New normal: a grounded theory study of reconciling change in appearance and function for men with head and neck cancer

Abstract

HNC incidence and mortality is greater in men and is associated with high risk behaviours and social deprivation. HNC is frequently diagnosed at advanced stages requiring multi-modality treatment which can have a significant impact on appearance and function. Gender can influence health behaviours yet research into male experiences of cancer has primarily focussed on prostate cancer and HNC is an area which is under investigated.

The aim of this study was to explore how men with HNC experience appearance and functional change in the first 12 months following diagnosis. Grounded theory methodology (GT) was chosen as the overall purpose of GT is the generation of theory from the data which has explanatory power and advances the understanding of social and psychological phenomena. Retrospective semi-structured interviews were performed with 12 men who were 12 to 24 months post-diagnosis. Key components of GT practice used were simultaneous data collection and analysis, constructing analytic categories from the data, constant comparison, memo-writing and theoretical sampling. Three categories emerged from the data which were inter-related: normalising change; “under siege”: getting through treatment; and reclaiming self. The core category was reconciling change; a new normal which reflects the social and psychological processes involved in accommodating and assimilating change in appearance and function for men with HNC. The substantive theory provides insight into how men with HNC prioritise function and actively distance themselves from concerns regarding appearance. Furthermore, it identifies men who are at risk of social anxiety and isolation due to multiple changes or body incompetence. This study builds on theories of masculinity, body image and disfigurement. The substantive theory developed provides health and social care professionals with new knowledge to support clinical practice and improve care provision.