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Clinical outcomes following pharyngolaryngectomy reconstruction: a 20-year single-centre study. The Journal of Laryngology & Otology 2022; 136:1105-1112. [DOI: 10.1017/s0022215122000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Advanced malignant neoplasms of the larynx and hypopharynx pose many therapeutic challenges. Total pharyngolaryngectomy and total laryngectomy provide an opportunity to cure these tumours but are associated with significant morbidity. Reconstruction of the pharyngeal defect following total pharyngolaryngectomy demands careful consideration and remains an area of debate within surgical discussions.
Methods
This paper describes a systemic analysis of pharyngeal reconstruction following total pharyngolaryngectomy and total laryngectomy, leveraging data collected over a 20-year period at a large tertiary referral centre.
Results
Analysing 155 patients, the results show that circumferential pharyngeal defects and prior radiotherapy have a significant impact on surgical complications. In addition, free tissue transfer in larger pharyngeal defects showed lower rates of post-operative anastomosis leak and stricture.
Conclusion
Pharyngeal resection carries a substantial risk of post-operative complications, and free tissue transfer appears to be an effective means of reconstruction for circumferential defects.
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2
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Beck AJCC, van Harten WH, van den Brekel MWM, Navran A, Retèl VP. Cost-Effectiveness of Surgery Versus Organ Preservation in Advanced Laryngeal Cancer. Laryngoscope 2020; 131:E509-E517. [PMID: 32776557 DOI: 10.1002/lary.28954] [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: 03/27/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Treatment decision-making for patients with laryngeal cancer consists of a complex trade-off between survival and quality of life. For decision makers on coverage and guidelines, costs come in addition to this equation. Our aim was to perform a cost-effectiveness analysis of surgery (laryngectomy with or without radiotherapy) versus organ preservation (OP: radiotherapy, chemo- and/or bioradiation) in advanced laryngeal cancer patients from a healthcare perspective. METHODS A cost-effectiveness analysis was conducted using a Markov model. For each modality, data on survival and quality-adjusted life years (QALYs) were sourced from relevant articles in agreement with experts, and national benchmark cost prices were included regarding treatment, follow-up, adverse events, and rehabilitation. RESULTS Total QALYs of the surgical approach (6.59) were substantially higher compared to the OP approach (5.44). Total lifetime costs were higher for the surgical approach compared to the OP approach, namely €95,881 versus €47,233. The surgical approach was therefore more effective and more costly compared to OP, resulting in an incremental cost-effectiveness ratio of €42,383/QALY. CONCLUSION Based on current literature, surgical treatment was cost-effective compared to OP in advanced laryngeal cancer within most willingness-to-pay thresholds. The study provides information on the survival adjusted for quality of life in combination with costs of two different approaches for advanced laryngeal cancer, relevant for patients, physicians, and policy makers. As financial toxicity is a relevant aspect in this population, collection of real-world data on country-specific costs and utilities is strongly recommended to enable further generalization. LEVEL OF EVIDENCE N/A. Laryngoscope, 131:E509-E517, 2021.
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Affiliation(s)
- Ann-Jean C C Beck
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands.,Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (AUMC), Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
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3
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Abstract
Outcomes research is a fast-growing field of study that focuses on patient-related aspects of medical or surgical outcomes such as satisfaction and quality of life. In the realm of facial plastic surgery, many outcomes are subjective evaluations based on the patient and physician's judgment as to the surgical result, but little has been done to quantify these qualitative results in an objective manner. This paper discusses the basis for outcomes research and suggests its application to the field of facial plastic surgery. Four new facial plastic outcomes instruments have been developed and are provided for the potential use in measuring the quality of life results of rhytidectomy, rhinoplasty, blepharoplasty, and skin rejuvenation procedures.
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4
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van Sluis KE, van Son RJJH, van der Molen L, MCGuinness AJ, Palme CE, Novakovic D, Stone D, Natsis L, Charters E, Jones K, Dirven R, van den Brekel MWM. Multidimensional evaluation of voice outcomes following total laryngectomy: a prospective multicenter cohort study. Eur Arch Otorhinolaryngol 2020; 278:1209-1222. [PMID: 32696251 PMCID: PMC7954718 DOI: 10.1007/s00405-020-06216-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study is to assess the general course of acoustic, patient rated, and clinician-rated voice outcomes from pre- up to 12 months post total laryngectomy. Methods Patients admitted to a total laryngectomy in five participating hospitals in Australia and The Netherlands were included. Assessments took place at pre-, 3 months, 6 months, and 12 months post-surgery. Voice outcomes are evaluated with the Acoustic Voice Quality Index (AVQI), perceptual scales, and patient-reported outcome measures including VHI-10 and EQ-5D-5L. Statistical analyses include descriptive statistics, t tests (pre- to 6 months post-surgery), Linear Mixed Effect models. Results The study included 43 participants. A significant worsening of AVQI is seen from pre- to post-surgery evaluated with t test (p < 0.001). The Linear Mixed Effect model confirmed Time as a significant factor in predicting AVQI score (p ≤ 0.001), as well as perceptual rated voice quality by the clinician (p = 0.015) and patient-reported perceptual rated voice quality (p = 0.002). No statistical significance was found in VHI-10 scores over time. Conclusion Successful TE-speech was achieved in most participants, some had to rely on augmentative alternative communication methods. Patient-reported outcomes indicate acceptance of the condition and sufficient coping in the long term. However, acoustic rated voice quality is abnormal at all post-surgery time-points. AVQI proved to be a useful instrument to evaluate TE-speech. There is a need for validation and determination of cut-off values for VHI-10 and AVQI for use in TE-speech.
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Affiliation(s)
- Klaske E van Sluis
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands. .,Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands.
| | - Rob J J H van Son
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.,Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.,Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
| | - Anthony John MCGuinness
- Head and Neck Department, Department of Surgery, Chris O'Brien Lifehouse Hospital, Sydney, NSW, Australia.,Department of Ear, Nose and Throat, Head and Neck Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - Carsten E Palme
- Head and Neck Department, Department of Surgery, Chris O'Brien Lifehouse Hospital, Sydney, NSW, Australia.,Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Department of Surgery, Ear Nose & Throat, Westmead Hospital, Westmead, NSW, Australia.,Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Daniel Novakovic
- Head and Neck Department, Department of Surgery, Chris O'Brien Lifehouse Hospital, Sydney, NSW, Australia.,Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Danielle Stone
- Department of Surgery, Ear Nose & Throat, Westmead Hospital, Westmead, NSW, Australia
| | - Lydia Natsis
- Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Emma Charters
- Head and Neck Department, Department of Surgery, Chris O'Brien Lifehouse Hospital, Sydney, NSW, Australia
| | - Kelly Jones
- Department of Ear, Nose and Throat, Head and Neck Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - Richard Dirven
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.,Amsterdam Center for Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
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5
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Lee MT, Govender R, Roy PJ, Vaz F, Hilari K. Factors affecting swallowing outcomes after total laryngectomy: Participant self-report using the swallowing outcomes after laryngectomy questionnaire. Head Neck 2020; 42:1963-1969. [PMID: 32118341 DOI: 10.1002/hed.26132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 02/04/2020] [Accepted: 02/20/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Little is known about what factors affect patient-reported swallowing outcome after total laryngectomy. We explored whether patient demographics, surgical variables, use of adjuvant treatment, and time since surgery were associated with patient-reported swallowing outcome. METHODS Cross-sectional study of laryngectomees in eight UK hospitals. Demographic, treatment, and surgical variables were drawn from medical notes. The swallowing outcomes after laryngectomy (SOAL) questionnaire captured perceived swallowing outcome. RESULTS Two hundred and twenty one participants had complete data on treatment-related variables. In regression analysis, having a free jejunum flap repair and requiring chemoradiation were the only two variables that added significantly to the model of worse self-reported swallowing outcome (R2 adjusted = .23, P < .001). CONCLUSION The SOAL is a sensitive measure of self-reported swallowing outcome after laryngectomy. Type of surgical closure and the type of additional treatment influenced the swallowing outcome reported by patients. Changes in perceived swallowing function need to be routinely evaluated to inform clinical decision-making and intervention.
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Affiliation(s)
- Mary T Lee
- Head and Neck Centre, University College London Hospital, London, UK
| | - Roganie Govender
- Head and Neck Centre, University College London Hospital, London, UK.,Research Department of Behavioural Science and Health, University College London, London, UK
| | - Penny J Roy
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
| | - Francis Vaz
- Head and Neck Centre, University College London Hospital, London, UK
| | - Katerina Hilari
- Centre for Language and Communication Science Research, School of Health Sciences, City, University of London, London, UK
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6
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Parrilla C, Salvati A, Mastrapasqua RF, Artuso A, Paludetti G, Galli J. Functional and aesthetic results after septorhinoplasty and concomitant radiofrequency of the inferior turbinate: is there a role for patient reported outcome measures (PROMs)? Eur Arch Otorhinolaryngol 2019; 276:745-751. [PMID: 30604059 DOI: 10.1007/s00405-018-05269-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/24/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Functional and aesthetic results after septorhinoplasty (SRP) are often not clearly demonstrated. There is still an open topic in the literature about analysis of aesthetic, functional results and patients' satisfaction after SRP. The aim of our study is to determine patients' satisfaction after SRP and concomitant radiofrequency of the inferior turbinate (RF) regarding nose appearance and improvement of symptoms, using patient reported outcome measures (PROMs). METHODS ROE questionnaire and the NOSE scale were used for a retrospective evaluation to assess patient's satisfaction in 369 patients undergoing SRP surgery from 2003 to 2016. Two additional questions were asked to confirm satisfaction following surgery. RESULTS 258 patients completed the questionnaires (71.7%). The global average ROE score was 18.14 (75.6%). The percentage of satisfaction of aesthetic result was 87.3%, in particular 10.5% were very happy, 57% very much satisfied and 19.8% moderately satisfied. The global post-operative average NOSE score was 13.1 with the resolution of nasal obstruction in 72.1% cases and a marked improvement in 9.3%. The results of the two additional questions showed that 81% of patients would undergo the procedure again if required and 72.1% of patients were globally satisfied. CONCLUSIONS Our study demonstrates the utility of PROMs in evaluating aesthetic and functional results after SRP and simultaneous RF. In our series, the patients undergoing SRP and RF are generally satisfied by the functional and aesthetic results. This kind of assessments should be the most common post-operative evaluation methods in this surgery.
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Affiliation(s)
- Claudio Parrilla
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Antonio Salvati
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Rodolfo Francesco Mastrapasqua
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Alberto Artuso
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Gaetano Paludetti
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Jacopo Galli
- Otolaryngology Institute-Department of Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
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7
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Abstract
The effect on quality of life (QOL) of laryngectomy and organ preservation protocols is important in decision making. The aim of this cross-sectional study was to evaluate QOL outcomes of patients with advanced laryngeal tumors who were treated with laryngectomy or organ preservation protocols in Latin America. A total of 35 patients from three oncology units were enrolled. Patients with stage III/IV laryngeal cancer who were treated using organ preservation protocols or laryngectomy were assessed with the University of Washington QOL Questionnaire. The most important domains that affected QOL for both groups were speech and activity. In the laryngectomy group, the next most important domains were appearance, taste, pain, and recreation, whereas in the organ preservation group, they were saliva, recreation, mood, and swallowing. There were no statistically or clinically significant differences in the global score or the 7 days of QOL assessments before patients were interviewed. Global QOL assessments were similar when comparing laryngectomy and organ preservation protocols.
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Affiliation(s)
- Jessie C Everaert
- Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium
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8
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Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach. Head Neck 2018; 41:16-29. [DOI: 10.1002/hed.25192] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/03/2018] [Accepted: 03/02/2018] [Indexed: 11/08/2022] Open
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Caulley L, Hunink MG, Kilty S, Metha V, Scangas G, Rodin D, Randolph G, Shin JJ. Evidence-Based Medicine in Otolaryngology Part 9: Valuing Health Outcomes. Otolaryngol Head Neck Surg 2018; 160:11-21. [PMID: 30252610 DOI: 10.1177/0194599818800477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Decisions about resource allocation are increasingly based on value trade-offs between health outcomes and cost. This process relies on comprehensive and standardized definitions of health status that accurately measure the physical, mental, and social well-being of patients across disease states. These metrics, assessed through clinical trials, observational studies, and health surveys, can facilitate the integration of patient preferences into clinical practice. This ninth installment in the Evidence-Based Medicine in Otolaryngology Series is a practical overview of health outcome valuation, as well as the integration of both quality and quantity of life into standardized metrics for health research, program planning, and resource allocation. Tools for measuring preference-based health states, measures of effectiveness, and the application of metrics in economic evaluations are discussed.
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Affiliation(s)
- Lisa Caulley
- 1 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,2 Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,3 The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Myriam G Hunink
- 4 Department of Epidemiology and Department of Radiology, Erasmus MC, Rotterdam, The Netherlands.,5 Center for Health Decision Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shaun Kilty
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,3 The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Vikas Metha
- 6 Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, USA
| | - George Scangas
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Danielle Rodin
- 8 Department of Radiation Oncology, Dana Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.,9 Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gregory Randolph
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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10
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Sanabria A, Sánchez D, Chala A, Alvarez A. Quality of life in patients with larynx cancer in Latin America: Comparison between laryngectomy and organ preservation protocols. EAR, NOSE & THROAT JOURNAL 2018; 97:83-90. [PMID: 29554402 DOI: 10.1177/014556131809700323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The effect on quality of life (QOL) of laryngectomy and organ preservation protocols is important in decision making. The aim of this cross-sectional study was to evaluate QOL outcomes of patients with advanced laryngeal tumors who were treated with laryngectomy or organ preservation protocols in Latin America. A total of 35 patients from three oncology units were enrolled. Patients with stage III/IV laryngeal cancer who were treated using organ preservation protocols or laryngectomy were assessed with the University of Washington QOL Questionnaire. The most important domains that affected QOL for both groups were speech and activity. In the laryngectomy group, the next most important domains were appearance, taste, pain, and recreation, whereas in the organ preservation group, they were saliva, recreation, mood, and swallowing. There were no statistically or clinically significant differences in the global score or the 7 days of QOL assessments before patients were interviewed. Global QOL assessments were similar when comparing laryngectomy and organ preservation protocols.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Calle 67 No. 53-108, Medellin, Colombia.
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11
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Trivedi NP, Swaminathan DK, Thankappan K, Chatni S, Kuriakose MA, Iyer S. Comparison of Quality of Life in Advanced Laryngeal Cancer Patients after Concurrent Chemoradiotherapy vs Total Laryngectomy. Otolaryngol Head Neck Surg 2018; 139:702-7. [DOI: 10.1016/j.otohns.2008.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Revised: 06/03/2008] [Accepted: 06/03/2008] [Indexed: 11/16/2022]
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12
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Costa JM, López M, García J, León X, Quer M. Impacto de la laringectomía total en la situación laboral. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:74-79. [DOI: 10.1016/j.otorri.2017.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/25/2017] [Indexed: 12/12/2022]
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13
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Costa JM, López M, García J, León X, Quer M. Impact of Total Laryngectomy on Return to Work. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.otoeng.2017.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kara M, Ertekin H, Şahin B, Cevizci S, Dereköy FS. Larenks kanserli hastalarda adjuvant radyoterapinin ses ve yaşam kalitesi ile ilişkisi. FAMILY PRACTICE AND PALLIATIVE CARE 2017. [DOI: 10.22391/920.308837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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LoTempio MM, Wang KH, Sadeghi A, Delacure MD, Juillard GF, Wang MB. Comparison of quality of life outcomes in laryngeal cancer patients following chemoradiation vs. total laryngectomy. Otolaryngol Head Neck Surg 2016; 132:948-53. [PMID: 15944570 DOI: 10.1016/j.otohns.2004.12.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE: To evaluate quality of life issues in patients with laryngeal cancer after treatment with either chemoradiation or total laryngectomy and radiation therapy. METHODS: Forty-nine patients with a history of stage II-IV laryngeal squamous cell carcinoma treated primarily with either chemoradiation or by total laryngectomy with postoperative radiation completed the University of Washington Quality of Life instrument, version 4. Patients were identified on a volunteer basis in an academic university head and neck clinic setting. Each patient completed the above instrument, and statistical analysis was performed by Wilcoxon and X 2 , tests. RESULTS: Instruments were completed by all 49 patients: 15 patients who underwent primary chemoradiation and 34 patients who underwent a total laryngectomy followed by radiation. Domains reported in both treatment groups without significant differences were appearance, activity, recreation, moods, taste, saliva, anxiety, and general questions. However, there were significant differences between the 2 groups in the domains of pain, swallowing, chewing, speech, and shoulder function. The laryngectomy patients reported greater impairment of speech ( P = 0.001), and shoulder function ( P = 0.018), whereas the chemoradiation patients suffered from greater pain, difficulty swallowing ( P = 0.061), and problems chewing ( P = 0.027). CONCLUSIONS: Most patients with laryngeal cancer, whether treated primarily with chemoradiation or total laryngectomy, reported excellent functional outcomes and health-related quality of life. Pain, swallowing, chewing, saliva, and shoulder function were recorded as significant factors affecting their daily quality of life.
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Affiliation(s)
- Maria M LoTempio
- Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1624, USA
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Impact of Expression of CD44, a Cancer Stem Cell Marker, on the Treatment Outcomes of Intensity Modulated Radiation Therapy in Patients With Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2015; 94:461-8. [PMID: 26867875 DOI: 10.1016/j.ijrobp.2015.11.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/18/2015] [Accepted: 11/11/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the significance of CD44 protein expression on the treatment outcomes of radiation therapy in patients with oropharyngeal squamous cell carcinoma (OPSCC) with or without p16 protein expression in the tumor tissue. METHODS AND MATERIALS We reviewed the medical records of 58 OPSCC patients who had undergone radiation therapy and examined the tumor tissue expressions of CD44 and p16 protein by immunohistochemical staining. The correlations between the expressions of these proteins and the patients' treatment outcomes were analyzed. RESULTS The data of 58 consecutive OPSCC patients who had undergone definitive intensity modulated radiation therapy were analyzed. The male/female ratio was 55:3, and the median age was 64 years. The clinical stage of the disease was stage II in 7 patients, stage III in 5 patients, stage IVA in 35 patients, and stage IVB in 11 patients. Of the patients, 79% received additional induction and/or concurrent chemotherapy. The median follow-up duration was 34 months. The 3-year overall survival, progression-free survival (PFS) and locoregional control (LRC) rates of all the patients, regardless of the results of immunohistochemistry, were 73%, 64% and 76%, respectively. The PFS and LRC rates in the CD44(-) patients (86% and 93%, respectively) were significantly higher than those in the CD44(+) patients (57% and 70%, respectively). The PFS and LRC rates in the p16(+) patients (83% and 90%, respectively) were significantly higher than those in the p16(-) patients (45% and 61%, respectively). Patients who were CD44(-)/p16(+) showed the best LRC rates, and those who were CD44(+)/p16(-) showed the worst PFS and LRC rates among all the groups. CONCLUSIONS Profiling of CD44 and p16 protein expressions by immunohistochemical staining is useful for predicting the treatment outcomes in patients with OPSCC undergoing definitive intensity modulated radiation therapy.
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17
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Biggs TC, Fraser LR, Ward MJ, Sunkaraneni VS, Harries PG, Salib RJ. Patient reported outcome measures in septorhinoplasty surgery. Ann R Coll Surg Engl 2015; 97:63-5. [PMID: 25519270 DOI: 10.1308/003588414x14055925059075] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Surgical procedures incorporating a cosmetic element such as septorhinoplasty and otoplasty are currently under threat in the National Health Service (NHS) as they are deemed to be procedures of 'limited clinical benefit' by many primary care providers. Patient reported outcome measures (PROMs), which assess the quality of care delivered from the patients' perspective, are becoming increasingly important in documenting the effectiveness of such procedures. METHODS The Rhinoplasty Outcomes Evaluation (ROE) questionnaire, a validated PROM tool, was used to assess patient satisfaction in 141 patients undergoing septorhinoplasty surgery over a 90-month period at the University Hospital Southampton NHS Foundation Trust. RESULTS Overall, 100 patients with a mean follow-up period of 36 months completed the study. The mean ROE score was 73.3%. In addition, 75% of patients questioned were happy with the final result of their operation and 83% would undergo the procedure again if required. These benefits occurred irrespective of age, sex and primary versus revision surgery, and were maintained for up to 71 months following surgery. CONCLUSIONS This study has shown that patients are generally satisfied with their functional and cosmetic outcomes following septorhinoplasty surgery. These results help support the case for septorhinoplasty surgery to continue being funded as an NHS procedure.
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Affiliation(s)
- T C Biggs
- University Hospital Southampton NHS Foundation Trust, UK
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18
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Ch'ng S, Oates J, Gao K, Foo K, Davies S, Brunner M, Clark JR. Prospective quality of life assessment between treatment groups for oral cavity squamous cell carcinoma. Head Neck 2013; 36:834-40. [DOI: 10.1002/hed.23387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/25/2013] [Accepted: 05/15/2013] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sydney Ch'ng
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Justine Oates
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Kerwyn Foo
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Sarah Davies
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Markus Brunner
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Jonathan R. Clark
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
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Oral function after maxillectomy and reconstruction with an obturator. Int J Oral Maxillofac Surg 2012; 41:1387-92. [PMID: 22939876 DOI: 10.1016/j.ijom.2012.07.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/14/2012] [Accepted: 07/19/2012] [Indexed: 11/22/2022]
Abstract
Maxillectomy defects can be reconstructed by a prosthetic obturator or (free) flap transfer, but there is no consensus about the optimal method. This study evaluated 32 maxillectomy patients with prosthetic obturation regarding function (mastication, subjective oral and swallowing complaints and maximal mouth opening). Outcomes were related to the extent of the resection (Brown maxillectomy classification), dentition and history of adjuvant radiotherapy. Maxillectomy defects ranged from 2-1 to 4B on the Brown classification, and most had a defect graded as 2-A or 2-B. Mean mixing ability test after 10 chewing strokes was 24.2 and after 20 chewing strokes 19.7, which compares to edentulous healthy individuals. None of the outcomes was influenced by Brown classification. Radiotherapy negatively influenced mean maximal mouth opening (29.1mm versus 40.9 mm, p=0.017) and subjective outcomes. Edentate obturated patients had worse outcomes than dentate patients, measured by mixing ability test and questionnaire. In conclusion, mastication after obturator reconstruction of a maxillectomy defect is comparable to mastication with full dentures. Size of the maxillectomy defect did not significantly influence functional outcome, but adjuvant radiotherapy resulted in worse mouth opening and self-reported oral and swallowing problems. Residual dentition had a positive influence on mastication and subjective outcomes.
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Şenkal HA, Hayran M, Karakaya E, Yueh B, Weymuller EA, Hoşal AŞ. The validity and reliability of the Turkish version of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer. Am J Otolaryngol 2012; 33:417-26. [PMID: 22137146 DOI: 10.1016/j.amjoto.2011.10.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 10/05/2011] [Accepted: 10/12/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE The University of Washington Quality of Life Questionnaire (UW-QOL) is an English-language survey used to assess the quality of life of patients with head and neck cancer. The present study aimed to translate this widely used questionnaire into Turkish according to international guidelines and to statistically determine its validity and reliability by administering it to native Turkish-speaking patients. MATERIALS AND METHODS This prospective study was performed at Hacettepe University, Faculty of Medicine, Turkey. The study included patients newly diagnosed as having head and neck cancer. Translation and cultural adaptation of the questionnaire were performed first. Then, the translated version was tested on a consecutive series of patients seen in the department of otorhinolaryngology head and neck surgery and the department of radiation oncology between September 2006 and February 2008. The patients were asked to complete 3 sets of questionnaires. The first set was completed 1 day before the beginning of treatment, the second 3 months after the completion of treatment, and the third 10 days after the second questionnaire was completed. The first and second sets included the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire-Turkish version and UW-QOL-Turkish version. The third set included the Turkish UW-QOL only. Performance status was assessed and rated by a physician using the Karnofsky and ZEW (Zubrod/The Eastern Cooperative Oncology Group (ECOG)/World Health Organization) performance scales, synchronous with the first and second sets of questionnaires. RESULTS The original English version of UW-QOL was carefully translated into Turkish, and a final Turkish version of UW-QOL was developed in an iterative fashion. To determine its validity and reliability, 67 patients were included in the study. Internal consistency (Cronbach α = .757) was adequate, and test-retest reliability (interclass correlation coefficient, 0.941) was excellent. The composite scores of the translated UW-QOL were compared statistically with the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire scores, Karnofsky and ZEW performance scales, T stage of the disease, and UW-QOL global questions scores to support the scale's construct validity, and statistically significant associations were observed. CONCLUSIONS The Turkish UW-QOL appears to be a valid and reliable tool for use with Turkish patients with head and neck cancer; it can also be used in clinical investigations and routine clinical practice in Turkey.
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Azevedo EHM, Montoni N, Gonçalves Filho J, Kowalski LP, Carrara-de Angelis E. Vocal Handicap and Quality of Life After Treatment of Advanced Squamous Carcinoma of the Larynx and/or Hypopharynx. J Voice 2012; 26:e63-71. [DOI: 10.1016/j.jvoice.2011.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 02/17/2011] [Indexed: 11/16/2022]
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Williamson JS, Ingrams D, Jones H. Quality of life after treatment of laryngeal carcinoma: a single centre cross-sectional study. Ann R Coll Surg Engl 2011; 93:591-5. [PMID: 22041234 DOI: 10.1308/147870811x13137608455253] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Laryngeal cancer treatment inherently affects life's most basic functions and significantly affects quality of life (QOL). We aimed to identify which aspects of QOL and which patients are most affected by the various treatment options. METHODS The University of Washington Quality of Life (UW-QOL) questionnaire was administered to all patients with laryngeal cancer treated at a single institution over a seven-year period (2003-2010). RESULTS In total, 41 patients responded. All had been treated for squamous cell carcinoma of the larynx. Questionnaires were completed at a median of 18.5 months after treatment. The overall quality of life was 81.1/100 as assessed by the UW-QOL scale, with only 4.9% reporting 'poor' or worse QOL. Neither patient age nor time after treatment significantly affected any aspect of QOL. Patients undergoing primary radiotherapy reported the best QOL. Those undergoing chemoradiotherapy or combined surgical treatment and chemoradiotherapy reported the worst QOL, particularly in terms of social eating, taste and saliva production. Patients with a T stage ≥2 and those with nodal metastases reported a significantly worse QOL. CONCLUSIONS Overall, QOL in our patients was good. This study highlights the aspects of QOL most affected by various treatments for laryngeal cancer and identifies areas in which therapeutic intervention may be focused. It also provides information to guide clinicians when assisting patients to make informed decisions regarding treatment of their head and neck cancer.
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Affiliation(s)
- J S Williamson
- Department of ENT, Royal Gwent hospital, Cardiff Road, Newport, NP20 2UB, UK.
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Guibert M, Lepage B, Woisard V, Rives M, Serrano E, Vergez S. Quality of life in patients treated for advanced hypopharyngeal or laryngeal cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:218-23. [DOI: 10.1016/j.anorl.2011.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 02/12/2011] [Accepted: 02/14/2011] [Indexed: 10/18/2022]
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Management of total laryngectomy patients over time: from the consultation announcing the diagnosis to long term follow-up. Eur Arch Otorhinolaryngol 2011; 268:1407-19. [DOI: 10.1007/s00405-011-1661-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 05/26/2011] [Indexed: 01/22/2023]
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Nazar G, Garmendia ML, Royer M, McDowell JA, Weymuller EA, Yueh B. Spanish validation of the University of Washington Quality of Life questionnaire for head and neck cancer patients. Otolaryngol Head Neck Surg 2010; 143:801-7, 807.e1-2. [PMID: 21109081 DOI: 10.1016/j.otohns.2010.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 07/11/2010] [Accepted: 08/10/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The University of Washington Quality of Life (UW-QOL) questionnaire is one of the most widely used instruments to evaluate the quality of life of head and neck cancer patients. The aim of this study was to perform a Spanish translation and validation of the UW-QOL questionnaire. STUDY DESIGN A cross-sectional study. SETTING Three tertiary-care hospitals and a laryngectomee rehabilitation center. SUBJECTS AND METHODS The translation and cultural adaptation of the questionnaire were performed following accepted international guidelines. The psychometric validation was performed on a consecutive series of patients treated for squamous cell carcinoma of the upper aerodigestive tract with no signs of relapse, recruited from May 2007 to December 2008. Eligible subjects were invited to complete the Spanish version of the UW-QOL questionnaire during routine clinical consultation, and complete it again within 15 days. Subjects also completed a validated Spanish version of the Goldberg Mental Health Survey and were evaluated by the use of the Karnofsky Index. RESULTS A Spanish version of the questionnaire was developed in iterative fashion. In the psychometric validation process, a total of 76 patients were analyzed. Reliability was excellent, including both internal consistency (Cronbach's alpha of 0.84) and test-retest reliability (intraclass correlation coefficient between 0.91 and 0.97 with a confidence interval of 95%). Construct validity was supported by statistically significant relationships between the Karnofsky Index, the Goldberg Mental Health Survey, and the translated UW-QOL questionnaire. CONCLUSION The Spanish version of the UW-QOL questionnaire appears to be culturally appropriate and psychometrically valid.
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Affiliation(s)
- Gonzalo Nazar
- Department of Otolaryngology, Clínica Las Condes, Santiago, Chile.
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Speech and swallowing after surgical treatment of advanced oral and oropharyngeal carcinoma: a systematic review of the literature. Eur Arch Otorhinolaryngol 2009; 266:1687-1698. [PMID: 19756680 DOI: 10.1007/s00405-009-1089-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 08/27/2009] [Indexed: 10/20/2022]
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Abstract
The focus of this article is the palliative treatment of a variety of dysphonic conditions. Symptomatic relief of hoarseness can be achieved by voice therapy, augmentative alternative communication modalities, and surgery. The causes of dysphonia addressed herein include amyotrophic lateral sclerosis, Parkinson's disease, multiple sclerosis, stroke, head and neck cancers requiring glossectomy or laryngectomy, unilateral vocal fold paralysis, and presbyphonia. Palliative treatment of dysphonia and voice disorders provides symptomatic relief but not a cure of the underlying disease state. For these patients there are a number of palliative interventions that can greatly improve their quality of life.
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Linsen S, Schmidt-Beer U, Fimmers R, Grüner M, Koeck B. Craniomandibular pain, bite force, and oral health-related quality of life in patients with jaw resection. J Pain Symptom Manage 2009; 37:94-106. [PMID: 19111778 DOI: 10.1016/j.jpainsymman.2006.12.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Revised: 12/28/2006] [Accepted: 12/28/2006] [Indexed: 10/21/2022]
Abstract
The present study evaluated the connection between temporomandibular disorders (TMD), maximum voluntary bite force and oral health-related quality of life (OHRQoL) in patients with oral cancer. Twenty-six prosthetically rehabilitated patients with partial resection of the upper and/or lower jaw with segmental mandibulectomy, with and without reconstruction, were examined. The examination comprised the Research Diagnostic Criteria for TMD (RDC/TMD), determination of the individual pain threshold, evaluation of the maximum voluntary bite force, and OHRQoL according to the Oral Health Impact Profile (OHIP) questionnaire. Male pain thresholds were significantly higher than female pain thresholds (P=0.003). Patients with maxillary resection showed higher pain threshold values than patients with (segmental) mandibulectomy. Bite force was significantly (P=0.000014) lower in resected jaw areas than in healthy ones. Patients with resections of the maxilla showed higher voluntary bite forces than patients with resections of the mandible; males showed higher bite forces than females. The prevalence of negative responses ("often"-2 and "very often"-1) on the OHIP items was 10.39%, whereas the prevalence of positive responses ("from time to time"-3, "seldom"-4, and "never"-5) was 89.60%. The prevalence for negative responses was 2.46% in male patients and 8.07% in female patients. Patients with resections in the maxilla suffered from negative responses of 3.92%, patients with resection of the mandible of 6.64%. According to the OHIP, the psychological disposition of these patients clearly referred to coping mechanisms.
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Affiliation(s)
- Sabine Linsen
- Department of Prosthodontics, Dental School, University of Bonn, Bonn, Germany.
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Patient Self-Report of Disability of the Upper Extremity following Osteocutaneous Radial Forearm Free Flap Harvest. Plast Reconstr Surg 2008; 122:1479-1484. [DOI: 10.1097/prs.0b013e3181882129] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Babin E, Sigston E, Hitier M, Dehesdin D, Marie JP, Choussy O. Quality of life in head and neck cancers patients: predictive factors, functional and psychosocial outcome. Eur Arch Otorhinolaryngol 2008; 265:265-70. [PMID: 18188577 DOI: 10.1007/s00405-007-0561-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 12/17/2007] [Indexed: 11/29/2022]
Abstract
The principal endpoints in head and neck cancer are survival with improvement of quality of life (QoL) in cancer patients. Patients treated for head and neck cancer suffer from a number of symptom domains: physical symptoms linked to diet and feeding, communication disorders, pain and their general state of health; psychological symptoms including depression, irritability, loss of self-esteem (occasionally feelings of shame), and social symptoms including relationship difficulties with partner (sexual disorders) or with other family members, loss of work, reduction in salary, and sense of uselessness, resulting in a negative impact on their daily life. At present, most tools only partially evaluate patient QoL, concentrating on the global impact of disease and its treatment on patients' physical and psychological condition. The "sociability" of individual patients is rarely evaluated, and the development of qualitative studies in this domain will enable improved understanding of the social factors involved in each patient's adaptability to disease, its treatment and after-effects.
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Affiliation(s)
- E Babin
- ENT and Head and Neck Surgery Department, CHU-Charles Nicolle University Hospital, 76 000 Rouen, France.
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Murphy BA, Ridner S, Wells N, Dietrich M. Quality of life research in head and neck cancer: a review of the current state of the science. Crit Rev Oncol Hematol 2007; 62:251-67. [PMID: 17408963 DOI: 10.1016/j.critrevonc.2006.07.005] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 05/31/2006] [Accepted: 07/19/2006] [Indexed: 10/23/2022] Open
Abstract
Quality of life (QOL) has become an increasingly important outcome measure for patient's undergoing treatment for a wide array of illnesses. QOL is a global construct that reflects a patient's general sense of well being. It is by definition multi-dimensional and reflective of the patient's point of view. Health related issues are among the many factors that may influence QOL. Since head and neck cancer (HNC) affects structures that are critical for normal functions such as speech and swallowing, and treatment may lead to deformities that adversely impact psychosocial functioning, there is particular interest in assessing QOL in this cohort of patients. In order to interpret the HN QOL literature, it is important to have an understanding of the significance and limitations of QOL assessments in the head and neck patient population as well as an appreciation for the currently available measurement tools. Unfortunately, the HNC QOL literature has many limitations including: small sample size, lack of prospective data and poor study design. None-the-less, important insights can be obtained by review of the current literature. First, it is important that QOL studies be reported in such a way as to provide clinically meaningful data to clinicians. Linking measurements with clinical benchmarks is one way to accomplish this goal. In addition, both general and HNC specific measures are needed in order to provide a comprehensive assessment of global health and tumor specific issues. In general, QOL declines immediately after therapy and returns toward baseline by 1 year. Several factors have been identified that may predict for worse QOL outcomes including: the presence of a feeding tube, co-morbid disease, tracheotomy, site and stage. Data correlating QOL with functional outcome and symptom burden fails to demonstrate a consistent relationship. This may be attributed to methodological issues in study design or the patient's ability to adapt to functional and symptom control problems. Whether routine use of QOL measures in the clinical setting is beneficial to patients has yet to be determined. Further studies are warranted as currently available instruments may not be valid for repeated clinical use.
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Affiliation(s)
- Barbara A Murphy
- Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, 777 Preston Research Building, Nashville, TN 37215, USA.
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Kazi R, De Cordova J, Kanagalingam J, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Quality of Life following Total Laryngectomy: Assessment Using the UW-QOL Scale. ORL J Otorhinolaryngol Relat Spec 2006; 69:100-6. [PMID: 17148941 DOI: 10.1159/000097792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Accepted: 06/30/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the quality of life (QOL) in patients using valved speech following total laryngectomy with a validated patient self-report scale. STUDY DESIGN Cross-sectional cohort study. PATIENTS 63 patients following total laryngectomy using valved speech. INTERVENTION University of Washington Quality of Life (UW-QOL) questionnaire. MAIN OUTCOME MEASURES Patient perception of the QOL over the last 7 days following total laryngectomy in response to specific questions and correlated with sociodemographic and treatment factors. RESULTS Responses were received from 44 males and 11 females (response rate: 87.3%) with a median age of 66 years (range: 40-84). The mean (SD) composite score of the QOL in our series of patients with total laryngectomy was 81.3 (10.9). As regards the overall QOL, 80% of our patients cited it as very good (45.5%) to good (34.5%). Patients identified speech, appearance, and activity as the most important issues following total laryngectomy. Only age and pharyngo-oesophageal segment closure were significant predictors of QOL scores (Student t test, p < 0.05) and not other demographic and treatment variables. CONCLUSIONS The composite score and overall QOL were high in our series of total laryngectomy patients and this possibly reflects adequate multidisciplinary management. We strongly urge the use of prospective longitudinal studies that will adequately identify any QOL changes over time. Although the UW-QOL questionnaire is a simple and brief scale, it has limitations that can curtail its effective use in laryngectomy patients and we advise supplementing it with the use of domain-specific questionnaires.
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Affiliation(s)
- R Kazi
- Head and Neck Unit, Royal Marsden Hospital, London, UK.
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Toth G, Hirose H, Tsukuda M. Communication strategies and interpersonal skills of instructors of esophageal speech: an observation study. PATIENT EDUCATION AND COUNSELING 2006; 63:152-60. [PMID: 16242901 DOI: 10.1016/j.pec.2005.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Revised: 09/08/2005] [Accepted: 09/17/2005] [Indexed: 05/05/2023]
Abstract
OBJECTIVE In this article, the way that the Instructor of Esophageal Speech (IES) works is considered from an interactive-analytic perspective. METHODS The observation project data were gathered during 6 months in 2004 at the training sessions of the Ginreikai-Asian Federation of Laryngectomees' Association using the Six Category Intervention Analysis framework (6CIA) by a trained communication specialist as an active-observer. RESULTS Mean scores of each of the six categories and a series of percentage distributions were extracted from the usage-frequency data and interpreted together with the results of Chi-square analysis of usage-frequency units. We found the IES used more frequently authoritative categories and used less facilitative categories. Our results of the data analysis show that the 30 IES used more authoritative interventions and used more frequently the prescription and information giving than the confrontation or cathartic interventions. CONCLUSION The results of the present study show that the 6CIA framework has its potential and value as an analytic tool to explore the IES' actual behavior in a specific therapy related context. PRACTICE IMPLICATIONS We argue for the utility of the 6CIA as an analytic framework to investigate the interpersonal behavior of the IES in the Japanese cultural setting.
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Affiliation(s)
- Gabor Toth
- Department of Biology and Function in the Head and Neck, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama-shi 236 0004, Japan.
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Vilaseca I, Chen AY, Backscheider AG. Long-term quality of life after total laryngectomy. Head Neck 2006; 28:313-20. [PMID: 16200627 DOI: 10.1002/hed.20268] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is a perception that a total laryngectomy has a devastating effect on patients and their families, but only a few studies have addressed long-term quality of life (QOL) after laryngectomy. METHODS A cross-sectional study of 49 patients more than 2 years since laryngectomy was performed with a general health status instrument (Short Form-12, version 2 [SF-12 v2.]) and a disease-specific QOL instrument (University of Washington Quality of Life questionnaire, version 4 [UW-QOL v4.]) in a national meeting of laryngectomy survivors. RESULTS As measured by the UW-QOL, patients identified speech, appearance, and activity as the most important problems after total laryngectomy, but surprisingly, no correlation was seen between speech and overall QOL. Age was a predictor of appearance and anxiety, women were more likely to report difficulties swallowing, irradiated patients reported more difficulties with speech and anxiety, and patients who received chemotherapy were more likely to report difficulties with mood. The SF-12 captured no differences between normal subjects and laryngectomees in the physical summary domain (p = .21); however, laryngectomees scored better in the mental domain (p = .004). Laryngectomees had lower scores in physical function (p = .005) and role physical (p = .036). CONCLUSIONS Long-term QOL is not decreased after total laryngectomy when it is measured with general health instruments and compared with the normal population, but impairment in physical scales is found when disease-specific questionnaires or subscale scores are included. Age, sex, radiation therapy, and chemotherapy are independent predictors of UW-QOL subscales. Voice handicap is identified as a problem but is not predictive of overall QOL. A strong relationship exists between UW-QOL and SF-12.
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Affiliation(s)
- Isabel Vilaseca
- Department of Otolaryngology, Hospital Clínic i Universitari, Barcelona, Spain
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Vázquez de la Iglesia F, Fernández González S, de la Cámara Gómez M. Evaluación espectral cualitativa de la voz esofágica. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2006; 57:319-23. [PMID: 17036994 DOI: 10.1016/s0001-6519(06)78719-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of the study is to determine the accuracy of acoustic spectrography as an outstanding tool in the characterization and monitoring of esophageal voice. MATERIAL AND METHODS Our subjects were comprised of 33 laryngectomized patients (all male) that underwent qualitative acoustic (spectrography of vowel /a/ and a sentence), quantitative acoustic (phonation time, fundamental frequency, maximun intensity sound level, speech rate) and perceptual protocol. RESULTS There is a significant statistical relationship among Yanagihara-like spectrographic chart classification, psycho-acoustical perception and quantitative acoustic parameters. CONCLUSION We consider that acoustic spectrography is an easy, effective method for studying esophageal voice, seeking for improving oral communication skills and rehabilitation in the laryngectomee population.
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Vartanian JG, Carvalho AL, Yueh B, Furia CLB, Toyota J, McDowell JA, Weymuller EA, Kowalski LP. Brazilian–Portuguese validation of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer. Head Neck 2006; 28:1115-21. [PMID: 16823873 DOI: 10.1002/hed.20464] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The University of Washington Quality of Life (UW-QOL) questionnaire is an English-language survey instrument used worldwide to assess the quality of life of patients with head and neck cancer. To be used in other cultures, such instruments require careful translation and psychometric validation in other languages. METHODS The translation and cultural adaptation of the questionnaire were performed following accepted international guidelines. The psychometric validation was performed on a consecutive series of patients with at least 1 year of disease-free survival after treatment for squamous cell carcinoma of the upper aerodigestive tract, recruited from October 2004 to January 2005 from a tertiary cancer center hospital. Eligible subjects were invited to complete the Portuguese version of the UW-QOL questionnaire during routine clinical consultation and complete it again within 15 days. They also completed a validated Portuguese version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and a questionnaire to evaluate anxiety and depression symptoms (Hospital Anxiety and Depression Scale [HADS]). RESULTS A Portuguese version of the questionnaire was developed in iterative fashion. In the psychometric validation process, a total of 109 patients were analyzed. Reliability was excellent, including both internal consistency (Cronbach's alpha [alpha] of 0.744) and test retest reliability (intraclass correlation coefficient [ICC] of 0.882). Construct validity was supported by statistically significant relationships between the SF-36 and HAD questionnaires and the translated UW-QOL questionnaire. CONCLUSIONS The Brazilian-Portuguese version of the UW-QOL questionnaire appears to be culturally appropriate and psychometrically valid. This version is a valuable tool to evaluate accurately the quality of life of Brazilian patients with head and neck cancer.
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Affiliation(s)
- Jose Guilherme Vartanian
- Head and Neck Surgery and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa Hospital do Cancer A. C. Camargo, Rua Professor Antonio Prudente, 211-01509-900 Sao Paulo, SP, Brazil
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Babin E, Joly F, Vadillo M, Dehesdin D. [Oncology and quality of life. Study in head and neck cancer]. ACTA ACUST UNITED AC 2005; 122:134-41. [PMID: 16142092 DOI: 10.1016/s0003-438x(05)82338-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED The principal endpoints in oncology are survival with improvement of quality of life in cancer patients. OBJECTIVES To give an accurate account of current literature on quality of life and head and neck cancers. METHODS Two keys words are used: "quality of life" and "cancer" enabling to trace articles in Medical and Human Science journals. Analysis and synthesis of these documents. RESULTS Quality of life is difficult to evaluate as it is a multidimensional concept with three main symptom domains: physical, psychological and social. Several quality of life evaluation scales have been developed enabling authors to estimate the effects of disease on patients as well as treatment-related symptoms. Reports on quality of life in ENT patients have offered improved knowledge on patient experience and aftereffects, and therapies have been adapted and improved in view of such studies. CONCLUSION Quality of life evaluation tools need to be improved. At present, most tools only partially evaluate patient quality of life, concentrating on the global impact of disease and its treatment on patients' physical and psychological condition. The "sociability" of individual patients is rarely evaluated, and the development of qualitative studies in this domain will enable improved understanding of the social factors involved in each patient's adaptability to disease, its treatment and after-effects.
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Affiliation(s)
- E Babin
- Service ORL et de Chirurgie Cervico-Faciale, CHU, avenue de la côte de nacre, 14033 Caen cedex.
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Ledeboer QCP, Velden LA, Boer MF, Feenstra L, Pruyn JFA. Physical and psychosocial correlates of head and neck cancer: an update of the literature and challenges for the future (1996-2003). Clin Otolaryngol 2005; 30:303-19. [PMID: 16209671 DOI: 10.1111/j.1365-2273.2005.01035.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
An update of the literature on physical and psychosocial aspects of head and neck cancer, with special emphasis on effects of treatment, patient-related factors and psychosocial intervention on quality of life (QoL). QoL deteriorates during and directly after treatment and returns only slowly to pre-treatment values. Organ preservation, gender and coping-strategies are factors related to QoL after treatment. As prognosis and survival were found to be comparable under different treatment regimes, we noticed a gradual shift in therapy towards organ preservation. Systematic care, using specific instruments is important for improving the QoL. We feel that more attention should be given to improving support, in order to optimize the QoL of patients during the palliative stage.
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Affiliation(s)
- Q C P Ledeboer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, Rotterdam.
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39
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Abstract
For advanced head and neck cancer (HNC) patients, aggressive radiation and chemoradiation treatments offer new therapy options. The aims of these regimens are increased survival and organ preservation, with the goals of preserving organ function, minimizing late effects, and improving quality of life (QOL). At the same time, the toxicities of these regimens are acknowledged as is the potential for long-term dysfunction. Thus, particularly now, with the increasing use of aggressive chemoradiation therapy (CRT) regimens, documentation of the QOL and functional outcomes of these treatments is critical. The implications for speech and swallowing are widely recognized and the broader effects of these impairments on overall QOL have received some attention. This article presents data on the performance, functional, and QOL results of radiation therapy (RT) and various CRT regimens in HNC.
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Affiliation(s)
- Marcy A List
- University of Chicago Cancer Research Center, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637-1470, USA.
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Scharloo M, Baatenburg de Jong RJ, Langeveld TPM, van Velzen-Verkaik E, Doorn-op den Akker MM, Kaptein AA. Quality of life and illness perceptions in patients with recently diagnosed head and neck cancer. Head Neck 2005; 27:857-63. [PMID: 16114002 DOI: 10.1002/hed.20251] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate which illness perceptions of patients recently diagnosed with head and neck cancer explain variance in their quality of life (QOL) to identify potential targets for interventions aimed at improving QOL. METHODS Sixty-eight patients (mainly with stage III and IV disease) completed the Illness Perception Questionnaire-Revised (IPQ-R) and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). RESULTS Pretreatment cross-sectional results from this prospective study show that, after controlling for age and comorbidity, illness perceptions were significantly related to the QLQ-C30 physical, role, emotional, cognitive, social functioning, and global health subscales. Patients with increased attention to symptoms, who believed in a greater likelihood of recurrence, who were more likely to engage in self-blame, and who had a stronger emotional reaction to the illness had lower QOL scores. CONCLUSION Our results suggest that restructuring negative pretreatment illness perceptions may help patients to cope more adequately during and after treatment.
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Affiliation(s)
- Margreet Scharloo
- Psychology Unit, Leiden University Medical Center, PO Box 9555, 2300 RB Leiden, The Netherlands.
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41
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Moore RJ, Chamberlain RM, Khuri FR. A qualitative study of head and neck cancer. Support Care Cancer 2004; 12:338-46. [PMID: 15064931 DOI: 10.1007/s00520-003-0532-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2002] [Accepted: 08/19/2003] [Indexed: 12/17/2022]
Abstract
The findings presented contribute to quality of life (QOL) research by highlighting the significance of factors affecting the communication by patients with primary-stage squamous cell carcinoma of the head and neck cancer (SCCHN) of their experiences of suffering after treatment to their clinicians. Qualitative research methodology based on open-ended interviews with 18 survivors of American Joint Committee on Cancer primary stage I and II SCCHN were used. The interviews were transcribed verbatim and thematically analyzed. Three important themes emerged: (1). a diminished self (2). fears of addiction, and (3). hopelessness and the loss of meaning in life after SCCHN. The findings indicate that SCCHN patients under-report their experiences mainly due to fear. As a consequence, and perhaps due to a failure on the part of clinicians and patients to adequately address such fears, SCCHN patients may experience greater psychological morbidity, becoming increasingly fatalistic about biomedicine's ability to restore them to health after cancer despite being "cured", or to relieve related symptoms. This qualitative study provides a perspective as to why such under-reporting occurs, thereby potentially enhancing clinician-patient communication and the QOL of SCCHN patients who present with curable disease.
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Affiliation(s)
- R J Moore
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Moore RJ, Chamberlain RM, Khuri FR. Communicating suffering in primary stage head and neck cancer*. Eur J Cancer Care (Engl) 2004; 13:53-64. [PMID: 14961776 DOI: 10.1111/j.1365-2354.2004.00444.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The findings presented in this discussion seek to make a contribution to quality of life (QOL) research, by highlighting the import of factors affecting the communication of primary stage head and neck cancer patient's experiences of suffering after treatments by their clinicians. Qualitative research methodology based on open-ended interviews with 18 survivors of American Joint Committee on Cancer (AJCC) Stage I and Stage II, squamous cell carcinoma of the head and neck (SCCHN) were used. The interviews were transcribed verbatim and thematically analysed. In this preliminary analysis, three important themes emerged: (1) a self diminished by cancer; (2) the fear of addiction to pain medications; and (3) hopelessness and the loss of meaning in life after SCCHN. Our present findings indicate that SCCHN patients understand their experiences of cancer and under-report their experiences of suffering mainly because of fear. These include fears of: being further diminished by SCCHN, fears of addiction, and an inability to cope with the additional losses associated with SCCHN. As a consequence, and perhaps, because of a failure the part of clinicians and patients to adequately address these fears, SCCHN patients may also experience greater psychological morbidity, becoming fatalistic about biomedicine's ability to restore them to health after cancer, or related symptoms, including pain, despite being 'cured.' This study provides a perspective on why this under-reporting occurs, thereby potentially enhancing clinician-patient communication and the QOL of SCCHN patients who present with curable disease.
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Affiliation(s)
- R J Moore
- Departments of Epidemiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Happ MB, Roesch T, Kagan SH. Communication Needs, Methods, and Perceived Voice Quality Following Head and Neck Surgery. Cancer Nurs 2004; 27:1-9. [PMID: 15108946 DOI: 10.1097/00002820-200401000-00001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with head and neck cancer experience complex and frustrating communication problems after surgery, yet patient communication during the in-hospital postoperative period has received relatively little attention in clinical and research literature. A computerized and hand search of the medical (MEDLINE, Cancerlit), psychological (health and psychosocial instruments), and nursing (CINAHL) literature (1968 to April 2002) produced 10 published studies and 1 clinical case report specifically addressing the communication needs, methods, or perceived voice quality of patients with head and neck cancer during the postoperative period (< or = 12 months after surgery). This review presents a summary and critique of research and related literature on in-hospital postoperative communication with adult patients who have head and neck cancer. Three major themes are addressed: (1) information needs, (2) communication methods and perceived voice quality and (3) quality-of-life perceptions related to communication, disfigurement, and socialization. This review shows that the communication needs, communication methods, and perception of voice quality among patients with head and neck cancer have been ignored during the in-hospital period. Clinical issues and technological advancements in augmentative and alternative communication applicable to the in-hospital period are discussed, and research implications are presented.
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Affiliation(s)
- Mary Beth Happ
- Acute/Tertiary Department, School of Nursing, University of Pittsburgh, PA 15261, USA.
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Happ MB, Roesch T, Kagan SH. Communication Needs, Methods, and Perceived Voice Quality Following Head and Neck Surgery. Cancer Nurs 2003; 26:346-54. [PMID: 14710795 DOI: 10.1097/00002820-200310000-00002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with head and neck cancer experience complex and frustrating communication problems after surgery, yet patient communication during the in-hospital postoperative period has received relatively little attention in clinical and research literature. A computerized and hand search of the medical (MEDLINE, Cancerlit), psychological (health and psychosocial instruments), and nursing (CINAHL) literature (1968 to August, 2001) produced 10 published studies and 1 clinical case report specifically addressing the communication needs, methods, or perceived voice quality of patients with head and neck cancer during the postoperative period (3 days to 19 months). This review presents a summary and critique of research and related literature on in-hospital postoperative communication with adult patients who have head and neck cancer. Four major themes are addressed: 1) information needs, 2) communication methods and perceived voice quality, 3) adjustment and adaptation to communication impairment, and 4) quality-of-life perceptions related to communication and socialization. This review shows that the communication needs, communication methods, and perception of voice quality among patients with head and neck cancer have been ignored during the in-hospital period. Clinical issues and technological advancements in augmentative and alternative communication applicable to the in-hospital period are discussed, and research implications are presented.
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Affiliation(s)
- Mary Beth Happ
- Acute/Tertiary Department, School of Nursing, University of Pittsburgh, Pennsylvania 15261, USA.
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Morton RP. Studies in the quality of life of head and neck cancer patients: results of a two-year longitudinal study and a comparative cross-sectional cross-cultural survey. Laryngoscope 2003; 113:1091-103. [PMID: 12838004 DOI: 10.1097/00005537-200307000-00001] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine quality-of-life (QL) changes that occur over time among patients treated for head and neck cancer and to compare QL outcomes in two geographically separate and culturally distinct populations. STUDY DESIGN A prospective, observational longitudinal study was made of QL changes over time in head and neck cancer patients, and a matched-pairs cross-sectional study was conducted for comparison of QL outcomes between groups of head and neck cancer patients from two different sociocultural environments. METHODS Patients attending a tertiary head and neck cancer center in Auckland, New Zealand, were interviewed using a validated questionnaire before treatment and at 3, 12, and 24 months after treatment. Changes over time were assessed according to gender, site and stage of primary tumor, and type of treatment received. A second group of patients from Toronto, Ontario, Canada, were matched to the first group for age, gender, site and stage of tumor, and time since treatment and interviewed using the same questionnaire. The group comparison was followed by a matched-pairs analysis for the 12-month follow-up interval. RESULTS In the longitudinal study, combined modality treatment resulted in greater physical and somatic dysfunction than single modality treatment. Patients learned to cope well with dysfunction and disability and with adjusting their lifestyle so that overall QL was not related to treatment received. Even so, pain scores and measures of psychological distress were related to overall QL. Otherwise there was no consistent correlation between specific symptoms and QL. An illustration of patients' adaptation to dysfunction was evident in scores for perceived difficulty swallowing, which decrease despite the ongoing need for a soft or liquid diet. In the comparative study, significantly different global QL scores were evident in the two clinical groups studied, despite similar social, somatic, and physical functioning. There was also a significant but inconstant difference in emotional functioning. Although the clinical groups received significantly different treatment regimens, the observed differences in global QL were independent of treatment received. CONCLUSIONS Patients with head and neck cancer generally managed well despite disability and dysfunction after treatment. Patients' expectations, emotional responses, and desired outcomes seemed to be determined by sociocultural factors, causing different patient groups to view their overall QL outcome somewhat differently.
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Affiliation(s)
- Randall P Morton
- Department of Otolaryngology-Head & Neck Surgery, Green Lane Hospital, Green Lane West 3, Auckland, New Zealand.
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46
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Affiliation(s)
- Marcy A List
- University of Chicago Cancer Research Center, Chicago, IL 60637, USA
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47
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Hall FT, O'Brien CJ, Clifford AR, McNeil EB, Bron L, Jackson MA. Clinical outcome following total laryngectomy for cancer. ANZ J Surg 2003; 73:300-5. [PMID: 12752286 DOI: 10.1046/j.1445-2197.2003.02562.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with advanced cancers of the larynx and hypopharynx have been treated with total laryngectomy at the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney in the past. Increasingly, these patients are being managed with organ-sparing protocols using chemo-therapy and radiotherapy. The aim of the present study was to review complication, recurrence and survival rates following total laryngectomy. METHODS Patients who had total laryngectomy for squamous carcinomas of the larynx or hypopharynx between 1987 and 1998 and whose clinicopathological data had been prospectively accessioned onto the computerized database of the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, were reviewed. Patients whose laryngectomy was a salvage procedure for failed previous treatment were included. RESULTS A total of 147 patients met the inclusion criteria for the study, including 128 men and 19 women with a median age of 63 years. Primary cancers involved the larynx in 90 patients and hypopharynx in 57. There were 30 patients who had recurrent (n = 24) or persistent disease (n = 6) after previous treatment with radiotherapy (26 larynx cases and four hypopharynx cases). Pharyngo-cutaneous fistulas occurred in 26 cases (17.7%) and, using multivariate analysis, the incidence did not correlate with T stage, previous treatment or concomitant neck dissection. Local control rates were 86% for the larynx and 77% for the hypo-pharynx groups and neck control was 84% and 75%, respectively. Five-year survival for the larynx cancer group was 67% and this was significantly influenced by T stage and clinical and pathological N stage. Survival in the hypopharynx group was 37% at 5 years and this did not significantly correlate with T or N stage. There was a non-significant trend to improved survival among previously treated patients whose laryngectomy was a salvage procedure. CONCLUSION Patients with cancer of the larynx had a significantly better survival following total laryngectomy than patients with hypopharyngeal cancer. Those whose laryngectomy was carried out as a salvage procedure following failed previous treatment did not have a worse outcome than previously untreated patients.
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Affiliation(s)
- Francis T Hall
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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48
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Abstract
For patients with laryngeal cancer, rehabilitation following laryngectomy may be difficult. However, significant variability in coping skills and adaptation of this patient population exists. Healthcare providers commonly perceive disfigurement, alteration in function (i.e., loss of natural voice), and disease control as the most relevant issues in the postoperative period, yet patients and their families may not share these same priorities. Management of physical symptoms, social reintegration, participation in enjoyed activities, and vocational issues following laryngectomy may present significant barriers to achieving optimal quality of life. Comprehensive preoperative counseling that includes patients and their caregivers is an important aspect of preparation for surgery. This review examines dimensions of adaptation, rehabilitation, and quality of life following laryngectomy.
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49
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Abstract
Tracheoesophageal puncture has made high-quality voice restoration readily available to most individuals who must undergo TL. Although none of these patients would voluntarily choose to undergo TL if not faced with a life-threatening condition, at least some achieve a better quality of life, including better vocal function, after treatment and rehabilitation. The methods involved in placement and maintenance of a tracheoesophageal prosthesis are straightforward and permit successful, long-term voice restoration for most patients. Although far from perfect, TL with TEP affords both quality and quantity of life to a group of individuals who currently have no alternative but to undergo debilitating surgery in an effort to extend their lives.
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Affiliation(s)
- Wayne M Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, USA.
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50
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Rogers SN, Gwanne S, Lowe D, Humphris G, Yueh B, Weymuller EA. The addition of mood and anxiety domains to the University of Washington quality of life scale. Head Neck 2002; 24:521-9. [PMID: 12112548 DOI: 10.1002/hed.10106] [Citation(s) in RCA: 303] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There are numerous head and neck specific quality of life questionnaires, each having its own merits and disadvantages. The University of Washington questionnaire has been widely used and is notable by the inclusion of a shoulder dysfunction domain, domain importance ratings, and patient free text. It is short, simple to process, and provides clinically relevant information. However, it has lacked any psychological dimension of quality of life. The aim of this study was to report the inclusion of two psychological domains (mood, anxiety) to the most recent refinement of the questionnaire (version 3). METHOD A cross-sectional survey was performed in April 2000. Questionnaires were sent to 183 patients alive and disease free after surgery for oral and oro-pharyngeal malignancy. Replies were received from 145 patients (79% response rate). RESULTS The new domains (mood and anxiety) correlated significantly with the emotional functioning domains from the EORTC C30 and with the pain and appearance domains of UW-QOL. There were also significant correlations between the "global quality of life" item and the two new domains. Mood (p =.005) and anxiety (p <.001) scores were associated with patient age but with no other clinicodemographic variable. CONCLUSION The addition of mood and anxiety domains makes the UW-QOL version 4 a single broad measure suitable for effective health-related quality of life evaluation in the routine clinical setting.
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Affiliation(s)
- Simon N Rogers
- Consultant and Honorary Reader, Regional Maxillofacial Unit, University Hospital Aintree, Fazakerley, Liverpool L9 1AL United Kingdom.
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