Awareness of Prosthetic Rehabilitation Options for Head and Neck Cancer Patients

Sivashankari R et al | DOI: 10.65188/nurexus.1044

Page 15

Journal of MedVerse Research & Practice

ISSN: 3107-4278

Awareness of Prosthetic Rehabilitation Options for Head and Neck Cancer

Patients

Dr. R Sivashankari

Associate Professor

Department of Prosthodontics, Government Dental College and Hospital, Chennai

Email: Sivashankari83@gmail.com

Submission Date: 26.08.2025

Accepted Date: 22.09.2025

Published Date: 30.09.2025

DOI: 10.65188/nurexus.1044

article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Abstract

Background: Head and neck cancers (HNC) often lead to structural, functional, and aesthetic challenges,

significantly impacting patients’ quality of life. Maxillofacial prosthetic rehabilitation offers a valuable, non-surgical

approach to address these deficits. Despite its benefits, awareness of such treatment options remains limited.

Objective: This study aimed to evaluate the level of awareness regarding maxillofacial prosthetic rehabilitation

among HNC patients and to identify factors influencing this awareness, as well as potential obstacles to accepting

treatment.

Methods: A cross-sectional observational study was conducted with 100 patients attending the Prosthodontics

outpatient department at Tamil Nadu Government Dental College and Hospital, Chennai, between July 2024 and July

2025. Participants completed a structured, validated questionnaire capturing sociodemographic details, clinical

history, awareness of prosthetic rehabilitation, and perceived barriers to treatment. Associations between awareness

and demographic or clinical variables were assessed using Chi-square or Fisher’s exact tests, with statistical

significance set at p<0.05.

Results: Among the participants, 38% reported awareness of maxillofacial prosthetic options, with doctors serving as

the main source of information (63.2%). Only 30% believed that prosthetic rehabilitation could improve the quality

of life. Awareness was significantly higher in individuals aged ≤45 years (52.9% vs. 30.3%, p=0.021) and those with

higher secondary education or above (54.5% vs. 25%, p=0.003). No significant associations were observed between

awareness and gender or treatment modality. Key barriers identified included financial limitations, lack of

information, and restricted access to specialized care centers.

Conclusion: The findings reveal considerable gaps in patient knowledge regarding maxillofacial prosthetic

treatments. These results emphasize the importance of targeted educational programs and proactive communication

by healthcare providers. Enhancing patient understanding can support informed decision-making, promote

acceptance of rehabilitation, and ultimately improve quality of life for individuals with HNC.

Keywords: Head and neck cancer, maxillofacial prosthetics, patient awareness, rehabilitation, health literacy, quality

of life

Introduction

Head and neck cancers represent a significant global health concern, accounting for approximately 4–5%

of all malignancies, with higher incidence rates reported in Asian countries, especially India [1,2].

Management of these cancers often involves extensive surgical removal, radiotherapy, chemotherapy, or a

combination of these approaches. While such treatments have improved survival rates, they frequently lead

to substantial anatomical, functional, and aesthetic deficits. Surgical procedures affecting the oral cavity,

maxilla, mandible, or other craniofacial regions can disrupt essential functions, including chewing,

swallowing, speech, and facial expression [3]. These functional limitations are often accompanied by

Sivashankari R et al | DOI: 10.65188/nurexus.1044

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psychological, emotional, and social challenges, collectively reducing the patient’s quality of life [4].

Effective rehabilitation of head and neck cancer patients therefore, requires attention not only to disease

control but also to the restoration of form, function, and psychosocial well-being. Maxillofacial prosthetics

plays a critical role in this process by providing artificial replacements for missing oral and facial

structures. Such prostheses help restore oral function, improve speech clarity, and enhance facial aesthetics,

thereby supporting patient confidence and facilitating social reintegration [5,6]. Unlike surgical

reconstruction, which may be constrained by the size of the defect, patient health status, or resource

availability, prosthetic rehabilitation offers a practical, non-invasive, and cost-effective alternative [7].

Despite these benefits, awareness and utilization of maxillofacial prosthetic solutions remain low. Research

indicates that many patients receive insufficient information regarding rehabilitation options, largely due to

limited referral practices, inadequate counselling, socioeconomic barriers, and scarcity of specialized

centres [8]. In several low- and middle-income countries, maxillofacial prosthodontics continues to be

under-recognized as a vital component of comprehensive cancer care [9].

In India, head and neck cancers account for a disproportionately high fraction of all malignancies, with

some regions reporting rates as high as 30–40% [10]. The coastal regions of Karnataka are considered high-

risk zones due to lifestyle factors, including tobacco and betel quid use, alcohol consumption, and specific

dietary patterns [11]. While access to surgical and oncological treatment has expanded, post-treatment

rehabilitation services - particularly maxillofacial prosthetic care—remain underutilized. Limited patient

awareness further exacerbates the gap between cancer survival and overall quality of life [12].

Materials & Methods

Study Design and Setting: This cross-sectional observational study was conducted in the Department of

Prosthodontics at Tamil Nadu Government Dental College and Hospital, Chennai, over one year from July

2024 to July 2025.

Study Population: The study included patients with a confirmed diagnosis of head and neck cancer, either

undergoing active treatment or in the post-treatment phase, who attended the outpatient department during

the study period.

Sample Size: A total of 100 patients was enrolled to ensure adequate representation of the target population

and to maintain statistical validity.

Inclusion Criteria

1. Patients aged 18 years and above.

2. Patients with a confirmed diagnosis of head and neck cancer, regardless of treatment stage.

3. Patients willing to provide informed consent and participate in the study.

Exclusion Criteria

1. Patients with recurrent or metastatic disease who were critically ill and unable to participate.

2. Patients with cognitive impairments or communication difficulties that could hinder effective

participation.

3. Patients unwilling to provide informed consent.

Data Collection: Data were collected using a structured, pre-tested, and validated questionnaire designed

to evaluate awareness of maxillofacial prosthetic rehabilitation. The questionnaire included sections on

sociodemographic characteristics, clinical history, treatment details, knowledge of prosthetic options, and

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perceived barriers to accessing rehabilitation services.

Ethical Considerations: The present study obtained approval from the Institutional Ethics Committee of

Government Dental College and Hospital, Chennai (Ref No: GDCH/IEC/2024/52871). A detailed

Participant Information Sheet was provided to all participants, and written informed consent was obtained

prior to their participation in the study.

Statistical Analysis

Collected data were entered into Microsoft Excel and analyzed using IBM SPSS Statistics version 25.0

(IBM Corp., Armonk, NY, USA). Descriptive statistics - including frequencies, percentages, means, and

standard deviations - were used to summarize demographic information and awareness levels. Associations

between awareness and demographic or clinical variables were evaluated using the Chi-square test or

Fisher’s exact test, as appropriate. A p-value of <0.05 was considered statistically significant.

Results

Table 1. Sociodemographic characteristics of study participants (N = 100)

Variable

Category

Frequency (n)

Percentage (%)

Age group (years)

18–30

12.0

31–45

22.0

46–60

38.0

>60

28.0

Gender

Male

66.0

Female

34.0

Educational status

No formal education

20.0

Primary/secondary

36.0

Higher secondary

28.0

Graduate & above

16.0

Occupation

Unemployed

18.0

Unskilled labor

42.0

Skilled/professional

40.0

Residence

Urban

44.0

Rural

56.0

The study included 100 patients, with the majority belonging to the 46–60 years age group (38%), followed

by those above 60 years (28%), reflecting the higher risk of head and neck cancers in middle-aged and

elderly individuals. Males (66%) outnumbered females (34%), consistent with the greater prevalence of

risk behaviors such as tobacco and alcohol use among men. Educational status showed that over half (56%)

had only up to primary/secondary education or no formal education, which may influence awareness levels.

Occupationally, most were unskilled laborers (42%), followed by skilled/professionals (40%), indicating a

predominantly working-class background. A larger proportion of participants belonged to rural areas

(56%), highlighting the regional demographic distribution and potential barriers to accessing specialized

prosthetic rehabilitation services.

Table 2. Clinical profile of patients with head and neck cancer (N = 100)

Clinical Variable

Category

Frequency (n)

Percentage (%)

Cancer site

Oral cavity

48.0

Oropharynx

18.0

Hypopharynx

12.0

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Larynx

14.0

Others

8.0

Treatment modality

Surgery only

26.0

Radiotherapy only

12.0

Chemotherapy only

6.0

Multimodal therapy

56.0

Duration since diagnosis

<6 months

34.0

6–12 months

28.0

>12 months

38.0

The oral cavity (48%) was the most common cancer site, followed by the oropharynx (18%) and larynx

(14%), which aligns with regional patterns of head and neck cancer linked to tobacco and betel quid habits.

Regarding treatment, the majority underwent multimodal therapy (56%), reflecting the current practice of

combining surgery, radiotherapy, and chemotherapy for better outcomes. A smaller proportion received

surgery alone (26%), radiotherapy (12%), or chemotherapy (6%). In terms of disease duration, 38% had

been diagnosed for more than 12 months, while 34% were within 6 months and 28% between 6–12 months,

showing a mix of newly diagnosed and longer-term survivors within the study population.

Table 3. Awareness regarding maxillofacial prosthetic rehabilitation (N = 100)

Awareness Question

Response

Category

Frequency

(n)

Percentage

(%)

Have you heard of prosthetic rehabilitation?

Yes

38.0

62.0

Source of information (if yes, n=38)

Doctor

63.2

Family/friends

21.1

Media

15.7

Do you believe a prosthesis improves the quality

of life?

Yes

30.0

No/Not sure

70.0

Less than half of the participants knew prosthetic rehabilitation, with only 38% reporting awareness, while

a majority (62%) had never heard of it. Among those who were aware, the main source of information was

doctors (63.2%), followed by family/friends (21.1%) and media (15.7%), indicating limited community or

media-level awareness. When asked about the role of prostheses in improving quality of life, only 30%

believed they could be beneficial, whereas 70% were either unsure or did not perceive any benefit,

reflecting a substantial gap in patient understanding and highlighting the need for better education and

counseling.

Table 4. Association Between prosthetic rehabilitation and sociodemographic/clinical variables

Variable

Category

Aware n (%)

Not aware n (%)

p-value

Age group

≤45 years (n=34)

18 (52.9)

16 (47.1)

0.021*

>45 years (n=66)

20 (30.3)

46 (69.7)

Gender

Male (n=66)

26 (39.4)

40 (60.6)

0.512

Female (n=34)

12 (35.3)

22 (64.7)

Education

Up to secondary (n=56)

14 (25.0)

42 (75.0)

0.003*

Higher secondary+ (n=44)

24 (54.5)

20 (45.5)

Treatment modality

Surgery only (n=26)

8 (30.8)

18 (69.2)

0.417

Multimodal (n=56)

22 (39.3)

34 (60.7)

Participants aged ≤45 years demonstrated significantly higher awareness (52.9%) compared to those aged

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>45 years (30.3%), with a statistically significant difference (p = 0.021), indicating that younger individuals

had better awareness. Awareness levels were slightly higher among males (39.4%) than females (35.3%),

though this difference was not statistically significant (p = 0.512). Participants with higher secondary

education or above showed markedly better awareness (54.5%) compared to those with education up to

secondary level (25.0%), and this difference was statistically significant (p = 0.003). Awareness was also

slightly higher among participants receiving multimodal treatment (39.3%) compared to those who

underwent surgery only (30.8%), although the difference did not reach statistical significance (p = 0.417).

Discussion

This study provides a novel exploration of awareness regarding maxillofacial prosthetic treatment among

patients with head and neck cancer (HNC). To our knowledge, it is the first investigation specifically

targeting this underserved and understudied population, highlighting the pressing need for region-specific

research, as emphasized by Senchak et al. [13]. Understanding patient perspectives differs fundamentally

from understanding those of healthcare providers, as patients often have limited exposure to the full

spectrum of treatment options and face unique challenges in accessing and utilizing these services. In

contrast, practitioners are typically well-informed about clinical guidelines and recent technological

advancements, as noted by Elbashti et al. [14]. Therefore, obtaining data directly from patients is critical for

accurately assessing awareness levels and the factors influencing treatment decisions, a concept further

supported by Kondeti et al. [15].

A patient-centered approach provides valuable insight into current awareness levels and underscores the

importance of addressing knowledge gaps to improve outcomes and quality of life. Awareness can also

vary significantly among healthcare providers themselves. For example, Shreya and Ramesh reported that

97.6% of undergraduate dental students were aware of maxillofacial defects and that 89.5% had knowledge

of available treatment modalities. In contrast, the present study demonstrates that patients’ understanding of

maxillofacial prosthetic options is considerably lower and less comprehensive, highlighting a substantial

gap in knowledge transfer from providers to patients. While healthcare professionals acquire information

through structured education and clinical exposure, patients often lack access to comparable resources,

which may limit informed decision-making and reduce utilization of prosthetic rehabilitation services, as

discussed by Kondeti et al. [15].

Recognizing these communication gaps is essential for developing targeted educational strategies to bridge

the divide and enable patients to participate actively in treatment planning. This observation aligns with

findings from other healthcare contexts; for instance, Bhat et al. reported that socioeconomic factors

significantly influence cancer-related health decisions in Indian populations [11]. Similarly, Senchak et al.

emphasized that psychosocial and informational interventions play a crucial role in improving quality of

life among HNC patients [13]. Our findings further indicate that awareness and acceptance of maxillofacial

prosthetic rehabilitation are closely linked to patients’ understanding of potential benefits, limitations, and

long-term outcomes.

Health literacy principles stress the importance of providing clear, accessible, and patient-appropriate

information to empower individuals in making informed healthcare decisions. In the context of

maxillofacial prosthetics, patients must understand the available treatment options, their advantages and

limitations, and their impact on function and quality of life. Addressing barriers such as cost, access, and

follow-up care is equally important, as highlighted by Shenoy et al., who identified financial and logistical

challenges as major deterrents to prosthetic rehabilitation among oral cancer patients [12].

Applying health literacy strategies to maxillofacial prosthetic care requires the development of tailored

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educational interventions that bridge the knowledge gap between providers and patients. Such initiatives

can empower patients, promote shared decision-making, and enhance collaboration with healthcare

professionals. These approaches are consistent with the recommendations outlined by Elbashti et al.

regarding patient education and digital integration in maxillofacial prosthetic services [14], ultimately

contributing to improved quality of care and patient satisfaction.

Conclusion

The findings highlight significant deficiencies in patient awareness, particularly regarding the availability

and potential advantages of specialized maxillofacial prosthetic rehabilitation. Major obstacles to treatment

uptake included financial constraints, limited knowledge, and restricted access to specialized care centers.

Introducing targeted educational initiatives and strengthening communication between healthcare providers

and patients can empower individuals to make informed decisions, thereby improving treatment adherence

and overall quality of life. Future studies should focus on designing and evaluating effective educational

interventions aimed at closing these knowledge gaps and ensuring equitable access to maxillofacial

prosthetic services across diverse socioeconomic groups.

Conflict of Interest: Nil

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