Evaluation of Prognostic Factors Affecting Quality of Life in Patients Three Months After Surgery for Head Cancer - A Qualitative Study

Evaluation of Prognostic Factors Affecting Quality of Life in Patients Three Months After Surgery for Head Cancer - A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of Prognostic Factors Affecting Quality of Life in Patients Three Months After Surgery for Head Cancer - A Qualitative Study Edyta Laska, Mariola Kłak This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8225118/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Context : The aim of this innovative study was to assess prognostic factors affecting the quality of life of patients with head cancer three months after surgery. The research has direct relevance to the care of patients with head cancer during rehabilitation, assessing patient independence and quality of life, and also highlights the important issue of social support and acceptance of the disease during the patient's recovery after surgery. Methods : A qualitative research design was adopted using standardized tools: WHOQOL-BREF, MSPSS, I-ADL, AIS. A diagnostic survey was conducted among patients three months after surgery for head cancer from July 2023 to October 2024 at the Clinic of St. Raphael's Hospital in Krakow in Polen. Results : A statistically significant positive correlation was found between the patient independence scale and the disease acceptance scale and quality of life scale. A statistically significant negative correlation was found between the patient independence scale and the social support scale, as well as between the social support scale and quality of life, disease acceptance and independence. Conclusions : The prognostic factors affecting the quality of life of patients three months after surgery for head cancer include: the type of cancer, patient independence, acceptance of the disease, and social support. The quality of life three months after surgery for head cancer can be described as good, taking into account the type of head cancer. The more independent the patients were, the higher their quality of life and the better they accepted their disease, and they also needed less support. Study registration : The study was registered by the ClinicalTrials.gov PRS research team (NCT 06395805). Registration date: June 2023. head cancer prognostic factors quality of life independence social support acceptance of illness qualitative study Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Head and neck cancer (HNC) is the seventh most common cancer worldwide, accounting for about 650 000 new cases and 350 000 deaths each year [1]. Epileptic seizures, convulsions and speech disorders are the most common symptoms revealing this cancer. Their incidence varies, depending on the type of tumor, its grade and location [2]. The most common head tumors we diagnose in patients are meningiomas, while the worst prognosis is for gliomas.Meningiomas are among the most common primary brain tumors and are classified by the World Health Organization (WHO) as benign (WHO grade 1), atypical (WHO grade 2) and malignant (WHO grade 3), with varying prognoses. More than 90% of meningiomas are WHO grade 1 tumor. Despite their mostly benign course, they can lead to significant morbidity if not controlled by compression of vital structures [3]. Gliomas, on the other hand, are primary brain tumors with a high degree of malignancy, which are associated with frequent recurrence of the tumor and reduced quality of life [4]. As such, HNC can have a significant impact on patients' quality of life (QOL) and mental health. Cancer survivors, especially head and neck cancer patients, represent a diverse patient population, suggesting that a specific follow-up regimen may not meet all patients' needs for quality of life observations and prognostic factors affecting quality of life [5,6]. In addition, follow-up care after surgical treatment is intended to monitor the patient in order to detect recurrent cancer and disturbing complications of treatment [7]. Unfortunately, little time is devoted during such follow-up visits to health issues related to quality of life. This is particularly important in the case of people with head cancer, where the limitations resulting from the disease and the treatment used can significantly affect the daily functioning and independence of patients [8,9]. Impairments in physical functioning and daily activities after surgery for head cancer contribute to a deterioration in the quality of life of these patients. In addition to these physical and psychosocial consequences of head cancer treatment and the need for neurological rehabilitation after surgery, patients usually begin cancer treatment already in poor physical and psychosocial health due to multiple chronic diseases, so their QOL is already lower at the outset, even before surgical intervention [7]. Therefore, prehabilitation of oncology patients, focusing on comprehensive physical and mental preparation of the patient for surgery, has a very significant impact on the patient's recovery after such difficult treatment and allows for the assessment of prognostic factors affecting quality of life at every stage of treatment. Cancer is a powerful stressor, and when it appears in a patient's life, it forces them to make adaptive changes in order to adjust to a new, unfavorable situation. Depending on the type of life experiences acquired by the patient, they either accept it and enter into the role of a sick person, or deny and reject the role of a patient [10]. The main problems faced by patients are coping with the consequences of the losses brought about by cancer, the changes associated with it, and the threats that may arise in the future, such as loss of independence. The loss of interpersonal contacts caused by the symptoms of the disease, therapy, or the fear of others at the sight of pain and suffering these consequences are more pronounced and more severe in people who have not accepted the new situation and have not coped with the negative emotions resulting from cancer [11]. The assessment of prognostic factors allows us to identify patients' health problems, determine how to deal with them, and plan specialist treatment and care, as well as greater support for patients. The available literature on head cancer emphasizes that it has a significant impact on patients' quality of life and mental health. Quality of life varies depending on the type of tumor, its stage, and location. Limitations resulting from the disease, treatment, and rehabilitation can also significantly affect quality of life, patient independence, acceptance of the disease, and social support. The aim of the study was to assess prognostic factors affecting the quality of life of patients with head cancer three months after surgery. The study made a significant contribution to the care of cancer patients, as each patient was examined using four standardized research tools, plus an additional analysis of medical records, which provided a broader insight into quality of life, independence, acceptance of the disease, and social support for patients during rehabilitation or after their return home, and also allowed for the identification of important prognostic factors. Methods The study was conducted using a diagnostic survey method on 93 patients three months after surgery for head cancer between July 2023 and October 2024 at the Neurological Rehabilitation Ward and the Neurosurgery Clinic of St. Raphael's Hospital in Krakow in Poland. The study was conducted in accordance with the World Medical Association Code of Ethics (Declaration of Helsinki) with human participants. Approval was obtained to conduct the study in accordance with the standard for reporting qualitative research. The manuscript complies with the Recommendations for Conducting, Reporting, Editing and Publishing Scientific Papers in Medical Journals. All procedures were performed in accordance with relevant institutional regulations and guidelines and the relevant bioethics committee. Approval was obtained from the bioethics committee at the university (KBKA 31/0/2023). The study was registered in accordance with the recommendations of the International Committee of Medical Journal Editors. The study was registered by the Clinical trials.gov PRS research team (NCT 06395805). Patients gave written informed consent to participate in the study. The method of recruiting patients was that any patient who was admitted to the Neurological Rehabilitation Unit or Neurosurgical Outpatient Clinic and had undergone surgery to remove a head tumor three months ago, and gave written informed consent to the study and the processing of personal data was recruited into the study. Inclusion criteria for the study group included patients who gave written, informed consent to participate in the study three months after surgery, and completed the questionnaires post-legally. On the other hand, the exclusion criteria included patients who refused to participate further in the study during the course of the study, as well as when the questionnaires were not completely or correctly completed. Calculations were performed using IBM SPSS software. Descriptive statistics were calculated for qualitative variables, where abundances were represented by percentages. Spearman's correlation coefficients were used to assess relationships between quantitative variables. Non-parametric methods were chosen because the distributions deviated from the normal distribution. As the limit of the significance level, p<0.05 was used. Schedule for collecting research material: Three months after surgery for head cancer at the hospital department of Neurological Rehabilitation and the Neurosurgical Outpatient Clinic, a diagnostic survey using the research tools outlined below. The research was conducted using a diagnostic survey method with standardized research tools: Abbreviated version of the questionnaire assessing quality of life - The World Health Organization Quality of Life (WHOQOL) -BREF https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.przeglepidemiol.pzh.gov.pl/pdf-180121-100695%3Ffilename%3DDevelopment%2520of%2520interest.pdf&ved=2ahUKEwjO-rLRitaQAxUSDRAIHeHbAJYQFnoECBcQAQ&usg=AOvVaw3XOsgsTPTmoP-co2Bt5Iqd Zimet's Multidimensional Perceived Social Support Scale - original version MSPSS (SWS - Social Support Scale) https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://pfp.ukw.edu.pl/archive/article/345/buszman_wsparcie_spoleczne/article.pdf&ved=2ahUKEwiz_6HHi9aQAxVgUFUIHZwKBCMQFnoECBkQAQ&usg=AOvVaw15FCskUeK--MKzgeFEh9Kp I - ADL scale according to Lawton https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://bonumvitae.org.pl/wp-content/uploads/2025/01/8.5_Skala-Katza-i-Lawtona.pdf&ved=2ahUKEwjxq7qOjNaQAxVGcfEDHaJjIucQFnoECCEQAQ&usg=AOvVaw0KQ_ygcx07fE-L6iXRinTT AIS questionnaire https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.practest.com.pl/files/AIS_arkusz.pdf&ved=2ahUKEwiP7q3VjdaQAxXmcPEDHck1PaQQFnoECBgQAQ&usg=AOvVaw1tCul1s1YXBy7O_JXKjxEp The questionnaires used in the study as standardized tools have been used by other researchers and have already been used as research tools elsewhere by me for other studies. I am sending a link to the article: https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.onlinescientificsresearch.com/articles/quality-of-life-support-before-and-after-surgery-which-cholelithiasis-by-laparoscopic-and-traditional-methods.pdf&ved=2ahUKEwjUz-3L-5qRAxX7GRAIHbFLOBwQFnoECBsQAQ&usg=AOvVaw2kVNAptDVnvaAmXOfxHoMU The study lasted a long time—a year and four months—and is very reliable, allowing patients to be examined using four standardized research tools simultaneously, whereas most studies of cancer patients only assess quality of life in this research group. The aim of the study was to assess prognostic factors affecting the quality of life of patients with head cancer three months after surgery Results 1. The assessment of patients' quality of life three months after surgery for head cancer is shown in Table 1 . Table 1 Descriptive statistics WHOQOL BREF – somatic domain (after surgery, 0-100) WHOQOL BREF – psychological domain (after surgery, 0-100) WHOQOL BREF – social domain (after surgery, 0-100) WHOQOL BREF – environmental domain (after surgery, 0-100) N - 93 93 93 93 Mean 73,746 75,02 74,55 83,401 Median 75,000 81,30 75,00 90,625 Sd 26,0917 25,039 21,681 21,9959 Minimum 16,7 13 17 21,9 Maximum 100,0 100 100 100,0 The average values were well above the midpoint of the scale. 2. Assessment of quality of life in patients three months after surgery for head cancer according to the cause of surgery - type of cancer. Due to the high variability, the large number of groups and the small size of the groups, statistical tests were not performed, comparisons were made using the error bar graphs below in Figs. 1 – 4 . 3. The relationship between patients' independence three months after surgery for head cancer and quality of life and acceptance of the disease is shown in Table 2 . Table 2 Correlations I-ADL Spearman rho WHOQOL BREF – somatic domain (after surgery, 0-100) Correlation coefficient 0,684 p < 0,001 N 93 WHOQOL BREF – psychological domain (po zabiegu, 0-100) Correlation coefficient 0,656 p < 0,001 N 93 WHOQOL BREF – social domain (after surgery, 0-100) Correlation coefficient 0,664 p < 0,001 N 93 WHOQOL BREF – environmental domain (after surgery, 0-100) Correlation coefficient 0,691 p < 0,001 N 93 AIS Correlation coefficient 0,731 p < 0,001 N 93 Statistically significant positive correlations were found between the I-ADL scale and the AIS and BREF scales in terms of quality of life. 4. The relationship between patients' independence three months after surgery for head cancer and social support is shown in Table 3 . Table 3 Correlations I-ADL Spearman rho SWS Total result Correlation coefficient -0,654 p < 0,001 N 93 SWS Significant Person Correlation coefficient -0,670 p < 0,001 N 93 SWS Family Correlation coefficient -0,677 p < 0,001 N 93 SWS Friend Correlation coefficient -0,652 p < 0,001 N 93 There was a statistically significant negative relationship between the I-ADL and MSPSS scales. 5. The relationship between social support in patients three months after surgery for head cancer and quality of life, acceptance of the disease, self-reliance, patients' age and waiting time for surgery is shown in Table 4 . Table 4 Correlations SWS Total Result SWS Significant Person SWS Family SWS Friend Spearman rho WHOQOL BREF – somatic domain (after surgery, 0-100) Correlation coefficient -,673 -,667 -,675 -,679 p ,000 ,000 ,000 ,000 WHOQOL BREF – psychological domain (after surgery, 0-100) Correlation coefficient -,677 -,648 -,672 -,686 p ,000 ,000 ,000 ,000 WHOQOL BREF – social domain (after surgery, 0-100) Correlation coefficient -,689 -,663 -,702 -,674 p ,000 ,000 ,000 ,000 WHOQOL BREF – environmental domain (after surgery, 0-100) Correlation coefficient -,731 -,707 -,731 -,724 p ,000 ,000 ,000 ,000 AIS Correlation coefficient -,687 -,677 -,697 -,698 p ,000 ,000 ,000 ,000 I-ADL Correlation coefficient -,654 -,670 -,677 -,652 p ,000 ,000 ,000 ,000 2. Age (years) Correlation coefficient -,148 -,166 -,127 -,151 p ,162 ,116 ,230 ,154 10. Time (in months) to surgery Correlation coefficient ,085 ,035 ,073 ,074 p ,420 ,740 ,485 ,481 There were statistically significant negative relationships between SWS scales and quality of life scales, AIS scale, I-ADL scale. Relationships were not significant between MSPSS scales and age and time to surgery. 6. The relationship between acceptance of the disease three months after surgery for head cancers and the reason for surgery - the type of cancer - is shown in Fig. 5 . The results of groups 8 and 11 were significantly different from those of groups 7 and 10. 7. The relationship between acceptance of the disease three months after surgery for head tumours and the patients' quality of life and self-efficacy is shown in Table 5 . Table 5 Relationship between disease acceptance three months after surgery for head tumours and patients' quality of life and self-efficacy. Correlations AIS Spearman rho WHOQOL BREF – somatic domain (after surgery, 0-100) Correlation coefficient 0,713 p < 0,0010 N 93 WHOQOL BREF – psychological domain (after surgery, 0-100) Correlation coefficient 0,667 p < 0,001 N 93 WHOQOL BREF – social domain (after surgery, 0-100) Correlation coefficient 0,691 p < 0,001 N 93 WHOQOL BREF – environmental domain (after surgery, 0-100) Correlation coefficient 0,727 p < 0,001 N 93 I-ADL Correlation coefficient 0,731 p < 0,001 N 93 Statistically significant positive relationships between the variables were shown. Discussion Qualitative research is very common and valued in international medical journals and scientific research. In order to increase the quality and clarity of scientific research, it is important to: establish the main objective and specific objectives of the study, consider the research question ( research problem), establish research hypotheses, use appropriate research methods and present relevant conclusions, as well as the completeness and clarity of research reporting. The quality of life of patients affected by oncological diseases is one of the strategic areas of research in medicine and health psychology. The progression of the disease, its treatment and possible complications affect both physical aspects and the emotional and social functioning of the patient [8,9]. Therefore, the evaluation of prognostic factors affecting quality of life is very important in patients with head cancer after surgical treatment. In addition to the physical aspects, the psychological well-being of cancer patients is extremely important. The diagnosis and long-term treatment often lead to severe stress, sleep difficulties and lowered mood, which can develop into more serious disorders such as depression or anxiety. Patients also struggle with uncertainty about the future, which puts additional strain on their mental health. Cancer patients' quality of life also includes the social sphere, which plays a key role in the treatment process and adaptation to a new reality. Relationships with loved ones, the possibility to receive emotional support and the maintenance of existing social roles can affect the level of satisfaction with life despite the disease. The support of the environment, both from family and professional caregivers, helps patients cope with daily challenges and better adapt to changing conditions. The spiritual dimension cannot be overlooked either, and for many patients this becomes an extremely important part of coping with their illness. Finding meaning in a difficult situation, accepting a new reality and developing ways to maintain internal balance can contribute to an improvement in overall well-being [12–14]. The success of cancer therapy is not just about prolonging a patient's life, but also about maintaining it to the highest possible quality. Cancer treatment is accompanied by numerous side effects that can significantly reduce the patient's quality of life. Analysis of these aspects allows us to better understand the needs of patients and to tailor medical and psychological care in a way that improves their quality of life despite the difficulties resulting from the disease and its treatment. Research on quality of life not only assesses the effectiveness of treatment, but also allows the therapeutic approach to be adapted in a way that takes into account medical outcomes, comfort and well-being of patients [15]. The negative effects of head cancer have been attributed to both the natural progression of the disease and treatment, which usually consists of maximally safe chirurgical resection followed at some point by radiation therapy, chemotherapy or a combination of the two. Concerns about tumor recurrence/progression, limited ability to work and reduced functional independence can add to patients' suffering [4]. Awareness of the importance of exercise therapy and neurological rehabilitation to prevent complications after surgery for head cancer during and after treatment is growing rapidly. Sufficient levels of physical activity before, during and after cancer treatment have been shown to be associated with a better prognosis, lower risk of recurrence and mortality, and fewer negative treatment-related side effects [7]. The European Organization for Research, Treatment of Cancer (EORTC) introduced the Quality of Life Assessment Tool in 1994 as a way to measure quality of life in cancer. This was useful in identifying patients whose lower quality of life had a major impact on their daily living activities, particularly to the greatest extent after surgical treatment. Describing the needs of head and neck cancer patients during follow-up care is a critical step in evaluating current practice and designing for improvement. Future research efforts should include collaborating with other researchers to select standardized instruments to improve comparability between studies, and gathering rich information from patients through experiences detailed in qualitative studies. Evaluating other creative approaches to meeting the needs of this patient population through randomized controlled trials and raising awareness among health care providers about unmet patient needs and prognostic factors affecting patients' quality of life. This study highlights the importance of identifying each patient's individual and unique needs as part of routine follow-up care. Future studies are needed to elucidate the reasons for unmet care, assess the psychological support of patients diagnosed with head cancer to help improve the quality of life of these patients, and the need to analyze prognostic factors affect quality of life [16]. Addition, analysis of quality of life survey results can help identify subgroups of patients who are more likely to experience disorders and therefore require additional targeted support in their recovery [17]. The difficulty is how best to define the concepts of quality of life and how to measure them empirically and then draw conclusions that will serve to improve the quality of life of cancer patients [18]. Thanks to medical advances over the past 20 years, the marked increase in the life expectancy of patients with diffuse glioma opens the field to new therapeutic targets. Neurocognitive performance, epileptic seizures and activities of daily living are direct indicators of brain function and quality of life in patients with diffuse glioma. The number of tumor resections is positively correlated with return to normal socio-professional life. Rydén and co-authors add that age, cognitive function, resection and follow-up treatment (chemotherapy or radiation therapy) determine return to work [2]. The results of the study by Vigano et al. showed that after a longer period of time after surgery and radiotherapy, quality of life improved after 3–6 months compared to immediately after surgery. Time was found to be a predictor of all three factors of the questionnaire, that is, general and specific symptoms and interference with daily life [19]. Our own research has shown that the prognostic factors affecting the quality of life of patients three months after surgery for head cancer include the type of cancer, patients' independence, acceptance of the disease and social support. The level of quality of life as exemplified by the somatic, psychological, social and environmental domains in the study group of patients three months after surgery for head cancer can be described as good, taking into account the cause of the cancerous lesion. Quality of life is becoming an important issue in clinical decision-making for gliomas. Some patients returned to an active socio-occupational life after surgery for glioma after repeat surgery, and some patients showed neurocognitive impairment in the post-operative period, which significantly affected their quality of life. Several studies have found that lower physical fitness in glioma patients is associated with higher levels of fatigue and more impairment, so exercise and other interventions to improve physical functioning could potentially help reduce symptoms and improve quality of life [4]. Our own study showed that in terms of somatic and psychological domains, the lowest quality of life three months after surgery for head cancer was reported in the group of patients with glioma, and the highest in the group of patients with meningioma. Since cancer patients often begin treatment with poor physical fitness, exercise therapy should be started at the time of diagnosis and continued during and after treatment. The results of the study by Vigano et al. showed that older patients had a reduced quality of life, which is understandable in that patients who have undergone surgery for head cancer may be debilitated, have poorer physical function even before surgery, and are additionally burdened by multiple chronic diseases [19]. Hannon et al. showed a correlation between poor quality of life and reduced satisfaction with treatment and acceptance of the disease. In addition, patients who were less satisfied with their treatment had a reduced quality of life [20]. Our own research similarly showed that the more independent the patients were three months after surgery for head cancer, the higher their quality of life and the better they accepted their illness, and the less social support they needed. The long-term neurocognitive and psychosocial sequelae of treatment are increasingly important in patients with head cancer. Prospective evaluations of the efficacy of cancer-targeted treatment appear to be crucial [21]. Treatment in patients with head cancer often interferes with vital structures, resulting in survivors experiencing bio-psycho-social problems related to changes in appearance, communication, breathing, eating and drinking, intimate relationships, and feeling their impact on long-term quality of life [22]. A strength of the present study is the use of four research tools that are standarised, which translated into the reliability of the results. In addition, the study was conducted in a thorough and reliable manner and lasted a long period of time − 16 months. Also a strength is the innovative nature of the study and the emphasis on its direct relevance to the care of oncology patients with head cancer. A weakness of the study was the relatively small size of the study group, due to the fact that some patients refused to participate in the study due to health difficulties and could not complete the questionnaires. In the light of the results obtained and taking into account the limitations of the study, it seems reasonable to continue research into the quality of life of oncology patients on a larger scale. In the future, it would be worth considering conducting studies on larger and more diverse patient populations, which would increase the statistical power of the analyses and enable a more precise assessment of the impact of individual clinical and socio-demographic factors on quality of life. Conclusions 1. Prognostic factors affecting patients' quality of life three months after surgery for head cancer include: type of cancer, patients' independence, acceptance of the disease and social support. 2. The level of quality of life as exemplified by the somatic, psychological, social and environmental domains in the study group of patients three months after surgery for head cancer can be described as good, taking into account the cause of the neoplastic lesion. Made it possible to learn about patients' health problems, their ability to cope and to plan more support for them. Therefore, an individual and interdisciplinary approach of the whole therapeutic team to the patient, which should be holistic, is crucial. In terms of the somatic and psychological domain, the lowest quality of life three months after surgery for head cancer was found in the group of patients with glioma, and the highest quality of life in the group of patients with meningioma. In terms of the psychological domain, single sural neuroma and VIII nerve sheath patients had higher scores than meningioma patients. In terms of the social domain of quality of life, the lowest values were recorded equally in the glioma patients and the highest in the meningioma patients. Individuals with sural neuroblastoma and neuroblastoma VIII had higher scores than patients with meningioma. In terms of the environmental domain of quality of life, the lowest values were similarly reported in the glioma patient group, the highest in the meningioma patient group. 3. The more independent the patients were three months after surgery for head cancer, the higher their quality of life and the better they accepted their illness, and the less social support they needed. 4.The less support patients received from family, friends, lower quality of life, poorer acceptance of the disease and lower independence were observed. 5.There is no relationship between acceptance of the disease three months after surgery for head cancer and the location of the cancer lesion and chronic diseases. 6. The greater the acceptance of the disease three months after surgery for head cancer, the higher the patients' quality of life and self-reliance, which made it possible to use rehabilitation to be more effective for patients. The relevance and significance of the study The study made a significant contribution to the care of cancer patients, as each patient was examined using four standardized research tools, plus an additional analysis of medical records, which provided a broader insight into quality of life, independence, acceptance of the disease, and social support for patients during rehabilitation or after their return home, and also allowed for the identification of important prognostic factors. Abbreviations HNC - Head and Neck Cancers WHO - World Health Organization QOL - Quality of Life IBM SPSS - Statistical Package for the Social Sciences WHOQOL - The World Health Organization Quality of Life MSPSS - Multidimensional Scale of Perceived Social Support (SWS - Social Support Scale) AIS - Acceptance of Illness Scale I - ADL – Instrumental Activities of Daily Living Scale EORTC - The European Organization for Research, Treatment of Cancer Declarations Ethics committee approval and consent to participate Approval was obtained from the university's bioethics committee (KBKA – Bioethics Committee of the Krakow Academy 31/0/2023) and a scan was sent in a file. The study was registered in accordance with the recommendations of the International Committee of Medical Journal Editors. The study was registered by the Clinical trials.gov PRS research team (NCT 06395805). Patients gave their written informed consent to participate in the study – file attached. Written consent from the hospital management to conduct the study was obtained and sent in the file. Consent for publication Not applicable Data availability All data generated and analyzed during this study are included in this published article and its supplementary information file. Conflicts of interest Not applicable Funding Not applicable Authors' contributions MK analyzed and interpreted the patient data from all questionnaires. EL analyzed the research results received from the statistician, wrote the conclusions and discussion, and made a significant contribution to the writing of the manuscript. All authors read and approved the final version of the manuscript. Acknowledgements Thanks to Mr. Professor Ryszard Czepko - Head of the Department of Neurosurgery at St. Raphael's Hospital in Kraków for permission for the research and valuable guidance before conducting it. References Vermaire AJ, Raaijmakers CPJ, Monninkhof EM et al. 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Pertz M, Schlömer S, Seidel C, Longterm neurocognitive function and quality of life after multimodal therapy in adult glioma patients: a prospective long term follow up. Journal of Neurooncology., Rogers SN, Semple CJ et al. Exploration of family members’ perceptions of an online resource to provide information and support for patients with head and neck cancer and their informal carers: a qualitative study. European Journal of Oncology Nursing. 2025;77. Additional Declarations No competing interests reported. Supplementary Files Filewithsupplementaryinformation.xlsx Patientdatabase.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Mar, 2026 Reviewers agreed at journal 02 Jan, 2026 Reviewers agreed at journal 25 Dec, 2025 Reviewers invited by journal 25 Dec, 2025 Editor assigned by journal 23 Dec, 2025 Editor invited by journal 01 Dec, 2025 Submission checks completed at journal 01 Dec, 2025 First submitted to journal 01 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":19514,"visible":true,"origin":"","legend":"\u003cp\u003eSomatic domain quality of life in patients three months after surgery for head cancer according to the cause of surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e x-axis – Reason for surgery; Y-axis – somatic domain (after surgery, 0-100).\u003c/p\u003e\n\u003cp\u003eReason for needing surgical treatment for head cancer - type of lesion\u003c/p\u003e\n\u003cp\u003eof neoplastic lesion:\u003c/p\u003e\n\u003cp\u003e5 - cerebellar tumour\u003c/p\u003e\n\u003cp\u003e6 - recurrence of cerebellar tumour\u003c/p\u003e\n\u003cp\u003e7 - neuroblastoma of the auditory nerve\u003c/p\u003e\n\u003cp\u003e8 - pituitary adenoma\u003c/p\u003e\n\u003cp\u003e9 - recurrence of meningioma\u003c/p\u003e\n\u003cp\u003e10 - meningioma\u003c/p\u003e\n\u003cp\u003e11 - glioma\u003c/p\u003e\n\u003cp\u003e12 - recurrent brain tumour\u003c/p\u003e\n\u003cp\u003e13 - casing of nerve VIII\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-8225118/v1/3e51ba69b4a20e8efa265520.png"},{"id":99221863,"identity":"735ea3c0-cc6a-4c8b-ab9b-6babeb7ab7d4","added_by":"auto","created_at":"2025-12-30 09:52:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19354,"visible":true,"origin":"","legend":"\u003cp\u003ePsychological domain quality of life in patients three months after surgery for head cancer according to the cause of surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e x-axis – Reason for surgery; Y-axis – psychological domain (after surgery, 0-100).\u003c/p\u003e\n\u003cp\u003eReason for needing surgical treatment for head cancer - type of lesion\u003c/p\u003e\n\u003cp\u003eof neoplastic lesion:\u003c/p\u003e\n\u003cp\u003e5 - cerebellar tumour\u003c/p\u003e\n\u003cp\u003e6 - recurrence of cerebellar tumour\u003c/p\u003e\n\u003cp\u003e7 - neuroblastoma of the auditory nerve\u003c/p\u003e\n\u003cp\u003e8 - pituitary adenoma\u003c/p\u003e\n\u003cp\u003e9 - recurrence of meningioma\u003c/p\u003e\n\u003cp\u003e10 - meningioma\u003c/p\u003e\n\u003cp\u003e11 - glioma\u003c/p\u003e\n\u003cp\u003e12 - recurrent brain tumour\u003c/p\u003e\n\u003cp\u003e13 - casing of nerve VIII\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-8225118/v1/4fc2ea9666d1b665cf028bc2.png"},{"id":99318529,"identity":"72206720-c635-473a-8bb3-7d24919db853","added_by":"auto","created_at":"2025-12-31 16:33:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":18523,"visible":true,"origin":"","legend":"\u003cp\u003eQuality of life in terms of the social domain in patients three months after surgery for head cancer according to the cause of surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e x-axis – Reason for surgery; Y-axis – social domain (after surgery, 0-100).\u003c/p\u003e\n\u003cp\u003eReason for needing surgical treatment for head cancer - type of lesion\u003c/p\u003e\n\u003cp\u003eof neoplastic lesion:\u003c/p\u003e\n\u003cp\u003e5 - cerebellar tumour\u003c/p\u003e\n\u003cp\u003e6 - recurrence of cerebellar tumour\u003c/p\u003e\n\u003cp\u003e7 - neuroblastoma of the auditory nerve\u003c/p\u003e\n\u003cp\u003e8 - pituitary adenoma\u003c/p\u003e\n\u003cp\u003e9 - recurrence of meningioma\u003c/p\u003e\n\u003cp\u003e10 - meningioma\u003c/p\u003e\n\u003cp\u003e11 - glioma\u003c/p\u003e\n\u003cp\u003e12 - recurrent brain tumour\u003c/p\u003e\n\u003cp\u003e13 - casing of nerve VIII\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-8225118/v1/3848f74400642311550e56b4.png"},{"id":99221868,"identity":"80b0e56f-77a4-4a94-a212-4095387d687f","added_by":"auto","created_at":"2025-12-30 09:52:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":19096,"visible":true,"origin":"","legend":"\u003cp\u003eQuality of life in terms of the environmental domain in patients three months after surgery for head cancer according to the cause of surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e x-axis – Reason for surgery; Y-axis – environmental domain (after surgery, 0-100).\u003c/p\u003e\n\u003cp\u003eReason for needing surgical treatment for head cancer - type of lesion\u003c/p\u003e\n\u003cp\u003eof neoplastic lesion:\u003c/p\u003e\n\u003cp\u003e5 - cerebellar tumour\u003c/p\u003e\n\u003cp\u003e6 - recurrence of cerebellar tumour\u003c/p\u003e\n\u003cp\u003e7 - neuroblastoma of the auditory nerve\u003c/p\u003e\n\u003cp\u003e8 - pituitary adenoma\u003c/p\u003e\n\u003cp\u003e9 - recurrence of meningioma\u003c/p\u003e\n\u003cp\u003e10 - meningioma\u003c/p\u003e\n\u003cp\u003e11 - glioma\u003c/p\u003e\n\u003cp\u003e12 - recurrent brain tumour\u003c/p\u003e\n\u003cp\u003e13 - casing of nerve VIII\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-8225118/v1/92078f4c55ba674e919ba0fb.png"},{"id":99317174,"identity":"d2380c32-dca9-44a5-a1ce-0687318a1fd3","added_by":"auto","created_at":"2025-12-31 16:29:43","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":14086,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e x-axis – Reason for surgery;\u003c/p\u003e\n\u003cp\u003eReason for needing surgical treatment for head cancer - type of lesion\u003c/p\u003e\n\u003cp\u003eof neoplastic lesion:\u003c/p\u003e\n\u003cp\u003e5 - cerebellar tumour\u003c/p\u003e\n\u003cp\u003e6 - recurrence of cerebellar tumour\u003c/p\u003e\n\u003cp\u003e7 - neuroblastoma of the auditory nerve\u003c/p\u003e\n\u003cp\u003e8 - pituitary adenoma\u003c/p\u003e\n\u003cp\u003e9 - recurrence of meningioma\u003c/p\u003e\n\u003cp\u003e10 - meningioma\u003c/p\u003e\n\u003cp\u003e11 - glioma\u003c/p\u003e\n\u003cp\u003e12 - recurrent brain tumour\u003c/p\u003e\n\u003cp\u003e13 - casing of nerve VIII\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-8225118/v1/082f8520743f2e65ad731cc3.png"},{"id":99324135,"identity":"03958c3f-3295-4aee-b062-9680ba867ae2","added_by":"auto","created_at":"2025-12-31 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09:52:11","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":235968,"visible":true,"origin":"","legend":"","description":"","filename":"Patientdatabase.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8225118/v1/c2f77e50b8d885bd3ac2599a.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEvaluation of Prognostic Factors Affecting Quality of Life in Patients Three Months After Surgery for Head Cancer - A Qualitative Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eHead and neck cancer (HNC) is the seventh most common cancer worldwide, accounting for about 650 000 new cases and 350 000 deaths each year [1].\u003c/p\u003e \u003cp\u003eEpileptic seizures, convulsions and speech disorders are the most common symptoms revealing this cancer. Their incidence varies, depending on the type of tumor, its grade and location [2].\u003c/p\u003e \u003cp\u003eThe most common head tumors we diagnose in patients are meningiomas, while the worst prognosis is for gliomas.Meningiomas are among the most common primary brain tumors and are classified by the World Health Organization (WHO) as benign (WHO grade 1), atypical (WHO grade 2) and malignant (WHO grade 3), with varying prognoses. More than 90% of meningiomas are WHO grade 1 tumor. Despite their mostly benign course, they can lead to significant morbidity if not controlled by compression of vital structures [3]. Gliomas, on the other hand, are primary brain tumors with a high degree of malignancy, which are associated with frequent recurrence of the tumor and reduced quality of life [4].\u003c/p\u003e \u003cp\u003eAs such, HNC can have a significant impact on patients' quality of life (QOL) and mental health. Cancer survivors, especially head and neck cancer patients, represent a diverse patient population, suggesting that a specific follow-up regimen may not meet all patients' needs for quality of life observations and prognostic factors affecting quality of life [5,6].\u003c/p\u003e \u003cp\u003eIn addition, follow-up care after surgical treatment is intended to monitor the patient in order to detect recurrent cancer and disturbing complications of treatment [7].\u003c/p\u003e \u003cp\u003eUnfortunately, little time is devoted during such follow-up visits to health issues related to quality of life. This is particularly important in the case of people with head cancer, where the limitations resulting from the disease and the treatment used can significantly affect the daily functioning and independence of patients [8,9].\u003c/p\u003e \u003cp\u003eImpairments in physical functioning and daily activities after surgery for head cancer contribute to a deterioration in the quality of life of these patients. In addition to these physical and psychosocial consequences of head cancer treatment and the need for neurological rehabilitation after surgery, patients usually begin cancer treatment already in poor physical and psychosocial health due to multiple chronic diseases, so their QOL is already lower at the outset, even before surgical intervention [7]. Therefore, prehabilitation of oncology patients, focusing on comprehensive physical and mental preparation of the patient for surgery, has a very significant impact on the patient's recovery after such difficult treatment and allows for the assessment of prognostic factors affecting quality of life at every stage of treatment.\u003c/p\u003e \u003cp\u003eCancer is a powerful stressor, and when it appears in a patient's life, it forces them to make adaptive changes in order to adjust to a new, unfavorable situation. Depending on the type of life experiences acquired by the patient, they either accept it and enter into the role of a sick person, or deny and reject the role of a patient [10].\u003c/p\u003e \u003cp\u003eThe main problems faced by patients are coping with the consequences of the losses brought about by cancer, the changes associated with it, and the threats that may arise in the future, such as loss of independence. The loss of interpersonal contacts caused by the symptoms of the disease, therapy, or the fear of others at the sight of pain and suffering these consequences are more pronounced and more severe in people who have not accepted the new situation and have not coped with the negative emotions resulting from cancer [11].\u003c/p\u003e \u003cp\u003eThe assessment of prognostic factors allows us to identify patients' health problems, determine how to deal with them, and plan specialist treatment and care, as well as greater support for patients.\u003c/p\u003e \u003cp\u003eThe available literature on head cancer emphasizes that it has a significant impact on patients' quality of life and mental health. Quality of life varies depending on the type of tumor, its stage, and location. Limitations resulting from the disease, treatment, and rehabilitation can also significantly affect quality of life, patient independence, acceptance of the disease, and social support.\u003c/p\u003e \u003cp\u003eThe aim of the study was to assess prognostic factors affecting the quality of life of patients with head cancer three months after surgery.\u003c/p\u003e \u003cp\u003eThe study made a significant contribution to the care of cancer patients, as each patient was examined using four standardized research tools, plus an additional analysis of medical records, which provided a broader insight into quality of life, independence, acceptance of the disease, and social support for patients during rehabilitation or after their return home, and also allowed for the identification of important prognostic factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study was conducted using a diagnostic survey method on 93 patients three months after surgery for head cancer between July 2023 and October 2024 at the Neurological Rehabilitation Ward and the Neurosurgery Clinic of St. Raphael's Hospital in Krakow in Poland.\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the World Medical Association Code of Ethics (Declaration of Helsinki) with human participants.\u003c/p\u003e\n\u003cp\u003eApproval was obtained to conduct the study in accordance with the standard for reporting qualitative research.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The manuscript complies with the Recommendations for Conducting, Reporting, Editing and Publishing Scientific Papers in Medical Journals.\u003c/p\u003e\n\u003cp\u003eAll procedures were performed in accordance with relevant institutional regulations and guidelines and the relevant bioethics committee.\u003c/p\u003e\n\u003cp\u003eApproval was obtained from the bioethics committee at the university (KBKA 31/0/2023).\u003c/p\u003e\n\u003cp\u003eThe study was registered in accordance with the recommendations of the International Committee of Medical Journal Editors. The study was registered by the Clinical trials.gov PRS research team (NCT 06395805).\u0026nbsp; Patients gave written informed consent to participate in the study.\u003c/p\u003e\n\u003cp\u003eThe method of recruiting patients was that any patient who was admitted to the Neurological Rehabilitation Unit or Neurosurgical Outpatient Clinic and had undergone surgery to remove a head tumor three months ago, and gave written informed consent to the study and the processing of personal data was recruited into the study.\u003c/p\u003e\n\u003cp\u003eInclusion criteria for the study group included patients who gave written, informed consent to participate in the study three months after surgery, and completed the questionnaires post-legally. On the other hand, the exclusion criteria included patients who refused to participate further in the study during the course of the study, as well as when the questionnaires were not completely or correctly completed.\u003c/p\u003e\n\u003cp\u003eCalculations were performed using IBM SPSS software. Descriptive statistics were calculated for qualitative variables, where abundances were represented by percentages. \u003cbr /\u003e Spearman's correlation coefficients were used to assess relationships between quantitative variables. Non-parametric methods were chosen because the distributions deviated from the normal distribution. As the limit of the significance level, p\u0026lt;0.05 was used.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSchedule for collecting research material:\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eThree months after surgery for head cancer at the hospital department of Neurological Rehabilitation and the Neurosurgical Outpatient Clinic, a diagnostic survey using the research tools outlined below.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe research was conducted using a diagnostic survey method with standardized research tools:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eAbbreviated version of the questionnaire assessing quality of life - The World Health Organization Quality of Life (WHOQOL) -BREF\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ehttps://www.google.com/url?sa=t\u0026amp;source=web\u0026amp;rct=j\u0026amp;opi=89978449\u0026amp;url=https://www.przeglepidemiol.pzh.gov.pl/pdf-180121-100695%3Ffilename%3DDevelopment%2520of%2520interest.pdf\u0026amp;ved=2ahUKEwjO-rLRitaQAxUSDRAIHeHbAJYQFnoECBcQAQ\u0026amp;usg=AOvVaw3XOsgsTPTmoP-co2Bt5Iqd\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eZimet's Multidimensional Perceived Social Support Scale - original version MSPSS (SWS - Social Support Scale)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ehttps://www.google.com/url?sa=t\u0026amp;source=web\u0026amp;rct=j\u0026amp;opi=89978449\u0026amp;url=https://pfp.ukw.edu.pl/archive/article/345/buszman_wsparcie_spoleczne/article.pdf\u0026amp;ved=2ahUKEwiz_6HHi9aQAxVgUFUIHZwKBCMQFnoECBkQAQ\u0026amp;usg=AOvVaw15FCskUeK--MKzgeFEh9Kp\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eI - ADL scale according to Lawton\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ehttps://www.google.com/url?sa=t\u0026amp;source=web\u0026amp;rct=j\u0026amp;opi=89978449\u0026amp;url=https://bonumvitae.org.pl/wp-content/uploads/2025/01/8.5_Skala-Katza-i-Lawtona.pdf\u0026amp;ved=2ahUKEwjxq7qOjNaQAxVGcfEDHaJjIucQFnoECCEQAQ\u0026amp;usg=AOvVaw0KQ_ygcx07fE-L6iXRinTT\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eAIS questionnaire\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ehttps://www.google.com/url?sa=t\u0026amp;source=web\u0026amp;rct=j\u0026amp;opi=89978449\u0026amp;url=https://www.practest.com.pl/files/AIS_arkusz.pdf\u0026amp;ved=2ahUKEwiP7q3VjdaQAxXmcPEDHck1PaQQFnoECBgQAQ\u0026amp;usg=AOvVaw1tCul1s1YXBy7O_JXKjxEp\u003c/p\u003e\n\u003cp\u003eThe questionnaires used in the study\u0026nbsp; as standardized tools have been used by other researchers and have already been used as research tools elsewhere by me for other studies. I am sending a link to the article:\u003c/p\u003e\n\u003cp\u003ehttps://www.google.com/url?sa=t\u0026amp;source=web\u0026amp;rct=j\u0026amp;opi=89978449\u0026amp;url=https://www.onlinescientificsresearch.com/articles/quality-of-life-support-before-and-after-surgery-which-cholelithiasis-by-laparoscopic-and-traditional-methods.pdf\u0026amp;ved=2ahUKEwjUz-3L-5qRAxX7GRAIHbFLOBwQFnoECBsQAQ\u0026amp;usg=AOvVaw2kVNAptDVnvaAmXOfxHoMU\u003c/p\u003e\n\u003cp\u003eThe study lasted a long time\u0026mdash;a year and four months\u0026mdash;and is very reliable, allowing patients to be examined using four standardized research tools simultaneously, whereas most studies of cancer patients only assess quality of life in this research group.\u003c/p\u003e\n\u003cp\u003eThe aim of the study was to assess prognostic factors affecting the quality of life of patients with head cancer three months after surgery\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. The assessment of patients\u0026apos; quality of life three months after surgery for head cancer is shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eDescriptive statistics\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; somatic domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; psychological domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; social domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; environmental domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73,746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75,02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74,55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83,401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81,30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90,625\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eSd\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26,0917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25,039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21,681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21,9959\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe average values were well above the midpoint of the scale.\u003c/p\u003e\n\u003cp\u003e2. Assessment of quality of life in patients three months after surgery for head cancer according to the cause of surgery - type of cancer.\u003c/p\u003e\n\u003cp\u003eDue to the high variability, the large number of groups and the small size of the groups, statistical tests were not performed, comparisons were made using the error bar graphs below in Figs.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e3. The relationship between patients\u0026apos; independence three months after surgery for head cancer and quality of life and acceptance of the disease is shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCorrelations\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI-ADL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"15\" align=\"left\"\u003e\n \u003cp\u003eSpearman rho\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; somatic domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,684\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; psychological domain (po zabiegu, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,656\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; social domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,664\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; environmental domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,691\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eAIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,731\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eStatistically significant positive correlations were found between the I-ADL scale and the AIS and BREF scales in terms of quality of life.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e4. The relationship between patients\u0026apos; independence three months after surgery for head cancer and social support is shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCorrelations\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI-ADL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"12\" align=\"left\"\u003e\n \u003cp\u003eSpearman rho\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eSWS Total result\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,654\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eSWS Significant Person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,670\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eSWS Family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,677\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eSWS Friend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,652\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere was a statistically significant negative relationship between the I-ADL and MSPSS scales.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e5. The relationship between social support in patients three months after surgery for head cancer and quality of life, acceptance of the disease, self-reliance, patients\u0026apos; age and waiting time for surgery is shown in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCorrelations\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSWS Total Result\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSWS Significant Person\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSWS Family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSWS Friend\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"16\" align=\"left\"\u003e\n \u003cp\u003eSpearman rho\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; somatic domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; psychological domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,686\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; social domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,702\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,674\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; environmental domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,724\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eI-ADL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,652\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e2. Age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-,151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e10. Time (in months) to surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,481\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere were statistically significant negative relationships between SWS scales and quality of life scales, AIS scale, I-ADL scale. Relationships were not significant between MSPSS scales and age and time to surgery.\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e6. The relationship between acceptance of the disease three months after surgery for head cancers and the reason for surgery - the type of cancer - is shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eThe results of groups 8 and 11 were significantly different from those of groups 7 and 10.\u003c/p\u003e\n\u003cp\u003e7. The relationship between acceptance of the disease three months after surgery for head tumours and the patients\u0026apos; quality of life and self-efficacy is shown in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRelationship between disease acceptance three months after surgery for head tumours and patients\u0026apos; quality of life and self-efficacy.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eCorrelations\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAIS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"15\" align=\"left\"\u003e\n \u003cp\u003eSpearman rho\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; somatic domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,713\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,0010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; psychological domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,667\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; social domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,691\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eWHOQOL BREF \u0026ndash; environmental domain (after surgery, 0-100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,727\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eI-ADL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCorrelation coefficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,731\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eStatistically significant positive relationships between the variables were shown.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eQualitative research is very common and valued in international medical journals and scientific research.\u003c/p\u003e \u003cp\u003eIn order to increase the quality and clarity of scientific research, it is important to: establish the main objective and specific objectives of the study, consider the research question ( research problem), establish research hypotheses, use appropriate research methods and present relevant conclusions, as well as the completeness and clarity of research reporting.\u003c/p\u003e \u003cp\u003eThe quality of life of patients affected by oncological diseases is one of the strategic areas of research in medicine and health psychology. The progression of the disease, its treatment and possible complications affect both physical aspects and the emotional and social functioning of the patient [8,9].\u003c/p\u003e \u003cp\u003eTherefore, the evaluation of prognostic factors affecting quality of life is very important in patients with head cancer after surgical treatment. In addition to the physical aspects, the psychological well-being of cancer patients is extremely important. The diagnosis and long-term treatment often lead to severe stress, sleep difficulties and lowered mood, which can develop into more serious disorders such as depression or anxiety. Patients also struggle with uncertainty about the future, which puts additional strain on their mental health. Cancer patients' quality of life also includes the social sphere, which plays a key role in the treatment process and adaptation to a new reality. Relationships with loved ones, the possibility to receive emotional support and the maintenance of existing social roles can affect the level of satisfaction with life despite the disease. The support of the environment, both from family and professional caregivers, helps patients cope with daily challenges and better adapt to changing conditions. The spiritual dimension cannot be overlooked either, and for many patients this becomes an extremely important part of coping with their illness. Finding meaning in a difficult situation, accepting a new reality and developing ways to maintain internal balance can contribute to an improvement in overall well-being [12\u0026ndash;14].\u003c/p\u003e \u003cp\u003eThe success of cancer therapy is not just about prolonging a patient's life, but also about maintaining it to the highest possible quality. Cancer treatment is accompanied by numerous side effects that can significantly reduce the patient's quality of life. Analysis of these aspects allows us to better understand the needs of patients and to tailor medical and psychological care in a way that improves their quality of life despite the difficulties resulting from the disease and its treatment. Research on quality of life not only assesses the effectiveness of treatment, but also allows the therapeutic approach to be adapted in a way that takes into account medical outcomes, comfort and well-being of patients [15].\u003c/p\u003e \u003cp\u003eThe negative effects of head cancer have been attributed to both the natural progression of the disease and treatment, which usually consists of maximally safe chirurgical resection followed at some point by radiation therapy, chemotherapy or a combination of the two.\u003c/p\u003e \u003cp\u003eConcerns about tumor recurrence/progression, limited ability to work and reduced functional independence can add to patients' suffering [4].\u003c/p\u003e \u003cp\u003eAwareness of the importance of exercise therapy and neurological rehabilitation to prevent complications after surgery for head cancer during and after treatment is growing rapidly. Sufficient levels of physical activity before, during and after cancer treatment have been shown to be associated with a better prognosis, lower risk of recurrence and mortality, and fewer negative treatment-related side effects [7].\u003c/p\u003e \u003cp\u003eThe European Organization for Research, Treatment of Cancer (EORTC) introduced the Quality of Life Assessment Tool in 1994 as a way to measure quality of life in cancer. This was useful in identifying patients whose lower quality of life had a major impact on their daily living activities, particularly to the greatest extent after surgical treatment.\u003c/p\u003e \u003cp\u003eDescribing the needs of head and neck cancer patients during follow-up care is a critical step in evaluating current practice and designing for improvement.\u003c/p\u003e \u003cp\u003eFuture research efforts should include collaborating with other researchers to select standardized instruments to improve comparability between studies, and gathering rich information from patients through experiences detailed in qualitative studies. Evaluating other creative approaches to meeting the needs of this patient population through randomized controlled trials and raising awareness among health care providers about unmet patient needs and prognostic factors affecting patients' quality of life.\u003c/p\u003e \u003cp\u003eThis study highlights the importance of identifying each patient's individual and unique needs as part of routine follow-up care. Future studies are needed to elucidate the reasons for unmet care, assess the psychological support of patients diagnosed with head cancer to help improve the quality of life of these patients, and the need to analyze prognostic factors affect quality of life [16].\u003c/p\u003e \u003cp\u003eAddition, analysis of quality of life survey results can help identify subgroups of patients who are more likely to experience disorders and therefore require additional targeted support in their recovery [17].\u003c/p\u003e \u003cp\u003eThe difficulty is how best to define the concepts of quality of life and how to measure them empirically and then draw conclusions that will serve to improve the quality of life of cancer patients [18].\u003c/p\u003e \u003cp\u003eThanks to medical advances over the past 20 years, the marked increase in the life expectancy of patients with diffuse glioma opens the field to new therapeutic targets.\u003c/p\u003e \u003cp\u003eNeurocognitive performance, epileptic seizures and activities of daily living are direct indicators of brain function and quality of life in patients with diffuse glioma.\u003c/p\u003e \u003cp\u003eThe number of tumor resections is positively correlated with return to normal socio-professional life. Ryd\u0026eacute;n and co-authors add that age, cognitive function, resection and follow-up treatment (chemotherapy or radiation therapy) determine return to work [2].\u003c/p\u003e \u003cp\u003eThe results of the study by Vigano et al. showed that after a longer period of time after surgery and radiotherapy, quality of life improved after 3\u0026ndash;6 months compared to immediately after surgery. Time was found to be a predictor of all three factors of the questionnaire, that is, general and specific symptoms and interference with daily life [19].\u003c/p\u003e \u003cp\u003eOur own research has shown that the prognostic factors affecting the quality of life of patients three months after surgery for head cancer include the type of cancer, patients' independence, acceptance of the disease and social support. The level of quality of life as exemplified by the somatic, psychological, social and environmental domains in the study group of patients three months after surgery for head cancer can be described as good, taking into account the cause of the cancerous lesion.\u003c/p\u003e \u003cp\u003eQuality of life is becoming an important issue in clinical decision-making for gliomas.\u003c/p\u003e \u003cp\u003eSome patients returned to an active socio-occupational life after surgery for glioma after repeat surgery, and some patients showed neurocognitive impairment in the post-operative period, which significantly affected their quality of life.\u003c/p\u003e \u003cp\u003eSeveral studies have found that lower physical fitness in glioma patients is associated with higher levels of fatigue and more impairment, so exercise and other interventions to improve physical functioning could potentially help reduce symptoms and improve quality of life [4].\u003c/p\u003e \u003cp\u003eOur own study showed that in terms of somatic and psychological domains, the lowest quality of life three months after surgery for head cancer was reported in the group of patients with glioma, and the highest in the group of patients with meningioma.\u003c/p\u003e \u003cp\u003eSince cancer patients often begin treatment with poor physical fitness, exercise therapy should be started at the time of diagnosis and continued during and after treatment.\u003c/p\u003e \u003cp\u003eThe results of the study by Vigano et al. showed that older patients had a reduced quality of life, which is understandable in that patients who have undergone surgery for head cancer may be debilitated, have poorer physical function even before surgery, and are additionally burdened by multiple chronic diseases [19].\u003c/p\u003e \u003cp\u003eHannon et al. showed a correlation between poor quality of life and reduced satisfaction with treatment and acceptance of the disease. In addition, patients who were less satisfied with their treatment had a reduced quality of life [20].\u003c/p\u003e \u003cp\u003eOur own research similarly showed that the more independent the patients were three months after surgery for head cancer, the higher their quality of life and the better they accepted their illness, and the less social support they needed.\u003c/p\u003e \u003cp\u003eThe long-term neurocognitive and psychosocial sequelae of treatment are increasingly important in patients with head cancer. Prospective evaluations of the efficacy of cancer-targeted treatment appear to be crucial [21].\u003c/p\u003e \u003cp\u003eTreatment in patients with head cancer often interferes with vital structures, resulting in survivors experiencing bio-psycho-social problems related to changes in appearance, communication, breathing, eating and drinking, intimate relationships, and feeling their impact on long-term quality of life [22].\u003c/p\u003e \u003cp\u003eA strength of the present study is the use of four research tools that are standarised, which translated into the reliability of the results. In addition, the study was conducted in a thorough and reliable manner and lasted a long period of time \u0026minus;\u0026thinsp;16 months. Also a strength is the innovative nature of the study and the emphasis on its direct relevance to the care of oncology patients with head cancer.\u003c/p\u003e \u003cp\u003eA weakness of the study was the relatively small size of the study group, due to the fact that some patients refused to participate in the study due to health difficulties and could not complete the questionnaires.\u003c/p\u003e \u003cp\u003eIn the light of the results obtained and taking into account the limitations of the study, it seems reasonable to continue research into the quality of life of oncology patients on a larger scale. In the future, it would be worth considering conducting studies on larger and more diverse patient populations, which would increase the statistical power of the analyses and enable a more precise assessment of the impact of individual clinical and socio-demographic factors on quality of life.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e1. Prognostic factors affecting patients' quality of life three months after surgery for head cancer include: type of cancer, patients' independence, acceptance of the disease and social support.\u003c/p\u003e\n\u003cp\u003e2. The level of quality of life as exemplified by the somatic, psychological, social and environmental domains in the study group of patients three months after surgery for head cancer can be described as good, taking into account the cause of the neoplastic lesion. Made it possible to learn about patients' health problems, their ability to cope and to plan more support for them.\u003c/p\u003e\n\u003cp\u003eTherefore, an individual and interdisciplinary approach of the whole therapeutic team to the patient, which should be holistic, is crucial.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eIn terms of the somatic and psychological domain, the lowest quality of life three months after surgery for head cancer was found in the group of patients with glioma, and the highest quality of life in the group of patients with meningioma.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eIn terms of the psychological domain, single sural neuroma and VIII nerve sheath patients had higher scores than meningioma patients.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eIn terms of the social domain of quality of life, the lowest values were recorded equally in the glioma patients and the highest in the meningioma patients. Individuals with sural neuroblastoma and neuroblastoma VIII had higher scores than patients with meningioma.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eIn terms of the environmental domain of quality of life, the lowest values were similarly reported in the glioma patient group, the highest in the meningioma patient group.\u003c/p\u003e\n\u003cp\u003e3. The more independent the patients were three months after surgery for head cancer, the higher their quality of life and the better they accepted their illness, and the less social support they needed.\u003c/p\u003e\n\u003cp\u003e4.The less support patients received from family, friends, lower quality of life, poorer acceptance of the disease and lower independence were observed.\u003c/p\u003e\n\u003cp\u003e5.There is no relationship between acceptance of the disease three months after surgery for head cancer and the location of the cancer lesion and chronic diseases.\u003c/p\u003e\n\u003cp\u003e6. The greater the acceptance of the disease three months after surgery for head cancer, the higher the patients' quality of life and self-reliance, which made it possible to use rehabilitation to be more effective for patients.\u003c/p\u003e\n\u003ch3\u003eThe relevance and significance of the study\u003c/h3\u003e\n\u003cp\u003eThe study made a significant contribution to the care of cancer patients, as each patient was examined using four standardized research tools, plus an additional analysis of medical records, which provided a broader insight into quality of life, independence, acceptance of the disease, and social support for patients during rehabilitation or after their return home, and also allowed for the identification of important prognostic factors.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHNC - Head and Neck Cancers\u003c/p\u003e\n\u003cp\u003eWHO - World Health Organization\u003c/p\u003e\n\u003cp\u003eQOL - Quality of Life\u003c/p\u003e\n\u003cp\u003eIBM SPSS - Statistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003eWHOQOL - The World Health Organization Quality of Life\u003c/p\u003e\n\u003cp\u003eMSPSS - Multidimensional Scale of Perceived Social Support (SWS - Social Support Scale)\u003c/p\u003e\n\u003cp\u003eAIS - Acceptance of Illness\u0026nbsp;Scale\u003c/p\u003e\n\u003cp\u003eI - ADL – Instrumental Activities of Daily Living Scale\u003c/p\u003e\n\u003cp\u003eEORTC - The European Organization for Research, Treatment of Cancer\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics committee approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval was obtained from the university's bioethics committee (KBKA – Bioethics Committee of the Krakow Academy 31/0/2023) and a scan was sent in a file.\u003c/p\u003e\n\u003cp\u003eThe study was registered in accordance with the recommendations of the International Committee of Medical Journal Editors. \u0026nbsp;The study was registered \u0026nbsp; by the Clinical trials.gov PRS research team (NCT 06395805). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients gave their written informed consent to participate in the study – file attached.\u003c/p\u003e\n\u003cp\u003eWritten consent from the hospital management to conduct the study was obtained and sent in the file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated and analyzed during this study are included in this published article and its supplementary information file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMK analyzed and interpreted the patient data from all questionnaires.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEL analyzed the research results received from the statistician, wrote the conclusions and discussion, and made a significant contribution to the writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to Mr. Professor Ryszard Czepko - Head of the Department of Neurosurgery at St. Raphael's Hospital in Kraków for permission for the research and valuable guidance before conducting it.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVermaire AJ, Raaijmakers CPJ, Monninkhof EM et al. 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Eur J Cancer Care.2022; 31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKto HN, Iyer G, Chua A et al. Early quality of life outcomes after surgery in head and neck cancer survivors with EORTC QLQ-C30 and EORTC QLQ-HN35 in an Asian tertiary centre. Support Care Cancer. 2022;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinger S, Hammerlid E, Tomaszewska IM et al. Methodological approach for determining the Minimal Important Difference and Minimal Important Change scores for the European Organisation for Research and Treatment of Cancer Head and Neck Cancer Module (EORTC QLQ-HN43) exemplified by the Swallowing scale. Qual Life Res. 2022;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVigan\u0026ograve; A, De Felice F, Iacovelli NA et al. Quality of life changes over time and predictors in a large head and neck patients\u0026rsquo; cohort: secondary analysis from an Italian multicenter longitudinal, prospective, observational study\u0026mdash;a study of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) head and neck working group. Support Care Cancer. 2023; 31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFischl A, Gerken M, Lindberg-Scharf P et al. Health-Related Quality of Life and treatment satisfaction of patients with malignant IDHWild - type gliomas and their caregivers. Curr Oncol. 2024;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePertz M, Schl\u0026ouml;mer S, Seidel C, Longterm neurocognitive function and quality of life after multimodal therapy in adult glioma patients: a prospective long term follow up. Journal of Neurooncology., Rogers SN, Semple CJ et al. Exploration of family members\u0026rsquo; perceptions of an online resource to provide information and support for patients with head and neck cancer and their informal carers: a qualitative study. European Journal of Oncology Nursing. 2025;77.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"head cancer, prognostic factors, quality of life, independence, social support, acceptance of illness, qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-8225118/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8225118/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eContext\u003c/strong\u003e: The aim of this innovative study was to assess prognostic factors affecting the quality of life of patients with head cancer three months after surgery.\u003c/p\u003e\n\u003cp\u003eThe research has direct relevance to the care of patients with head cancer during rehabilitation, assessing patient independence and quality of life, and also highlights the important issue of social support and acceptance of the disease during the patient's recovery after surgery.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A qualitative research design was adopted using standardized tools: WHOQOL-BREF, MSPSS, I-ADL, AIS. A diagnostic survey was conducted among patients three months after surgery for head cancer from July 2023 to October 2024 at the Clinic of St. Raphael's Hospital in Krakow in Polen.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A statistically significant positive correlation was found between the patient independence scale and the disease acceptance scale and quality of life scale. A statistically significant negative correlation was found between the patient independence scale and the social support scale, as well as between the social support scale and quality of life, disease acceptance and independence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: The prognostic factors affecting the quality of life of patients three months after surgery for head cancer include: the type of cancer, patient independence, acceptance of the disease, and social support. The quality of life three months after surgery for head cancer can be described as good, taking into account the type of head cancer.\u003c/p\u003e\n\u003cp\u003eThe more independent the patients were, the higher their quality of life and the better they accepted their disease, and they also needed less support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy registration\u003c/strong\u003e: The study was registered by the ClinicalTrials.gov PRS research team (NCT 06395805). Registration date: June 2023.\u003c/p\u003e","manuscriptTitle":"Evaluation of Prognostic Factors Affecting Quality of Life in Patients Three Months After Surgery for Head Cancer - A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 09:52:07","doi":"10.21203/rs.3.rs-8225118/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-27T14:58:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283773412215985845740401736992772395138","date":"2026-01-02T19:38:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38919569891296451595001475657174778408","date":"2025-12-25T20:23:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-25T07:57:02+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-23T06:34:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-02T04:10:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-02T00:16:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-12-02T00:10:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e9bf04c2-4572-4aee-9aac-5d22ef147fda","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-30T09:52:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 09:52:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8225118","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8225118","identity":"rs-8225118","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}