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Noel CW, Sutradhar R, Chan WC, Fu R, Philteos J, Forner D, Irish JC, Vigod S, Isenberg-Grzeda E, Coburn NG, Hallet J, Eskander A. Gaps in Depression Symptom Management for Patients With Head and Neck Cancer. Laryngoscope 2023; 133:2638-2646. [PMID: 36748910 DOI: 10.1002/lary.30595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/27/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To understand practice patterns and identify care gaps within a large-scale depression screening program for patients with head and neck cancer (HNC). STUDY DESIGN Retrospective cohort study. METHODS This was a population-based study of adults diagnosed with a HNC between January 2007 and October 2020. Each patient was observed from time of first symptom assessment until end of study date, or death. The exposure of interest was a positive depressive symptom screen on the Edmonton Symptom Assessment System (ESAS). Outcomes of interest included psychiatry/psychology assessment, social work referral, or palliative care assessment. Cause specific hazard models with a time-varying exposure were used to investigate the exposure-outcome relationships. RESULTS Of 14,054 patients with HNC, 9016 (64.2%) reported depressive symptoms on at least one ESAS assessment. Within 60 days of first reporting depressive symptoms, 223 (2.7%) received a psychiatry assessment, 646 (7.9%) a social work referral, and 1131 (13.9%) a palliative care assessment. Rates of psychiatry/psychology assessment (HR 3.15 [95% CI 2.67-3.72]), social work referral (HR 1.83 [95% CI 1.64-2.02]), and palliative care assessment (HR 2.34 [95% CI 2.19-2.50]) were higher for those screening positive for depression. Certain patient populations were less likely to receive an assessment including the elderly, rural residents, and those without a prior psychiatric history. CONCLUSION A high proportion of head and neck patients report depressive symptoms, though this triggers a referral in a small number of cases. These data highlight areas for improvement in depression screening care pathways. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2638-2646, 2023.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Rui Fu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Simone Vigod
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Yan A, Howden K, Mahar AL, Scott I, Glidden C, Deleemans J, Chalifour K, Eaton G, Gupta A, Bolton JM, Garland SN, Oberoi S. Experiences of adolescent and young adult cancer survivors during the COVID-19 pandemic. J Cancer Surviv 2023; 17:370-383. [PMID: 35098486 PMCID: PMC8801282 DOI: 10.1007/s11764-021-01158-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to evaluate the impact of the COVID-19 pandemic on adolescent and young adult (AYA) cancer survivors. METHODS We conducted a cross-sectional survey of AYAs aged 18-49 with cancer in Canada between January and February 2021. Data from survivors, defined as AYAs more than one year off cancer treatment, were analysed. Multiple logistic regression was used to identify factors associated with psychological distress, loneliness and insomnia. RESULTS The analysis included 384 survivors. Moderate-to-severe psychological distress was reported by 257 (68.9%) survivors and was associated with an income ≥ $60,000 (adjusted odds ratio [AOR] 2.15, 95% CI 1.11-4.17) and the presence of a pre-existing chronic physical health condition (AOR 2.05, 95% CI 1.18-3.56). Loneliness was reported by 204 (54.0%) survivors and was associated with being unemployed (AOR 2.26 95%CI 1.18-4.31), pandemic causing finances to be worse (AOR 1.82, 95%CI 1.08-3.06) and the presence of a pre-pandemic mental health condition (AOR 1.88, 95% CI 1.03-3.42). Clinical insomnia was reported by 74 (19.5%) survivors and was associated with employment status as a student (AOR 3.00, 95% CI 1.08-8.29) or unemployed (AOR 3.97, 95% CI 1.46-10.83), earning $60,000 or more in the year 2020 (AOR 4.36, 95% CI 1.43-13.32), having haematologic cancer (AOR 2.21, 95% CI 1.05-4.70) and being single (AOR 2.52, 95% CI 1.08-5.91). Pandemic negatively affected employment, finances, physical activity, cancer care and substance use for 73.9%, 66.5%, 32.5%, 21.8% and 19.2% of survivors, respectively. Worries about finances, contracting COVID-19, cancer treatment increasing the risk of COVID-19 infection, and having poor health outcomes from contracting COVID-19 were reported by 46.0%, 45.6%, 55.0% and 47.3% of survivors, respectively. CONCLUSIONS The COVID-19 pandemic has had a significant impact on AYA cancer survivors, and these individuals report high levels of psychological distress, insomnia and loneliness. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors are at risk for worsening mental and physical health outcomes during the COVID-19 pandemic. Targeted interventions and support programs are urgently needed to support the mental health of AYA cancer survivors and optimize their health outcomes.
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Affiliation(s)
- Adam Yan
- Division of Pediatric Hematology Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Dana-Farber/Boston Children's Blood and Cancer Disorder Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kaitlyn Howden
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, 75 McDermot Ave, Winnipeg, MB, ON-2015R3E 0V9, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada
| | - Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - Camille Glidden
- Department of Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Julie Deleemans
- Department of Psychosocial Oncology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Karine Chalifour
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Geoff Eaton
- Young Adult Cancer Canada, St. John's, Newfoundland and Labrador, Canada
| | - Abha Gupta
- Division of Pediatric Hematology Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Princess Margaret Cancer Care Research Institute, Toronto, ON, Canada
| | - James M Bolton
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Sapna Oberoi
- Department of Pediatrics and Child Health, CancerCare Manitoba, University of Manitoba, 75 McDermot Ave, Winnipeg, MB, ON-2015R3E 0V9, Canada.
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada.
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, R3E0V9, Canada.
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Nguyen L, Hallet J, Eskander A, Chan WC, Noel CW, Mahar A, Sutradhar R. The impact of a cancer diagnosis on nonfatal self-injury: a matched cohort study in Ontario. CMAJ Open 2023; 11:E291-E297. [PMID: 37015741 PMCID: PMC10079310 DOI: 10.9778/cmajo.20220157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Psychological distress following a cancer diagnosis potentially increases the risk of intentional, nonfatal self-injury. The purpose of this work is to evaluate and compare rates of nonfatal self-injury among individuals in Ontario diagnosed with cancer against matched controls with no history of cancer. METHODS Adults in Ontario diagnosed with cancer from 2007 to 2019 were matched to 2 controls with no history of cancer, based on age and sex. We calculated the absolute and relative difference in rates of nonfatal self-injury in the 5 years before and after the index date (date of cancer diagnosis and dummy date for controls). We used crude difference-in-differences methods and adjusted Poisson regression-based analyses to examine whether the change in rates of nonfatal self-injury before and after index differed between cancer patients and controls. RESULTS The cohort included 803 740 people with cancer and 1 607 480 matched controls. In the first year after diagnosis, individuals with cancer had a 1.17-fold increase in rates of nonfatal self-injury (95% confidence interval [CI] 1.03-1.33) compared with matched controls, after accounting for pre-existing differences in rates of nonfatal self-injury and other clinical characteristics between the groups. Rates of nonfatal self-injury remained elevated in the cancer group by 1.07-fold for up to 5 years after diagnosis (95% CI 0.95-1.21). INTERPRETATION In this study, incidence of nonfatal self-injury was higher among individuals diagnosed with cancer, with the greatest impact observed in the first year after diagnosis. This work highlights the need for robust and accessible psychosocial oncology programs to support mental health along the cancer journey.
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Affiliation(s)
- Lena Nguyen
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man.
| | - Julie Hallet
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
| | - Antoine Eskander
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
| | - Wing C Chan
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
| | - Christopher W Noel
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
| | - Alyson Mahar
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
| | - Rinku Sutradhar
- ICES (Nguyen, Hallet, Eskander, Chan, Noel, Mahar, Sutradhar); Dalla Lana School of Public Health (Hallet, Eskander, Noel, Mahar, Sutradhar) and Temerty Faculty of Medicine (Hallet, Eskander, Noel), University of Toronto; Evaluative Clinical Sciences (Hallet, Eskander), Sunnybrook Research Institute, Toronto, Ont.; Department of Community Health Sciences (Mahar), University of Manitoba, Winnipeg, Man
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4
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Noel CW, Hueniken K, Forner D, Liu G, Eng L, Hosni A, Hahn E, Irish JC, Gilbert R, Yao CMKL, Monteiro E, O’Sullivan B, Waldron J, Huang SH, Goldstein DP, de Almeida JR. Association of Household Income at Diagnosis With Financial Toxicity, Health Utility, and Survival in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:63-70. [PMID: 36416855 PMCID: PMC9685545 DOI: 10.1001/jamaoto.2022.3755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/02/2022] [Indexed: 11/24/2022]
Abstract
Importance While several studies have documented a link between socioeconomic status and survival in head and neck cancer, nearly all have used ecologic, community-based measures. Studies using more granular patient-level data are lacking. Objective To determine the association of baseline annual household income with financial toxicity, health utility, and survival. Design, Setting, and Participants This was a prospective cohort of adult patients with head and neck cancer treated at a tertiary cancer center in Toronto, Ontario, between September 17, 2015, and December 19, 2019. Data analysis was performed from April to December 2021. Exposures Annual household income at time of diagnosis. Main Outcome and Measures The primary outcome of interest was disease-free survival. Secondary outcomes included subjective financial toxicity, measured using the Financial Index of Toxicity (FIT) tool, and health utility, measured using the Health Utilities Index Mark 3. Cox proportional hazards models were used to estimate the association between household income and survival. Income was regressed onto log-transformed FIT scores using linear models. The association between income and health utility was explored using generalized linear models. Generalized estimating equations were used to account for patient-level clustering. Results There were 555 patients (mean [SD] age, 62.7 [10.7] years; 109 [20%] women and 446 [80%] men) included in this cohort. Two-year disease-free survival was worse for patients in the bottom income quartile (<$30 000: 67%; 95% CI, 58%-78%) compared with the top quartile (≥$90 000: 88%; 95% CI, 83%-93%). In risk-adjusted models, patients in the bottom income quartile had inferior disease-free survival (adjusted hazard ratio, 2.13; 95% CI, 1.22-3.71) and overall survival (adjusted hazard ratio, 2.01; 95% CI, 0.94-4.29), when compared with patients in the highest quartile. The average FIT score was 22.6 in the lowest income quartile vs 11.7 in the highest quartile. In adjusted analysis, low-income patients had 12-month FIT scores that were, on average, 134% higher (worse) (95% CI, 16%-253%) than high-income patients. Similarly, health utility scores were, on average, 0.104 points lower (95% CI, 0.026-0.182) for low-income patients in adjusted analysis. Conclusions and Relevance In this cohort study, patients with head and neck cancer with a household income less than CAD$30 000 experienced worse financial toxicity, health status, and disease-free survival. Significant disparities exist for Ontario's patients with head and neck cancer.
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Affiliation(s)
- Christopher W. Noel
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Geoffrey Liu
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lawson Eng
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M. K. L. Yao
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology–Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Brian O’Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David P. Goldstein
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Philteos J, Noel CW, Hallet J, Eskander A. Mental health considerations in patients undergoing complex head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2022; 30:380-383. [PMID: 35924661 DOI: 10.1097/moo.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To summarize recent advances in the psycho-oncology literature, with a focus on findings relevant to the head and neck cancer patient. RECENT FINDINGS Patients with cancer are at an increased risk of suicide and self-harm. Head and neck cancer patients are among the highest risk compared with other cancer patients. Unique challenges pertaining to disfigurement and voicelessness may, in part, explain these observations. Patient-reported outcome measures can be used to help identify high-risk patients. SUMMARY Psychosocial support needs are highest for head and neck cancer patients. Patient-reported outcome measures should be integrated within clinical workflows to identify high-risk patients.
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Affiliation(s)
- Justine Philteos
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto
| | - Jullie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto.,Division of Surgical Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto
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Noel CW, Du Y(J, Baran E, Forner D, Husain Z, Higgins KM, Karam I, Chan KKW, Hallet J, Wright F, Coburn NG, Eskander A, Gotlib Conn L. Enhancing Outpatient Symptom Management in Patients With Head and Neck Cancer: A Qualitative Analysis. JAMA Otolaryngol Head Neck Surg 2022; 148:333-341. [PMID: 35238872 PMCID: PMC8895314 DOI: 10.1001/jamaoto.2021.4555] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Patients with head and neck cancer manage a variety of symptoms at home on an outpatient basis. Clinician review alone often leaves patient symptoms undetected and untreated. Standardized symptom assessment using patient-reported outcomes (PROs) has been shown in randomized clinical trials to improve symptom detection and overall survival, although translation into real-world settings remains a challenge. OBJECTIVE To better understand how patients with head and neck cancer cope with cancer-related symptoms and to examine their perspectives on standardized symptom assessment. DESIGN, PARTICIPANTS, AND SETTING This was a qualitative analysis using semistructured interviews of patients with head and neck cancer and their caregivers from November 2, 2020, to April 16, 2021, at a regional tertiary center in Canada. Purposive sampling was used to recruit a varied group of participants (cancer subsite, treatment received, sociodemographic factors). Drawing on the Supportive Care Framework, a thematic approach was used to analyze the data. Data analysis was performed from November 2, 2020, to August 2, 2021. MAIN OUTCOMES AND MEASURES Patient perception of ambulatory symptom management and standardized symptom assessment. RESULTS Among 20 participants (median [range] age, 59.5 [33-74] years; 9 [45%] female; 13 [65%] White individuals), 4 themes were identified: (1) timely physical symptom management, (2) information as a tool for symptom management, (3) barriers to psychosocial support, and (4) external factors magnifying symptom burden. Participants' perceptions of standardized symptom assessment varied. Some individuals described the symptom monitoring process as facilitating self-reflection and symptom detection. Others felt disempowered by the process, particularly when symptom scores were inconsistently reviewed or acted on. CONCLUSIONS AND RELEVANCE This qualitative analysis provides a novel description of head and neck cancer symptom management from the patient perspective. The 4 identified themes and accompanying recommendations serve as guides for enhanced symptom monitoring.
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Affiliation(s)
- Christopher W. Noel
- Department of Otolaryngology−Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Yue (Jennifer) Du
- Department of Otolaryngology−Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elif Baran
- Department of Otolaryngology−Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Division of Otolaryngology−Head and Neck Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin M. Higgins
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin K. W. Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Frances Wright
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G. Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Ontario Health Cancer Care, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology−Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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7
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Hallet J, Sutradhar R, Isenberg-Grzeda E, Noel CW, Mahar AL, Vigod SN, Bolton J, Deleemans J, Chan WC, Coburn NG, Eskander A. Association of Patient-Reported Outcomes With Subsequent Nonfatal Self-injury After a New Cancer Diagnosis. JAMA Oncol 2022; 8:e220203. [PMID: 35357419 DOI: 10.1001/jamaoncol.2022.0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Nonfatal self-injury (NFSI) is a patient-centered manifestation of severe distress occurring in 3 out of 1000 patients after cancer diagnosis. How to identify patients at risk for NFSI remains unknown. Objective To examine the associations between patient-reported outcome measures and subsequent NFSI in patients with cancer. Design, Setting, and Participants This population-based matched case-control study included adults with a new cancer diagnosis reporting an Edmonton Symptom Assessment System (ESAS) score within 36 months of diagnosis in Ontario, Canada, 2007 to 2019. Data analysis was performed January 2007 to December 2019. Main Outcomes and Measures Cases included patients with NFSI, and controls were patients without NFSI. Cases and controls were matched 1:4. Multivariable conditional logistic regression assessed the association between moderate to severe ESAS symptom scores and total ESAS (t-ESAS, range 0-90) score with NFSI in the subsequent 180 days. Results Of 408 858 patients reporting 1 or more ESAS assessments, 425 patients experienced NFSI and reported an ESAS score in the preceding 180 days. Of those, 406 cases were matched to 1624 control patients without an NFSI. Cases reported a higher proportion of moderate to severe symptoms and higher t-ESAS score than controls prior to the event. After adjustment, moderate to severe anxiety (odds ratio [OR], 1.61; 95% CI, 1.14-2.27), depression (OR, 1.66; 95% CI, 1.20-2.31), and shortness of breath (OR, 1.65; 95% CI, 1.18-2.31) and each 10-point increase in t-ESAS score (OR, 1.51; 95% CI, 1.40-1.63) were independently associated with higher odds of subsequent NFSI. Conclusions and Relevance In this case-control study, reporting moderate to severe anxiety, depression, and shortness of breath and an increasing t-ESAS score after cancer diagnosis were associated with higher odds of NFSI in the following 180 days. These data support the prospective use of routine ESAS screening as a means of identifying patients at higher risk for NFSI to improve supportive care.
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Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Elie Isenberg-Grzeda
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Psychosocial Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Christopher W Noel
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Alyson L Mahar
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, Women's College Hospital and Research Institute, Toronto, Ontario, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Deleemans
- Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Division of Surgical Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada
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8
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McDowell L, Rischin D, Gough K, Henson C. Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer. Front Oncol 2022; 12:834068. [PMID: 35242716 PMCID: PMC8885992 DOI: 10.3389/fonc.2022.834068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the most common cancer involving the mucosal surfaces of the head and neck and is associated with a number of etiological factors, including cigarette smoking, alcohol and betel nut consumption and exposure to high-risk human papillomavirus. The risk of HNSCC increases with age, peaking in the seventh and eighth decade, but this varies by anatomical and histological subtype. While several advancements have been made in the treatment of head and neck cancer (HNC) in recent decades, undertaking curative treatment still subjects the majority of HNSCC patients to substantial treatment-related toxicity requiring patients to tolerate a gamut of physical, psychological, and emotional demands on their reserves. In conjunction with other patient-related factors, clinicians involved in treating patients with HNSCC may incorporate advancing chronological age into their decision-making process when determining treatment recommendations. While advancing chronological age may be associated with increased concerns regarding physical treatment tolerability, clinicians may also be concerned about heightened vulnerability in various health and wellbeing outcomes. The available literature, however, does not provide evidence of this vulnerability in patients with advancing age, and, in many instances, older patients self-report greater resilience compared to their younger counterparts. While this data is reassuring it is limited by selection bias and heterogeneity in trial and study design and the absence of a consistent definition of the elderly patient with HNSCC. This narrative review article also includes a review of the measures used to assess HRQL, psychosocial outcomes and unmet needs in elderly or older patients with HNSCC.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
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9
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Noel CW, Forner D, Chepeha DB, Baran E, Chan KKW, Parmar A, Husain Z, Karam I, Hallet J, Coburn NG, Eskander A. The Edmonton Symptom Assessment System: A narrative review of a standardized symptom assessment tool in head and neck oncology. Oral Oncol 2021; 123:105595. [PMID: 34775181 DOI: 10.1016/j.oraloncology.2021.105595] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 10/01/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Symptom burden is common in head and neck cancer patients though it frequently remains undetected and untreated. The Edmonton Symptom Assessment System - revised version (ESAS-r) is a generic symptom scale deployed in many outpatient settings worldwide. The ESAS-r is meant to improve symptom detection and management. We sought to review the ESAS-r and its psychometric properties in a head and neck oncology population. METHODS Narrative Review. RESULTS Over the past 30 years, the ESAS-r has emerged as one of the most used symptom scales for cancer patients. Its psychometric properties in a heterogenous cancer population are well supported, proving to be reliable and valid in a variety of settings. The linking of ESAS-r scores with Ontario administrative health data has led to a detailed assessment of validity in head and neck cancer. The ESAS-r can discriminate between high and low levels of symptom burden and is responsive to change over time in this patient population. ESAS-r scores have also been shown to be a strong predictor of future emergency department use and unplanned hospitalization in head and neck cancer patients. CONCLUSIONS The ESAS-r is reliable and valid in the head and neck cancer population and may serve as a useful clinical endpoint in research studies.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Division of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Elif Baran
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ambica Parmar
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada.
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