Understanding Functional Communication in Head and Neck Cancer Survivors Using a Mixed Methods Design

Background Functional communication, defined as everyday communication with family and friends, at work, and in the community, is an important but understudied concept in the head and neck cancer (HNC) survivor population. Objective The aim of this study was to better understand functional communication by using a mixed methods approach. Methods Head and neck cancer survivors participated in semistructured interviews and completed self-report questionnaires assessing multiple aspects of well-being and health-related quality of life (HRQOL). These qualitative and quantitative data were collected concurrently, analyzed separately, and then integrated. Results Survivors' perceptions of functional communication ranged from "Communication is good" to "Communication has changed" to "Communication is difficult." Using these qualitative results, survivors were categorized into 3 mutually exclusive groups. Clinically meaningful cut points were exceeded on measures of depressive symptoms (18%), state (40%) and trait (54%) anxiety, and pain (18%). Health-related quality of life scores were moderate to high for the sample as a whole. Statistically significant group differences were found only on the HNC-specific measure of HRQOL. A surprising finding was that the lowest mean score on social function was in the "Communication has changed" group. This group perceived changes in speech and voice that bothered them when communicating in social situations, although their speech was clear to a listener. Conclusion An underrecognized subpopulation of HNC survivors may exist, whose day-to-day functional communication has changed in ways that impact their relationships and sense of self. Implications for Practice Clinical identification of this subpopulation and provision of appropriate interventions are essential to facilitate optimal HRQOL after HNC treatment.