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Recovering function and surviving treatments are primary motivators for health behavior change in patients with head and neck cancer: Qualitative focus group study

Published online by Cambridge University Press:  23 November 2015

Melissa Henry*
McGill University, Montreal, Quebec, Canada Jewish General Hospital, Montreal, Quebec, Canada
Ala Bdira
McGill University, Montreal, Quebec, Canada
Maria Cherba
Jewish General Hospital, Montreal, Quebec, Canada University of Montreal, Montreal, Quebec, Canada
Sylvie Lambert
McGill University, Montreal, Quebec, Canada
Franco A. Carnevale
McGill University, Montreal, Quebec, Canada McGill University Health Centre, Montreal, Quebec, Canada
Christina MacDonald
Jewish General Hospital, Montreal, Quebec, Canada
Michael Hier
McGill University, Montreal, Quebec, Canada Jewish General Hospital, Montreal, Quebec, Canada
Anthony Zeitouni
McGill University, Montreal, Quebec, Canada McGill University Health Centre, Montreal, Quebec, Canada
Karen Kost
McGill University, Montreal, Quebec, Canada McGill University Health Centre, Montreal, Quebec, Canada
Alex Mlynarek
McGill University, Montreal, Quebec, Canada Jewish General Hospital, Montreal, Quebec, Canada McGill University Health Centre, Montreal, Quebec, Canada
Martin Black
McGill University, Montreal, Quebec, Canada Jewish General Hospital, Montreal, Quebec, Canada
Zeev Rosberger
McGill University, Montreal, Quebec, Canada Jewish General Hospital, Montreal, Quebec, Canada
Saul Frenkiel
McGill University, Montreal, Quebec, Canada Jewish General Hospital, Montreal, Quebec, Canada
Address correspondence and reprint request to: Melissa Henry, Jewish General Hospital, 3755 Cote Sainte-Catherine Rd, Pavilion H, Room H-366, Montreal, Quebec, Canada, H3T 1E2. E-mail:



Against medical advice, head and neck cancer (HNC) patients have been shown to continue to smoke and misuse alcohol post-diagnosis and treatment. This study aimed to better understand the barriers to and facilitators of health behavior change (HBC) in HNC patients.


We conducted nine focus groups following a standard protocol. Eligible patients were diagnosed less than three years previously with a primary HNC and selected using maximum variability sampling (gender, age, cancer stage, smoking, and alcohol misuse). Thematic analysis was conducted using NVivo 10 software.


Participants were mostly men (79%), 65 years of age (SD = 10.1), and married/common-law (52%, n = 15). Mean time from diagnosis was 19 months (SD = 12.3, range = 5.0–44.5), and most had advanced cancer (65.5%, n = 19). Participants provided a larger than anticipated definition of health behaviors, encompassing both traditional (smoking, drinking, diet, exercise, UV protection) and HNC-related (e.g., dental hygiene, skin care, speech exercises, using a PEG, gaining weight). The main emerging theme was patient engagement, that is, being proactive in rehabilitation, informed by the medical team, optimistic, flexible, and seeking support when needed. Patients were primarily motivated to stay proactive and engage in positive health behaviors in order to return to normal life and reclaim function, rather than to prevent a cancer recurrence. Barriers to patient engagement included emotional aspects (e.g., anxiety, depression, trauma, demoralization), symptoms (e.g., fatigue, pain), lack of information about HBC, and healthcare providers' authoritarian approach in counseling on HBC. We found some commonalities in barriers and facilitators according to behavior type (i.e., smoking/drinking/UV protection vs. diet/exercise).

Significance of Results:

This study underlines the key challenges in addressing health behaviors in head and neck oncology, including treatment-related functional impairments, symptom burden, and the disease's emotional toll. This delicate context requires health promotion strategies involving close rehabilitative support from a multidisciplinary team attentive to the many struggles of patients both during treatments and in the longer-term recovery period. Health promotion in HNC should be integrated into routine clinical care and target both traditional and HNC-related behaviors, emphasizing emotional and functional rehabilitation as key components.

Original Articles
Copyright © Cambridge University Press 2015 

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Babor, T. & Kadden, R.M. (2005). Screening and interventions for alcohol and drug problems in medical settings: What works? The Journal of Trauma: Injury, Infection, and Critical Care, 59(3), S80S87.Google ScholarPubMed
Beckjord, E.B., Rutten, F., Arora, N.K., et al. (2008). Information processing and negative affect: Evidence from the 2003 Health Information National Trends Survey. Health Psychology, 27(2), 249257.CrossRefGoogle ScholarPubMed
Bjorklund, M., Sarvimaki, A. & Berg, A. (2008). Health promotion from the perspective of individuals living with head and neck cancer. European Journal of Oncology Nursing, 12(1), 2634.Google Scholar
Bultz, B.D., Waller, A., Cullum, J., et al. (2013). Implementing routine screening for distress, the sixth vital sign, for patients with head and neck and neurologic cancers. Journal of the National Comprehensive Cancer Network, 11, 12491261.Google Scholar
Canadian Cancer Society (2011). Canadian cancer statistics 2011. Toronto: Canadian Cancer Society. Available from Scholar
Canadian Partnership Against Cancer (2012). Screening for distress, the 6th vital sign: A guide to implementing best practices in person-centered care. Available from,Google Scholar
Carpenter, C.J. (2010). A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Communication, 25(8), 661669.Google Scholar
Cherpitel, C.J. (2000). A brief screening instrument for alcohol dependence in the emergency room: The RAPS4. Journal of Studies on Alcohol, 61, 447449.Google Scholar
Ciccolo, J.T. & Busch, A.M. (2014). Behavioral interventions to enhance smoking cessation: A summary of current evidence. American Journal of Lifestyle Medicine, 9. Available from Scholar
Glasgow, R.E., Vogt, T.M. & Boles, S.M. (1999). Evaluating the public health impact of health promotion interventions: The RE–AIM framework. American Journal of Public Health, 89, 13221327.Google Scholar
Gritz, E.R., Fingeret, M.C., Vidrine, D.J., et al. (2006). Successes and failures of the teachable moment: Smoking cessation in cancer patients. Cancer, 106(1), 1727.Google Scholar
Hettema, J., Steele, J. & Miller, W.R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91111.Google Scholar
Hollander, J.A. (2004). The social context of focus groups. Journal of Contemporary Ethnography, 33, 602636.Google Scholar
Hsieh, H.F. & Shannon, S.E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 12771288.Google Scholar
Institute of Medicine, National Research Council, Hewitt, M. & Ganz, P.A. (2006). From cancer patient to cancer survivor. Lost in transition: An American Society of Clinical Oncology and Institute of Medicine symposium. Washington, DC: National Academies Press.Google Scholar
Janz, N.K. & Becker, M.H. (1984). The health belief model: A decade later. Health Education & Behavior, 11(1), 147.Google Scholar
Kitzinger, J. (1994). The methodology of focus groups: The importance of interaction between research participants. Sociology of Health & Illness, 16(1), 103121.Google Scholar
Kitzinger, J. (1995). Introducing focus groups. BMJ, 311(7000), 299302.Google Scholar
Kolappa, K. & Henderson, D.C. (2013). No physical health without mental health: Lessons unlearned. Bulletin of the World Health Organization, 91, 33A.Google Scholar
Krueger, R.A. & Casey, M.A. (2000). Focus groups: A practical guide for applied research. Thousand Oaks, CA: Sage Publications.Google Scholar
Logan, J. & Graham, I. D. (1998). Toward a comprehensive interdisciplinary model of health care research use. Science Communication, 20, 227246.Google Scholar
Matthias, C., Harreus, U. & Strange, R. (2006). Influential factors on tumor recurrence in head and neck cancer patients. European Archives of Oto-Rhino-Laryngology, 263(1), 3742.CrossRefGoogle ScholarPubMed
Mehnert, A., Brähler, E., Faller, H., et al. (2014). Four-week prevalence of mental disorders in patients with cancer across major tumor entities. Journal of Clinical Oncology, 32(31), 35403546.Google Scholar
Miller, W.R. & Rollnick, S. (2002). Motivational interviewing: Helping people change (3rd Edition). New York: The Guilford Press.Google Scholar
Morgan, D. (1997). Focus groups as qualitative research. Thousand Oaks, CA: Sage Publications.CrossRefGoogle Scholar
Murphy, B.A., Ridner, S., Wells, N., et al. (2007). Quality of life research in head and neck cancer: A review of the current state of the science. Critical Reviews in Oncology/Hematology, 62(3), 251267.Google Scholar
National Cancer Institute (2015). Fatigue—for health professionals. Rockville, MD: National Cancer Institute. Available from Scholar
NVivo (2012). NVivo qualitative data analysis software, version 10. Melbourne: QSR International.Google Scholar
Ozakinci, G., Wells, M., Williams, B., et al. (2010). Cancer diagnosis: An opportune time to help patients and their families stop smoking? Public Health, 124(8), 479482.CrossRefGoogle ScholarPubMed
Patton, M.Q. (1990). Qualitative evaluation and research methods, 2nd ed.Newbury Park, CA: Sage Publications.Google Scholar
Ranney, L., Melvin, C., Lux, L., et al. (2006). Systematic review: Smoking cessation intervention strategies for adults and adults in special populations. Annals of Internal Medicine, 145(11), 845856.Google Scholar
Rollnick, S., Miller, W.R. & Butler, C.C. (2008). Motivational interviewing in health care. New York: Guilford Press.Google Scholar
Rosenstock, I. (1974). Historical origins of the health belief model. Health Education & Behavior, 2(4), 328335.Google Scholar
Rubak, S., Sandbaek, A., Lauritzen, T., et al. (2005). Motivational interviewing: A systematic review and meta-analysis. The British Journal of General Practice, 55(513), 305312.Google Scholar
Sharp, L. & Tishelman, C. (2005). Smoking cessation for patients with head and neck cancer. Cancer Nursing, 28(3), 226235.Google Scholar
Sharp, L., Johansson, H., Fagerstrom, K., et al. (2008). Smoking cessation among patients with head and neck cancer: Cancer as a “teachable moment.” European Journal of Cancer Care, 17(2), 114119.Google Scholar
Shenton, A.K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22, 6375.Google Scholar
Simmons, V.N., Litvin, E.B., Unrod, M., et al. (2012). Oncology healthcare providers' implementation of the 5A's model of brief interventions for smoking cessation: Patients' perceptions. Patient Education and Counseling, 86(3), 414419.Google Scholar
Stewart, D.W. & Shamdasani, P.N. (2014). Focus group: Theory and practice, 3rd ed.Thousand Oaks, CA: Sage Publications.Google Scholar
Teunissen, S., Wesker, W., Kruitwagen, C., et al. (2007). Symptom prevalence in patients with incurable cancer: A systematic review. Journal of Pain and Symptom Management, 34(1), 94104.CrossRefGoogle ScholarPubMed
van den Beuken–van Everdingen, M.H.J., de Rijke, J.M., Kessels, A.G., et al. (2007). Prevalence of pain in patients with cancer: A systematic review of the past 40 years. Annals of Oncology, 18(9), 14371449.Google Scholar
Warren, G.W., Marshall, J.R., Cummings, K.M., et al. (2013). Addressing tobacco use in patients with cancer: A survey of American Society of Clinical Oncology members. Journal of Oncology Practice, 9(5), 258262.CrossRefGoogle Scholar
Whitlock, E.P., Polen, M.R., Green, C.A., et al. (2004). Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 40(7), 557568.CrossRefGoogle Scholar
World Health Organization (2009). Global health risks: Mortality and burden of disease attributable to selected major risks. WHO Library Cataloguing-in-Publication Data. Available from Scholar