ABSTRACT
At the beginning of Part III, sixteen hypotheses were put forward. These hypotheses are now reviewed in the light of the empirical evidence.
Patients with facial cancer will tend to be from the lower socio-economic groups, more male than female, in late middle age, and to be heavy smokers and drinkers. Hypothesis supported. The social characteristics of the sample were similar to those described in previous studies.
Facially disfigured people will be stigmatised, and people will deal differently with those who have undergone facial surgery. Hypothesis supported. More than half the group felt that others’ attitudes to them had changed for the worse. However, social contact and functioning were impaired more by the physical condition than by the attitudes of others.
Patients will manage their differentness by ‘covering’, ‘withdrawing’ or ‘fighting’, to use Goffman’s categories. Hypothesis partially supported. Withdrawal was observed to be the most common response.
Patients will retain acceptance by those close to them, and will feel the greatest tension when meeting strangers. Hypothesis partially supported. Because of the tendency to withdraw, little contact with strangers took place. The little that did produced discomfort, particularly when children were encountered.
Early detection of head and neck cancer will increase the 278chances of survival. Not capable of being tested without a longitudinal study. Some social features associated with survival were beginning to emerge.
Patients who are accepting of surgery and changed appearance will have a distinctive social profile. Hypothesis supported. Those who found it easier to accept the changes to themselves tended to be male, living alone, of manual occupation, and with strong egos.
Patients will be assisted in their recovery by keeping control of their treatment and management. Hypothesis untested. Patients were largely passive recipients of treatment. This may have been due to the characteristics of the sample, or to the expectations of NHS patients in general.
Patients will vary in the amount of reconstructive work which they feel they need, in order to satisfy their own self-respect, and to make them presentable to others. Hypothesis supported. Sometimes there was a strong motivation to improve appearance, and on other occasions patients were content that functional performance was restored.
Patients who have had facial surgery are likely to experience feelings characteristic of bereavement, since changed facial appearance is a form of loss. Hypothesis supported for a small number of patients. The majority had been well prepared by the surgeons. On the other hand, most of the patients sustained a great loss because of reduced expectation of survival, and because of their reduced social functioning.
Patients will feel separated from others because of difficulties with speech and eating, and because of their appearance. Hypothesis supported. Functional difficulties caused the greatest feelings of detachment, but fear of meeting people, particularly children, was noted.
Surgery for head and neck cancer will be accompanied by signs of depression, dissatisfaction with the body, reduction in quality of life, and family tensions. Hypothesis unproven. Those whose outlook scores improved between the first and second interview tended to be living with others, of manual 279occupations, and who felt that their appearance had not changed.
Patients who function better after illness and treatment will be those with strong and intact egos, older people with a settled way of life, and those with a good family support network. Not supported. Those who functioned best after surgery were female patients, living alone, and of white collar occupation. There was no association between feeling positive and functioning well.
Facial disfigurement through surgery will cause a major upheaval in people’s lives. Hypothesis supported. The combined effect of the life- threatening condition, the painful and lengthy treatment, the residual scarring and functional deficit resulted in a substantial reduction in quality of life.
Good communication between surgeon and patient will enable trust to develop, which in turn will affect the patient’s acceptance of surgery. Hypothesis supported. Where the surgeon was open with the patient, this was much appreciated.
Social workers will play a major part in the rehabilitation process. Not supported. Only a few patients had had any contact with a social worker, and this was for practical matters.
280Patients will benefit from professional teamwork more than they would from professionals operating independently from each other. Not proven. Surgeons communicated well with each other, and surgeons and nurses worked in close cooperation, but there was little other sense of teamwork, and relatively little contact between hospital and community services.
