Quality-of-life outcomes in the evaluation of head and neck cancer treatments

The Inconsistent Assessment of Quality of Life in Patients Treated for Head and Neck Cancer with Anti-EGFR Inhibitors: A Systematic Scoping Review

In patients receiving treatment for head and neck cancer (HNC), there is a correlation between quality of life (QoL) scores and treatment outcomes. Higher QoL scores have been associated with improved survival. Despite this, the assessment of QoL in clinical trials varies considerably. Three databases (Scopus, PubMed, and Cinahl) were queried for articles published in English between 2006 and 2022. Two reviewers (SRS and ANT) performed study screening, data extraction, and risk of bias assessment. The authors identified 21 articles that met the inclusion criteria. A total of 5961 patients were evaluated. QoL was reported as average scores for specific variables across five different surveys in 12 included articles. Supplemental QoL data were available in 10 included studies. Critical appraisal of studies indicated a high risk of bias due to the inclusion of trials. There is no standard method for reporting QoL data in clinical trials for HNC patients undergoing treatment with anti-EGFR inhibitors. Future clinical trials should standardize their method for assessing and reporting quality-of-life data to increase patient-centered care and refine treatment choices to optimize survival.

Comparison of functional outcomes and health-related quality of life one year after treatment in patients with oral and oropharyngeal cancer treated with three different reconstruction methods

We evaluated the functional outcomes and health-related quality of life (HRQoL) of 117 patients (who had had primary operations for oral and oropharyngeal squamous cell carcinoma) using the University of Washington Quality of Life Questionnaire version 4 (UW- QOL V4), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire version 3 (EORTC QLQ-C30 v3) and Head and Neck version 1 (EORTC H&N35 v1). The patients were divided into groups according to the reconstruction techniques used: primary closure, submental island pedicled flap (SIPF), and radial forearm free flap (RFFF). Patients who had reconstruction with RFFF had better HRQoL as measured by swallowing, mastication, speaking, and overall score, than the primary closure group (p<0.05). There was no significant difference (p>0.05) between the RFFF and SIPF groups in overall QOL one year postoperatively. The HRQoL of the SIPF group was also better than that of the primary closure group in terms of mastication, speaking, and loss of appetite. Swallowing, mastication, and speaking are major factors that affect the HRQoL of patients one year after operation for oral and oropharyngeal cancer. Flap reconstruction can improve patients' QoL postoperatively. They can regain their ability to speak and swallow through training, and the importance of this issue must be addressed postoperatively.

Prognostic indicators of improved survival and quality of life in surgically treated oral cancer

OBJECTIVE

No published study has analyzed the prognostic factors of surgically treated oral squamous cell carcinoma (OSCC) in relation to both survival and quality of life (QoL). The aim of this study was to analyze postoperative QoL in relation to survival to identify which parameters can predict the long-term outcome allowing the best QoL.

STUDY DESIGN

This retrospective cohort study considered 167 patients affected by OSCC treated surgically at the Otolaryngology Department of Cattinara Hospital (Trieste, Italy) by a single surgeon. We collected data about the main prognostic factors and the postoperative QoL 12 month after surgery.

RESULTS

The 5-year overall survival rate was equal to 68.1%, and the 5-year disease-specific survival was 77.8%. In this sample, 32% of patients also underwent adjuvant chemoradiotherapy. On stepwise Cox regression, the best predictors of disease-specific survival were the N stage (P < .001) and tumor depth of invasion (P < .001). QoL was affected by N stage, depth of invasion, invasive surgical approach, radiotherapy, and neck dissection (P < .05).

CONCLUSION

The prognostic factors that affect both survival rates and residual QoL are the surgical approach, the neck stage, and the depth of invasion, all of which can be minimized by early diagnosis.

Impact of a telehealth intervention on quality of life and symptom distress in patients with head and neck cancer

BACKGROUND

Patients undergoing treatment for head and neck cancer commonly experience signi•cant changes in quality of life (QoL) and levels of symptom distress. It is not known if a telehealth intervention would mitigate these changes.

OBJECTIVE

To evaluate the impact of a telehealth intervention on QoL and symptom burden in patients undergoing initial treatment for head and neck cancers.

METHODS

A randomized clinical trial comparing the impact on QoL and symptom distress of telehealth intervention and standard care was conducted with 80 patients (45 treatment, 35 control) who had been diagnosed with head or neck cancer and were receiving 1 or more treatment modalities. Treatment group participants responded daily to symptom management algorithms using a simple telehealth messaging device. QoL was evaluated by the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACTHN) and symptom burden by the Memorial Symptom Assessment Scale (MSAS). Control group participants completed assessments while they received routine care.

RESULTS

In the posttreatment phase, the telehealth participants had signi•cantly better scores than the controls for physical well-being (20.6 vs 17.0, P = .02) and trial outcome index (59.9 vs. 50.2, P = .04) on the FACT-HN, and total scores on the MSAS (0.9 vs. 1.2, P = .04).

LIMITATIONS

The moderate sample size of 80 patients limits the power to measure more subtle impacts of the intervention.

CONCLUSIONS

Using telehealth to provide support to patients with head and neck cancer during the acute phase of treatment improved some aspects of posttreatment QoL and symptom burden.

Comparison of quality of life outcomes in laryngeal cancer patients following chemoradiation vs. total laryngectomy

OBJECTIVE: To evaluate quality of life issues in patients with laryngeal cancer after treatment with either chemoradiation or total laryngectomy and radiation therapy.

METHODS: Forty-nine patients with a history of stage II-IV laryngeal squamous cell carcinoma treated primarily with either chemoradiation or by total laryngectomy with postoperative radiation completed the University of Washington Quality of Life instrument, version 4. Patients were identified on a volunteer basis in an academic university head and neck clinic setting. Each patient completed the above instrument, and statistical analysis was performed by Wilcoxon and X 2 , tests.

RESULTS: Instruments were completed by all 49 patients: 15 patients who underwent primary chemoradiation and 34 patients who underwent a total laryngectomy followed by radiation. Domains reported in both treatment groups without significant differences were appearance, activity, recreation, moods, taste, saliva, anxiety, and general questions. However, there were significant differences between the 2 groups in the domains of pain, swallowing, chewing, speech, and shoulder function. The laryngectomy patients reported greater impairment of speech ( P = 0.001), and shoulder function ( P = 0.018), whereas the chemoradiation patients suffered from greater pain, difficulty swallowing ( P = 0.061), and problems chewing ( P = 0.027).

CONCLUSIONS: Most patients with laryngeal cancer, whether treated primarily with chemoradiation or total laryngectomy, reported excellent functional outcomes and health-related quality of life. Pain, swallowing, chewing, saliva, and shoulder function were recorded as significant factors affecting their daily quality of life.

Evaluation of Efficacy of an Herbal Compound on Dry Mouth in Patients With Head and Neck Cancers

Dry mouth is a common complication of radiotherapy for head and neck cancers. This study compared the efficacy of an herbal compound containing Malva sylvestris and Alcea digitata (Boiss) with artificial saliva (Hypozalix) for improving the symptoms of dry mouth in head and neck cancer patients. The study examined a total of 62 subjects assigned to 2 groups. The herbal compound and Hypozalix were administered for 4 weeks. Efficacy was assessed using the visual analog scale and by grading the degree of dry mouth. Both groups showed a significant difference between visual analog scale before and following intervention. There was also a significant difference in visual analog scale between groups at 4 weeks after onset of intervention. The herbal group showed a significant difference between the grade of dry mouth before and after intervention, but no change was observed for grade of dry mouth in the Hypozalix group. This study supports the efficacy of the herbal compound for controlling symptoms of dry mouth in head and neck cancer patients.

Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQ-H&N35: a methodological review

PURPOSE

The EORTC QLQ-H&N35 (H&N35) is widely used to measure quality of life in head and neck cancer patients. The aims of this study were to obtain insight into a) the languages in which the H&N35 has been used and the psychometric properties in those languages, b) the study designs, and c) its acceptance by patients and investigators.

METHODS

A systematic literature review was performed searching for all original papers that had used at least one item of the H&N35. Identified papers were read and the information about methodological issues abstracted statistically analysed.

RESULTS

A total of 136 papers were identified. The H&N35 was administered in 19 different languages in 27 countries. The study design was cross-sectional in the majority of studies (53 %), prospective cohort studies (31 %), phase-II-trials (7 %), phase-III-trials (6 %) and case-control studies (1 %). The scales with the highest percentages of missing values were Sexuality (11.5 %) and Speech (7 %). The median Cronbach's alpha of the multi-item scales ranged from 0.61 (Senses) to 0.93 (Sexuality). Construct validity was rarely investigated. On average, 12 scales (range 0-18) of the instrument were used by the investigators. The scale most often used was swallowing (in 85 % of studies) and least often used was Weight Gain (39 %).

CONCLUSION

The H&N35 is widely used throughout the world, mainly in observational studies, and has demonstrated robust psychometric features in different languages. However, some methodological problems reported imply that the instrument can be improved in some areas.

The validity and reliability of the Turkish version of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer

PURPOSE

The University of Washington Quality of Life Questionnaire (UW-QOL) is an English-language survey used to assess the quality of life of patients with head and neck cancer. The present study aimed to translate this widely used questionnaire into Turkish according to international guidelines and to statistically determine its validity and reliability by administering it to native Turkish-speaking patients.

MATERIALS AND METHODS

This prospective study was performed at Hacettepe University, Faculty of Medicine, Turkey. The study included patients newly diagnosed as having head and neck cancer. Translation and cultural adaptation of the questionnaire were performed first. Then, the translated version was tested on a consecutive series of patients seen in the department of otorhinolaryngology head and neck surgery and the department of radiation oncology between September 2006 and February 2008. The patients were asked to complete 3 sets of questionnaires. The first set was completed 1 day before the beginning of treatment, the second 3 months after the completion of treatment, and the third 10 days after the second questionnaire was completed. The first and second sets included the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire-Turkish version and UW-QOL-Turkish version. The third set included the Turkish UW-QOL only. Performance status was assessed and rated by a physician using the Karnofsky and ZEW (Zubrod/The Eastern Cooperative Oncology Group (ECOG)/World Health Organization) performance scales, synchronous with the first and second sets of questionnaires.

RESULTS

The original English version of UW-QOL was carefully translated into Turkish, and a final Turkish version of UW-QOL was developed in an iterative fashion. To determine its validity and reliability, 67 patients were included in the study. Internal consistency (Cronbach α = .757) was adequate, and test-retest reliability (interclass correlation coefficient, 0.941) was excellent. The composite scores of the translated UW-QOL were compared statistically with the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire scores, Karnofsky and ZEW performance scales, T stage of the disease, and UW-QOL global questions scores to support the scale's construct validity, and statistically significant associations were observed.

CONCLUSIONS

The Turkish UW-QOL appears to be a valid and reliable tool for use with Turkish patients with head and neck cancer; it can also be used in clinical investigations and routine clinical practice in Turkey.

The quality of quality of life publications in the spinal literature: are we getting any better?

OBJECT

Criteria for methodological quality have been widely accepted in many fields of surgical practice. These criteria include those of Velanovich and Gill and Feinstein. No such analysis of the spine surgery literature has ever been reported. This study is a systematic review of the quality of life (QOL) publications to determine if the recent interest in QOL measurements following spinal surgery has been accompanied by an improvement in the quality of the papers published.

METHODS

The archives of the journals Journal of Neurosurgery: Spine, Spine, Journal of Spinal Disorders & Techniques, European Spine Journal, and The Spine Journal, for the years 2000-2004 inclusive, were examined, and all publications reporting QOL outcomes were analyzed. Each paper was scored according to the criteria of Velanovich and Gill and Feinstein, and the methodological quality of these manuscripts-and any time-dependent changes-were determined.

RESULTS

During the study period, the total number of articles published increased by 36%, while the number of QOL articles increased by 102%. According to the criteria of Velanovich, there was a statistically significant improvement in the quality of the publications over the study period (p = 0.0394). In 2000, only 27% of outcome measures were disease specific, 77% were valid, and 77% were appropriate for the study design. In 2004, 43% were disease specific, 88% were valid, and 89% were appropriate. In 2000, 53% of studies used appropriate statistical analysis compared with 100 and 96% for 2003 and 2004, respectively. There was no demonstrable improvement in the fulfillment of the more rigorous Gill and Feinstein criteria for any of the 5 journals over the period of the study.

CONCLUSIONS

The authors' study illustrates a moderate improvement in the quality of these publications over the study period but much methodological improvement is required.

Toward a construct definition of informed consent comprehension

VARIATION IN HOW INFORMED CONSENT comprehension tests have been developed may be largely due to the absence of a standardized construct definition. Developing a construct definition would provide a standardized framework for determining how an instrument should be constructed, implemented, interpreted, and applied. Therefore, we utilized the Delphi consensus approach with an international expert panel (N = 19) to gather knowledge, opinions and eventually consensus for a construct definition. Expert consensus was achieved after three revision cycles. While acknowledging that there are limitations to this study, it nonetheless should be considered as a step toward standardization of a construct definition of informed consent comprehension.

Validity and Reliability of the Eating Assessment Tool (EAT-10)

Objectives:

The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10).

Methods:

The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses.

Results:

A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (±SD) EAT-10 score of the normal cohort was 0.40 ± 1.01. The mean EAT-10 score was 23.58 ± 13.18 for patients with esophageal dysphagia, 23.10 ± 12.22 for those with oropharyngeal dysphagia, 9.19 ± 12.60 for those with voice disorders, 22.42 ± 14.06 for those with head and neck cancer, and 11.71 ± 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p < 0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 ± 10.5 to 5.2 ± 7.4 after treatment (p < 0.001).

Conclusions:

The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.

Attitudes of Children With Dysphonia

SUMMARY

Because voice disorders in childhood may have a negative impact on communicative effectiveness, social development, and self-esteem, the objective was to determine the impact of voice disorders on lives of children from the perspective of chronically dysphonic children and their parents. This study consisted of focused interviews with chronically dysphonic children and their caregivers. Focused interviews were conducted with 10 children in each of the following age groups: Toddler (2-4 years old), Young Child (5-7 years old), School-Aged Child (8-12 years old), and Adolescent (13-18 years old). Interview questions were formulated to elicit attitudes in the following conceptual domains: emotional, social/functional, and physical. Interviews were transcribed and subjected to systematic qualitative analyses that identified common themes within each age group for each conceptual domain. For Toddlers, interviews relied heavily on parents and the biggest concerns were found in the physical and functional domains. Young Children expressed that their biggest issues related to voice were physical ("run out of air," "sometimes voice does not work"). Ninety percent of Young Children were repeatedly asked to use a quieter voice. Emotional factors and physical factors were prominent in the interviews of School-Aged Children and Adolescents. Children and Adolescents often felt that their dysphonic voice received undue attention and also limited their participation in important events. Anger, sadness, and frustration were also expressed. Chronic dysphonia negatively affects the lives of children. This work will serve as the basis for development of a valid, reliable, and age-appropriate measure of voice-related quality of life in children.

Impact of conventional radiotherapy on health-related quality of life and critical functions of the head and neck

PURPOSE

Head-and-neck radiotherapy is associated with significant morbidities. Our purpose was to document impact of morbidities by use of multiple objective measures and health-related quality of life (HR-QOL).

METHODS AND MATERIALS

Ten head-and-neck cancer patients were evaluated before receiving conventional head-and-neck radiotherapy and at 1 month and 6 months after treatment. We evaluated weight, saliva production, diet, swallow function, auditory function, and HR-QOL.

RESULTS

After radiotherapy, weight was reduced in 89% of subjects. Salivary function was significantly reduced and did not resolve by 6 months. Diet impairment and abnormalities in swallowing function persisted at 6 months. Perception of physical functioning was reduced after treatment, and swallowing, coughing, and dry-mouth symptoms increased. Very few changes were observed in auditory function.

CONCLUSIONS

Conventional head-and-neck radiotherapy is associated with substantial functional deficits and diminished HR-QOL. Deficits reported here can serve as a baseline for comparison with results derived from new radiotherapy-treatment techniques.

Pretreatment, Preoperative Swallowing Exercises May Improve Dysphagia Quality of Life

OBJECTIVES

Dysphagia is commonly associated with head and neck cancer treatment. Traditional dysphagia management strategies focus on post-treatment therapy. This study evaluated the utility of pretreatment swallowing exercises in improving post-treatment swallowing quality of life (QOL).

STUDY DESIGN

Prospective cohort study and cross-sectional QOL analysis.

METHODS

This study includes 37 patients who underwent primary radiation or combined chemoradiation treatment for newly diagnosed hypopharyngeal, laryngeal, or oropharyngeal primary tumors at the University of Alabama at Birmingham. Of the 37, 25 patients underwent swallowing exercises beginning 2 weeks prior to the start of radiation. The M.D. Anderson Dysphagia Inventory (MDADI) was administered an average of 14 months after treatment to assess the success of the protocol. Analysis of QOL scores related to gender, primary site, stage, and race were obtained.

RESULTS

Patients who performed pretreatment swallowing exercises (n = 25) showed improvement in the overall MDADI score (P = .0002) compared to the control population (n = 12) who underwent post-treatment therapy. Furthermore, a separate analysis of individual domains of the MDADI (global, emotional, functional, and physical) demonstrated improved quality of life.

CONCLUSIONS

Implementation of pretreatment swallowing education and exercise may improve dysphagia-specific QOL in head and neck cancer patients undergoing radiation and/or chemoradiation therapy.

Quality of life after free-flap reconstruction in patients with oral and pharyngeal cancer

BACKGROUND

Our aim was to investigate quality of life and outcome after microvascular free-flap reconstruction after oncologic surgery.

METHODS

Forty-four patients with a large carcinoma in the oral cavity, oral pharynx, or hypopharynx underwent free-flap surgery with or without radiotherapy. Patients completed the University of Washington Quality-of-Life Questionnaire preoperatively and four times during the 12 postoperative months. Survival rates and complications were analyzed.

RESULTS

Postoperative composite quality-of-life scores were significantly lower than before treatment with no significant overall improvement during the follow-up. The scores for disfigurement, chewing, speech, and shoulder function remained significantly below the preoperative level throughout the follow-up. Sociodemographic factors predicted quality of life. Heavy drinking and unemployment caused a 2.4-fold and a 4.4-fold increase in risk of death, respectively. The rates for overall survival, tumor recurrence, flap success, and surgical complications were consistent with previous literature.

CONCLUSION

Sociodemographic variables affect quality of life and patient survival in patients with oral cancer treated with microvascular free-flap reconstruction.

Psychosocial Interventions for Patients With Head and Neck Cancer

A diagnosis of head and neck cancer, like any cancer diagnosis, is often accompanied by much fear and uncertainty. In addition, patients with head and neck cancer face difficulties in eating, chewing, drinking, breathing, speaking, as well as changes in appearance. Simultaneously, the burden of head and neck cancer is often manifested in psychosocial dysfunction, which can have a negative impact on quality of life. Although a phenomenon well recognized, little is known about many factors that influence or impact psychosocial dysfunction in individuals with head and neck cancer. Even less is known about the effective management of psychosocial dysfunction. To date, there is evidence to suggest that psychosocial interventions generally provide an overall positive effect. Moreover, some intervention studies, such as education alone, have failed to achieve the desired results. In addition, some studies suggest an advantage of cognitive- behavioral therapy over other forms of psychological treatment. With the growing impetus to investigate factors associated with psychosocial dysfunction, and considerable advancement in the development and validation of many global and disease-specific measures, there is an opportunity for further research to develop an appropriate clinical intervention program for such patients.

Swallowing-related quality of life after head and neck cancer treatment

OBJECTIVES

To determine the role of treatment modality in swallowing outcome after head and neck cancer treatment and to identify potential risk factors for posttreatment dysphagia.

STUDY DESIGN

Cross-sectional survey of patients with no evidence of disease 12 months or more after the treatment of a stage III or IV squamous cell carcinoma of the oropharynx, larynx, or hypopharynx.

METHODS

Potential subjects were stratified by tumor site and tumor T-stage to achieve a balanced comparison between chemoradiation (n = 18) and surgery/radiation (n = 22) groups. Outcome measures included a dysphagia risk factor survey, the MD Anderson Dysphagia Inventory (MDADI), and the Short-Form 36 (SF-36).

RESULTS

Patients who received chemoradiation for oropharyngeal primaries demonstrated significantly better scores on the emotional (P =.03) and functional (P =.02) subscales of the MDADI than did patients who underwent surgery followed by radiation. There were no significant differences between chemoradiation and surgery/radiation groups for laryngeal and hypopharyngeal primaries. Additional risk factors for posttreatment dysphagia include prolonged (>2 weeks) nothing by mouth (NPO) status (P =.002) and low SF-36 Mental Health Subscale score (P =.002).

CONCLUSION

The study suggests that chemoradiation may provide superior swallowing outcome to surgery/radiation in patients with oropharyngeal primary. Patients with depressed mental health and prolonged feeding tubes may be at higher risk of long-term dysphagia.

Quality of life in patients with oropharynx carcinomas: assessment after accelerated radiotherapy with or without chemotherapy versus radical surgery and postoperative radiotherapy

BACKGROUND

In oropharyngeal carcinomas, it is assumed that the effectiveness of the different treatment approaches is roughly equivalent, whereas the functional outcome after radical radiotherapy (RT) is superior to that associated with primary surgery. The aim of this study is to assess quality of life (QoL) outcomes of patients after two treatment strategies: radical surgery with postoperative RT and accelerated concomitant boost RT with or without chemotherapy.

METHODS

Sixty patients who were disease free at least 1 year after treatment of oropharynx carcinoma were studied. Forty had been treated with radical RT (median tumor dose, 69.9 Gy in 5.5 weeks), and 20 had been treated with primary surgery and postoperative monofractionated RT (median dose, 60.2 Gy). Seven of the former patients received chemotherapy concomitantly with, and one before, RT. Functional outcome was assessed by the subjective Performance Status Scale for Head and Neck cancer (PSSHN) and the general QoL by the European Organization for Research and Treatment of Cancer Core QoL questionnaire (EORTC QLQ-C30). The unpaired t test was used to assess for significant differences between means.

RESULTS

By use of the PSSHN module, scores were generally higher in the RT group, with a significant difference in the speech subscale (p =.005), a trend for a significant difference for the eating in public subscale (p =.08), and an insignificant difference for the normalcy of diet subscale (p =.25). When analyzed by tumor stage, no significant differences were observed for T1-2 tumors, whereas for patients with T3-4 tumors highly significant differences favoring the RT group became evident for all three subscales. Although no significant differences were observed using the EORTC QLQ C-30 functional scales, patients treated with primary surgery reported significantly more dyspnea (28 vs 12, p =.04) and appetite loss (30 vs 13, p =.05). In patients with T3-4 tumors, trends toward better scores favoring the RT group were observed for physical, role, emotional, and social functions, as well as a significantly better score for pain symptoms.

CONCLUSIONS

Although for early stages no clear advantage in QoL outcome was noted for the RT group compared with the surgery group, for advanced-stage disease an advantage favoring radical RT seemed apparent. For those patients, if an equivalency between the two treatment strategies could be assumed regarding oncologic results, then nonsurgical treatment should be considered the preferred option.

Ethical considerations in the treatment of head and neck cancer

BACKGROUND

The second half of the 20th century saw not only important developments in medical science and technology, but also a rapid growth in the application of biomedical ethics in medical decision making. Withdrawal of treatment, allowing to die, informed consent, and patient autonomy are concerns that now comprise a part of the overall medical treatment, particularly in patients with head and neck cancers.

METHODS

The author discusses ethical issues relating to disfigurement/dysfunction in head and neck cancer patients and examines the aspects of "principlism": autonomy, nonmaleficence, beneficence, and justice. Two case reports are presented to illustrate the ethical challenges that may confront physicians who treat head and neck cancer patients.

RESULTS

Head and neck oncology generates unique problems relating to disfigurement and dysfunction. An algorithm that considers the patient's medical good and greater good, as well as the goods of others, can assist in arriving at appropriate ethical decisions.

CONCLUSIONS

Bioethical decision making requires the integration of virtues with principles, followed by the application of these standards to each patient.