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Geiss C, Hoogland AI, Arredondo B, Rodriguez Y, Bryant C, Chung CH, Patel KB, Gonzalez BD, Jim HSL, Kirtane K, Oswald LB. Psychosocial consequences of head and neck cancer symptom burden after chemoradiation: a mixed-method study. Support Care Cancer 2024; 32:254. [PMID: 38538780 PMCID: PMC11062256 DOI: 10.1007/s00520-024-08424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/05/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Patients with head and neck cancer (HNC) experience significant symptom burden from combination chemotherapy and radiation (chemoradiation) that affects acute and long-term health-related quality of life (HRQOL). However, psychosocial impacts of HNC symptom burden are not well understood. This study examined psychosocial consequences of treatment-related symptom burden from the perspectives of survivors of HNC and HNC healthcare providers. METHODS This was a cross-sectional, mixed-method study conducted at an NCI-designated comprehensive cancer center. Participants (N = 33) were survivors of HNC who completed a full course of chemoradiation (n = 20) and HNC healthcare providers (n = 13). Participants completed electronic surveys and semi-structured interviews. RESULTS Survivors were M = 61 years old (SD = 9) and predominantly male (75%), White (90%), non-Hispanic (100%), and diagnosed with oropharynx cancer (70%). Providers were mostly female (62%), White (46%) or Asian (31%), and non-Hispanic (85%) and included physicians, registered nurses, an advanced practice nurse practitioner, a registered dietician, and a speech-language pathologist. Three qualitative themes emerged: (1) shock, shame, and self-consciousness, (2) diminished relationship satisfaction, and (3) lack of confidence at work. A subset of survivors (20%) reported clinically low social wellbeing, and more than one-third of survivors (35%) reported clinically significant fatigue, depression, anxiety, and cognitive dysfunction. CONCLUSION Survivors of HNC and HNC providers described how treatment-related symptom burden impacts psychosocial identity processes related to body image, patient-caregiver relationships, and professional work. Results can inform the development of supportive interventions to assist survivors and caregivers with navigating the psychosocial challenges of HNC treatment and survivorship.
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Affiliation(s)
- Carley Geiss
- Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-AS PRISM, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA
| | - Brandy Arredondo
- Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-AS PRISM, Tampa, FL, USA
| | - Yvelise Rodriguez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA
| | - Crystal Bryant
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, USA
| | - Krupal B Patel
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA
| | - Kedar Kirtane
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA.
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Liu DT, Mueller CA, Sedaghat AR. A scoping review of Rasch analysis and item response theory in otolaryngology: Implications and future possibilities. Laryngoscope Investig Otolaryngol 2024; 9:e1208. [PMID: 38362194 PMCID: PMC10866592 DOI: 10.1002/lio2.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
Objective Item response theory (IRT) is a methodological approach to studying the psychometric performance of outcome measures. This study aims to determine and summarize the use of IRT in otolaryngological scientific literature. Methods A systematic search of the Medline, Embase, and the Cochrane Library databases was performed for original English-language published studies indexed up to January 28, 2023, per the following search strategy: ("item response theory" OR "irt" OR "rasch" OR "latent trait theory" OR "modern mental test theory") AND ("ent" OR "otorhinolaryngology" OR "ear" OR "nose" OR "throat" OR "otology" OR "audiology" OR "rhinology" OR "laryngology" OR "neurotology" OR "facial plastic surgery"). Results Fifty-five studies were included in this review. IRT was used across all subspecialties in otolaryngology, and most studies utilizing IRT methodology were published within the last decade. Most studies analyzed polytomous response data, and the most commonly used IRT models were the partial credit and the rating scale model. There was considerable heterogeneity in reporting the main assumptions and results of IRT. Conclusion IRT is increasingly being used in the otolaryngological scientific literature. In the otolaryngology literature, IRT is most frequently used in the study of patient-reported outcome measures and many different IRT-based methods have been used. Future IRT-based outcome studies, using standardized reporting guidelines, might improve otolaryngology-outcome research sustainably by improving response rates and reducing patient response burden. Level of evidence 2.
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Affiliation(s)
- David T. Liu
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Christian A. Mueller
- Department of Otorhinolaryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Ahmad R. Sedaghat
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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3
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Bobevski I, Kissane DW, Desroches J, De Simone A, Henry M. Validation of the Canadian Version of the Shame and Stigma Scale for Head and Neck Cancer Patients. Curr Oncol 2023; 30:7553-7565. [PMID: 37623029 PMCID: PMC10453664 DOI: 10.3390/curroncol30080548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Cancers of the head and neck and their treatment can cause disfigurement and loss of functioning, with a profound negative impact on the person's self-image and psychosocial wellbeing. This can lead to experiences of shame and stigma, which are important targets for psychosocial interventions. Accurate measurement and identification of these problems enables clinicians to offer appropriate interventions and monitor patients' progress. This study aimed to validate the Canadian version of the Shame and Stigma Scale (SSS) among French- and English-speaking head and neck cancer patients. Data from 254 patients from two major Canadian hospitals were analysed. The existing four-factor structure of the SSS was supported, with the following subscales: Shame with Appearance, Sense of Stigma, Regret, and Social/Speech Concerns. The Canadian SSS showed adequate convergent and divergent validity and test-retest reliability. Rasch analysis suggested scale improvement by removing two misfitting items and two items with differential functioning between French- and English-speaking patients. The final 16-item scale version was an adequate fit with the Rasch model. The SSS provides more accurate measures for people with high levels of shame and stigma, and thus has utility in identifying patients with more severe symptoms who may be in need of psychosocial interventions.
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Affiliation(s)
- Irene Bobevski
- School of Medicine, University of Notre Dame Australia, Darlinghurst, NSW 2010, Australia;
- Department of Psychiatry, School of Clinical Sciences, Monash Health and Monash University, Clayton, VIC 3168, Australia
| | - David W. Kissane
- School of Medicine, University of Notre Dame Australia, Darlinghurst, NSW 2010, Australia;
- Department of Psychiatry, School of Clinical Sciences, Monash Health and Monash University, Clayton, VIC 3168, Australia
| | - Justin Desroches
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada; (J.D.)
| | - Avina De Simone
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada; (J.D.)
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
- Lady-Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
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4
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Graboyes EM, Barbon CEA. Optimizing Function and Appearance After Head and Neck Reconstruction: Measurement and Intervention. Otolaryngol Clin North Am 2023:S0030-6665(23)00074-9. [PMID: 37246027 DOI: 10.1016/j.otc.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Approximately 50% of head and neck cancer (HNC) survivors are left with dysphagia as a result of treatment sequele, and 25% of survivors experience clinically significant body image distress (BID). Both dysphagia and BID adversely affect quality of life and should be tracked using validated clinician- and patient-reported outcome measures such as the Performance Status Scale for Head and Neck Cancer, MD Anderson Dysphagia Inventory, and Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN). Subjective and objective evaluation measures are critical to dysphagia workup and management. Building a renewed image after head and neck cancer treatment, a brief telemedicine-based cognitive behavioral therapy, has become the first evidence-based treatment for BID among HNC survivors.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA; Department of Public Health Sciences, Medical University of South Carolina
| | - Carly E A Barbon
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Unit 1445, 1515 Holcombe Boulevard, Houston, TX 77030-400, USA.
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Ivanova A, Rodríguez-Cano R, Kvalem IL, Harcourt D, Kiserud CE, Amdal CD. Body image concerns in long-term head and neck cancer survivors: prevalence and role of clinical factors and patient-reported late effects. J Cancer Surviv 2023; 17:526-534. [PMID: 36509859 PMCID: PMC10036408 DOI: 10.1007/s11764-022-01311-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Head and neck cancer (HNC) patients are at risk of long-term body image distress (BID). We aimed to investigate the severity of BID in long-term HNC survivors and to explore the associations between sociodemographic and clinical factors, patient-reported late effects, and cancer-related body image (BI) concerns. METHODS This cross-sectional study included quality of life and BI assessment in an 8-year (SD = 1.58) follow-up after treatment among 258 HNC survivors. Multinomial logistic regression analysis was used to investigate the relationship between three groups of BI concerns (no concerns, mild to moderate concerns, and BID) and patient-reported late effects. Sociodemographic and clinical variables were included in the model as covariates. RESULTS A total of 51.2% of participants had mild to moderate BI concerns, and 9.5% reported BID. Compared to those with no BI concerns, participants with BID were more likely to live without a partner, to have had radiotherapy and surgery, and to report worse emotional functioning and higher oral and throat pain. Compared to participants with no BI concerns, those with mild to moderate concerns reported higher oral and throat pain and speech problems. CONCLUSIONS Some level of cancer-related BI concerns persisted in the majority of HNC survivors many years after treatment, while a small proportion of survivors experienced BID. BI concerns were associated with treatment modality and patients' daily functioning and symptoms. IMPLICATIONS FOR CANCER SURVIVORS Insight into factors associated with BI problems may help to identify survivors at risk and may facilitate closer follow-up of survivors in need.
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Affiliation(s)
- Anna Ivanova
- Department of Psychology, University of Oslo, Blindern, PB 1094, 0317, Oslo, Norway.
| | - Rubén Rodríguez-Cano
- Department of Psychology, University of Oslo, Blindern, PB 1094, 0317, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ingela Lundin Kvalem
- Department of Psychology, University of Oslo, Blindern, PB 1094, 0317, Oslo, Norway
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | | | - Cecilie D Amdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Research support services, Oslo University Hospital, Oslo, Norway
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Dealing with the Vicissitudes and Abject Consequences of Head and Neck Cancer: A Vital Role for Psycho-Oncology. Curr Oncol 2022; 29:6714-6723. [PMID: 36135096 PMCID: PMC9497961 DOI: 10.3390/curroncol29090527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/22/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Patients with head and neck cancer face important life-altering effects in appearance and function, affecting distress and quality of life and requiring the involvement of a multidisciplinary team. Psycho-oncology makes an important contribution to the field, as head and neck cancers carry a huge adaptational toll. To illustrate the value of this discipline, we report two cases of patients with advanced head and neck cancer for which the treatment-related body changes were of major significance. A commentary by the treating surgeons and psycho-oncologists precedes a general discussion about the clinical management of such patients. The article outlines strategies to address health literacy, doctor–patient communication, treatment decision-making, and emotional distress; placing the person at the center of oncological care. It calls for the broad application of principles of psychological first aid by healthcare professionals in oncology.
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7
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Biopsychosocial Markers of Body Image Concerns in Patients with Head and Neck Cancer: A Prospective Longitudinal Study. Curr Oncol 2022; 29:4438-4454. [PMID: 35877213 PMCID: PMC9319375 DOI: 10.3390/curroncol29070353] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
(1) Background: Patients and survivors of head and neck cancer (HNC) are at a high risk of developing body image concerns. Despite the prevalence of body image concerns in patients with HNC, there is a lack of longitudinal research exploring the wide array of its associated determinants. The current longitudinal study examined the determinants and longitudinal course of body image dissatisfaction in patients with HNC. (2) Methods: Patients participated in Structured Clinical Interviews and self-administered questionnaires at four time-points: (T1) upon cancer diagnosis, (T2) at 3 months post-diagnosis, (T3) at 6 months post-diagnosis, and (T4) at 12 months post-diagnosis. They also underwent a disfigurement rating on an objective scale. (3) Results: Two hundred and twenty-four patients participated in our study. Fourteen percent to twenty-eight percent of patients reported at least moderate body image concerns across time points, with the lowest rates at baseline and the highest at 3 months (T1). It was found that patients more predisposed to developing higher levels of body image concerns presented physical markers (i.e., advanced cancer stage, lower physical functioning, higher disfigurement), psychosocial markers (i.e., higher depression, higher anxiety, and higher levels of coping with denial), and health disparities (i.e., younger age, female sex, French language, and marital status, with divorced and widowers most affected). (4) Conclusions: The findings of this study highlight the multifaceted nature of body image concerns in patients with HNC and its biopsychosocial determinants. Clinicians should pay specific attention to these biopsychosocial markers in their clinics to predict high levels of body image concerns and tailor communication/refer for support accordingly.
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8
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Henry M, Albert JG, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Richardson K, Mascarella M, Morand GB, Chartier G, Sadeghi N, Lo C, Rosberger Z. Body Image Concerns in Patients With Head and Neck Cancer: A Longitudinal Study. Front Psychol 2022; 13:816587. [PMID: 35401366 PMCID: PMC8988682 DOI: 10.3389/fpsyg.2022.816587] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Head and neck cancer (HNC) treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: (1) the prevalence, level, and course of body image concerns; (2) correlates of upon cancer diagnosis (pre-treatment) body image concerns; (3) predictors of immediate post-treatment body image concerns; and (4) association between body image concerns and levels of anxiety, depression, suicidal ideation, support (i.e., satisfaction with support from physician, social/family wellbeing, and unmet support needs), and alcohol and drug misuse. Methods Two hundred and twenty-three (participation rate = 72%), newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model. Results Sixty-eight percent of patients with HNC (n = 148 of 218) presented some level of body image concerns. Body image concerns at baseline (i.e., upon cancer diagnosis, pre-treatment) and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment (i.e., at 3 month follow-up), 89% (n = 132 of 148) presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism. Conclusion This longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions.
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Affiliation(s)
- Melissa Henry
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Oncology, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Justine G. Albert
- Department of Oncology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Saul Frenkiel
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Michael Hier
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Karen Kost
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Martin Black
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Christina MacDonald
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Marco Mascarella
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Gregoire B. Morand
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Gabrielle Chartier
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Christopher Lo
- Department of Psychology, College of Healthcare Sciences, James Cook University, Singapore, Singapore
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Zeev Rosberger
- Department of Oncology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
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Macias D, Hand BN, Pipkorn P, Williams AM, Chang SS, Zenga J, Nilsen ML, Rhoten BA, Huang AT, Osazuwa-Peters N, Maurer S, Balliet W, Li H, Ruggiero KJ, Sterba KR, Graboyes EM. Association of Inventory to Measure and Assess imaGe Disturbance - Head and Neck Scores With Clinically Meaningful Body Image-Related Distress Among Head and Neck Cancer Survivors. Front Psychol 2021; 12:794038. [PMID: 34956022 PMCID: PMC8702522 DOI: 10.3389/fpsyg.2021.794038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: The Inventory to Measure and Assess imaGe disturbance – Head and Neck (IMAGE-HN) is a validated patient-reported outcome measure of head and neck cancer-related body image-related distress (BID). However, the IMAGE-HN score corresponding to clinically relevant BID is unknown. The study objective is to determine the IMAGE-HN cutoff score that identifies head and neck cancer patients with clinically relevant BID. Methods: We conducted a cross-sectional study at six academic medical centers. Individuals ≥18 years old with a history of head and neck cancer treated with definitive intent were included. The primary outcome measure was the IMAGE-HN. A Receiver Operating Characteristic curve analysis was performed to identify the IMAGE-HN score that maximized sensitivity and specificity relative to a Body Image Scale score of ≥10 (which indicates clinically relevant BID in a general oncology population). To confirm the validity of the IMAGE-HN cutoff score, we compared the severity of depressive [Patient Health Questionnaire-9 (PHQ-9)] and anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7)], and quality of life [University of Washington-QOL (UW-QOL)] in patients with IMAGE-HN scores above and below the cutoff. Results: Of the 250 patients, 70.4% were male and the mean age was 62.3 years. An IMAGE-HN score of ≥22 was the optimal cutoff score relative to a Body Image Scale score of ≥10 and represents a clinically relevant level of head and neck cancer-related BID. Relative to those with an IMAGE-HN score of <22, patients with IMAGE-HN scores of ≥22 had a clinically meaningful increase in symptoms of depression (mean PHQ-9 score difference = 5.8) and anxiety (mean GAD-7 score difference = 4.1) as well as worse physical (mean UW-QOL score difference = 18.9) and social-emotional QOL (mean UW-QOL score difference = 21.5). Using an IMAGE-HN cutoff score ≥22, 28% of patients had clinically relevant BID. Conclusion: An IMAGE-HN score of ≥22 identifies patients with clinically relevant head and neck cancer-related BID. This score may be used to detect patients who could benefit from strategies to manage their distress, select patients for studies evaluating interventions to manage head and neck cancer-related BID, and improve our understanding of the underlying epidemiology of the disorder.
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Affiliation(s)
- David Macias
- Department of Otolaryngology, Head, and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, United States
| | - Patrik Pipkorn
- Department of Otolaryngology, Head, and Neck Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Amy M Williams
- Department of Otolaryngology, Head, and Neck Surgery, Henry Ford Health System, Detroit, MI, United States
| | - Steven S Chang
- Department of Otolaryngology, Head, and Neck Surgery, Henry Ford Health System, Detroit, MI, United States
| | - Joseph Zenga
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Marci L Nilsen
- Department of Otolaryngology, Head, and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Bethany A Rhoten
- Vanderbilt University School of Nursing, Nashville, TN, United States
| | - Andrew T Huang
- Bobby R. Alford Department of Otolaryngology, Head, and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Stacey Maurer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Hong Li
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Evan M Graboyes
- Department of Otolaryngology, Head, and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
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The psychometric properties of the Persian version of the body image after breast Cancer questionnaire: A second- order confirmatory factor analysis. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01741-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Graboyes EM, Hand BN, Ellis MA, Huang AT, Nilsen ML, Pipkorn P, Marsh CH, Maurer S, Day TA, Sterba KR. Validation of a Novel, Multidomain Head and Neck Cancer Appearance- and Function-Distress Patient-Reported Outcome Measure. Otolaryngol Head Neck Surg 2020; 163:979-985. [PMID: 32482151 DOI: 10.1177/0194599820927364] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Distress with self-perceived changes in appearance and function can result in body image disturbance (BID), which is common in head and neck cancer (HNC) survivors and a major source of psychosocial morbidity. To address the lack of psychometrically sound patient-reported outcome measures (PROMs) of HNC-related BID, we aim to create and validate the Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN). STUDY DESIGN Survey study. SETTING Multiple academic centers. SUBJECTS AND METHODS Following item development, HNC survivors from 4 academic centers completed the IMAGE-HN. Item responses were psychometrically analyzed using confirmatory factor analysis (CFA) and Rasch analysis. RESULTS Item development resulted in a 31-item PROM consisting of 5 individual domains and a global domain. In total, 305 HNC survivors of diverse ages, HNC subsites, and reconstructive paradigms completed the initial items. After removal of 3 items for local dependence, CFA confirmed the unidimensionality and local independence (item residual correlations <|0.20|) for each domain. Rasch analysis indicated acceptable fit (infit and outfit mean squares <2.0), monotonicity of all rating scale categories, and low person misfit (<4%). Person separation indices and person reliability were adequate for each domain except appearance concealment, which was removed (4 items). This resulted in the IMAGE-HN, a psychometrically acceptable 24-item PROM of HNC-related BID consisting of a global scale and 4 subscales measuring unique constructs and comprised independent items. CONCLUSIONS IMAGE-HN is a novel, psychometrically sound, multidomain PROM of HNC-related BID for use in clinical and research settings.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Mark A Ellis
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew T Huang
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Marci L Nilsen
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Courtney H Marsh
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stacey Maurer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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