Dual challenges of oral cancer and COVID-19: a qualitative exploration of barriers, experiences, and coping strategies among patients in Pakistan

Abstract

Objectives: To explore the physical, psychological, and social experiences of oral cancer patients six months after diagnosis and completion of treatment during the COVID-19 pandemic in Khyber Pakhtunkhwa, Pakistan. Methods: This qualitative follow-up study was conducted in January 2021 during the second wave of COVID-19. Seventeen patients with oral squamous cell carcinoma, originally recruited at diagnosis in July 2020 from the Department of Maxillofacial Surgery, Khyber College of Dentistry, Peshawar, Pakistan, were re-interviewed using face-to-face semi-structured interviews. Maximum-variation purposive sampling ensured diversity in age, gender, and cancer stage. Interviews were conducted in Pashto, audio-recorded with consent, transcribed ad verbatim into English, and analyzed thematically using Braun and Clarke’s framework with ATLAS.ti 8.0 software. Methodological rigor was maintained through peer debriefing, member checking, and confirmability audits. Results: Five themes emerged: (1) psychological vulnerability due to treatment delays, facial disfigurement, and COVID-19-related restrictions; (2) physical impairments including speech difficulties, dry mouth, and restricted jaw movement; (3) reliance on faith as a source of emotional strength; (4) social support systems, particularly family support and the Sehat Sahulat Program, which facilitated access to care; and (5) financial decline aggravated by treatment costs, unemployment, and long-term indebtedness. Conclusion: Six months after diagnosis, oral cancer patients in Khyber Pakhtunkhwa experienced persistent physical symptoms, emotional distress, and financial strain, compounded by the COVID-19 pandemic. Reliance on faith and social support were central coping strategies. These findings highlight the need for integrated, patient-centered cancer care addressing psychosocial and financial dimensions, particularly during public health crises in resource-limited settings.