Introduction: The study aimed to assess resilience and its associated factors in head and neck cancer patients, post-treatment in a low middle income country (LMIC), Pakistan.
Methods: An analytical cross-sectional study was conducted from November 2019 to May 2020 among head and neck cancer patients aged at least 18 years at the largest private tertiary care hospital, in Karachi, Pakistan. Information regarding resilience was collected through Wagnild and Young’s Resilience scale comprising of 14 items (RS-14). Depression and anxiety were assessed via Hospital Anxiety and Depression Scale (HADS) and social support by Enriched Social Support Instrument (ESSI).
Results: The data was analyzed by linear regression modeling. Unadjusted and adjusted beta coefficients with 95% CI were reported. Total 250 head and neck cancer patients were recruited, 79% were males. Mean age of the patients was 51.59 years with 93% having high social support and only 8% having severe depression and 3% having severe anxiety. After adjusting for covariates in multivariable analysis lower resilience was associated with severe depression (-17 [-20.98,-12.93]) or borderline depression (-4[-8.41,-0.39]), severe anxiety (-11 [-17.88,-4.18]), low social support (-6 [-9.62,-1.71 ]), family members > 6 in the household (- 2[-4.31,-0.29), smokeless tobacco quitters post- treatment (10 [ 5.79, 14.45]), and those who underwent tracheotomy (-4 [-7.67,-0.21]). There was significant interaction between education and role in the family (decision maker).
Conclusion: Resilience and social support is highly prevalent in our part of the world where collectivist culture prevails, thus resulting in low prevalence of depression and anxiety. High resilience score is reported among current smokeless tobacco users as compared to quitters post treatment. Tracheotomy and Large family size are inversely related to resilience. Formal education and decision making power in the household are mediators to resilience, demonstrating protective effect on mental health in head and neck cancer patients. Resilience-building interventions should be formulated to aid head and neck cancer patients to cope with the disease.