The challenge of post-oncological quality of life: the practitioner's perspective

Survival after oral cavity cancer is not limited to tumour eradication; it imposes a complex clinical reality where functional and psychological sequelae weigh heavily on daily life. This qualitative study examines the perception of quality of life (QoL) by healthcare professionals, a parameter often relegated to the background behind surgical imperatives. The objective is to decipher how practitioners define and evaluate this QoL in post-operative patients, integrating the physical, social, emotional and financial dimensions of recovery.

The study was conducted among 12 medical specialists (maxillofacial surgeons, oncologists, plastic surgeons and prosthodontists) practising exclusively in private hospitals in urban India, with clinical experience ranging from 5 to 20 years. The authors explore the hypothesis that the practitioner's understanding of QoL, often based on practical experience rather than theoretical models, influences the management of postoperative comorbidities such as trismus, dysphagia or social isolation. The issue is critical: the collected data suggest that nearly 50% of patients feel "psychologically disabled" after their treatment, highlighting the need for a multidisciplinary approach to bridge the gap between technical success and functional reintegration.

Methodology

This study adopts an exploratory qualitative design aimed at gathering clinical perspectives on the postoperative quality of life (QOL) of oral cancer survivors.

• Population and sample: The study recruited 12 physicians (7 males, 5 females) practising exclusively in private hospitals in urban areas in India. The participants have professional experience ranging from 5 to 20 years, with a median of 12 years.
• Multidisciplinary composition: The panel includes:
  • Oral and maxillofacial surgeons (n = 2);
  • Oncologists (n = 3);
  • Plastic surgeons (n = 2);
  • Prosthodontists (n = 2);
  • Psychiatrist (n = 1), general surgeon (n = 1) and specialist in general medicine (n = 1).
• Collection protocol: Data were collected through interviews focusing on the understanding of the QOL concept and the clinical experience of postoperative patient management, particularly regarding physical, social, and emotional functions, as well as financial issues.
• Analysis method: A thematic analysis was performed to identify categories and subcategories from the verbatims, resulting in the extraction of five major themes reflecting the challenges of rehabilitation and survival.

Clinical perceptions of quality of life (QoL)

The analysis of interviews conducted with 12 multidisciplinary practitioners reveals a discrepancy between academic theory and clinical reality in the field. Although definitions vary between "absence of disease" and "functional health", a consensus emerges regarding the severe impairment of postoperative QoL. According to reported observations, approximately 50% of patients are considered psychologically disabled after treatment. On a functional level, practitioners estimate that less than 70% of patients regain an operational capacity comparable to that of healthy individuals.

Areas of impact and clinical observations

The study identifies four critical areas where QoL is systematically compromised. Practitioners emphasise that while physical pain is often relieved by surgery, other functional and psychosocial sequelae persist, particularly in cases of advanced stages (3 and 4) associated with radiotherapy.

Factors modulating QoL

The qualitative results highlight several factors influencing the QoL prognosis:

• Surgical rehabilitation: The evolution of surgical modules and reconstructive options over the past decade is perceived as a key factor in restoring patient confidence, provided early diagnosis is achieved.
• Sequelae of radiotherapy: Practitioners observe a marked deterioration in salivary function and nutritional intake (inability to consume spicy foods) in irradiated patients.
• Stigmatisation: Post-operative cosmetic changes lead to social self-exclusion, with patients often seeking to conceal surgical sequelae to avoid the gaze of others.

The study emphasises that QoL should not be viewed as a static state, but as a dynamic process involving treatment tolerance, available human resources and continuous psychological support.

The gap between clinical survival and functional reality

This qualitative study reveals a major disconnect between surgical success and the perception of quality of life (QOL). Although the surveyed practitioners aim for clinical healing, they observe that approximately 50% of patients find themselves "psychologically crippled" postoperatively. The data show that even if the tissues have healed, less than 70% of patients regain full functionality. The terminological confusion noted among practitioners, often equating QOL with the absence of disease, highlights a need for the standardisation of care objectives beyond simple carcinological resection.

The impact of advanced stages (80% of cases seen in stage 3 or 4) is crucial. The study highlights that surgery alone preserves functions relatively better than combination with radiotherapy, the latter being systematically linked to xerostomia and severe dysphagia. Clinically, this confirms that early reconstruction (maxillary or mandibular) is the primary lever for restoring emotional confidence and social integration, by limiting the aesthetic stigma that drives patients into isolation.

The limitations of this study lie in its small sample size (n=12) and its exclusive recruitment in an Indian private hospital setting. Resource constraints in the public sector could alter these perspectives. Nevertheless, practitioners corroborate the literature data regarding the concept of a persistent "social handicap": the stigma associated with scarring and speech difficulties remains a major barrier, regardless of the technical success of the excision.

Summary of results

This qualitative study, conducted in an urban private hospital setting, reveals that although survival is improving, nearly 50% of patients remain psychologically impaired following treatment. Practitioners observe that fewer than 70% of survivors regain complete functional autonomy, highlighting a disconnect between surgical success and actual quality of life (QOL) integrating social and emotional dimensions.

In practical terms, for the practitioner:

• Beyond the clinical scope: Therapeutic success must no longer be limited to the absence of disease; systematically integrate functional comfort indicators (mastication, deglutition, phonation) from the immediate post-operative follow-up.
• Screening for psychological disability: With one in two patients potentially "psychologically crippled", early referral for psychiatric or oncopsychological support is crucial to manage the anxiety of recurrence and depression.
• Preventing social isolation: Anticipate the impact of aesthetic sequelae (scars, trismus) that drive patients to self-exclusion; facial reconstruction and prosthetic rehabilitation must aim to restore social confidence as much as function.

Technical glossary of the study

Trismus: Involuntary jaw constriction limiting mouth opening, identified by clinicians as a key marker of post-therapeutic functional impairment.

Dysphagia: Difficulty or discomfort during swallowing, frequently reported following surgery or radiotherapy, impacting nutrition and social comfort.

Xerostomia: Dry mouth induced by radiotherapy, particularly in advanced stages (III and IV), complicating salivary function and eating.

Local flap: Reconstruction technique whose study highlights the functional and aesthetic limitations compared to current rehabilitation standards.

Mastication: The ability to grind food, defined by practitioners as an essential pillar of functional health and quality of life for the post-operative patient.

Resection: Procedure for the excision of the cancerous lesion which, according to the study, requires careful reconstruction to prevent social and psychological isolation.

Swallowing: The swallowing process, whose post-operative impairment constitutes a major obstacle to the recovery of the patient's autonomy and social life.

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