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Xu W, Wan H, Xiang L, Wang S, Zhu Y, Zheng M. Effectiveness of acceptance commitment therapy for head and neck cancer patients with body image distress in China: a study protocol for randomised controlled trial. BMJ Open 2024; 14:e085551. [PMID: 39242157 DOI: 10.1136/bmjopen-2024-085551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2024] Open
Abstract
INTRODUCTION The head and neck comprise vital organs and are apparent human body parts. Tumours here impair physical and sensory functions as well as appearance and social interactions, leading to body image distress (BID) and threatening mental health and quality of life. Acceptance and commitment therapy has shown effectiveness in improving BID in groups such as breast cancer patients. This study aims to apply this therapy to intervene in head and neck cancer (HNC) patients, aiming to improve BID and promote better psychological well-being. METHODS AND ANALYSIS This study is a prospective, parallel-group, randomised controlled trial. A total of 64 HNC patients will be allocated to either an intervention group or a control group. The intervention group will engage in a 3 week, six-session group-based acceptance and commitment therapy programme, while the control group will receive standard treatment. The primary outcome is cancer-related BID, and secondary outcomes are HNC-related BID, psychological flexibility, coping style and psychological distress. These indicators will be measured at baseline, postintervention and 1 month following the intervention's completion. ETHICS AND DISSEMINATION The trial has received approval from the Institutional Review Board of Shanghai Proton and Heavy Ion Hospital (2308-67-02). The study results will be shared through peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER ChiCTR2300077863.
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Affiliation(s)
- Wenjie Xu
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital; Shanghai Key Laboratory of Radiation Oncology; and Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Hongwei Wan
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital; Shanghai Key Laboratory of Radiation Oncology; and Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Lina Xiang
- Department of Nursing, Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuman Wang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital; Shanghai Key Laboratory of Radiation Oncology; and Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Yu Zhu
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital; Shanghai Key Laboratory of Radiation Oncology; and Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Mimi Zheng
- Department of Nursing, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
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Alrayshouni Z, Dayekh A, El‐Tassi A, Pakai A. Rationalizing the Influence of Co-Design on Distress, Clinical Decision-Making and Disease Self-Management of Cancer Patients-as-Partners: A Quasi-Experimental Study. Health Expect 2024; 27:e14113. [PMID: 38872504 PMCID: PMC11176735 DOI: 10.1111/hex.14113] [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: 02/27/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Cancer is regarded as a major worldwide burden. Patient distress has been linked to disease progression. Studies show that engagement strategies affect clinical decision-making and patient outcomes. The optimal engagement method is a partnership that integrates the patient's expertise into the comprehensive co-design of the healthcare system. OBJECTIVES This is the first study to investigate cancer patient-as-partner experience and its impact on distress levels, decision-making and self-management. METHODS It is a quantitative and quasi-experimental study that adopted a partnership committee at a Lebanese hospital. A stratified random sampling approach was used, and data were collected by self-administered questionnaires. We utilized the standardized distress thermometer and PPEET. RESULTS We recruited 100 patient partners. Cancer patients-as-partners had optimal engagement experience in QI projects (mean = 4; SD = 0.4). The main partnership benefit was improved hospitalization experience (49%). Almost half of PP reported no challenges faced (49%). Recommendations for improvement were training (19%), team dynamics management (12%) and proper time allocation (7%). The distress level post-partnership was significantly reduced (t = 12.57, p < 0.0001). This study highlights the importance of partnership and its ability to influence shared decision-making preference [χ2(2) = 13.81, p = 0.025] and self-management practices [F(3, 11.87) = 7.294, p = 0.005]. CONCLUSION Research findings suggest that partners from disadvantaged groups can have optimal partnership experience. A partnership model of care can shape the healthcare system into a people-oriented culture. Further research is needed to explore diverse PP engagement methodologies and their effect on organizational development. PATIENT OR PUBLIC CONTRIBUTION Patients and family members were engaged in the co-design of the study methodology, especially the modification of a research instrument. Patient partners with lived experience were involved in the patient partnership committee as core members to improve healthcare system design and evaluation.
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Affiliation(s)
| | - Alaa Dayekh
- Doctoral School of Health Sciences, Faculty of Health SciencesUniversity of PécsPécsHungary
| | - Ahmad El‐Tassi
- Nursing Department, Faculty of Health SciencesBeirut Arab UniversityBeirutLebanon
| | - Annamária Pakai
- Doctoral School of Health Sciences, Faculty of Health SciencesUniversity of PécsPécsHungary
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3
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Graboyes EM, Kistner-Griffin E, Hill EG, Maurer S, Balliet W, Williams AM, Padgett L, Yan F, Rush A, Johnson B, McLeod T, Dahne J, Ruggiero KJ, Sterba KR. Mechanism underlying a brief cognitive behavioral treatment for head and neck cancer survivors with body image distress. Support Care Cancer 2023; 32:32. [PMID: 38102496 PMCID: PMC10798060 DOI: 10.1007/s00520-023-08248-7] [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: 08/28/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Body image distress (BID) among head and neck cancer (HNC) survivors is a debilitating toxicity associated with depression, anxiety, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment) is a brief cognitive behavioral therapy (CBT) that reduces BID for these patients. This study examines the mechanism underlying BRIGHT. METHODS In this randomized clinical trial, HNC survivors with clinically significant BID were randomized to receive five weekly psychologist-led video tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Body image coping strategies, the hypothesized mediators, were assessed using the Body Image Coping Skills Inventory (BICSI). HNC-related BID was measured with the Inventory to Measure and Assess imaGe disturbancE-Head and Neck (IMAGE-HN). Causal mediation analyses were used to estimate the mediated effects of changes in BICSI scores on changes in IMAGE-HN scores. RESULTS Among 44 HNC survivors with BID allocated to BRIGHT (n = 20) or AC (n = 24), mediation analyses showed that BRIGHT decreased avoidant body image coping (mean change in BICSI-Avoidance scale score) from baseline to 1-month post-intervention relative to AC (p = 0.039). Decreases in BICSI-Avoidance scores from baseline to 1-month resulted in decreases in IMAGE-HN scores from baseline to 3 months (p = 0.009). The effect of BRIGHT on IMAGE-HN scores at 3 months was partially mediated by a decrease in BICSI-Avoidance scores (p = 0.039). CONCLUSIONS This randomized trial provides preliminary evidence that BRIGHT reduces BID among HNC survivors by decreasing avoidant body image coping. Further research is necessary to confirm these results and enhance the development of interventions targeting relevant pathways to reduce BID among HNC survivors. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT03831100 .
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Hollings Cancer Center, MUSC, Charleston, SC, USA.
| | - Emily Kistner-Griffin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Stacey Maurer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Amy M Williams
- Office of Physician Well-Being and Professionalism, Corewell Health, Detroit, MI, USA
| | - Lynne Padgett
- Veteran Affairs Office of Research and Development, Washington, DC, USA
| | - Flora Yan
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, USA
| | - Angie Rush
- Head and Neck Cancer Alliance, Charleston, SC, USA
| | - Brad Johnson
- Head and Neck Cancer Alliance, Charleston, SC, USA
| | - Taylor McLeod
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Hollings Cancer Center, MUSC, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, MUSC, Charleston, SC, USA
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Gliwska E, Barańska K, Maćkowska S, Różańska A, Sobol A, Spinczyk D. The Use of Natural Language Processing for Computer-Aided Diagnostics and Monitoring of Body Image Perception in Patients with Cancers. Cancers (Basel) 2023; 15:5437. [PMID: 38001696 PMCID: PMC10670138 DOI: 10.3390/cancers15225437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Head and neck cancers (H&NCs) constitute a significant part of all cancer cases. H&NC patients experience unintentional weight loss, poor nutritional status, or speech disorders. Medical interventions affect appearance and interfere with patients' self-perception of their bodies. Psychological consultations are not affordable due to limited time. METHODS We used NLP to analyze the basic emotion intensity, sentiment about one's body, characteristic vocabulary, and potential areas of difficulty in free notes. The emotion intensity research uses the extended NAWL dictionary developed using word embedding. The sentiment analysis used a hybrid approach: a sentiment dictionary and a deep recursive network. The part-of-speech tagging and domain rules defined by a psycho-oncologist determine the distinct language traits. Potential areas of difficulty were analyzed using the dictionaries method with word polarity to define a given area and the presentation of a note using bag-of-words. Here, we applied the LSA method using SVD to reduce dimensionality. A total of 50 cancer patients requiring enteral nutrition participated in the study. RESULTS The results confirmed the complexity of emotions in patients with H&NC in relation to their body image. A negative attitude towards body image was detected in most of the patients. The method presented in the study appeared to be effective in assessing body image perception disturbances, but it cannot be used as the sole indicator of body image perception issues. LIMITATIONS The main problem in the research was the fairly wide age range of participants, which explains the potential diversity of vocabulary. CONCLUSIONS The combination of the attributes of a patient's condition, possible to determine using the method for a specific patient, can indicate the direction of support for the patient, relatives, direct medical personnel, and psycho-oncologists.
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Affiliation(s)
- Elwira Gliwska
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
- Cancer Epidemiology and Primary Prevention Department, The Maria Sklodowska-Curie National Research Institute of Oncology, 15B Wawelska Street, 02-034 Warsaw, Poland
| | - Klaudia Barańska
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800 Zabrze, Poland; (K.B.); (S.M.)
- Polish National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Stella Maćkowska
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800 Zabrze, Poland; (K.B.); (S.M.)
| | - Agnieszka Różańska
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800 Zabrze, Poland; (K.B.); (S.M.)
| | - Adrianna Sobol
- Department of Oncological Propaedeutics, Medical University of Warsaw, 00-518 Warsaw, Poland
| | - Dominik Spinczyk
- Department of Medical Informatics and Artificial Intelligence, Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800 Zabrze, Poland; (K.B.); (S.M.)
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Fahy E, Cantwell LA, Patterson JM, Cherry MG, Rogers S, Akpan A, Hamilton DW. Treatment priorities and regret in older adults with head and neck cancer: A systematic review. Clin Otolaryngol 2023; 48:809-819. [PMID: 37669764 DOI: 10.1111/coa.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/26/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The majority of head and neck cancer (HNC) diagnoses are seen in people aged 70 and older; these numbers are set to increase. Greater understanding of treatment needs of older patients with HNC is essential. These older patients often have co-existing health conditions, are prone to frailty and may not prioritise survival when considering treatment options. This systematic review examines the current research with regard to priorities and factors influencing treatment regret in older people with HNC. METHODS Studies were eligible for inclusion if they (i) reported data from patients with a mean age of 65 years or older who had a confirmed diagnosis of HNC and had been treated using surgery, chemotherapy and/or radiotherapy with either palliative or curative intent, (ii) considered patient's priorities or preferences or examined treatment regret as one of the primary outcomes of the study (iii) were published in English. RESULTS Pilot search identified n = 7222 articles; however, following screening, only four papers met the inclusion criteria. Narrative synthesis was indicated to analyse quantitative and qualitative evidence in parallel, as meta-analyses were not possible. DISCUSSION There is a paucity in the literature examining older adults with HNC. There is an indication that older adults prioritise maintaining independence when making treatment decisions and treatment regret is seen in those with high levels of depression with level of frailty also a contributing factor. Clinicians should consider patient's social circumstances, premorbid status and priorities in maintaining independence and managing symptoms when making treatment decisions in this cohort.
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Affiliation(s)
- Emer Fahy
- Speech and Language Therapy, The Clatterbridge Cancer Centre, Liverpool, UK
| | - Linda A Cantwell
- Department of Nutrition & Dietetics, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Joanne M Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Simon Rogers
- Department of Maxillofacial, Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Hospital, Wirral, UK
| | - Asangaedem Akpan
- Liverpool University Hospitals NHS FT & Merseycare NHS FT, Liverpool, UK
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Wilson AD, Ernst Z, Wise A, Flores H, Garrett M, Torgerson T, Hamilton T, Vassar M. Harms Reporting in Systematic Reviews of the Microvascular Free Flap in Head and Neck Reconstruction. Otolaryngol Head Neck Surg 2023; 169:755-764. [PMID: 36924192 DOI: 10.1002/ohn.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE To evaluate harms reporting in systematic reviews (SRs) of microvascular free flap (MFF) in head and neck reconstruction. DATA SOURCES This cross-sectional analysis included searches from the following major databases from 2012 to June 1, 2022: MEDLINE (Pubmed and Ovid), Embase, Epistemonikos, and the Cochrane Database of Systematic Reviews. REVIEW METHODS In a masked duplicate manner, screening was performed using Rayyan, and data were extracted using a pilot-tested Google form. A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to appraise the methodological quality of reviews and the corrected covered area was calculated to detect primary study overlap across all reviews. Reviews were then grouped in pairs of 2, called dyads, and the corrected covered area was calculated again for each individual dyad. Dyads with high overlap (≥50%) were further investigated for the accuracy of harms reporting. RESULTS Our initial search yielded 268 records, with 50 SRs meeting the inclusion criteria. A total of 46 (92%) of the included reviews demonstrated 50% or more adherence to the items assessed in our harms checklist. Our corrected covered area tool revealed 0.6% primary study overlap across all reviews, and 1 dyad with high overlap (≥50%). No statistically significant relationship was observed between the completeness of harms reporting and reviews listing harms as a primary outcome, reviews reporting adherence to Preferred Reporting Items of Systematic Reviews and Meta-Analyses, or a review's AMSTAR rating. CONCLUSION This study identifies how harms reporting in SRs of MFF reconstruction of the head and neck can be improved and provides suggestions with the potential to mitigate the paucity in current literature.
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Affiliation(s)
- Andrew D Wilson
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Zachary Ernst
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Audrey Wise
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Holly Flores
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Morgan Garrett
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Trevor Torgerson
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Tom Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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Graboyes EM, Kistner-Griffin E, Hill EG, Maurer S, Balliet W, Williams AM, Padgett L, Yan F, Rush A, Johnson B, McLeod T, Dahne J, Ruggiero KJ, Sterba KR. Mechanism Underlying a Brief Cognitive Behavioral Treatment for Head and Neck Cancer Survivors with Body Image Distress. RESEARCH SQUARE 2023:rs.3.rs-3303379. [PMID: 37720013 PMCID: PMC10503855 DOI: 10.21203/rs.3.rs-3303379/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Purpose Body image distress (BID) among head and neck cancer (HNC) survivors is a debilitating toxicity associated with depression, anxiety, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment) is a brief cognitive behavioral therapy (CBT) that reduces BID for these patients. This study examines the mechanism underlying BRIGHT. Methods In this randomized clinical trial, HNC survivors with clinically significant BID were randomized to receive 5 weekly psychologist-led video tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Body image coping strategies, the hypothesized mediators, were assessed using the Body Image Coping Skills Inventory (BICSI). HNC-related BID was measured with the IMAGE-HN. Causal mediation analyses were used to estimate the mediated effects of changes in BICSI scores on changes in IMAGE-HN scores. Results Among 44 HNC survivors with BID, mediation analyses showed that BRIGHT decreased avoidant body image coping (mean change in BICSI-Avoidance scale score) from baseline to 1-month post-intervention relative to AC (p = 0.039). Decreases in BICSI-Avoidance scores from baseline to 1-month decreased IMAGE-HN scores from baseline to 3-months (p = 0.009). The effect of BRIGHT on IMAGE-HN scores at 3-months was partially mediated by a decrease in BICSI-Avoidance scores (p = 0.039). Conclusions This randomized trial provides preliminary evidence that BRIGHT reduces BID among HNC survivors by decreasing avoidant body image coping. Further research is necessary to confirm these results and enhance the development of interventions targeting relevant pathways to reduce BID among HNC survivors. Trial Registration This trial was registered on ClinicalTrials.gov identifier NCT03831100 on February 5, 2019.
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Graboyes EM, Kistner-Griffin E, Hill EG, Maurer S, Balliet W, Williams AM, Padgett L, Yan F, Rush A, Johnson B, McLeod T, Dahne J, Ruggiero KJ, Sterba KR. Efficacy of a brief cognitive behavioral therapy for head and neck cancer survivors with body image distress: secondary outcomes from the BRIGHT pilot randomized clinical trial. J Cancer Surviv 2023:10.1007/s11764-023-01454-6. [PMID: 37644354 PMCID: PMC10902187 DOI: 10.1007/s11764-023-01454-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Body image distress (BID) among head and neck cancer (HNC) survivors leads to depression, social isolation, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment) is a brief, tailored cognitive behavioral therapy (CBT) that reduces HNC-related BID. This trial examines the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID. METHODS In this pilot randomized trial, HNC survivors with clinically significant BID were randomized to 5 weekly psychologist-led tele-CBT sessions (BRIGHT) or dose and delivery-matched survivorship education (attention control [AC]). Secondary psychosocial outcomes were assessed using validated patient-reported outcomes at baseline and 1 and 3-month post-intervention. RESULTS Among 44 HNC survivors with BID, BRIGHT resulted in a greater reduction in depression relative to AC (mean model-based 1-month difference in Δ PROMIS SF v1.0-Depression 8a score, -3.4; 90% CI, -6.4 to -0.4; 3-month difference, -4.3; 90% CI, -7.8 to -0.8). BRIGHT also decreased shame and stigma relative to AC (mean model-based 3-month difference in Δ Shame and Stigma Scale score, -9.7; 90% CI, -15.2 to -4.2) and social isolation (mean model-based 3-month difference in Δ PROMIS SF v2.0 Social Isolation 8a score, -2.9; 90% CI, -5.8 to -0.1). CONCLUSIONS In this planned secondary analysis of a pilot RCT, BRIGHT improved a broad array of psychosocial outcomes among HNC survivors with BID. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03831100 . IMPLICATIONS FOR CANCER SURVIVORS These promising preliminary data suggest the need for a large efficacy trial evaluating the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Emily Kistner-Griffin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth G Hill
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Stacey Maurer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Amy M Williams
- Office of Physician Well-Being and Professionalism, Corewell Health, Detroit, MI, USA
| | - Lynne Padgett
- Veteran Affairs Office of Research and Development, Washington, DC, USA
| | - Flora Yan
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, USA
| | - Angie Rush
- Head and Neck Cancer Alliance, Charleston, SC, USA
| | - Brad Johnson
- Head and Neck Cancer Alliance, Charleston, SC, USA
| | - Taylor McLeod
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Dahne
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Graboyes EM, Kistner-Griffin E, Hill EG, Maurer S, Balliet W, Williams AM, Padgett L, Yan F, Rush A, Johnson B, McLeod T, Dahne J, Ruggiero KJ, Sterba KR. Efficacy of a Brief Cognitive Behavioral Therapy for Head and Neck Cancer Survivors with Body Image Distress: Secondary Outcomes from the BRIGHT Pilot Randomized Clinical Trial. RESEARCH SQUARE 2023:rs.3.rs-3222601. [PMID: 37609318 PMCID: PMC10441452 DOI: 10.21203/rs.3.rs-3222601/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Purpose: Body image distress (BID) among head and neck cancer (HNC) survivors leads to depression, social isolation, stigma, and poor quality of life. BRIGHT ( B uilding a R enewed I ma G e after H ead & neck cancer T reatment) is a brief, tailored cognitive behavioral therapy (CBT) that reduces HNC-related BID. This trial examines the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID. Methods: In this pilot randomized trial, HNC survivors with clinically significant BID were randomized to 5 weekly psychologist-led tele-CBT sessions (BRIGHT) or dose-and delivery matched survivorship education (attention control [AC]). Secondary psychosocial outcomes were assessed using validated patient-reported outcomes at baseline and 1- and 3-months post-intervention. Results: Among 44 HNC survivors with BID, BRIGHT resulted in a greater reduction in depression relative to AC (mean model-based 1-month difference in Δ PROMIS SF v1.0-Depression 8a score, -3.4; 90% CI, -6.4 to -0.4; 3-month difference, -4.3; 90% CI, -7.8 to -0.8). BRIGHT also decreased shame and stigma relative to AC (mean model-based 3-month difference in Δ Shame and Stigma Scale score, -9.7; 90% CI, -15.2 to -4.2) and social isolation (mean model-based 3-month difference in Δ PROMIS SF v2.0 Social Isolation 8a score, -2.9; 90% CI, -5.8 to -0.1). Conclusions: In this planned secondary analysis of a pilot RCT, BRIGHT improved a broad array of psychosocial outcomes among HNC survivors with BID. Implications for Cancer Survivors: These promising preliminary data suggest the need for a large efficacy trial evaluating the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID. Trial Registration: ClinicalTrials.gov identifier: NCT03831100.
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Graboyes EM, Barbon CEA. Optimizing Function and Appearance After Head and Neck Reconstruction: Measurement and Intervention. Otolaryngol Clin North Am 2023; 56:835-852. [PMID: 37246027 PMCID: PMC10330938 DOI: 10.1016/j.otc.2023.04.017] [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] [Indexed: 05/30/2023]
Abstract
Approximately 50% of head and neck cancer (HNC) survivors are left with dysphagia as a result of treatment sequele, and 25% of survivors experience clinically significant body image distress (BID). Both dysphagia and BID adversely affect quality of life and should be tracked using validated clinician- and patient-reported outcome measures such as the Performance Status Scale for Head and Neck Cancer, MD Anderson Dysphagia Inventory, and Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN). Subjective and objective evaluation measures are critical to dysphagia workup and management. Building a renewed image after head and neck cancer treatment, a brief telemedicine-based cognitive behavioral therapy, has become the first evidence-based treatment for BID among HNC survivors.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA; Department of Public Health Sciences, Medical University of South Carolina
| | - Carly E A Barbon
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Unit 1445, 1515 Holcombe Boulevard, Houston, TX 77030-400, USA.
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11
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Ts P, Sreenath NR, Krishna V. Prevalence of Depression and Coping Strategies Among Head and Neck Cancer Patients: A Hospital-Based Study. Cureus 2023; 15:e43687. [PMID: 37724204 PMCID: PMC10505270 DOI: 10.7759/cureus.43687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Background The burden of cancer is increasing in all countries and so is in India. Among Indian males, lung, mouth, and tongue are very common cancers. Cancer is a life-threatening stressful condition, and cancer survivors report negative effects which decrease the quality of life because of long-term post-treatment effects. When cancer treatment is ongoing, patients express mixed emotion which is happiness and relief. This study aimed to find out the prevalence of depression and assess the coping strategies among the same head and neck cancer patients. Material and methods This cross-sectional study was conducted at the outpatient level in the Department of Radiotherapy, Sri Devaraj Urs Medical College (SDUMC), Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, for a period of three years. The sample size was calculated based on the previous study. Head and Neck cancer patients who are more than 18 years old and histologically diagnosed with cancer were included in the study, and head and neck cancer patients with previously diagnosed mental illness or patients with mental health medications or chronically debilitated cancer were excluded. For sociodemographic details, a pretested semi-structured questionnaire was used. To assess depression Zung Depression Scale was used. To assess coping strategy the Cancer Coping Questionnaire was used. All data collected by interview technique which will last not less than 20 minutes. All data were entered in a Microsoft Excel sheet and analyzed using SPSS version 22 (Armonk, NY: IBM Corp.). To compare between groups, t-test and ANOVA were used with a statistically significant p<0.05. Results Of 188 head and neck cancer patients, 117 (62.2%) aged 31-60 years, 136 (72.3%) were females, 121 (64.4%) belonged to rural background, 143 (76.1%) were illiterates, 105 (55.9%) belonged to joint family, and 110 (58.5%) belonged to class IV modified BG Prasad classification. This study showed 16% of head and neck cancer patients had depression according to the Zung Depression Scale. With respect to the coping domain, cancer patients from rural backgrounds had higher coping scores, and illiterate had higher scores. With respect to the positive focus coping subdomain, male cancer patients had higher scores compared, to rural cancer patients, who had higher scores, and illiterate had higher scores. With respect to the diversion domain, rural cancer patients had higher scores, illiterate patients had higher scores, and this difference was statistically significant. With respect to the interpersonal scale domain, rural patients, patients belonging to joint families, patients aged more than 60 years, and illiterate patients had higher scores compared with literates, and these were statistically significant with p<0.05. This study demonstrated that the presence of depression had no impact on coping domains, and there was no significant correlation between depression and coping scores. Conclusion Mental health must be thoughtfully considered among cancer patients as cancer with depression may have a negative impact on their experience with cancer. Cancer keeps growing as a public health problem and all cancer-treating hospitals should work on various preventable measures for reducing the future burden of various health dimensions affected by cancer. The very intention of treating cancer should be improving the survival of the diagnosed case and this needs targeted mental health intervention.
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Affiliation(s)
- Pradeep Ts
- Community Medicine, Sri Devaraj Urs Medical College (SDUMC) Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, IND
| | - Nagireddy Reddy Sreenath
- Preventive Medicine, Sri Devaraj Urs Medical College (SDUMC) Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, IND
| | - Vamsi Krishna
- Preventive Medicine, Sri Devaraj Urs Medical College (SDUMC) Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar, IND
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12
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Ivanova A, Rodríguez-Cano R, Kvalem IL, Harcourt D, Kiserud CE, Amdal CD. Body image concerns in long-term head and neck cancer survivors: prevalence and role of clinical factors and patient-reported late effects. J Cancer Surviv 2023; 17:526-534. [PMID: 36509859 PMCID: PMC10036408 DOI: 10.1007/s11764-022-01311-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Head and neck cancer (HNC) patients are at risk of long-term body image distress (BID). We aimed to investigate the severity of BID in long-term HNC survivors and to explore the associations between sociodemographic and clinical factors, patient-reported late effects, and cancer-related body image (BI) concerns. METHODS This cross-sectional study included quality of life and BI assessment in an 8-year (SD = 1.58) follow-up after treatment among 258 HNC survivors. Multinomial logistic regression analysis was used to investigate the relationship between three groups of BI concerns (no concerns, mild to moderate concerns, and BID) and patient-reported late effects. Sociodemographic and clinical variables were included in the model as covariates. RESULTS A total of 51.2% of participants had mild to moderate BI concerns, and 9.5% reported BID. Compared to those with no BI concerns, participants with BID were more likely to live without a partner, to have had radiotherapy and surgery, and to report worse emotional functioning and higher oral and throat pain. Compared to participants with no BI concerns, those with mild to moderate concerns reported higher oral and throat pain and speech problems. CONCLUSIONS Some level of cancer-related BI concerns persisted in the majority of HNC survivors many years after treatment, while a small proportion of survivors experienced BID. BI concerns were associated with treatment modality and patients' daily functioning and symptoms. IMPLICATIONS FOR CANCER SURVIVORS Insight into factors associated with BI problems may help to identify survivors at risk and may facilitate closer follow-up of survivors in need.
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Affiliation(s)
- Anna Ivanova
- Department of Psychology, University of Oslo, Blindern, PB 1094, 0317, Oslo, Norway.
| | - Rubén Rodríguez-Cano
- Department of Psychology, University of Oslo, Blindern, PB 1094, 0317, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ingela Lundin Kvalem
- Department of Psychology, University of Oslo, Blindern, PB 1094, 0317, Oslo, Norway
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | | | - Cecilie D Amdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Research support services, Oslo University Hospital, Oslo, Norway
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13
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Abstract
Survivorship for head and neck cancer patients presents unique challenges related to the anatomic location of their disease. After treatment, patients often have functional impairments requiring additional care and support. In addition, patients may have psychological challenges managing the effect of the disease and treatment. Routine screening is recommended for the identification of psychological conditions. This article reviews the latest research on key psychological conditions associated with head and neck cancer. It discusses risk factors for the development of each condition and provides recommendations for the management of patients who may present with psychological concerns.
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Affiliation(s)
- Ciaran Lane
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Ryan C. Higgins
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Neerav Goyal
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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14
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Graboyes EM, Maurer S, Balliet W, Li H, Williams AM, Osazuwa-Peters N, Yan F, Padgett L, Rush A, Ruggiero KJ, Sterba KR. Efficacy of a Brief Tele-Cognitive Behavioral Treatment vs Attention Control for Head and Neck Cancer Survivors With Body Image Distress: A Pilot Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2023; 149:54-62. [PMID: 36454561 PMCID: PMC9716435 DOI: 10.1001/jamaoto.2022.3700] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/01/2022] [Indexed: 12/05/2022]
Abstract
Importance Although 1 in 4 head and neck cancer (HNC) survivors experience clinically significant body image distress (BID), a psychosocial morbidity that adversely affects quality of life, effective interventions for these patients are lacking. Objective To evaluate the acceptability and preliminary efficacy of BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment), a brief tele-cognitive behavioral therapy, at reducing BID among HNC survivors. Design, Setting, and Participants This parallel-group pilot randomized clinical trial recruited adult HNC survivors with BID between August 13, 2020, and December 9, 2021, from the Medical University of South Carolina HNC clinic during a routine survivorship encounter. Data were analyzed from May 3 to June 16, 2022. Interventions BRIGHT consisted of 5 weekly psychologist-led video tele-cognitive behavioral therapy sessions. Attention control (AC) consisted of dose- and delivery-matched survivorship education. Main Outcomes and Measures Change in HNC-related BID was assessed using IMAGE-HN (Inventory to Measure and Assess imaGe disturbancE-Head and Neck), a validated patient-reported outcome (score range, 0-84, with higher scores indicating greater HNC-related BID). Clinical response rate was measured as the proportion of patients with a clinically meaningful change in IMAGE-HN scores. Results Of the 44 HNC survivors with BID allocated to BRIGHT (n = 20) or AC (n = 24), the median (range) age was 63 (41-80) years, and 27 patients (61%) were female. Patients rated BRIGHT's acceptability highly (all metrics had a mean rating of ≥4.5/5), and 19 of 20 patients (95%) receiving BRIGHT were likely or highly likely to recommend it to other HNC survivors with BID. BRIGHT decreased HNC-related BID from baseline to 1 month postintervention relative to AC (mean model-based difference in change in IMAGE-HN score, -7.9 points; 90% CI, -15.9 to 0.0 points) and from baseline to 3 months postintervention relative to AC (mean model-based difference in change in IMAGE-HN score, -17.1 points; 90% CI, -25.6 to -8.6 points). At 3 months postintervention, the clinical response rate of BRIGHT was 6.6-fold higher than AC (model-based odds ratio, 6.6; 90% CI, 2.0-21.8). The improvement in HNC-related BID for BRIGHT vs AC at 3 months was clinically significant, and the effect size was large (Cohen d, -0.9; 90% CI, -1.4 to -0.4). Conclusions and Relevance In this pilot randomized clinical trial, BRIGHT was acceptable, may result in a clinically meaningful improvement in HNC-related BID, and showed a high clinical response rate. These promising preliminary data support conducting a large efficacy trial to establish BRIGHT as the first evidence-based treatment for HNC survivors with BID. Trial Registration ClinicalTrials.gov Identifier: NCT03831100.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
| | - Stacey Maurer
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston
| | - Hong Li
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
| | - Amy M. Williams
- Department of Family Medicine, Henry Ford Health, Detroit, Michigan
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Flora Yan
- Department of Otolaryngology–Head and Neck Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Lynne Padgett
- Office of Research and Development, US Department of Veteran Affairs, Washington, DC
| | - Angie Rush
- Head and Neck Cancer Alliance, Charleston, South Carolina
| | | | - Katherine R. Sterba
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston
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15
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Macias D, Hand BN, Zenga J, Pipkorn P, Nilsen ML, Williams AM, Graboyes EM. Association Between Observer-Rated Disfigurement and Body Image-Related Distress Among Head and Neck Cancer Survivors. JAMA Otolaryngol Head Neck Surg 2022; 148:688-689. [PMID: 35554492 PMCID: PMC9100447 DOI: 10.1001/jamaoto.2022.0822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David Macias
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Marci L Nilsen
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Amy M Williams
- Department of Family Medicine, Henry Ford Health System, Detroit, Michigan
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
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16
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Nikita, Rani R, Kumar R. Body image distress among cancer patients: needs for psychosocial intervention development. Support Care Cancer 2022; 30:6035-6043. [PMID: 35412075 PMCID: PMC9002224 DOI: 10.1007/s00520-022-07049-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/06/2022] [Indexed: 11/07/2022]
Abstract
Objectives This study examines the body image distress among patients with head and neck cancer (HNC) visiting a tertiary care hospital for follow-ups. Design A cross-sectional survey purposively enrolled 170 head and neck cancer (HNC) patients who had undergone cancer surgery at a newly established tertiary care hospital, North India. Methods A structured pre-tested socio-demographic and clinical profile checklist and the Derriford Appearance Scale-24 (DAS-24) were used to collect information. An appropriate descriptive and inferential statistic was applied to compute the findings. Results The median age of the participants was 46.0 years, and 80% of the participants were unemployed. The mean body image distress score was 57.95 (SD = 10.3, 47–66.75, range 42–77). The body image distress shows a significant association with age (p < .001), gender (p = 0.003), and working status (p = 0.032) of the HNC patients. Multilinear regression reported gender as an independent predictor (95% CI: 0.615–8.646, p = 0.025) for body image distress in HNC patients. Conclusions HNC patients reported substantial body image distress due to changes in body appearance. Female patients who had undergone surgery at young age reported higher body image distress. Recommending cosmetic surgery and nurse-led psychosocial nursing intervention on routine follow-ups are other potential strategies to improve facial appearance to overcome the negative impact of body image.
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Affiliation(s)
- Nikita
- All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India, 751029
| | - Ruchika Rani
- Department of Nursing, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India, 249203
| | - Rajesh Kumar
- Department of Nursing, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India, 249203.
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17
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Macias D, Hand BN, Pipkorn P, Williams AM, Chang SS, Zenga J, Nilsen ML, Rhoten BA, Huang AT, Osazuwa-Peters N, Maurer S, Balliet W, Li H, Ruggiero KJ, Sterba KR, Graboyes EM. Association of Inventory to Measure and Assess imaGe Disturbance - Head and Neck Scores With Clinically Meaningful Body Image-Related Distress Among Head and Neck Cancer Survivors. Front Psychol 2021; 12:794038. [PMID: 34956022 PMCID: PMC8702522 DOI: 10.3389/fpsyg.2021.794038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: The Inventory to Measure and Assess imaGe disturbance – Head and Neck (IMAGE-HN) is a validated patient-reported outcome measure of head and neck cancer-related body image-related distress (BID). However, the IMAGE-HN score corresponding to clinically relevant BID is unknown. The study objective is to determine the IMAGE-HN cutoff score that identifies head and neck cancer patients with clinically relevant BID. Methods: We conducted a cross-sectional study at six academic medical centers. Individuals ≥18 years old with a history of head and neck cancer treated with definitive intent were included. The primary outcome measure was the IMAGE-HN. A Receiver Operating Characteristic curve analysis was performed to identify the IMAGE-HN score that maximized sensitivity and specificity relative to a Body Image Scale score of ≥10 (which indicates clinically relevant BID in a general oncology population). To confirm the validity of the IMAGE-HN cutoff score, we compared the severity of depressive [Patient Health Questionnaire-9 (PHQ-9)] and anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7)], and quality of life [University of Washington-QOL (UW-QOL)] in patients with IMAGE-HN scores above and below the cutoff. Results: Of the 250 patients, 70.4% were male and the mean age was 62.3 years. An IMAGE-HN score of ≥22 was the optimal cutoff score relative to a Body Image Scale score of ≥10 and represents a clinically relevant level of head and neck cancer-related BID. Relative to those with an IMAGE-HN score of <22, patients with IMAGE-HN scores of ≥22 had a clinically meaningful increase in symptoms of depression (mean PHQ-9 score difference = 5.8) and anxiety (mean GAD-7 score difference = 4.1) as well as worse physical (mean UW-QOL score difference = 18.9) and social-emotional QOL (mean UW-QOL score difference = 21.5). Using an IMAGE-HN cutoff score ≥22, 28% of patients had clinically relevant BID. Conclusion: An IMAGE-HN score of ≥22 identifies patients with clinically relevant head and neck cancer-related BID. This score may be used to detect patients who could benefit from strategies to manage their distress, select patients for studies evaluating interventions to manage head and neck cancer-related BID, and improve our understanding of the underlying epidemiology of the disorder.
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Affiliation(s)
- David Macias
- Department of Otolaryngology, Head, and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
| | - Patrik Pipkorn
- Department of Otolaryngology, Head, and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Amy M Williams
- Department of Otolaryngology, Head, and Neck Surgery, Henry Ford Health System, Detroit, MI, United States
| | - Steven S Chang
- Department of Otolaryngology, Head, and Neck Surgery, Henry Ford Health System, Detroit, MI, United States
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Marci L Nilsen
- Department of Otolaryngology, Head, and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Bethany A Rhoten
- Vanderbilt University School of Nursing, Nashville, TN, United States
| | - Andrew T Huang
- Bobby R. Alford Department of Otolaryngology, Head, and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Stacey Maurer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Hong Li
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Evan M Graboyes
- Department of Otolaryngology, Head, and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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