{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:35:15Z","timestamp":1791855315678,"version":"4.3.4"},"reference-count":36,"publisher":"BMJ","issue":"11","funder":[{"name":"The Ministry of Science and Technology of the Republic of China"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,9,27]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore the influences of facial disfigurement and social support for psychosocial adjustment in patients with oral cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional design was used for the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and setting<\/jats:title>\n                    <jats:p>A convenience sample of 77 patients with oral cancer was recruited from the otolaryngology and oral and maxillofacial surgery outpatient clinics of three general hospitals in Taiwan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>Data were collected using the study questionnaires, including the Facial Disfigurement Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean score on the Psychosocial Adjustment to Illness Scale was 413.01 (SD=32.32); 71.4% of the participants were maladjusted. Results of multiple regression analysis showed statistically significant main effects of tumour site (beta=0.37), facial disfigurement (beta=0.35) and social support (beta=\u22121.01), and the interaction effect of facial disfigurement and social support (beta=0.79) (all p&lt;0.05) on psychosocial adjustment after controlling for other sociodemographic and clinical variables. All variables together explained 62% of the variance in psychosocial adjustment (F(16, 55)=14.98, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The level of psychosocial adjustment in patients with oral cancer was suboptimal. Poorer psychosocial adjustment was reported by patients with more severe facial disfigurement and less social support. Patients with cancers in other areas of the oral cavity also reported poorer psychosocial adjustment than patients with cancers in the buccal mucosa. Medical professionals may use these variables to identify higher risk groups for early intensive intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-023670","type":"journal-article","created":{"date-parts":[[2018,11,26]],"date-time":"2018-11-26T05:05:29Z","timestamp":1543208729000},"page":"e023670","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Influences of facial disfigurement and social support for psychosocial adjustment among patients with oral cancer in Taiwan: a cross-sectional study"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8714-5530","authenticated-orcid":false,"given":"Tsae-Jyy","family":"Wang","sequence":"first","affiliation":[{"name":"School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Hsiu","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei-Ling","family":"Kuo","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Kang Ning, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Tzu Chi Hospital, Hualien, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Chiung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Nursing, Veteran General Hospital, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Yuan","family":"Liang","sequence":"additional","affiliation":[{"name":"School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,11,25]]},"reference":[{"key":"2025120520304836000_8.11.e023670.1","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/j.1471-6712.2011.00914.x","article-title":"Life experiences of Taiwanese oral cancer patients during the postoperative period","volume":"26","author":"Chen","year":"2012","journal-title":"Scand J Caring Sci"},{"key":"2025120520304836000_8.11.e023670.2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1990"},{"key":"2025120520304836000_8.11.e023670.3","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.oraloncology.2016.12.014","article-title":"Depression and survival in head and neck cancer patients","volume":"65","author":"Rieke","year":"2017","journal-title":"Oral Oncol"},{"key":"2025120520304836000_8.11.e023670.4","first-page":"2323","article-title":"Feelings, perceptions, and expectations of patients during the process of oral cancer diagnosis","volume":"24","author":"Graner","year":"2016","journal-title":"Support Care Cancer"},{"key":"2025120520304836000_8.11.e023670.5","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.oraloncology.2013.04.005","article-title":"Body image in patients with head and neck cancer: a review of the literature","volume":"49","author":"Rhoten","year":"2013","journal-title":"Oral Oncol"},{"key":"2025120520304836000_8.11.e023670.6","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.oraloncology.2016.11.013","article-title":"Functional and cognitive impairment, social environment, frailty and adverse health outcomes in older patients with head and neck cancer, a systematic review","volume":"64","author":"van Deudekom","year":"2017","journal-title":"Oral Oncol"},{"key":"2025120520304836000_8.11.e023670.7","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.ijom.2017.02.1269","article-title":"Changes in health-related quality of life of oral cancer patients treated with curative intent: experience of a developing country","volume":"46","author":"Doss","year":"2017","journal-title":"Int J Oral Maxillofac Surg"},{"key":"2025120520304836000_8.11.e023670.8","doi-asserted-by":"crossref","first-page":"327","DOI":"10.4103\/jiaphd.jiaphd_35_17","article-title":"Health-related quality of life and the perceived palliative care needs among oral cancer patients","volume":"15","author":"Kumar","year":"2017","journal-title":"J Indian Assoc Public Health Dent"},{"key":"2025120520304836000_8.11.e023670.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2009.01.012"},{"key":"2025120520304836000_8.11.e023670.10","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0347(200003)22:2<132::AID-HED4>3.0.CO;2-K"},{"key":"2025120520304836000_8.11.e023670.11","first-page":"157","article-title":"Cancer-related trauma, stigma and growth: the \u2018lived\u2019 experience of head and neck cancer","volume":"25","author":"Threader","year":"2016","journal-title":"Eur J Cancer Care"},{"key":"2025120520304836000_8.11.e023670.12","doi-asserted-by":"publisher","DOI":"10.1188\/12.CJON.153-159"},{"key":"2025120520304836000_8.11.e023670.13","doi-asserted-by":"publisher","DOI":"10.1111\/scd.12039"},{"key":"2025120520304836000_8.11.e023670.14","doi-asserted-by":"crossref","first-page":"347","DOI":"10.4103\/IJPC.IJPC_33_17","article-title":"Narrative: The fear of disfigurement in cancer patients","volume":"23","author":"Deshpande","year":"2017","journal-title":"Indian J Palliat Care"},{"key":"2025120520304836000_8.11.e023670.15","doi-asserted-by":"crossref","unstructured":"Halliwell E , Diedrichs P . Influence of the media. The Oxford Handbook of the Psychology of Appearance. Oxford: Oxford University Press, 2012:217\u201338.","DOI":"10.1093\/oxfordhb\/9780199580521.013.0019"},{"key":"2025120520304836000_8.11.e023670.16","first-page":"22","article-title":"Issues of self-image, disfigurement, and sadness in people living with cancer","volume":"6","author":"Messner","year":"20132013","journal-title":"The Oncol Pharmacist"},{"key":"2025120520304836000_8.11.e023670.17","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1080\/13548506.2013.855319","article-title":"Appearance concerns and psychosocial adjustment following head and neck cancer: A cross-sectional study and nine-month follow-up","volume":"19","author":"Clarke","year":"2014","journal-title":"Psychol Health Med"},{"key":"2025120520304836000_8.11.e023670.18","first-page":"2981","article-title":"Coping with oral cancer: the impact of health and disease-related personality traits","volume":"22","author":"Rana","year":"2014","journal-title":"Support Care Cancer"},{"key":"2025120520304836000_8.11.e023670.19","doi-asserted-by":"publisher","DOI":"10.1037\/a0023477"},{"key":"2025120520304836000_8.11.e023670.20","doi-asserted-by":"crossref","first-page":"4571","DOI":"10.7314\/APJCP.2013.14.8.4571","article-title":"Depression and predictors in Taiwanese survivors with oral cancer","volume":"14","author":"Chen","year":"2013","journal-title":"Asian Pac J Cancer Prev"},{"key":"2025120520304836000_8.11.e023670.21","doi-asserted-by":"crossref","first-page":"3429","DOI":"10.7314\/APJCP.2014.15.8.3429","article-title":"Effect of perceived social support on psychosocial adjustment of Turkish patients with breast cancer","volume":"15","author":"Rizalar","year":"2014","journal-title":"Asian Pac J Cancer Prev"},{"key":"2025120520304836000_8.11.e023670.22","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12955-016-0481-z","article-title":"Effects of social support, hope and resilience on quality of life among Chinese bladder cancer patients: a cross-sectional study","volume":"14","author":"Li","year":"2016","journal-title":"Health Qual Life Outcomes"},{"key":"2025120520304836000_8.11.e023670.23","doi-asserted-by":"publisher","DOI":"10.1002\/hed.10174"},{"key":"2025120520304836000_8.11.e023670.24","doi-asserted-by":"publisher","DOI":"10.3758\/BRM.41.4.1149"},{"key":"2025120520304836000_8.11.e023670.25","doi-asserted-by":"publisher","DOI":"10.1001\/archfaci.3.4.241"},{"key":"2025120520304836000_8.11.e023670.26","first-page":"4","article-title":"The relationships of symptom distress, social support and self-care behaviors in heart transplant recipients","volume":"6","author":"Wang","year":"1998","journal-title":"J Nurs Res"},{"key":"2025120520304836000_8.11.e023670.27","doi-asserted-by":"crossref","unstructured":"Derogatis LR , Fleming MP , Sudler NC , et al . Psychological assessment. In: Nicassio PA , Smith PA , eds. Managing Chronic Illness: A Biopsychosocial PerspectiveAmerican Psychological Association. DC: Washington, 1995:59\u2013115.","DOI":"10.1037\/10511-003"},{"key":"2025120520304836000_8.11.e023670.28","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3999(86)90069-3"},{"key":"2025120520304836000_8.11.e023670.29","unstructured":"Derogatis LR , Derogatis MA. P . PAIS & PAIS-SR: Administration, Scoring & Procedures Manual-II. Baltimore. Baltimore, MD: Clinical Psychometric Research, 1990."},{"key":"2025120520304836000_8.11.e023670.30","unstructured":"Derogatis LR , Fleming MP . Psychosocial adjustment to illness scale. Spilker B , ed. Quality of Life and Pharmacoeconomics in Clinical Trials. 2nd Ed. New York: NY: Raven Press, 1996:347\u201354."},{"key":"2025120520304836000_8.11.e023670.31","first-page":"127","article-title":"An investigation of body image changes and coping behaviors in oral cancer patients following surgery","volume":"9","author":"Tsui","year":"2013","journal-title":"J Nurs Healthcare Res"},{"key":"2025120520304836000_8.11.e023670.32","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1080\/00207594.2012.696652","article-title":"Experiences and psychosocial adjustment of Darfuri female students affected by war: an exploratory study","volume":"48","author":"Badri","year":"2013","journal-title":"Int J Psychol"},{"key":"2025120520304836000_8.11.e023670.33","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-012-1553-1"},{"key":"2025120520304836000_8.11.e023670.34","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/hed.21181","article-title":"Multidimensional analysis of body image concerns among newly diagnosed patients with oral cavity cancer","volume":"32","author":"Fingeret","year":"2010","journal-title":"Head Neck"},{"key":"2025120520304836000_8.11.e023670.35","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.bjoms.2011.05.005","article-title":"Identifying appearance-related concerns in routine follow-up clinics following treatment for oral and oropharyngeal cancer","volume":"50","author":"Flexen","year":"2012","journal-title":"Br J Oral Maxillofac Surg"},{"key":"2025120520304836000_8.11.e023670.36","doi-asserted-by":"crossref","first-page":"184","DOI":"10.4103\/0973-1075.92334","article-title":"Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments","volume":"17","author":"Arunachalam","year":"2011","journal-title":"Indian J Palliat Care"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-023670","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T04:30:54Z","timestamp":1764995454000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-023670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":36,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2018,11,25]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1136\/bmjopen-2018-023670"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-023670","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,11]]}}}