Dual challenges of oral cancer and COVID-19: a qualitative exploration of barriers, experiences, and coping strategies among patients in Pakistan
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Abstract
Objectives: To explore the physical, psychological, and social experiences of oral cancer patients six months after diagnosis and completion of treatment during the COVID-19 pandemic in Khyber Pakhtunkhwa, Pakistan.
Methods: This qualitative follow-up study was conducted in January 2021 during the second wave of COVID-19. Seventeen patients with oral squamous cell carcinoma, originally recruited at diagnosis in July 2020 from the Department of Maxillofacial Surgery, Khyber College of Dentistry, Peshawar, Pakistan, were re-interviewed using face-to-face semi-structured interviews. Maximum-variation purposive sampling ensured diversity in age, gender, and cancer stage. Interviews were conducted in Pashto, audio-recorded with consent, transcribed ad verbatim into English, and analyzed thematically using Braun and Clarke’s framework with ATLAS.ti 8.0 software. Methodological rigor was maintained through peer debriefing, member checking, and confirmability audits.
Results: Five themes emerged: (1) psychological vulnerability due to treatment delays, facial disfigurement, and COVID-19-related restrictions; (2) physical impairments including speech difficulties, dry mouth, and restricted jaw movement; (3) reliance on faith as a source of emotional strength; (4) social support systems, particularly family support and the Sehat Sahulat Program, which facilitated access to care; and (5) financial decline aggravated by treatment costs, unemployment, and long-term indebtedness.
Conclusion: Six months after diagnosis, oral cancer patients in Khyber Pakhtunkhwa experienced persistent physical symptoms, emotional distress, and financial strain, compounded by the COVID-19 pandemic. Reliance on faith and social support were central coping strategies. These findings highlight the need for integrated, patient-centered cancer care addressing psychosocial and financial dimensions, particularly during public health crises in resource-limited settings.
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Funding data
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Khyber Medical University
Grant numbers KMU/ORIC/FARE/IPH&SS/022
References
1. Fekadu G, Bekele F, Tolossa T, Fetensa G, Turi E, Getachew M, et al. Impact of COVID-19 pandemic on chronic diseases care follow-up and current perspectives in low resource settings: a narrative review. Int J Physiol Pathophysiol Pharmacol 2021;13(3):86-93.
2. Ayele TA, Alamneh TS, Shibru H, Sisay MM, Yilma TM, Melak MF, et al. Effect of COVID-19 pandemic on missed medical appointment among adults with chronic disease conditions in Northwest Ethiopia. PLoS One 2022;17(10):e0274190. https://doi.org/10.1371/journal.pone.0274190
3. Sabetkish N, Rahmani A. The overall impact of COVID-19 on healthcare during the pandemic: A multidisciplinary point of view. Health Sci Rep 2021;4(4):e386. https://doi.org/10.1002/hsr2.386
4. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394-424. https://doi.org/10.3322/caac.21492. Erratum in: CA Cancer J Clin 2020;70(4):313. https://doi.org/10.3322/caac.21609
5. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136(5):E359-86. https://doi.org/10.1002/ijc.29210
6. McIlvanna E, McCarthy C, Gurzawska-Comis K. The impact of the COVID-19 pandemic on oral and oropharyngeal cancer. Curr Oral Health Rep 2023;10:154-62. https://doi.org/10.1007/s40496-023-00349-w
7. Venkatasai J, John C, Kondavetti SS, Appasamy M, Parasuraman L, Ambalathandi R, et al. Impact of COVID-19 pandemic on patterns of care and outcome of head and neck cancer: real-world experience from a tertiary care cancer center in India. JCO Glob Oncol 2022;8:e2100339. https://doi.org/10.1200/GO.21.00339
8. Popovic M, Fiano V, Moirano G, Chiusa L, Conway DI, Garzino Demo P, et al. The impact of the COVID-19 pandemic on head and neck cancer diagnosis in the Piedmont Region, Italy: interrupted time-series analysis. Front Public Health 2022;10:809283. https://doi.org/10.3389/fpubh.2022.809283
9. da Cunha AR, Antunes JLF, Martins MD, Petti S, Hugo FN. The impact of the COVID-19 pandemic on hospitalizations for oral and oropharyngeal cancer in Brazil. Community Dent Oral Epidemiol 2021;49(3):211-5. https://doi.org/10.1111/cdoe.12632
10. Khattak MI, Khan M, Khattak SI, Khan Z, Ul-Haq Z, Saddki N. The experiences of oral cancer patients: a narrative review. Malaysian J Public Health Med 2021;21(2):168-77. https://doi.org/10.37268/mjphm/vol.21/no.2/art.902
11. Metzger K, Mrosek J, Zittel S, Pilz M, Held T, Adeberg S, et al. Treatment delay and tumor size in patients with oral cancer during the first year of the COVID-19 pandemic. Head Neck 2021;43(11):3493-7. https://doi.org/10.1002/hed.26858
12. De Berardinis R, Guiddi P, Ugolini S, Chu F, Pietrobon G, Pravettoni G, et al. Coping with oral tongue cancer and COVID-19 infection. Front Psychiatry 2021;12:562502. https://doi.org/10.3389/fpsyt.2021.562502
13. Khattak MI, Khattak SI, Khan M, Khan Z, Dikomitis L, Ul-Haq Z, et al. Experiences of newly diagnosed oral cancer patients during the first wave of the COVID-19 pandemic: a qualitative study from Pakistan. Int J Environ Res Public Health 2022;19(14):8508. https://doi.org/10.3390/ijerph19148508
14. Lincoln YS, Guba EG. Naturalistic inquiry. 1st ed. Newbury Park: Sage Publications Inc 1985. ISBN: 978-0803924314
15. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: Guided by information power. Qual Health Res 2016;26(13):1753-60. https://doi.org/10.177/1049732315617444
16. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007;19(6):349-57. https://doi.org/10.1093/intqhc/mzm042
17. Sundler AJ, Lindberg E, Nilsson C, Palmér L. Qualitative thematic analysis based on descriptive phenomenology. Nurs Open 2019;6(3):733-9. https://doi.org/10.1002/nop2.275
18. Braun V, Clarke V. Thematic analysis. In: Cooper H, Camic PM, Long DL, Panter AT, Rindskopf D, Sher KJ, editors. APA handbook of research methods in psychology, Vol 2 Research designs: Quantitative, qualitative, neuropsychological, and biological: American Psychological Association; 2012. pp. 57-71. https://psycnet.apa.org/doi/10.1037/13620-004
19. Saunders CH, Goldwag JL, Read JT, Durand MA, Elwyn G, Ivatury SJ. 'Because everybody is so different': a qualitative analysis of the lived experiences and information needs of rectal cancer survivors. BMJ Open 2021;11(5):e043245. https://doi.org/10.1136/bmjopen-2020-043245
20. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach 2020;42(8):846-54. https://doi.org/10.1080/0142159X.2020.1755030
21. Khokhar MA, Gibson B, Winslow M, Owens J. 'Oral cancer is a punishment for my sins': oral histories of oral cancer, fatalism and Islamic religious beliefs in Pakistan. J Relig Health 2022;61(6):4337-51. https://doi.org/10.1007/s10943-022-01585-7
22. Qureshi MA, Syed SA, Sharafat S. Lip and oral cavity cancers (C00-C06) from a mega city of Pakistan: ten-year data from the Dow Cancer Registry. J Taibah Univ Med Sci 2021;16(4):624-7. https://doi.org/10.1016/j.jtumed.2021.02.001
23. Jajeh N, Liew J, Sainuddin S, Petersen H. Oral cancer diagnosis amid COVID-19 pandemic: Identifying tell-tale signs to avoid pitfalls in general dental practice. Prim Dent J 2022;11(1):66-71. https://doi.org/10.1177/20501684221085837
24. Scherpenhuizen A, van Waes AM, Janssen LM, Van Cann EM, Stegeman I. The effect of exercise therapy in head and neck cancer patients in the treatment of radiotherapy-induced trismus: a systematic review. Oral Oncol 2015; 51(8):745-50. https://doi.org/10.1016/j.oraloncology.2015.05.001
25. Rohr Y, Adams J, Young L. Oral discomfort in palliative care: results of an exploratory study of the experiences of terminally ill patients. Int J Palliat Nurs 2010;16(9):439-44. https://doi.org/10.12968/ijpn.2010.16.9.78638
26. Rodriguez GM, Kumar D, Patel MI. "I have constant fear": a national qualitative study on the impact of COVID-19 on cancer care and potential solutions to improve the cancer care experience during the COVID-19 pandemic. JCO Oncol Pract 2023;19(7):427-34. https://doi.org/10.1200/OP.22.00550
27. Hamilton JB, Best NC, Barney TA, Worthy VC, Phillips NR. Using spirituality to cope with COVID-19: the experiences of African American breast cancer survivors. J Cancer Educ 2022;37(5):1422-8. https://doi.org/10.007/s13187-021-01974-8
28. Kirtane K, Geiss C, Arredondo B, Hoogland AI, Chung CH, Muzaffar J, et al. "I have cancer during COVID; that's a special category": a qualitative study of head and neck cancer patient and provider experiences during the COVID-19 pandemic. Support Care Cancer 2022;30(5):4337-44. https://doi.org/10.1007/s00520-021-6773-x
29. Algtewi E, Owens J, Baker SR. Online support groups for head and neck cancer and health-related quality of life. Qual Life Res 2017;26(9):2351–62.
30. Datta BK, Husain MJ, Asma S. Assessing the relationship between out-of-pocket spending on blood pressure and diabetes medication and household catastrophic health expenditure: evidence from Pakistan. Int J Equity Health 2019;18(1):9. https://doi.org/10.1186/s12939-018-0906-x
31. Thaduri A, Garg PK, Malhotra M, Singh MP, Poonia DR, Priya M, et al. Financial toxicity and mental well-being of the oral cancer survivors residing in a developing country in the era of COVID 19 pandemic - a cross-sectional study. Psychooncology 2023;32(1):58-67. https://doi.org/10.1002/pon.6030
32. Rogers SN, Harvey-Woodworth CN, Hare J, Leong P, Lowe D. Patients' perception of the financial impact of head and neck cancer and the relationship to health related quality of life. Br J Oral Maxillofac Surg 2012;50(5):410-6.
33. Hasan SS, Mustafa ZU, Kow CS, Merchant HA. "Sehat Sahulat Program": a leap into the universal health coverage in Pakistan. Int J Environ Res Public Health 2022;19(12):6998. https://doi.org/10.3390/ijerph19126998
34. Molassiotis A, Rogers M. Symptom experience and regaining normality in the first year following a diagnosis of head and neck cancer: a qualitative longitudinal study. Palliat Support Care 2012;10(3):197-204. https://doi.org/10.1017/S147895151200020X