{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T01:35:16Z","timestamp":1791855316139,"version":"4.3.4"},"reference-count":61,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2023JJ30425"],"award-info":[{"award-number":["2023JJ30425"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Health Qual Life Outcomes"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postoperative quality of life (QoL) in oral cancer patients is not only influenced by physical impairments but also by interrelated psychosocial factors. However, few studies have investigated these multidimensional pathways during the acute recovery phase. This study aimed to examine how speech disorder, self-esteem, social alienation, and body image interact in relation to QoL in the first week following oral cancer surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted among 401 patients within 7 days post-surgery. Validated Chinese versions of standardized scales were administered to assess functional and psychosocial domains relevant to QoL. Structural equation modeling was used to test hypothesized pathways among speech disorder, self-esteem, social alienation, body image, and quality of life. Model fit was assessed with \u03c7\u00b2\/df, CFI, TLI, RMSEA, and SRMR, using established thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Speech disorder was negatively associated with QoL both directly (\u03b2 = \u22120.446) and indirectly through sequential pathways involving self-esteem, social alienation, and body image. Among these variables, speech disorder showed the strongest overall association with QoL when both direct and indirect pathways were considered (\u03b2 = \u22120.824), whereas body image demonstrated the strongest direct association with QoL (\u03b2 = \u22120.609). The structural equation modeling demonstrated acceptable model fit (\u03c7\u00b2 = 187.818, df\u2009=\u200978, \u03c7\u00b2\/df\u2009=\u20092.408, CFI\u2009=\u20090.969, TLI\u2009=\u20090.959, RMSEA\u2009=\u20090.059, SRMR\u2009=\u20090.039).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Postoperative QoL in oral cancer patients is shaped by complex mediation pathways linking speech dysfunction, psychosocial vulnerabilities, and body image. These findings highlight the need for early multidisciplinary interventions that integrate functional rehabilitation with psychosocial support to improve recovery. Future research is warranted to validate these associations through longitudinal and interventional studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12955-026-02476-1","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T18:53:59Z","timestamp":1769108039000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Structural equation modeling of multidimensional determinants of postoperative quality of life in patients with oral cancer"],"prefix":"10.1186","volume":"24","author":[{"given":"Ziyan","family":"Xiong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiajing","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiayao","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunni","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9146-3478","authenticated-orcid":false,"given":"Li","family":"Cong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"issue":"7","key":"2476_CR1","doi-asserted-by":"publisher","first-page":"1336","DOI":"10.1002\/ijc.35278","volume":"156","author":"M FILHO A M, LAVERSANNE","year":"2025","unstructured":"Filho AM, Laversanne M, Ferlay J, et al. The GLOBOCAN 2022 cancer estimates: data sources, methods, and a snapshot of the cancer burden worldwide [J]. Int J Cancer. 2025;156(7):1336\u201346. https:\/\/doi.org\/10.1002\/ijc.35278.","journal-title":"Int J Cancer"},{"key":"2476_CR2","doi-asserted-by":"publisher","unstructured":"Levitz JS, Bradley TP, Golden AL. Overview of smoking and all cancers [J]. Med Clin North Am. 2004;88(6): 1655-75:xiii.https:\/\/doi.org\/10.1016\/j.mcna.2004.07.005","DOI":"10.1016\/j.mcna.2004.07.005"},{"issue":"6","key":"2476_CR3","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.oraloncology.2010.03.009","volume":"46","author":"J BAGAN","year":"2010","unstructured":"Bagan J, Sarrion G, Jimenez Y. Oral cancer: clinical features [J]. Oral Oncol. 2010;46(6):414\u20137. https:\/\/doi.org\/10.1016\/j.oraloncology.2010.03.009.","journal-title":"Oral Oncol"},{"issue":"2","key":"2476_CR4","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1038\/nm0296-237","volume":"2","author":"J RUBIN GRANDIS","year":"1996","unstructured":"Rubin GJ, Zeng Q, Tweardy DJ. Retinoic acid normalizes the increased gene transcription rate of TGF-alpha and EGFR in head and neck cancer cell lines [J]. Nat Med. 1996;2(2):237\u201340. https:\/\/doi.org\/10.1038\/nm0296-237.","journal-title":"Nat Med"},{"issue":"1","key":"2476_CR5","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s12903-020-01386-y","volume":"21","author":"Y YANG","year":"2021","unstructured":"Yang Y, Zhou M. The burden of oral cancer in China, 1990\u20132017: an analysis for the global burden of Disease, Injuries, and risk factors study 2017 [J]. BMC Oral Health. 2021;21(1):44. https:\/\/doi.org\/10.1186\/s12903-020-01386-y.","journal-title":"BMC Oral Health"},{"issue":"1","key":"2476_CR6","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1002\/hed.25383","volume":"41","author":"S LEE Y A, LI","year":"2019","unstructured":"Lee YA, Li S, Chen Y, et al. Tobacco smoking, alcohol drinking, betel quid chewing, and the risk of head and neck cancer in an East Asian population [J]. Head Neck. 2019;41(1):92\u2013102. https:\/\/doi.org\/10.1002\/hed.25383.","journal-title":"Head Neck"},{"issue":"5","key":"2476_CR7","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1016\/j.oraloncology.2006.08.010","volume":"43","author":"X ZHANG","year":"2007","unstructured":"Zhang X, Reichart PA. A review of betel quid chewing, oral cancer and precancer in Mainland China [J]. Oral Oncol. 2007;43(5):424\u201330. https:\/\/doi.org\/10.1016\/j.oraloncology.2006.08.010.","journal-title":"Oral Oncol"},{"issue":"11","key":"2476_CR8","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1007\/s12094-010-0589-2","volume":"12","author":"NINR MES\u00edA","year":"2010","unstructured":"Mes\u00eda N, Pastor BM, Cruz Hern\u00e1ndez JJ, Isla CD. SEOM clinical guidelines for the treatment of head and neck cancer [J]. Clin Transl Oncol. 2010;12(11):742\u20138. https:\/\/doi.org\/10.1007\/s12094-010-0589-2.","journal-title":"Clin Transl Oncol"},{"issue":"1","key":"2476_CR9","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/s41368-023-00249-w","volume":"15","author":"Y TAN","year":"2023","unstructured":"Tan Y, Wang Z, Xu M, et al. Oral squamous cell carcinomas: state of the field and emerging directions [J]. Int J Oral Sci. 2023;15(1):44. https:\/\/doi.org\/10.1038\/s41368-023-00249-w.","journal-title":"Int J Oral Sci"},{"issue":"6","key":"2476_CR10","doi-asserted-by":"publisher","first-page":"e925","DOI":"10.1200\/op.21.00683","volume":"18","author":"MOTT N M","year":"2022","unstructured":"Mott NM, Mierzwa ML, Casper KA, et al. Financial hardship in patients with head and neck cancer [J]. JCO Oncol Pract. 2022;18(6):e925\u201337. https:\/\/doi.org\/10.1200\/op.21.00683.","journal-title":"JCO Oncol Pract"},{"issue":"13","key":"2476_CR11","doi-asserted-by":"publisher","first-page":"2561","DOI":"10.1002\/cam4.4636","volume":"11","author":"A HARRIS","year":"2022","unstructured":"Harris A, Li J, Atchison K, et al. Flourishing in head and neck cancer survivors [J]. Cancer Med. 2022;11(13):2561\u201375. https:\/\/doi.org\/10.1002\/cam4.4636.","journal-title":"Cancer Med"},{"issue":"4","key":"2476_CR12","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3322\/canjclin.52.4.195","volume":"52","author":"NEVILLE B W","year":"2002","unstructured":"Neville BW, Day TA. Oral cancer and precancerous lesions [J]. CA Cancer J Clin. 2002;52(4):195\u2013215. https:\/\/doi.org\/10.3322\/canjclin.52.4.195.","journal-title":"CA Cancer J Clin"},{"issue":"344","key":"2476_CR13","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1126\/scitranslmed.aag0382","volume":"8","author":"S PETTIT S D, LIPSHULTZ S E, CLEELAND","year":"2016","unstructured":"Pettit SD, Lipshultz SE, Cleeland CS, et al. Enhancing quality of life as a goal for anticancer therapeutics [J]. Sci Transl Med. 2016;8(344):344. https:\/\/doi.org\/10.1126\/scitranslmed.aag0382.","journal-title":"Sci Transl Med"},{"issue":"2","key":"2476_CR14","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1044\/2016_ajslp-15-0170","volume":"26","author":"G CONSTANTINESCU","year":"2017","unstructured":"Constantinescu G, Rieger J. Patient perception of speech outcomes: the relationship between clinical measures and Self-Perception of speech function following surgical treatment for oral cancer [J]. Am J Speech Lang Pathol. 2017;26(2):241\u20137. https:\/\/doi.org\/10.1044\/2016_ajslp-15-0170.","journal-title":"Am J Speech Lang Pathol"},{"issue":"1","key":"2476_CR15","doi-asserted-by":"publisher","first-page":"12320","DOI":"10.1038\/s41598-023-39658-6","volume":"13","author":"Y WANG","year":"2023","unstructured":"Wang Y, Zhu J, Xu Z, et al. Social support, oral health knowledge, attitudes, practice, self-efficacy and oral health-related quality of life in Chinese college students [J]. Sci Rep. 2023;13(1):12320. https:\/\/doi.org\/10.1038\/s41598-023-39658-6.","journal-title":"Sci Rep"},{"issue":"3","key":"2476_CR16","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1002\/hed.22980","volume":"35","author":"K FINGERET M C, HUTCHESON K A, JENSEN","year":"2013","unstructured":"Fingeret MC, Hutcheson KA, Jensen K, et al. Associations among speech, eating, and body image concerns for surgical patients with head and neck cancer [J]. Head Neck. 2013;35(3):354\u201360. https:\/\/doi.org\/10.1002\/hed.22980.","journal-title":"Head Neck"},{"issue":"8","key":"2476_CR17","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.22034\/apjcp.2017.18.8.2093","volume":"18","author":"VIANA T S A, SILVA P G B","year":"2017","unstructured":"Viana TSA, Silva PGB, Pereira KMA, et al. Prospective evaluation of quality of life in patients undergoing primary surgery for oral cancer: preoperative and postoperative analysis [J]. Asian Pac J Cancer Prev. 2017;18(8):2093\u2013100. https:\/\/doi.org\/10.22034\/apjcp.2017.18.8.2093.","journal-title":"Asian Pac J Cancer Prev"},{"issue":"4","key":"2476_CR18","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.1007\/s00520-020-05725-1","volume":"29","author":"HC MELISSANT","year":"2021","unstructured":"Melissant HC, Jansen F, Eerenstein SE, et al. Body image distress in head and neck cancer patients: what are we looking at? [J]. Support Care Cancer. 2021;29(4):2161\u20139. https:\/\/doi.org\/10.1007\/s00520-020-05725-1.","journal-title":"Support Care Cancer"},{"issue":"5","key":"2476_CR19","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1007\/s12070-025-05461-0","volume":"77","author":"R CHOWDHURY","year":"2025","unstructured":"Chowdhury R, Almhanedi H. Body image distress and depression in head and neck cancer Patients- a narrative review [J]. Indian J Otolaryngol Head Neck Surg. 2025;77(5):2219\u201325. https:\/\/doi.org\/10.1007\/s12070-025-05461-0.","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"2476_CR20","doi-asserted-by":"publisher","unstructured":"Wojtyna E, Pasek M. Self at risk: Self-Esteem and quality of life in cancer patients undergoing surgical treatment and experiencing bodily deformities [J]. Healthc (Basel). 2023;11(15). https:\/\/doi.org\/10.3390\/healthcare11152203.","DOI":"10.3390\/healthcare11152203"},{"issue":"12","key":"2476_CR21","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1007\/s00520-024-09015-y","volume":"32","author":"A YOKOI","year":"2024","unstructured":"Yokoi A, Maruyama T, Yamanaka R, et al. Relationship among cancer treatment, quality of life, and oral function in head and neck cancer survivors: A cross-sectional study [J]. Support Care Cancer. 2024;32(12):809. https:\/\/doi.org\/10.1007\/s00520-024-09015-y.","journal-title":"Support Care Cancer"},{"issue":"8","key":"2476_CR22","doi-asserted-by":"publisher","first-page":"1988","DOI":"10.1002\/hed.27673","volume":"46","author":"S HOLLENBEAK C","year":"2024","unstructured":"Hollenbeak CS, Duan F, Subramaniam RM, et al. Quality of life following surgery for head and neck cancer: evidence from ACRIN 6685 [J]. Head Neck. 2024;46(8):1988\u201398. https:\/\/doi.org\/10.1002\/hed.27673.","journal-title":"Head Neck"},{"issue":"4","key":"2476_CR23","doi-asserted-by":"publisher","first-page":"1970","DOI":"10.1111\/odi.14660","volume":"30","author":"WU H Y","year":"2024","unstructured":"Wu HY, Shan XF, Cai ZG, et al. Early swallowing training after free flap surgery in oral cancer: A randomized controlled trial [J]. Oral Dis. 2024;30(4):1970\u201380. https:\/\/doi.org\/10.1111\/odi.14660.","journal-title":"Oral Dis"},{"key":"2476_CR24","doi-asserted-by":"crossref","unstructured":"Garnier F, Motamed C, Sitbon P, Bourgain JL. Postoperative Pain Profile After Major Cervicofacial Cancer Surgery, F. 2021 [C].","DOI":"10.24018\/clinicmed.2021.2.2.20"},{"key":"2476_CR25","doi-asserted-by":"publisher","unstructured":"Hu ZY, Feng XQ, Fu MR, et al. Symptom patterns, physical function and quality of life among head and neck cancer patients prior to and after surgical treatment: A prospective study [J]. Eur J Oncol Nurs. 2020;46101770. https:\/\/doi.org\/10.1016\/j.ejon.2020.101770.","DOI":"10.1016\/j.ejon.2020.101770"},{"issue":"3","key":"2476_CR26","doi-asserted-by":"publisher","first-page":"500","DOI":"10.4103\/jcrt.JCRT_311_18","volume":"16","author":"A BASHIR","year":"2020","unstructured":"Bashir A, Kumar D. Quality of life of head and neck cancer patients before and after cancer-directed treatment - A longitudinal study [J]. J Cancer Res Ther. 2020;16(3):500\u20137. https:\/\/doi.org\/10.4103\/jcrt.JCRT_311_18.","journal-title":"J Cancer Res Ther"},{"issue":"3","key":"2476_CR27","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1002\/jso.70022","volume":"132","author":"S OROZCO-N\u00fa\u00f1EZ","year":"2025","unstructured":"Orozco-N\u00fa\u00f1ez S, Oishi N, Izquierdo J, et al. Postoperative evolution of health-related quality of life in patients with head and neck cancer [J]. J Surg Oncol. 2025;132(3):480\u20138. https:\/\/doi.org\/10.1002\/jso.70022.","journal-title":"J Surg Oncol"},{"issue":"2","key":"2476_CR28","first-page":"1","volume":"7","author":"Z-C Liu","year":"2021","unstructured":"Liu Z-C, Li Z-X, Zhang Y, et al. Interpretation of the 2020 global cancer statistics report. J Multidisciplinary Cancer Manage (Electronic). 2021;7(2):1\u201313. (in Chinese).","journal-title":"J Multidisciplinary Cancer Manage (Electronic)"},{"issue":"2","key":"2476_CR29","doi-asserted-by":"publisher","first-page":"2","DOI":"10.6004\/jnccn.2025.0007","volume":"23","author":"COLEVAS A D","year":"2025","unstructured":"Colevas AD, Cmelak AJ, Pfister DG, et al. NCCN Guidelines\u00ae insights: head and neck Cancers, version 2.2025 [J]. J Natl Compr Canc Netw. 2025;23(2):2\u201311. https:\/\/doi.org\/10.6004\/jnccn.2025.0007.","journal-title":"J Natl Compr Canc Netw"},{"issue":"1","key":"2476_CR30","doi-asserted-by":"publisher","first-page":"15446","DOI":"10.1038\/s41598-021-95007-5","volume":"11","author":"LIN N C","year":"2021","unstructured":"Lin NC, Hsien SI, Hsu JT, Chen MYC. Impact on patients with oral squamous cell carcinoma in different anatomical subsites: a single-center study in Taiwan [J]. Sci Rep. 2021;11(1):15446. https:\/\/doi.org\/10.1038\/s41598-021-95007-5.","journal-title":"Sci Rep"},{"issue":"6","key":"2476_CR31","doi-asserted-by":"publisher","first-page":"1366","DOI":"10.1007\/s11764-021-01118-3","volume":"16","author":"P JEHN","year":"2022","unstructured":"Jehn P, Spalthoff S, Lentge F. Postoperative quality of life and therapy-related impairments of oral cancer in relation to time-distance since treatment [J]. J Cancer Surviv. 2022;16(6):1366\u201378. https:\/\/doi.org\/10.1007\/s11764-021-01118-3.","journal-title":"J Cancer Surviv"},{"issue":"407","key":"2476_CR32","first-page":"41","volume":"84","author":"SM KENDALL","year":"1988","unstructured":"Kendall SM, Stuart A, Ord JK. Kendall\u2019s advanced theory of statistics. 1: distribution theory. [J] J Royal Stat Soc. 1988;84(407):41. 5th ed.","journal-title":"[J] J Royal Stat Soc"},{"key":"2476_CR33","volume-title":"Structural equation modeling: operation and application with AMOS","author":"M-L Wu","year":"2010","unstructured":"Wu M-L. Structural equation modeling: operation and application with AMOS. Chongqing: Chongqing University; 2010. (in Chinese)."},{"issue":"2","key":"2476_CR34","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/s0959-8049(00)00353-1","volume":"37","author":"P HOPWOOD","year":"2001","unstructured":"Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use with cancer patients [J]. Eur J Cancer. 2001;37(2):189\u201397. https:\/\/doi.org\/10.1016\/s0959-8049(00)00353-1.","journal-title":"Eur J Cancer"},{"issue":"4","key":"2476_CR35","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1002\/pon.5352","volume":"29","author":"L SONG","year":"2020","unstructured":"Song L, Han X, Zhang J. Body image mediates the effect of stoma status on psychological distress and quality of life in patients with colorectal cancer [J]. Psychooncology. 2020;29(4):796\u2013802. https:\/\/doi.org\/10.1002\/pon.5352.","journal-title":"Psychooncology"},{"issue":"7","key":"2476_CR36","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1002\/hed.20795","volume":"30","author":"RINKEL R N","year":"2008","unstructured":"Rinkel RN, Verdonck-De Leeuw IM, Van Reij EJ, et al. Speech handicap index in patients with oral and pharyngeal cancer: better Understanding of patients\u2019 complaints [J]. Head Neck. 2008;30(7):868\u201374. https:\/\/doi.org\/10.1002\/hed.20795.","journal-title":"Head Neck"},{"issue":"18","key":"2476_CR37","first-page":"28","volume":"29","author":"P-X Wu","year":"2014","unstructured":"Wu P-X, Yao Q, Wang W, Peng Z-R. Reliability and validity evaluation of the Chinese version of the speech handicap index. J Nurs Sci. 2014;29(18):28\u201331. (in Chinese).","journal-title":"J Nurs Sci"},{"issue":"1","key":"2476_CR38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1037\/h0034214","volume":"26","author":"R JESSOR","year":"1973","unstructured":"Jessor R, Jessor S L, Finney J. A social psychology of marijuana use: longitudinal studies of high school and college youth [J]. J Pers Soc Psychol. 1973;26(1):1\u201315. https:\/\/doi.org\/10.1037\/h0034214.","journal-title":"J Pers Soc Psychol"},{"issue":"6","key":"2476_CR39","first-page":"4","volume":"10","author":"S Wu","year":"2015","unstructured":"Wu S, Li YZ, Zhao XL, et al. Reliability and validity of the general alienation scale in the elderly. J Chengdu Med Coll. 2015;10(6):4\u20137. (in Chinese).","journal-title":"J Chengdu Med Coll"},{"key":"2476_CR40","doi-asserted-by":"crossref","unstructured":"Rosenberg M. Rosenberg Self-Esteem Scale (RSES) [J]. 1965.http:\/\/doi.org\/https:\/\/doi.org\/10.1037\/t01038-000.","DOI":"10.1037\/t01038-000"},{"key":"2476_CR41","volume-title":"Handbook of psychological and educational measurement","author":"Y-F Ji","year":"1993","unstructured":"Ji YF. Self-Esteem scale (SES). In: Zhang H-C, Wang D-F, editors. Handbook of psychological and educational measurement. Beijing: Beijing Normal University; 1993. (in Chinese)."},{"key":"2476_CR42","doi-asserted-by":"crossref","unstructured":"Ho JH. University of Washington quality of life questionnaire [J]. Springer Netherlands; 2014.","DOI":"10.1007\/978-94-007-0753-5_3115"},{"issue":"4","key":"2476_CR43","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.jfma.2017.01.002","volume":"116","author":"YUEHB LEE Y H, LAI Y H","year":"2017","unstructured":"Lee YH, Lai YH, Yueh B, et al. Validation of the university of Washington quality of life Chinese version (UWQOL-C) for head and neck cancer patients in Taiwan [J]. J Formos Med Assoc. 2017;116(4):249\u201356. https:\/\/doi.org\/10.1016\/j.jfma.2017.01.002.","journal-title":"J Formos Med Assoc"},{"issue":"1","key":"2476_CR44","first-page":"1","volume":"6","author":"PM HU L T, BENTLER","year":"1999","unstructured":"Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives [J]. Struct Equ Model. 1999;6(1):1\u201355.","journal-title":"Struct Equ Model"},{"issue":"11","key":"2476_CR45","doi-asserted-by":"publisher","first-page":"9127","DOI":"10.1007\/s00520-022-07334-6","volume":"30","author":"S CEREA","year":"2022","unstructured":"Cerea S, Sansoni M, ScarzellO G, et al. Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress [J]. Support Care Cancer. 2022;30(11):9127\u201339. https:\/\/doi.org\/10.1007\/s00520-022-07334-6.","journal-title":"Support Care Cancer"},{"issue":"23","key":"2476_CR46","doi-asserted-by":"publisher","first-page":"e40671","DOI":"10.1016\/j.heliyon.2024.e40671","volume":"10","author":"F FILIPPINI D M, CAROSI","year":"2024","unstructured":"Filippini DM, Carosi F, Panepinto O, et al. Health-related quality of life assessment in head and neck cancer: A systematic review of phase II and III clinical trials [J]. Heliyon. 2024;10(23):e40671. https:\/\/doi.org\/10.1016\/j.heliyon.2024.e40671.","journal-title":"Heliyon"},{"issue":"23","key":"2476_CR47","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1080\/14796694.2024.2370237","volume":"20","author":"S LIU","year":"2024","unstructured":"Liu S, Cai Y, Yao S, et al. Perceived social support mediates cancer and living meaningfully intervention effects on quality of life after breast cancer surgery [J]. Future Oncol. 2024;20(23):1675\u201387. https:\/\/doi.org\/10.1080\/14796694.2024.2370237.","journal-title":"Future Oncol"},{"key":"2476_CR48","doi-asserted-by":"publisher","first-page":"1461199","DOI":"10.3389\/fpsyg.2024.1461199","volume":"15","author":"M LI","year":"2024","unstructured":"Li M, Yu B, He H, et al. Impact of psychological resilience and social support on psycho-social adjustment in postoperative patients with primary hepatocellular carcinoma: mediating effects of fear of progression [J]. Front Psychol. 2024;15:1461199. https:\/\/doi.org\/10.3389\/fpsyg.2024.1461199.","journal-title":"Front Psychol"},{"issue":"2\u20133","key":"2476_CR49","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1080\/15524256.2018.1472718","volume":"14","author":"D NDETEI","year":"2018","unstructured":"Ndetei D, Musyimi C, Tele A, et al. Psychological Well-Being and social functioning across the cancer stages: implications for palliative care [J]. J Soc Work End Life Palliat Care. 2018;14(2\u20133):194\u2013208. https:\/\/doi.org\/10.1080\/15524256.2018.1472718.","journal-title":"J Soc Work End Life Palliat Care"},{"key":"2476_CR50","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.bodyim.2019.06.006","volume":"30","author":"J KLING","year":"2019","unstructured":"Kling J, Kwakkenbos L, Diedrichs PC, et al. Systematic review of body image measures [J]. Body Image. 2019;30:170\u2013211. https:\/\/doi.org\/10.1016\/j.bodyim.2019.06.006.","journal-title":"Body Image"},{"key":"2476_CR51","unstructured":"Murnen S, Cash T, et al. SMOLAK L,. body image: a handbook of science, practice, and prevention [J]. 2012."},{"issue":"5","key":"2476_CR52","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.bjoms.2005.07.017","volume":"44","author":"L MILLSOPP","year":"2006","unstructured":"Millsopp L, Brandom L, Humphris G, et al. Facial appearance after operations for oral and oropharyngeal cancer: a comparison of casenotes and patient-completed questionnaire [J]. Br J Oral Maxillofac Surg. 2006;44(5):358\u201363. https:\/\/doi.org\/10.1016\/j.bjoms.2005.07.017.","journal-title":"Br J Oral Maxillofac Surg"},{"issue":"1","key":"2476_CR53","doi-asserted-by":"publisher","first-page":"e70083","DOI":"10.1002\/pon.70083","volume":"34","author":"X WANG","year":"2025","unstructured":"Wang X, Lin C, Zhou J, et al. Exploration of body image in postoperative patients with oral cancer: an exploratory sequential mixed methods study [J]. Psychooncology. 2025;34(1):e70083. https:\/\/doi.org\/10.1002\/pon.70083.","journal-title":"Psychooncology"},{"issue":"4","key":"2476_CR54","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.jfludis.2012.05.003","volume":"37","author":"JM BEILBY","year":"2012","unstructured":"Beilby JM, Byrnes M L, Yaruss JS. Acceptance and commitment therapy for adults who stutter: psychosocial adjustment and speech fluency [J]. J Fluen Disord. 2012;37(4):289\u201399. https:\/\/doi.org\/10.1016\/j.jfludis.2012.05.003.","journal-title":"J Fluen Disord"},{"issue":"1","key":"2476_CR55","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12905-022-01635-y","volume":"22","author":"J AN","year":"2022","unstructured":"An J, Zhou K, Li M, Li X. Assessing the relationship between body image and quality of life among rural and urban breast cancer survivors in China [J]. BMC Womens Health. 2022;22(1):61. https:\/\/doi.org\/10.1186\/s12905-022-01635-y.","journal-title":"BMC Womens Health"},{"key":"2476_CR56","doi-asserted-by":"publisher","unstructured":"Chen YW, Lin TR, Kuo PL, et al. Psychosocial adjustment changes and related factors in postoperative oral cancer patients: A longitudinal study [J]. Biomedicines. 2022;10(12). https:\/\/doi.org\/10.3390\/biomedicines10123231.","DOI":"10.3390\/biomedicines10123231"},{"issue":"6","key":"2476_CR57","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1016\/j.jcms.2018.04.005","volume":"46","author":"M BSCHORER","year":"2018","unstructured":"Bschorer M, Schneider D, Hennig M, et al. Early intensive rehabilitation after oral cancer treatment [J]. J Craniomaxillofac Surg. 2018;46(6):1019\u201326. https:\/\/doi.org\/10.1016\/j.jcms.2018.04.005.","journal-title":"J Craniomaxillofac Surg"},{"issue":"1","key":"2476_CR58","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jcms.2014.10.025","volume":"43","author":"TENG T T","year":"2015","unstructured":"Teng TT, Ko EW, Huang CS, Chen YR. The effect of early physiotherapy on the recovery of mandibular function after orthognathic surgery for class III correction: part I\u2013jaw-motion analysis [J]. J Craniomaxillofac Surg. 2015;43(1):131\u20137. https:\/\/doi.org\/10.1016\/j.jcms.2014.10.025.","journal-title":"J Craniomaxillofac Surg"},{"issue":"5","key":"2476_CR59","doi-asserted-by":"publisher","first-page":"e19262","DOI":"10.2196\/19262","volume":"9","author":"E GHANBARI","year":"2021","unstructured":"Ghanbari E, Yektatalab S. Effects of psychoeducational interventions using mobile apps and mobile-Based online group discussions on anxiety and Self-Esteem in women with breast cancer: randomized controlled trial [J]. JMIR Mhealth Uhealth. 2021;9(5):e19262. https:\/\/doi.org\/10.2196\/19262.","journal-title":"JMIR Mhealth Uhealth"},{"issue":"5","key":"2476_CR60","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.pcad.2016.09.003","volume":"59","author":"JA STONEROCK G L, BLUMENTHAL","year":"2017","unstructured":"Stonerock GL, Blumenthal JA. Role of counseling to promote adherence in healthy lifestyle medicine: strategies to improve exercise adherence and enhance physical activity [J]. Prog Cardiovasc Dis. 2017;59(5):455\u201362. https:\/\/doi.org\/10.1016\/j.pcad.2016.09.003.","journal-title":"Prog Cardiovasc Dis"},{"issue":"4","key":"2476_CR61","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1097\/00006842-198308000-00006","volume":"45","author":"REVENSON T A","year":"1983","unstructured":"Revenson TA, Wollman CA, Felton BJ. Social supports as stress buffers for adult cancer patients [J]. Psychosom Med. 1983;45(4):321\u201331. https:\/\/doi.org\/10.1097\/00006842-198308000-00006.","journal-title":"Psychosom Med"}],"container-title":["Health and Quality of Life Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12955-026-02476-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12955-026-02476-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12955-026-02476-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:58:46Z","timestamp":1781629126000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12955-026-02476-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,22]]},"references-count":61,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["2476"],"URL":"https:\/\/doi.org\/10.1186\/s12955-026-02476-1","relation":{},"ISSN":["1477-7525"],"issn-type":[{"value":"1477-7525","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,22]]},"assertion":[{"value":"14 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethics Committee of the School of Medicine, Hunan Normal University (Approval No. 2023483). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki and its later amendments.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from all individual participants included in the study. Participation was voluntary, and participants were free to withdraw at any point without any impact on their subsequent medical care. Confidentiality, autonomy, fairness, and the principle of non-maleficence were strictly upheld throughout the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All authors have read and approved the final version of the manuscript and consent to its publication in the submitted journal.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"20"}}