BELIEFS OF LARYNGECTOMEES ABOUT THE CAUSES OF THEIR CANCER AND ITS RELATIONSHIP WITH PSYCHOSOCIAL ADJUSTMENT AND PREOPERATIVE AND POSTOPERATIVE TOBACCO AND ALCOHOL-CONSUMPTION

One or two days before operation 62 male patients with laryngeal or ph aryngeal malignancies were questioned about their subjective beliefs c oncerning the causes of their cancer. Additionally they were asked abo ut their current and past tobacco and alcohol consumption. Six months after the operation 51 of the 62 patients were interviewed about their psychosocial adjustment and their postoperative tobacco and alcohol c onsumption. Before the operation most of the patients (81%) reported t hat they already had been thinking about the possible causes of their malignant disease. Four out of five patients were smokers and consumed alcohol daily, at least until disease onset. According to psychiatric criteria more than 50% of the daily alcohol consumers were diagnosed as alcoholics. As was expected, ''smoking'' was rated as the most impo rtant causal factor in tumor etiology. Furthermore, ''air pollution'', ''unhealthy working conditions'' and ''fate'' were rated as important pathogenic factors of the individual cancer. Surprisingly ''alcohol'' was only rated as an important causal factor by a few patients. The c ausal factor ''smoking'' was correlated neither with actual pre- and p ostoperative smoking behavior, nor with postoperative psychosocial adj ustment.'' Alcohol'' was positively associated with a postoperative re duction of alcohol consumption, on the one hand, and with increased po stoperative psychological distress, on the other. Significant positive relationships were also found between ''fate'' and postoperative psyc hological distress and rejection of altered voice (e.g. laryngectomy). In conclusion, medical information about the possible causes of cance r should try to focus the attention of the patients on current and fut ure stress factors and not on past risk behavior (e.g. alcohol and tob acco consumption), which cannot be altered retrospectively. In order t o avoid passivity and negative emotional adjustment, the physican shou ld not reinforce the patients' self-reproach but support their active coping efforts.