[Quality of life stress in patients with large tumors of the mouth. 2: Dealing with the illness: coping, anxiety and depressive symptoms].

The psychosocial effects of disfigurements and dysfunctions after combined surgical and radio-oncological therapy of patients with large tumors of the oral cavity (n = 50) are investigated in a three-part study. Part 1 compared the "limitations of quality of life" (LQL) of these patients with those of patients after total laryngectomy (n = 34) and with a group of patients "without cancer" (n = 40). This second part records the coping strategies of the three groups of patients and relates them to the following variables: anxiety (STAI), depression (D-S'), despair (H-scale), self-image (GT), locus of control (KKG), intellectual capacity (shortend SPM) and psychosocial burden in early childhood (new questionnaire). The coping strategies of "compliance" and "self-encouragement" were used most often. Patients with a higher psychosocial burden in early childhood often chose defensive strategies (distrust, cognitive avoidance, distraction, reinforced control of emotions). Only few patients used strategies of healthy regression ("coasting values", A. Maslow). It seems that no specific single coping strategy (in particular not the frequently recommended "positive thinking") but an individualized selection of different strategies is of special value to patients. The self-esteem of the patient was identified as a crucial factor in increasing the effectiveness of coping strategies. The surgeon can support patients in their self-esteem by showing a genuine interest not only in their state of health but also in their personal background. The third part of the study is focused on a search for variables which could serve as preoperative indicators of the individual ability to bear the burden of illness and therapy.