Journal of Cancer Survivorship

, Volume 13, Issue 1, pp 43–55 | Cite as

Integrating self-management into daily life following primary treatment: head and neck cancer survivors’ perspectives

  • Simon Dunne
  • Laura Coffey
  • Linda Sharp
  • Deirdre Desmond
  • Rachael Gooberman-Hill
  • Eleanor O’Sullivan
  • Aileen Timmons
  • Ivan Keogh
  • Conrad Timon
  • Pamela GallagherEmail author



Self-management may help cancer survivors to better deal with challenges to their physical, functional, social and psychological well-being presented by cancer and its treatment. Nonetheless, little is known about how people integrate cancer self-management practices into their daily lives. The aim of this study was to describe and characterise the processes through which head and neck cancer (HNC) survivors attempt to integrate self-management into their daily lives following primary treatment.


Using a purposeful critical case sampling method, 27 HNC survivors were identified through four designated cancer centres in Ireland and participated in face-to-face semi-structured interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis.


Six themes describing HNC survivors’ attempts to integrate self-management into their lives following treatment were identified: grappling with having to self-manage, trying out self-management strategies, becoming an expert self-manager, struggling to integrate self-management strategies into daily life, avoiding recommended self-management and interpreting self-management.


This is the first study to describe HNC survivors’ attempts to integrate self-management into their daily lives following primary treatment. The findings indicate that HNC survivors exhibit highly individualised approaches to self-management integration and abandon self-management strategies that fail to meet their own specific needs.

Implications for Cancer Survivors

Survivors may benefit from skills training and structured support to assist their transition between in-patient care and having to self-manage after primary treatment, and/or ongoing support to deal with persistent and recurring challenges such as eating difficulties and fear of recurrence.


Head and neck cancer Cancer survivorship Self-management Qualitative Psycho-oncology 



We would like to thank the participants and Fiona Bradley, Carol Brennan, Annemarie Farrelly and Marie Manning for their assistance in recruitment.

Funding information

This study was funded by the Irish Cancer Society and the Health Research Board in Ireland under Grant No. SRP13GAL, MRCG/2013/11. AT was also supported by a grant from the Health Research Board (ICE/2012/9).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. We received formal ethical approval for the study from the following institutions in Ireland: Galway University Hospitals (Merlin Park University Hospital Clinical REC_C.A.1100); South/South West Hospital Group (UCC Clinical REC_ECM_4_(bbb)_03/06/14); St. James’s Hospital, Dublin (SJH/AMNCH REC Reference: 2014/05/Chairman’s_Action), Royal Victoria Eye and Ear Hospital, Dublin (RVEEH REC_25/06/14).

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Hoffman MA, Lent RW, Raque-Bogdan TL. A social cognitive perspective on coping with cancer: theory, research, and intervention. Couns Psychol. 2013;41(2):240–67.Google Scholar
  2. 2.
    Maher EJ. Managing the consequences of cancer treatment and the English National Cancer Survivorship Initiative. Acta Oncol. 2013;52(2):225–32.Google Scholar
  3. 3.
    Foster C, Breckons M, Cotterell P, Barbosa D, Calman L, Corner J, et al. Cancer survivors’ self-efficacy to self-manage in the year following primary treatment. J Cancer Surviv. 2015;9(1):11–9.Google Scholar
  4. 4.
    McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K, et al. Self-management: enabling and empowering patients living with cancer as a chronic illness. CA Cancer J Clin. 2011;61:50–62.Google Scholar
  5. 5.
    Foster C, Fenlon D. Recovery and self-management support following primary cancer treatment. Br J Cancer. 2011;105:S21–8.Google Scholar
  6. 6.
    Hammer MJ, Ercolano EA, Wright F, Dickson VV, Chyun D, Melkus GD. Self-management for adult patients with cancer: an integrative review. Cancer Nurs. 2015;38(2):E10–26.Google Scholar
  7. 7.
    Howell D, Harth T, Brown J, Bennett C, Boyko S. Self-management education interventions for patients with cancer: a systematic review. Support Care Cancer. 2017;25(4):1323–55.Google Scholar
  8. 8.
    Davies N, Batehup L. Self-management support for cancer survivors: guidance for developing interventions: an update of the evidence. London: Macmillan Group; 2010.Google Scholar
  9. 9.
    Kvale EA, Meneses K, Demark-Wahnefried W, Bakitas M, Ritchie C. Formative research in the development of a care transition intervention in breast cancer survivors. Eur J Oncol Nurs. 2015;19:329–35.Google Scholar
  10. 10.
    Dingley C, Roux G. The role of inner strength in quality of life and self-management in women survivors of cancer. Res Nurs Health. 2014;37(1):32–41.Google Scholar
  11. 11.
    Audulv A, Asplund K, Norbergh K-G. The integration of chronic illness self-management. Qual Health Res. 2012;22(3):332–45.Google Scholar
  12. 12.
    Audulv A, Norbegh K-G, Asplund A. An ongoing process of inner negotiation – a grounded theory study of self-management among people living with chronic illness. J Nurs Healthc Chron Ill. 2009;1(4):283–93.Google Scholar
  13. 13.
    Kralik D, Price K, Telford K. The meaning of self-care for people with chronic illness. J Nurs Healthc Chron Ill. 2010;2:197–204.Google Scholar
  14. 14.
    Hornsten A, Jutterstrom L, Audulv A, Lundman B. A model of integration of illness and self-management in type 2 diabetes. J Nurs Healthc Chron Ill. 2011;3:41–51.Google Scholar
  15. 15.
    Schulman-Green D, Jaser S, Martin F, Alonzo A, Grey M, McCorkle R, et al. Processes of self-management in chronic illness. J Nurs Scholarsh. 2012;44:136–44.Google Scholar
  16. 16.
    Fenlon D, Foster C. Self-management support: a review of the evidence. Macmillan Research Unit: University of Southampton; 2009.Google Scholar
  17. 17.
    Moser RP, Arndt J, Han PK, Waters EA, Amsellem M, Hesse BW. Perceptions of cancer as a death sentence: prevalence and consequences. J Health Psychol. 2014;19(12):1518–24.Google Scholar
  18. 18.
    Howren MB, Christensen AJ, Karnell LH, Funk GF. Psychological factors associated with head and neck cancer treatment and survivorship: evidence and opportunities for behavioural medicine. J Consult Clin Psychol. 2013;81:299–317.Google Scholar
  19. 19.
    Djan R, Pennington A. A systematic review of questionnaires to measure the impact of appearance on quality of life for head and neck cancer patients. J Plast Reconstr Aes. 2013;66:647–59.Google Scholar
  20. 20.
    Humphris GM, Rogers S, McNally D, Lee-Jones C, Brown J, Vaughan D. Fear of recurrence and possible cases of anxiety and depression in orofacial cancer patients. Int J Oral Max Surg. 2003;32:486–91.Google Scholar
  21. 21.
    Dunne S, Mooney O, Coffey L, Sharp L, Desmond D, Timon C, et al. Psychological variables associated with quality of life following primary treatment for head and neck cancer: a systematic review of the literature from 2004 to 2015. Psycho-Oncology. 2016;26(2):149–60.Google Scholar
  22. 22.
    Dunne S, Mooney O, Coffey L, Sharp L, Timmons A, Desmond D, et al. Self-management strategies used by head and neck cancer survivors following completion of primary treatment: a directed content analysis. Psycho-Oncology. 2017;26:2194–200.Google Scholar
  23. 23.
    Dunne S, Coffey L, Sharp L, Timmons A, Desmond D, O’Sullivan E, Keogh, I, Timon C, Gooberman-Hill R, Gallagher P. Barriers to active self-management following treatment for head and neck cancer: survivors’ perspectives. 2018. Manuscript under review.Google Scholar
  24. 24.
    Onwuegbuzie AJ, KMT C. A typology of mixed methods sampling designs in social science research. Qual Rep. 2007;12:281–316.Google Scholar
  25. 25.
    Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.Google Scholar
  26. 26.
    So WKW, Chan RJ, Chan DNS, Hughes BGM, Chair SY, Choi KC, et al. Quality of life among head and neck cancer survivors at one year after treatment- a systematic review. Eur J Cancer. 2012;48:2391–408.Google Scholar
  27. 27.
    Audulv A. The over time development of chronic illness self-management patterns: a longitudinal qualitative study. BMC Public Health. 2013;13:452.Google Scholar
  28. 28.
    Paterson BL, Russell C, Thorne S. Critical analysis of everyday self-care decision making in chronic illness. J Adv Nurs. 2001;35(3):335–41.Google Scholar
  29. 29.
    Audulve A, Asplund K, Norberg K-G. The influence of illness perspectives on self-management of chronic disease. J Nurs Healthc Chron Ill. 2011;3:109–18.Google Scholar
  30. 30.
    Csikszentmihályi M. The flow experience and its significance for human psychology. In: Csikszentmihályi M, editor. Optimal experience: psychological studies of flow in consciousness. Cambridge: Cambridge University Press; 1988. p. 15–35.Google Scholar
  31. 31.
    Reynolds F, Prior S. Creative adventures and flow in art-making: a qualitative study of women living with cancer. Brit J Occup Ther. 2006;69(6):1–8.Google Scholar
  32. 32.
    Ghazali N, Cadwallader E, Lowe D, Humphris G, Ozakinci G, Rogers SN. Fear of recurrence among head and neck cancer survivors: longitudinal trends. Psycho-Oncol. 2013;22(4):807–13.Google Scholar
  33. 33.
    Lang H, France E, Williams B, Humphris G, Wells M. The psychological experience of living with head and neck cancer: a systematic review and meta-synthesis. Psycho-Oncol. 2013;22:2648–63.Google Scholar
  34. 34.
    Hibbard JH, Mahoney ER, Stock R, Tusler M. Do increases in patient activation result in improved self-management behaviors? Health Serv Res. 2007;42(4):1443–63.Google Scholar
  35. 35.
    Festinger L. Cognitive dissonance. Sci Am. 1962;207:93–102.Google Scholar
  36. 36.
    Vassilev I, Rogers A, Kennedy A, Koetsenruijter J. The influence of social networks on self-management support: a metasynthesis. BMC Public Health. 2014;14:719.Google Scholar
  37. 37.
    Coffey L, Mooney O, Dunne S, Sharp L, Timmons A, Desmond D, et al. Cancer survivors’ perspectives on adjustment-focused self-management interventions: a qualitative meta-synthesis. J Cancer Surviv. 2016;10:1012–34.Google Scholar
  38. 38.
    Trappenburg J, Jonkman N, Jaarsma T, van Os-Medendorp H, Kort H, de Wit N, et al. Self-management: one size does not fit all. Patient Educ Couns. 2013;92(1):134–7.Google Scholar
  39. 39.
    Salander P. Why doesn’t mind matter when we are to find out what is helpful? Psycho-Oncology. 2011;20(4):441–2.Google Scholar
  40. 40.
    Taylor SJC, Pinnock H, Epiphaniou E, Pearce G, Parke HL, Schwappach A, et al. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – practical systematic review of self-management support for long-term conditions. NIHR HS & DR. 2014;2(53).Google Scholar
  41. 41.
    De Silva D. Helping people help themselves: a review of the evidence of whether it is worthwhile to support self-management. London: The Health Foundation; 2011.Google Scholar
  42. 42.
    Boger E, Ellis J, Latter S, Foster C, Kennedy A, Jones F, et al. Self-management and self-management support outcomes: a systematic review and mixed research synthesis of stakeholder views. PLoS One. 2015;10(7):e0130990.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Simon Dunne
    • 1
  • Laura Coffey
    • 2
  • Linda Sharp
    • 3
  • Deirdre Desmond
    • 2
  • Rachael Gooberman-Hill
    • 4
  • Eleanor O’Sullivan
    • 5
  • Aileen Timmons
    • 6
  • Ivan Keogh
    • 7
  • Conrad Timon
    • 8
  • Pamela Gallagher
    • 1
    Email author
  1. 1.School of Nursing and Human SciencesDublin City UniversityDublinIreland
  2. 2.Department of PsychologyMaynooth UniversityCo. KildareIreland
  3. 3.Institute of Health and SocietyNewcastle UniversityNewcastleUK
  4. 4.School of Clinical SciencesUniversity of BristolBristolUK
  5. 5.University College Cork Dental School and HospitalCorkIreland
  6. 6.National Cancer Registry IrelandCorkIreland
  7. 7.Academic Department of Oto Rhino LaryngologyNational University of Ireland GalwayGalwayIreland
  8. 8.Head and Neck Cancer ProgrammeSt. James’s HospitalDublinIreland

Personalised recommendations