Cancer and changes in facial appearance : a meta-ethnography of qualitative studies

Introduction: Living with an altered facial appearance as a result of treatment for cancer requires considerable psychological adjustment. As such it is essential that health care professionals understand the lived experience of people affected. This systematic review provides a metaethnography of studies that have explored the experience of changed facial appearance as a result of cancer. Methods: A search of four databases (Web of Science, CINAHL, PsycInfo and Scopus) took place using terms relating to qualitative research, cancer, and changed facial appearance. Thirteen studies were identified, appraised and included in the synthesis. The findings and interpretations within the studies were subject to meta-ethnography procedures so as to elicit novel cross cutting themes. Findings: The experience of changed facial appearance after cancer was clustered into three contexts. In the context of the disease, subthemes were the primacy of survival, the changing relationship with the disease and the impact of the care team on the experience of changed appearance. In the context of the social world, subthemes were positive reactions, negative reactions and coping strategies. In the context of the self, subthemes were the self under attack, self-to-self relating, the self in the world and rebuilding the self. Conclusions: The findings indicate that healthcare professionals must conduct holistic assessments, so as to fully recognise and where necessary address the impact upon self. The meta-ethnography shows that the experience of facial appearance change following cancer is complex and requires awareness of a number of theoretical areas including identity construction, social support, stigmatisation, and the specific literature on visible difference