Date of Award

12-2024

Degree Type

Thesis

Degree Name

MS in Public Health

First Advisor

Dr Uzma Shamsi

Second Advisor

Mr Iqbal Azam

Third Advisor

Dr Hira Tariq

Department

Community Health Sciences

Abstract

BACKGROUND: Oral cavity cancer (OCC) is a challenging diagnosis, particularly in South Asia, where it’s increasingly common due to widespread tobacco and betel nut use. For many patients, the battle is not just with the physical effects that the disease cause but with the profound social stigma that can come with it. Visible changes, like facial disfigurement or difficulty speaking, often draw unwanted attention, leading to feelings of shame, isolation, and profound psychological distress. In places like Pakistan, where cancer is at times seen with fear or misunderstanding, patients with OCC may find themselves facing not only the emotional burden of their illness but also a lack of social support. This makes an already difficult journey even harder. Stigma affects more than just morale; it can impact mental health, leading to anxiety, depression, and even a reluctance to continue with necessary treatments. For these patients, compassionate and culturally aware support systems are essential—ones that recognize both the emotional and physical challenges they face. OBJECTIVE: To determine the frequency of stigma and its association with psychosocial distress in oral cavity cancer patients in Karachi, Pakistan.
METHODS: We conducted a cross-sectional study on 287 oral cavity cancer patients in Aga Khan University Hospital (AKUH) and Jinnah Postgraduate Medical Center (JPMC) from September 2023 to October 2024. Stigma was assessed by the Shame and Stigma Scale v (SSS). To assess psychosocial distress, short form of Questionnaire on Distress in Cancer Patients scale (QSC-R23) which is QSC-R10 was used. Patients’ socio-demographics, clinical and treatment characteristics, and tumor characteristics were also assessed. The outcome variable, psychosocial distress, was a categorical variable, thus we used a binary logistic regression technique for the analysis. For continuous variables, we calculated means and standard deviations. Categorical variables were reported as frequencies with percentages. For all important associations, prevalence odds ratio with 95% confidence intervals were reported using multiple logistic regression.
RESULTS: Out of 341 patients, 287 were recruited for the study. Two-thirds of participants (77.7%) were males, with a mean age of 48.5 + 10.5 years. The frequency of stigma among individuals diagnosed with OCC was found to be 67.9% and the mean score was 29.63 ± 14.27, which is considered as mild stigma. The mean psychosocial distress, assessed by QSC R-10, was 19.53 + 7.19. 71.8% patients were identified to have psychosocial distress due to OCC in Karachi, Pakistan. Multivariable analysis using binary logistic regression revealed that stigma was associated with psychosocial distress (aPOR= 13.9, 95% CI: 4.44 - 43.74). Psychosocial distress was also higher among individuals who reported voice change due to OCC (aPOR=2.6, 95% CI: 1.24 – 5.47). Females had 3 times higher odds of distress (aPOR= 2.95, 95% CI: 1.20 – 7.23) compared to males. As age increased by 1 year, the odds of distress increased by 5% (aPOR= 1.05, 95% CI: 1.01 – 1.08). A notable interaction was observed between stigma and education level in the final model. The odds of distress in individuals with stigma and primary education was 16.3 (aPOR= 16.3, 95% CI: 1.28 – 207.7) times higher than those who were vi illiterate and had stigma. Individuals with secondary education and stigma status had 76% (aPOR= 0.24, 95% CI: 0.55 – 1.08) less odds of distress than those who were illiterate and were stigmatized.
CONCLUSION: Stigma, voice change due to OCC and/or its treatment, female gender, older age and lower education level were associated with psychosocial distress. This highlights the need for targeted interventions to reduce stigma and psychosocial distress among OCC patients, to improve their mental well-being and overall health outcome. These insights can inform clinical practices, influence policies, and guide future research in this area, for the benefit of OCC patients and their families

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Last Page

71

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