy, and socio-cultural constructs help patients to perceive a good quality of life.

1. Kleinman A. Concepts and a model for the comparison of medical systems as cultural systems. Soc Sci Med. 1978;12(2):85-95.

2. Kleinman A. Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley, Los Angeles, and London: University of California Press; 1980.

3. Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88(2):251-8.

4. Hu TW, Cooke M, McCarthy A. A qualitative study of the experience of oral cancer among Taiwanese men. Int J Nurs Pract. 2009;15(4):326-33.

5. Allen JD, Savadatti S, Levy AG. The transition from breast cancer 'patient' to 'survivor'. Psychooncology. 2009;18(1):71-88.

6. van der Molen B. Relating information-needs to the cancer experience. 1. Jenny's story: a cancer narrative. Eur J Cancer Care (Engl). 2000;9(1):41-7.

7. Cheng CH, Wang TJ, Lin YP, Lin HR, Hu WY, Wung SH, et al. The illness experience of middle-aged men with oral cancer. J Clin Nurs. 2013;22(23-24):3549-56.

8. Costa EF, Nogueira TE, de Souza Lima NC, Mendonca EF, Leles CR. A qualitative study of the dimensions of patients' perceptions of facial disfigurement after head and neck cancer surgery. Spec Care Dentist. 2014;34(3):114-21.

9. Pulte D, Brenner H. Changes in survival in head and neck cancers in the late 20th and early 21st century: a period analysis. Oncologist. 2010;15(9):994-1001.

10. Blanchard P, Volk RJ, Ringash J, Peterson SK, Hutcheson KA, Frank SJ. Assessing head and neck cancer patient preferences and expectations: A systematic review. Oral Oncol. 2016;62: 44-53.

11. Shield KD, Ferlay J, Jemal A, Sankaranarayanan R, Chaturvedi AK, Bray F, et al. The global incidence of lip, oral cavity, and pharyngeal cancers by subsite in 2012. CA Cancer J Clin. 2017; 67(1): 51-64.

12. Hunt LM. Moral reasoning and the meaning of cancer: causal explanations of oncologists and patients in southern Mexico. Med Anthropol Q. 1998;12(3):298-318.

13. Daher M. Cultural beliefs and values in cancer patients. Ann Oncol. 2012; 23(suppl 3): 66-69.

14. Chandu A, Smith AC, Rogers SN. Health-related quality of life in oral cancer: a review. J Oral Maxillofac Surg. 2006;64(3):495-502.

15. Murphy BA, Ridner S, Wells N, Dietrich M. Quality of life research in head and neck cancer: a review of the current state of the science. Crit Rev Oncol Hematol. 2007;62(3):251-67.

16. Ojo B, Genden EM, Teng MS, Milbury K, Misiukiewicz KJ, Badr H. A systematic review of head and neck cancer quality of life assessment instruments. Oral Oncol. 2012;48(10):923-37.

17. WHO Health Promotion Glossary 1998 [Internet]. World Health Organization. 1998 [cited 01-01-2019]. Available from: https://www.who.int/healthpromotion/about/HPG/en/.

18. Imsamran W, Pattatang A, Supattagorn P, Chiawiriyabunya I, Namthaisong K, Wongsena M, et al. Cancer in Thailand: Vol. IX, 2013-2015. Bangkok, Thailand: New Thammada Press (Thailand); 2018.

19. Tangjaturonrasme N, Vatanasapt P, Bychkov A. Epidemiology of head and neck cancer in Thailand. Asia Pac J Clin Oncol. 2018;14(1):16-22.

20. Komolmalai N, Chuachamsai S, Tantiwipawin S, Dejsuvan S, Buhngamongkol P, Wongvised C, et al. Ten-year analysis of oral cancer focusing on young people in northern Thailand. J Oral Sci. 2015;57(4):327-34.

21.Iamaroon A, Pattanaporn K, Pongsiriwet S, Wanachantararak S, Prapayasatok S, Jittidecharaks S, et al. Analysis of 587 cases of oral squamous cell carcinoma in northern Thailand with a focus on young people. Int J Oral Maxillofac Surg. 2004;33(1):84-8.

22. Vakharia KT, Ali MJ, Wang SJ. Quality-of-life impact of participation in a head and neck cancer support group. Otolaryngol Head Neck Surg. 2007;136(3):405-10.

23. Katz MR, Irish JC, Devins GM, Rodin GM, Gullane PJ. Psychosocial adjustment in head and neck cancer: the impact of disfigurement, gender and social support. Head Neck. 2003; 25(2): 103-12.

24. Moore KA, Ford PJ, Farah CS. "I have quality of life...but...": Exploring support needs important to quality of life in head and neck cancer. Eur J Oncol Nurs. 2014;18(2):192-200.

25. Jabbour J, Milross C, Sundaresan P, Ebrahimi A, Shepherd HL, Dhillon HM, et al. Education and support needs in patients with head and neck cancer: A multi-institutional survey. Cancer. 2017;123(11):1949-57.

26. O'Brien KM, Timmons A, Butow P, Gooberman-Hill R, O'Sullivan E, Balfe M, et al. Associations between neighbourhood support and financial burden with unmet needs of head and neck cancer survivors. Oral Oncol. 2017;65:57-64.

27. So WK, Chan RJ, Chan DN, Hughes BG, Chair SY, Choi KC, et al. Quality-of-life among head and neck cancer survivors at one year after treatment--a systematic review. Eur J Cancer. 2012; 48(15): 2391-2408.

28. Benner P. Quality of life: a phenomenological perspective on explanation, prediction, and understanding in nursing science. ANS Adv Nurs Sci. 1985;8(1):1-14.

29. Shosha GA. Employment of Colaizzi's strategy in descriptive phenomenology: a reflection of a researcher. Eur Sci J. 2012;8(27):31-43.

30. Loh J. Inquiry into Issues of Trustworthiness and Quality in Narrative Studies: A Perspective. TQR. 2013; 18(65): 1-15.Studies: A Perspective. TQR. 2013; 18(65): 1-15.

31. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273(1):59-65.

32. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory I. The IQOL theory: an integrative theory of the global quality of life concept. ScientificWorldJournal. 2003; 3:1030-40.

33. Juntaramano S, Swangareeruk J. The Wisdom of Indigenous Healers in Cancer Treatment. JTTAM. 2017;15(3):286-300.

34. Conway DI, Petticrew M, Marlborough H, Berthiller J, Hashibe M, Macpherson LM. Socioeconomic inequalities and oral cancer risk: a systematic review and meta-analysis of case-control studies. Int J Cancer. 2008;122(12):2811-9.

35. Scott SE, Grunfeld EA, Main J, McGurk M. Patient delay in oral cancer: a qualitative study of patients' experiences. Psychooncology. 2006;15(6):474-85.

36. Peacock ZS, Pogrel MA, Schmidt BL. Exploring the reasons for delay in treatment of oral cancer. J Am Dent Assoc. 2008;139(10):1346-152.

37. Jafari A, Najafi S, Moradi F, Kharazifard M, Khami M. Delay in the diagnosis and treatment of oral cancer. J Dent (Shiraz). 2013;14(3):146-50.

38. van der Molen B. Relating information needs to the cancer experience. 2. Themes from six cancer narratives. Eur J Cancer Care (Engl). 2000;9(1):48-54.

39. Bowman KF, Rose JH, Deimling GT. Appraisal of the cancer experience by family members and survivors in long-term survivorship. Psychooncology. 2006;15(9):834-45.

40. Llewellyn CD, McGurk M, Weinman J. Head and neck cancer: to what extent can psychological factors explain differences between health-related quality of life and individual quality of life? Br J Oral Maxillofac Surg. 2006; 44(5):351-7.

41. Horney DJ, Smith HE, McGurk M, Weinman J, Herold J, Altman K, et al. Associations between quality of life, coping styles, optimism, and anxiety and depression in pretreatment patients with head and neck cancer. Head Neck. 2011;33(1):65-71.

42. Schroevers MJ, Kraaij V, Garnefski N. Cancer patients' experience of positive and negative changes due to the illness: relationships with psychological well-being, coping, and goal reengagement. Psychooncology. 2011;20(2):165-72.

43. Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients' perspectives. JAMA. 1999; 281(2): 163-168.

44. van Deudekom FJ, Schimberg AS, Kallenberg MH, Slingerland M, van der Velden LA, Mooijaart SP. Functional and cognitive impairment, social environment, frailty and adverse health outcomes in older patients with head and neck cancer, a systematic review. Oral Oncol. 2017; 64: 27-36.

45. Rieke K, Schmid KK, Lydiatt W, Houfek J, Boilesen E, Watanabe-Galloway S. Depression and survival in head and neck cancer patients. Oral Oncol. 2017; 65: 76-82.

46. Bressan V, Stevanin S, Bianchi M, Aleo G, Bagnasco A, Sasso L. The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: A systematic review. Cancer Treat Rev. 2016; 45: 105-119.

Saladyanant T, Chitapanarux I, Win S, Chatiketu P. Oral Cancer Patients' Perspectives to Quality of Life: A Qualitative Study in the Context of Northern Thailand Medical and Cultural Systems: Original articles. CM Dent J [Internet]. 2021 Sep 30 [cited 2024 May 02];42(3):23-33. Available from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=31

Saladyanant, T., Chitapanarux, I., Win, S. & Chatiketu, P. (2021). Oral Cancer Patients' Perspectives to Quality of Life: A Qualitative Study in the Context of Northern Thailand Medical and Cultural Systems. CM Dent J, 42(3), 23-33. Retrieved from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=31

Saladyanant, T., Chitapanarux Imjai ,Win Swe Swe and Chatiketu Piyanart. 2021. "Oral Cancer Patients' Perspectives to Quality of Life: A Qualitative Study in the Context of Northern Thailand Medical and Cultural Systems." CM Dent J, 42(3), 23-33. https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=31

Saladyanant, T. et al. 2021. 'Oral Cancer Patients' Perspectives to Quality of Life: A Qualitative Study in the Context of Northern Thailand Medical and Cultural Systems', CM Dent J, 42(3), 23-33. Retrieved from https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=31

Saladyanant, T., Chitapanarux, I., Win, S. and Chatiketu, P. "Oral Cancer Patients' Perspectives to Quality of Life: A Qualitative Study in the Context of Northern Thailand Medical and Cultural Systems", CM Dent J, vol.42, no. 3, pp. 23-33, Sep. 2021.

Saladyanant, T., Chitapanarux, I., Win, S., et al. "Oral Cancer Patients' Perspectives to Quality of Life: A Qualitative Study in the Context of Northern Thailand Medical and Cultural Systems." CM Dent J, vol.42, no. 3, Sep. 2021, pp. 23-33, https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=31