Associations between psychosocial functioning and smiling intensity in patients with head and neck cancer

Increasing attention is being given to developing quantitative measures of facial expression. This study used quantitative facial expression analysis to examine associations between smiling intensity and psychosocial functioning in patients with head and neck cancer (HNC). Smiling intensity of 95 HNC patients was measured using 48 quantitative measures calculated from facial photographs with and without a smile. We computed a composite smiling intensity score for each patient representing the degree of similarity to healthy controls. A lower composite score indicates that the person is less expressive, on average, than healthy controls. Patients also completed self-report measures assessing domains of body image and quality of life (QOL). Spearman rank correlations were computed to examine relationships between composite scores and psychosocial functioning. Composite scores were significantly correlated with multiple measures of body image and QOL. Specifically, decreased smiling intensity was associated with feelings of dissatisfaction with one's body, perceived negative social impact of body image, increased use of avoidance as a body image-coping strategy, reduced functional well-being, and greater head and neck cancer-specific issues. To the best of our knowledge, this is the first study to demonstrate associations between an objectively quantified facial expression (i.e. smiling) and psychosocial functioning. Most previous studies have measured facial expression qualitatively. These findings indicate that smiling intensity may serve as an important clinical indicator of psychosocial well-being and warrants further clinical investigation.