Positive Psychological Change in Head and Neck Cancer populations

Sam Harding

DHealthPsych, Pines and Steps Southmead Hospital North Bristol Hospital Trust, Bristol, United Kingdom


Head and neck cancer (HNC) carry a high level of morbidity and mortality, but the impact of HNC on survivors differs widely among individuals, and a significant number of them suffer from negative psychological effects of the disease. However, some people report a significant positive effect of experiencing HNC and its treatment.

This review looks at demographic, clinical and psychological factors associated with positive psychological change (PPC) in HNC populations.

Eight quantitative manuscripts were identified as reporting on PPC in HNC. These studies were split between recruiting participants via cancer clinics and postal surveys, and the majority use a cross-sectional study design.

Demographic factors across the papers showed similar patterns of relationships across PPC; that higher education/qualification and cohabitation/marriage are associated with increased PPC. Limited research reported longitudinal patterns of change and showed that for people with lower stage tumours and those who only had a surgical intervention greater PPC developed over time. Multivariable modeling adjusting for psychosocial variables found that PPC had a quadratic relationship with time since diagnosis, increasing initially and leveling off after 18 months.

Further research would aid the identification of bio-psychosocial factors that influence the development of PPC and inform the development of rehabilitation interventions while enabling consideration of the natural development of the phenomenon.


There is evidence from the literature that some people report benefit from illness1-6. In some cases, these benefits go some way to mitigating the negative consequences of illness, but there are also instances where people report an overall benefit of being ill. Positivity in adversity has been cited in the context of other stressful life events such as combat and imprisonment, divorce, care giving and bereavement7. Stress-related growth in adversity is reported to be ‘remarkably common’7.

There is a growing body of literature supporting the suggestion that a stressful or traumatic event may be a catalyst for positive psychological change8,9. In 1991 Yalom and Lieberman10 used the term ‘positive psychological changes’ to refer to positive changes in the perceptions of oneself, social relationships with family and friends and life priorities and appreciation of life. These positive changes, which have also been referred to as ‘perceived benefits’, ‘benefit finding’, ‘thriving’, ‘stress-related growth’, ‘adversarial growth’, ‘post-traumatic growth’, or ‘existential growth’, may concern changes in the perceptions of oneself, social relationships with family and friends and life priorities and appreciation of life. The term ‘Post-traumatic growth’ is widely used due to its ability to describe the need for individuals to have experienced trauma before they experience positive change over time. However, premininent researchers in this field, Tedeschi and Calhoun, have suggested this these terms are roughly synomous11. In this paper, positive psychological change (PPC) will be used unless reporting data directly from a journal article where they use another term such as PTG. The choice of PPC over PTG was made due to the nature of the trauma experienced by the people with and following cancer. In presenting work on PPC to people who have received a diagnosis of head and neck cancer (HNC) the author has found that the word ‘growth’ has significant negative meaning, as it is a word associated with a cancerous tumour. In working with this group of people, Harding et al12 suggest that the phrase positive psychological change was better received and facilitated communication.

Within the field of cancer, breast cancer (BC) has received the greatest amount of investigation into PPC13-18. There is evidence indicating that a substantial number of BC survivors experience such positive changes, especially in the long term15-17,19,20. Cancer survivors from tumours in a range of locations frequently report having altered priorities including more concern for others, a greater sense of purpose and a greater appreciation of themselves and their lives life4,21-24. A challenge for HNC clinicians is to understand what factors are associated with the developed of PPC. Only eight quantitative articles have been published within the field of HNC and PPC25-32. Tables 1 and 2 provide an outline of the study designs, participants, and variable.

This over view of the current literature will describe which variables have been found to be associated with PPC in people following HNC. The current research literature does not provide many clear associations due to the limited number of studies. Most studies are also short duration which makes it more difficult to evaluate changes over time about identified variables.

Some variables may mediate the relationship between trauma and PPC. Within studies, these variables can be categorized as demographic, clinical and psychological.

Using a cross-sectional design with mixed cancer sites, Park et al33 found, in a mixed cancer site study, that women consistently reported higher levels of PPC than men. However, this study was of a largely young female cohort, over a comparatively short period (1 year) which makes it difficult to extrapolate to HNC survivors or other cancer sites, especially over an extended time frame.

In contrast to this, studies across cancer sites have found no relationship between gender and PPC in colorectal cancer34, hepatobiliary (having to do with liver, bile ducts, and bile) cancer35 or HNC25,27,28. Holtmaat et al29 found females developed more PPC than their male cohort in an HNC population, although no reason for this is offered.

To date, no published studies have found an impact of age on PPC in HNC, though it has been found that younger participants with BC reported higher levels of PPC36,37. The greater number of studies undertaken with BC patients, and the larger participant numbers in those studies (due to the greater occurrence of BC in the general population), has identified age as a factor in the trajectory of change in, and final level, of PPC in BC15,16.

No clear relationship has been found between to ethnicity and PPC. Bellizzi et al13 found that African-Americans treated for BC showed higher levels of PPC than Caucasians, whereas Kent et al18 found Caucasians with BC had higher PPC than African-Americans but not higher than Hispanics13,18. Studies of PPC across other traumas also found a mixed pattern. Milam38, for example, investigated AIDS/HIV and found that African-American and Hispanic participants reported higher levels of PPC than Caucasians respondents.

Educational attainment also lacks a clear relationship with PCC. A narrative systematic review by Koutrouli et al39 found that most studies reported that people with BC and lower education levels experienced higher levels of PPC. One study of HNC found higher educational level was associated with greater PPC32 and another found no association with education28.

Three studies following treatment for HNC reported a beneficial effect of marriage or stable cohabiting over single status in the reporting of PPC25,26,2. Although when assessed longitudinally Harding25 found no impact from marital status. In a study that examined the perspectives of BC patients and their partners, Manne et al37 measured marital quality and, despite concluding that partners influenced the course of PTG over time, they were not responsible for its prediction. This suggests that a stable social support system may have advantages over and above a high-quality one-to-one interaction.

Only one HNC study assessed the impact of socio-economic status and found that those participants with high or low socio-economic status reported greater levels of PPC than those in the middle of the scale25.

Eight HNC studies have investigated clinical factors of PPC25-32 using quantitative PPC measures. Harrington, McGurk, and Llewellyn27 did not find any relationship between PPC and treatment, time since treatment, stage of cancer or diagnosis of further illness in people treated for HNC. Leong et al31 did not find an association with stage of the tumour with development of PPC either. This pattern was partially reinforced by the findings of, Harding25, Harding and Moss26, Holtmaat et al29 and Llewellyn et al32.

Ho et al28 found that following HNC people with more advanced cancer (stages III and IV) reported a lower levels of PPC, but different treatment modalities did not significantly influence PPC. The pattern of tumour stage was supported by the work of Harding25 and Harding and Moss26. In relation to treatment modalities, Harding25 and Harding and Moss2 found that participants who had surgery alone reported more positive change than both those who had surgery with radiotherapy and those who were not treated surgically, but who had received radio-therapy with or without chemotherapy.

When compared to studies undertaken in BC15,164, the eight HNC studies have small sample sizes and lack clarity over the potential impact of, and mediating factors of, co-morbidities on PPC trajectories25-32.

Harrington, McGurk, and Llewellyn27 recruited people with HNC and found that dispositional optimism and positive reframing could account for 23% of the variance in PPC and additionally that higher levels of religious coping were correlated with greater PPC. They did not find any relationship between PPC and anxiety, or depression. Llewellyn et al.32 supported Harrington et al’s27 findings related to dispositional optimism and positive reframing, and also found that increased use of emotional support and a decrease in self-blame positively affect PPC. This combination of factors was found to account for 39% of PPC variance. Ho et al28 also investigated people who had been diagnosed as having HNC and found that the Hope scale, the Life Orientation Test-Revised (LOT-R), and the Post Traumatic Growth Inventory (PTGI) were all positively correlated. Results of regression analyses comparing hope and optimism in relation to PPC found that they contributed to a 25% variance of PPC as measure by the PTGI. However, only 'hope' was a significant individual indicator of PPC.

Lebel et al30 investigated the impact of stigma as a predictor of benefit finding and although they report their results as a mixed group of Lung and HN cancer, they found that when controlled for stressful life events and matched for cancer status, stigma and benefit finding predicted well-being.

Quality of Life (QoL) is an important psychological factor, and Llewellyn et al32 found that an increase in emotional growth was negatively related to the mental component summary (MCS) score. This indicates that higher levels of emotional growth are associated with poorer mental health-related QoL (HRQoL), but the study by Llewellyn et al32 did not use a HRQoL measure specifically designed to assess HNC HRQoL factors. Harding25 used a HNC specific measure of HRQoL and SF-12 (Table 1 & 2) and found that several subscales related to HNC and the Physical Component scale of the SF-12 were related to the development of PPC longitudinally.

Table 1: Study Descriptors
Study Author(s) Aim of the study Study Design Study measures Demographic Factors Medical Factors Time of measurement
1 Harrington, S., McGurk, M. & Llewellyn, C.D. (2008) 1) to determine the extent to which patient treated for HNC experience positive consequences of their illness, 2) to identify factors associated with benefit finding among this patient group Cross-sectional postal survey Benefit finding scale (BFS), Hospital Anxiety and Distress Scale (HADS), Life Orientation Test - Revised (LOT-R), Brief COPE Age, Gender, Ethnicity, Education, Employment, Marital status Type of treatment, time since last treatment, diagnosis of further illness since treatment, site, type of cancer and stage of cancer 0-6mths = 1, 6-12mths = 3, 13-24mths = 7, 25-47mths = 20, 48-72mths = 19, 73-121mths = 26
2 Llewellyn, C.D., Horney, D.J., McGurk, M., Weinman, J., Herold, J., Altman, K. & Smith, H.E. (2011) 1) to determine the extent to which patient treated for HNC experience positive consequences of their illness, 2) to establish the relationship between BF, other patient-reported outcomes and predictive factors such as coping strategy and level of optimism Repeated measures prospective study using self-completion questionnaires Benefit finding scale (BFS), Hospital Anxiety and Distress Scale (HADS), Life Orientation Test (LOT-R), Brief COPE, Medical Outcomes Short Form 12 (SF-12), Two-item measure derived from The European Organization for Research and Treatment (EORTC) of Cancer Quality of Life Questionnaire (QLQ-C30) Age, Gender, Ethnicity, Education, Employment, Marital status Type of treatment, site and stage of cancer T1 = Between diagnosis and start of treatment, T2 = 6 months after completion of treatment
3 Ho, S.M.Y., Rajandram, R.K, Chan, N., Samman, N., McGrath, C. & Zwahlen, R.A. (2011) Investigate if PTG occurs in oral cancer patients and if hope and optimism shows significant positive correlation with PTG Cross-sectional postal survey Chinese Posttraumatic Growth Inventory (PTGI), Hope scale (HS), Life Orientation Test - Revised (LOT-R) Age, Gender, Religion, Education level, income Time since diagnosis, stage of disease, and treatment type Mean time was 3.6yrs (SD 0.34)
4 Lebel, S. Costonguay, M., Mackness, G., Irish, J., Bezjak, A. & Devins, GM. (2013) Investigate if the relationship between stigma and subjective well-being will be moderated by benefit finding (the negative impact of stigma on distress and subjective well-being will be lower when people report high levels of benefit finding Cross-sectional postal survey Affect Balance Scale (ABS), Center for Epidemiological Studies Depression Scale (CES-D), Explanatory Model Interview Catalogue (EMIC), Illness Intrusiveness Ratings Scale (IIRS), Posttraumatic Growth Inventory (PTGI), Disfigurement Scale, Marlowe-Crown Social Desirability Scale Age, Gender, Martial status, number of children, number of other people in the home, employment status, education, annual household income, country of birth, religion, stressful life events. Years since diagnosis, Cancer stage, treatment type Mean time was 1.37 (SD 0.84) years since diagnosis
5 Leong Abdullah, M.F., Nik Jaafar, N.R., Zakaria. H., Rajandram, R.K., Mahadevan ,R., Mohamad Yunus, M.R. & Shah, S.A. (2015) Investigate the correlations between PTG with depression and anxiety. Cross-sectional Posttraumatic Growth Inventory – Short Form (PTGI-SF), Hospital Anxiety and Depression Scale (HADS) Age, Gender, Race, Monthly income, educational level, marital status Diagnosis, duration of diagnosis, treatment regime, Cancer stage T1 = Within 1 year of diagnosis, T2 = 6 months following T1
6 Holtmaat, K., van der Spek, N., Cuijper, P., Leemans, C.R. & Verdonck-de Leeuw, I.M. (2016) Investigate the occurrence of PTG among HNC survivors with psychological distress and to examine the associations of PTG with sociodemographic and clinical factors, nicotine and alcohol use disorders, anxiety and depression disorders and health-related quality of life Cross-sectional Posttraumatic Growth Inventory (PTGI), Hospital Anxiety and Depression Scale (HADS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – C30 (EORTC QLQ-C30) World Mental Health CIDI Age, Gender, marital status, years of education, employment status Tumour location, Cancer stage, Treatment regime, Months since treatment, CIDI diagnosis Mean time was 22.4 (SD 25.8) months since diagnosis
7 Harding, S. & Moss, T.P. (2017) Investigate the relationship between biomedical variable, health-related quality of life, social factors and subjective reports of PPC Cross-sectional postal survey Silver Lining Questionnaire (SLQ), University of Washington Head and Neck Caner Quality of Life (UoW), Medical Outcomes Short Form 12 (SF-12) Age at diagnosis, Age at time of completing questionnaire, Gender, Ethnicity, Index of Multiple Deprivation, Occupation, Family Status Cancer stage, Treatment regime, Months since treatment, Mean time was 6.52 (SD 2.8) months since diagnosis
8 Harding, S. (2017) Investigate the pattern or trajectory of development of PPC over a 5 year time period.
Investigate how biological, social and psychological variable are associated with PPC
5 year cross-sequential Silver Lining Questionnaire (SLQ), University of Washington Head and Neck Caner Quality of Life (UoW), Medical Outcomes Short Form 12 (SF-12) Age at diagnosis, Age at time of completing questionnaire, Gender, Ethnicity, Index of Multiple Deprivation, Occupation, Family Status Cancer stage, Treatment regime, Months since treatment, Seven time categories are used:
1) 3-6 months
2) 7-12 months
3) 13-18 months
4) 19-24 months
5) 25-36 months
6) 37-60 months
7) ≥61 months
Table 2: Participants and Variables
Study Author(s) Participants (Gender, Age) Time of measurement Non-respondents / Dropouts Exclusion Criteria Cancer Site Cancer Staging Cancer Treatments Time since completion of treatment
1 Harrington, S., McGurk, M. & Llewellyn, C.D. (2008) N = 76 (55% response rate; 37 Male, 39 Female; Mean Age 66.9, SD 12.6, Range 32-97; 71 White) 0-6mths = 1, 6-12mths = 3, 13-24mths = 7, 25-47mths = 20, 48-72mths = 19, 73-121mths = 26 Significant difference between gender in responders and non-responders (more females responding) Under 18 years of age. Having palliative treatment. Recurrent diagnosis, metastatic disease in other parts of the body (excluding neck nodes), a diagnosis of lymphoma, mental to cognitive impairments or insufficient understanding of English. Not stated Stage 1-2 - N = 53, Stage 3-4 - N = 23 Surgery only - N = 35,
Radiotherapy only - N = 10,
Surgery and Radiotherapy - N = 30,
Surgery, radiotherapy and chemotherapy - N = 1
0-6 months = 1,
6-12 months = 3,
13-24 months = 7,
25-47 months = 20,
48-72 months = 19,
73-121 months = 26
2 Llewellyn, C.D., Horney, D.J., McGurk, M., Weinman, J., Herold, J., Altman, K. & Smith, H.E. (2011) T1. N = 103 (73 Males, 30 Females; Mean Age 63, SD 13.9, Range 23-91; 93 White). T2. N = 68 (Gender, Age, Ethnicity data provided) T1 = Between diagnosis and start of treatment, T2 = 6 months after completion of treatment There were no significant differences between patients included and not included with respect to gender, stage of cancer. 35 people did not complete the second time point. No information is given about they compared at T1 Under 18 years of age. Having palliative treatment. Recurrent diagnosis, metastatic disease in other parts of the body (excluding neck nodes), a diagnosis of lymphoma, mental to cognitive impairments or insufficient understanding of English. Oral Cavity - N = 68, Pharynx - N = 8, Larynx - N = 19, Other - N = 8 Stage 1 - N = 34, Stage 2 - N = 25, Stage 3 - N = 23, Stage 4 - N = 17, Missing data - N = 4 Surgery only - N = 36, Radiotherapy only - N = 25, Chemotherapy only - N = 3, Surgery and Radiotherapy - N = 17, Radiotherapy and chemotherapy - N = 13, Surgery, radiotherapy and chemotherapy - N = 9 Six months at T2
3 Ho, S.M.Y., Rajandram, R.K, Chan, N., Samman, N., McGrath, C. & Zwahlen, R.A. (2011) N = 50 (21 Male, 29 Female), Mean Age 60, (SD 13.06) Mean time was 3.6yrs (SD 0.34) No information is reported Non-native Cantonese speakers, less than 6mths post treatment completion, recurrence Oral Cavity, Oropharynx, gingival, floor of mouth, tongue, salivary glands, buccal mucosa, palate. Numbers at each site not stated. Stage 1-2 - N = 41, Stage 3-4 - N = 5, Missing information - N = 4 Surgery only - N = 34, Surgery and Radiotherapy - N = 16 Mean time was 3.6yrs (SD 0.34)
4 Lebel, S. Costonguay, M., Mackness, G., Irish, J., Bezjak, A. & Devins, GM. (2013) N = 99 (48 Males, 51 Female) Mean Age 61.82 (SD .63) Mean time was 1.37yrs (SD 0.84) No data presented between responders and non-responders Diagnosis of secondary ore recurrent HNC, under 18 years of age, illiterate, still to undergo surgery, more than 3 years post treatment Not stated 60% identified as local disease, 40% advanced disease Surgery only - N = 52, Surgery plus other - N = 47, Chemo - N = 7, Radiotherapy - N = 45, Other - N = 4 Mean time was 1.37yrs (SD 0.84)
5 Leong Abdullah, M.F., Nik Jaafar, N.R., Zakaria. H., Rajandram, R.K., Mahadevan ,R., Mohamad Yunus, M.R. & Shah, S.A. (2015) N = 50 (33 Males, 17 Female), Mean Age 49.76 (SD 11.56) T1 = Within 1 year of diagnosis, T2 = 6 months following T1 No data presented between responders and non-responders Greater than 1 year post diagnosis, distant metastases, in a relationship for less than 6 months Not stated Stage 1 - N = 11, Stage 2 - N = 14, Stage 3 - N = 12, Stage 4 - N = 13 No treatment – N = 20, Surgery only - N = 8, Radiotherapy only - N = 4, Chemotherapy only - N = 3, Surgery and Radiotherapy - N = 2, Surgery and chemotherapy – N = 1, Radiotherapy and chemotherapy - N = 8, Surgery, radiotherapy and chemotherapy - N = 4 T1 = Within 1 year of diagnosis, T2 = 6 months following T1
6 Holtmaat, K., van der Spek, N., Cuijper, P., Leemans, C.R. & Verdonck-de Leeuw, I.M. (2016) N = 74 (43 Males, 31 Females), Mean Age 61.2 (SD 8.5) Mean time was 22.4 (SD 25.8) months since diagnosis No difference in gender or HADS score, but those that declined were older (P<0.05) Less than 1 month post treatment, <7 on the depression and/or anxiety sub-scale of HADS, cognitive dysfunction, high suicide risk, psychotic and/or manic signs, too little knowledge of Dutch to complete questionnaires Lip, oral cavity, oropharynx, hypopharynx, larynx Stage 1 or 2 - N = 33, Stage 3 or 4 - N = 37, Unknown – N= 4 Surgery – N = 12, Radiotherapy- N = 27, Chemotherapy – N = 10, Combination surgery and other – N = 25 Mean time was 22.4 (SD 25.8) months since diagnosis
7 Harding, S. & Moss, T.P. (2017) N = 52 (36 Male, 16 Female), Mean Age 65.63 (SD 10.31) Mean time was 6.52 (SD 2.8) months since diagnosis No difference between responders and non-responders on medical or demographic factors <18 years old, too little knowledge of English to complete questionnaires, tumour not histologically diagnosed as squamous cell Mouth, lip, oral cavity, salivary gland, pharynx, nasal cavity, sinuses Stage 1 - N = 10, Stage 2 - N = 1, Stage 3 - N = 13, Stage 4 - N = 26 Surgery – N = 16, Surgery and radiotherapy – N = 17, Radiotherapy ± chemotherapy – N = 18 Mean time was 6.52 (SD 2.8) months since diagnosis
8 Harding, S. (2017) N = 52 (36 Male, 16 Female), Mean Age 65.63 (SD 10.31)
Seven time points:
1) 3-6 months – 65.59 (SD 11.54)
2) 7-12 months – 63.43 (SD 8.93)
3) 13-18 months – 59.41 (SD 9.05)
4) 19-24 months – 59.55 (SD 12.91)
5) 25-36 months – 64.95 (SD 15.34)
6) 37-60 months – 58.87 (SD 10.86)
7) ≥61 months – 57.64 (SD 10.69)
Mean time was 6.52 (SD 2.8) months since diagnosis
Seven time categories are used:
1) 3-6 months – N = 40,
2) 7-12 months – N = 37,
3) 13-18 months – N = 22,
4) 19-24 months – N = 11,
5) 25-36 months – N = 20,
6) 37-60 months – N = 23,
7) ≥61 months – N = 25
No difference between responders and non-responders on medical or demographic factors <18 years old, too little knowledge of English to complete questionnaires, tumour not histologically diagnosed as squamous cell, recurrence over the time of data collection, new tumour diagnosed in any location Mouth, lip, oral cavity, salivary gland, pharynx, nasal cavity, sinuses Data for 7 time categories is presented in full paper. Data for 3-6 months was:
Stage 1 - N = 9, Stage 2 - N = 5, Stage 3 - N = 5, Stage 4 - N = 18
Data for 7 time categories is presented in full paper. Data for 3-6 months was:
Surgery – N = 16, Surgery and radiotherapy – N = 14, Radiotherapy ± chemotherapy – N = 8
Seven time categories are used:
1) 3-6 months
2) 7-12 months
3) 13-18 months
4) 19-24 months
5) 25-36 months
6) 37-60 months
7) ≥61 months

Holtmaat et al29 found that lower levels of depression as measured by that sub-scale on the hospital anxiety and depression scale combined with higher levels of social functioning resulted in greater PPC.

A key limitation of 6 of the 8 HNC studies is the short time frame over which data was collected26,28-32. One of those that looked at a greater time span only measured data once, so a trajectory of PPC developed could not be assessed27. To date, only Harding25 has tried to determine a longitudinal trajectory of the development of PPC and further work is needed to examine associations with trajectories of PPC over time. Harding25 goes some way to examine this, but was not able to differentiate if sub-groups with differing patterns of PPC development exist. Danhauer et al16 yielded a BC model with six PPC trajectories. They found age, race, chemotherapy status, use of adaptive coping strategies, illness intrusiveness, depressive symptoms and social support, all differed among the groups. The Danhauer et al15,16 work supports the idea that there are likely to be sub-groups within the HNC population. Greater numbers of people post HNC treatment are required to more fully understand differentiating factors.

A recent systematic review40 across cancer cohorts found that the vast majority of research has focused on BC, and that the majority of PPC research has focused on psychologcal variables, over looking cancer-realted variables. With the small number of HNC papers it is hard to draw comparisions with other cancer cohorts, due to the different gender, ages, rates of recurrance and 5-year surviaval times. However, the work of Danhauer15,16 and Harding25 suggest that their are similarilities in the development of PPC over time.

If PPC is going to be of benefit to health care professionals and service users, it needs to be harnessed as an intervention or elements of intervention packages. A meta-analysis assessed the relationship between intervention participation and PTG but failed to find any studies that included an outcome measure of PPC41. Roepke41 suggests that there is a modest increase in PPC following intervention, but due to the limited research reported on the natural development and time course of PPC, it is possible that even this modest increase could be due to the passage of time. Future clinical practise needs to be mindful of these factors and include a measure of PPC in the development and delivery of interventions.

The author has no competing interests.

No funding was sought to undertake this work.

  1. Collins RL, Taylor SE, Skokan LA. A Better World or a Shattered Vision? Changes in Life Perspectives Following Victimization. Soc Cogn. 1990; 8: 263–285. doi:10.1521/soco.1990.8.3.263
  2. Giovinco G, McDougald J. Logotherapy: A journey into meaning for people with AIDS. Int. Forum Logother. 1994; 17: 76–81.
  3. Laerum E, Johnsen N, Smith P, et al. Myocardial infarction may induce positive changes in life-style and in the quality of life. Scand. J Prim Health Care . 1988; 6: 67–71.
  4. LaFortune-Fredette SL. Breast cancer survivors: concerns and coping. Cancer Nurs. 1995; 18: 35–46.
  5. O’Connor AP, Wicker CA, Germino BB. Understanding the cancer patient’s search for meaning. Cancer Nurs. 1990; 13: 167–175.
  6. Taylor SE. Adjustment to threatening events. A theory of cognitive adaptation. Am. Psychol. 1983; 38: 1161–1173.
  7. Schaefer JA, Moos RH. Life crises and personal growth. In: Personal Coping: Theory, Research, and Application. Praeger Publishers/Greenwood Publishing Group, Westport, CT, US, 1992; 149–170.
  8. Tedeschi RG, Calhoun LG. Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychol Inq. 2004; 15: 1–18. doi:10.1207/s15327965pli1501_01
  9. Updegraff JA, Taylor SE. From vulnerability to growth: Positive and negative effects of stressful life events. In: Loss and Trauma: General and Close Relationship Perspectives. Brunner-Routledge, Philadelphia, P.A., 2000; 3–28.
  10. Yalom ID, Lieberman MA. Bereavement and heightened existential awareness. Psychiatry. 1991; 54: 334–345.
  11. Tedeschi RG, Calhoun LG. Posttraumatic Growth. In: Encyclopedia of Mental Health 2nd Edition. Editors in Chief H. Friedman. Academic Press, USA., 2015; 305-08.
  12. Harding S, Sanipour F, Moss T. Existence of benefit finding and posttraumatic growth in people treated for head and neck cancer: a systematic review. PeerJ 2. 2014; e256. doi:10.7717/peerj.256
  13. Bellizzi KM, Smith AW, Reeve BB, et al. Posttraumatic growth and health-related quality of life in a racially diverse cohort of breast cancer survivors. J Health Psychol. 2010; 15: 615–626. doi:10.1177/1359105309356364
  14. Carver CS, Antoni MH. Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis. Health Psychol Off J Div Health Psychol Am Psychol Assoc. 2004; 23: 595–598. doi:10.1037/0278-6133.23.6.595
  15. Danhauer SC, Case LD, Tedeschi R, et al. Predictors of posttraumatic growth in women with breast cancer. Psycho-oncology. 2013a; 22: 2676–2683. doi:10.1002/pon.3298
  16. Danhauer SC, Russell G, Case LD, et al. Trajectories of Posttraumatic Growth and Associated Characteristics in Women with Breast Cancer. Ann Behav Med Publ Soc Behav Med. 2015; 49: 650–659. doi:10.1007/s12160-015-9696-1
  17. Danhauer SC, Russell GB, Tedeschi RG, et al. A longitudinal investigation of posttraumatic growth in adult patients undergoing treatment for acute leukemia. J Clin Psychol Med Settings. 2013b; 20: 13–24. doi:10.1007/s10880-012-9304-5
  18. Kent EE, Alfano CM, Smith AW, et al. The roles of support seeking and race/ethnicity in posttraumatic growth among breast cancer survivors. J Psychosoc Oncol. 2013; 31: 393–412. doi:10.1080/07347332.2013.798759
  19. Thornton AA. Perceiving benefits in the cancer experience. J Clin Psychol Med Settings. 2002; 9: 153–165.
  20. Tomich PL, Helgeson VS, Nowak Vache EJ. Perceived growth and decline following breast cancer: a comparison to age-matched controls 5-years later. Psycho-oncology. 2005; 14: 1018–1029. doi:10.1002/pon.914
  21. Dow KH, Ferrell BR, Haberman MR, Eaton L. The meaning of quality of life in cancer survivorship. Oncol Nurs Forum. 1999; 26: 519–528.
  22. Ferrell BR, Grant M, Funk B, et al. Quality of life in breast cancer. Part II: Psychological and spiritual well-being. Cancer Nurs. 1998; 21: 1–9.
  23. Pelusi J. The lived experience of surviving breast cancer. Oncol Nurs Forum. 1197; 24: 1343–1353.
  24. Schroevers MJ, Ranchor AV, Sanderman R. The role of age at the onset of cancer in relation to survivors’ long-term adjustment: a controlled comparison over an eight-year period. Psycho-oncology. 2004; 13: 740–752. doi:10.1002/pon.780
  25. Harding SA. The trajectory of positive psychological change in a head and neck cancer population. Int J Oral Maxillofac Surg. 2017; pii: S0901-5027(17)31634-X. doi: 10.1016/j.ijom.2017.09.010. [Epub ahead of print]
  26. Harding SA, Moss T. The impact of treatment for head and neck cancer on positive psychological change within a year of completing treatment. Int J Oral Maxillofac Surg. 2018; 47(3): 302-308. doi: 10.1016/j.ijom.2017.07.023.
  27. Harrington S, McGurk M, Llewellyn CD. Positive consequences of head and neck cancer: key correlates of finding benefit. J Psychosoc Oncol. 2008; 26: 43–62. doi.org/10.1080/07347330802115848
  28. Ho S, Rajandram RK, Chan N, et al. The roles of hope and optimism on posttraumatic growth in oral cavity cancer patients. Oral Oncol. 2011; 47: 121–124. doi:10.1016/j.oraloncology.2010.11.015
  29. Holtmaat K, van der Spek N, Cuijpers P, et al. Posttraumatic growth among head and neck cancer survivors with psychological distress. Psycho-oncology. 2017; 26(1): 96-101. doi:10.1002/pon.4106
  30. Lebel S, Feldstain A, McCallum M, et al. Do behavioural self-blame and stigma predict positive health changes in survivors of lung or head and neck cancers. Psychol Health. 2013; 28(9): 1066-81. doi: 10.1080/08870446.2013.781602
  31. Leong AMFI, Nik Jaafar NR, Zakaria H, et al. Posttraumatic growth, depression and anxiety in head and neck cancer patients: examining their patterns and correlations in a prospective study. Psycho-oncology. 2015; 24: 894–900. doi:10.1002/pon.3740
  32. Llewellyn CD, Horney DJ, McGurk M, et al. Assessing the psychological predictors of benefit finding in patients with head and neck cancer. Psycho-oncology. 2013; 22: 97–105. doi:10.1002/pon.2065
  33. Park CL, Edmonson D, Fenster JR, et al. Meaning Making and Psychological Adjustment Following Cancer: The mediating roles of growth, life meaning and restored just-world beliefs. J Consult Clin Psychol. 2008; 76(5): 863-875. doi: 10.1037/a0013348.
  34. Salsman JM, Segerstrom SC, Brechting EH, et al. Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3-month longitudinal examination of cognitive processing. Psychooncology. 2009; 18: 30–41. doi:10.1002/pon.1367
  35. Steel JL, Gamblin TC, Carr BI. Measuring post-traumatic growth in people diagnosed with hepatobiliary cancer: directions for future research. Oncol Nurs Forum. 2008; 35: 643–650. doi:10.1188/08.ONF.643-650
  36. Low CA, Stanton AL, Thompson N, et al. Contextual life stress and coping strategies as predictors of adjustment to breast cancer survivorship. Ann Behav Med. 2006; 32: 235–244. doi:10.1207/s15324796abm3203_10
  37. Manne S, Ostroff J, Winkel G, et al. Posttraumatic Growth After Breast Cancer: Patient, Partner, and Couple Perspectives. Psychosom Med. 2004 66: 442–454.
  38. Milam JE. Posttraumatic Growth Among HIV/AIDS Patients1. J Appl Soc Psychol. 2004; 34: 2353–2376. doi:10.1111/j.1559-1816.2004.tb01981.x
  39. Koutrouli N, Anagnostopoulos F, Potamianos G. Posttraumatic Stress Disorder and Posttraumatic Growth in Breast Cancer Patients: A Systematic Review. Women Health. 2012; 52: 503–516. doi:10.1080/03630242.2012.679337
  40. Casellas-Grau A. Ocha C Ruini C. Psychological and clinical correlates of posttraumatic growth in cancer: A systematic and critical review. Psychooncology. 2017; 26(12): 2007-18. doi: 10.1002/pon.4426
  41. Roepke AM. Psychosocial Interventions and Posttraumatic Growth: A Meta-Analysis. Journal of Consulting and Clinical Psychology. 2015; 83(1): 129-142. doi: 10.1037/a0036872
 

Article Info

Article Notes

  • Published on: March 19, 2018

Keywords

  • Head Neck Cancer

  • Positive Psychological Change
  • Posttraumatic Growth
  • Benefit Finding

*Correspondence:

Dr. Sam Harding
Pines and Steps, Southmead Hospital North Bristol Hospital Trust
Bristol, BS10 5NB, United Kingdom
Telephone: +44 (0) 117 414 3957
Email: sharding.jb@gmail.com