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Huynh TTM, Falk RS, Hellebust TP, Dale E, Astrup GL, Hjermstad MJ, Malinen E, Bjordal K, Kiserud CE, Herlofson BB, Nome R, Amdal CD. Chronic fatigue in long-term survivors of head and neck cancer treated with radiotherapy. Radiother Oncol 2024; 195:110231. [PMID: 38518958 DOI: 10.1016/j.radonc.2024.110231] [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: 11/17/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND There is lack of evidence on chronic fatigue (CF) following radiotherapy (RT) in survivors of head and neck cancer (HNC). We aimed to compare CF in HNC survivors > 5 years post-RT with a reference population and investigate factors associated with CF and the possible impact of CF on health-related quality of life (HRQoL). MATERIAL AND METHODS In this cross-sectional study we included HNC survivors treated in 2007-2013. Participants filled in patient-reported outcome measures and attended a one-day examination. CF was measured with the Fatigue Questionnaire and compared with a matched reference population using t-tests and Cohen's effect size. Associations between CF, clinical and RT-related factors were investigated using logistic regression. HRQoL was measured with the EORTC Quality of Life core questionnaire. RESULTS The median age of the 227 HNC survivors was 65 years and median time to follow-up was 8.5 years post-RT. CF was twice more prevalent in HNC survivors compared to a reference population. In multivariable analyses, female sex (OR 3.39, 95 % CI 1.82-6.31), comorbidity (OR 2.17, 95 % CI 1.20-3.94) and treatment with intensity-modulated RT (OR 2.13, 95 % CI 1.16-3.91) were associated with CF, while RT dose parameters were not. Survivors with CF compared to those without, had significantly worse HRQoL. CONCLUSIONS CF in HNC survivors is particularly important for female patients, while specific factors associated with RT appear not to play a role. The high CF prevalence in long-term HNC survivors associated with impaired HRQoL is important information beneficial for clinicians and patients to improve patient follow-up.
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Affiliation(s)
- Thuy-Tien Maria Huynh
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway.
| | | | - Taran Paulsen Hellebust
- Department of Physics, University of Oslo, Oslo, Norway; Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Einar Dale
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | | | - Eirik Malinen
- Department of Physics, University of Oslo, Oslo, Norway; Department of Radiation Biology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Kristin Bjordal
- Faculty of Medicine, University of Oslo, Oslo, Norway; Research Support Services, Oslo University Hospital, Oslo, Norway
| | | | - Bente Brokstad Herlofson
- Faculty of Dentistry, University of Oslo, Oslo, Norway; Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Nome
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Cecilie Delphin Amdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Research Support Services, Oslo University Hospital, Oslo, Norway
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Govender R, Gilbody N, Simson G, Haag R, Robertson C, Stuart E. Post-Radiotherapy Dysphagia in Head and Neck Cancer: Current Management by Speech-Language Pathologists. Curr Treat Options Oncol 2024:10.1007/s11864-024-01198-0. [PMID: 38691257 DOI: 10.1007/s11864-024-01198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 05/03/2024]
Abstract
OPINION STATEMENT Dysphagia, difficulty in eating and drinking, remains the most common side effect of radiotherapy treatment for head and neck cancer (HNC) with devastating consequences for function and quality of life (QOL). Over the past decade, 5-year survival has improved due to multiple factors including treatment advances, reduction in smoking, introduction of the human papillomavirus (HPV) vaccine and more favourable prognosis of HPV-related cancers. Increased prevalence of HPV-positive disease, which tends to affect younger individuals, has led to an elevated number of people living for longer with the sequelae of cancer and its treatment. Symptoms are compounded by late effects of radiotherapy which may lead to worsening of dysphagia for some long-term survivors or new-onset dysphagia for others. Speech-language pathology (SLP) input remains core to the assessment and management of dysphagia following HNC treatment. In this article, we present current SLP management of dysphagia post-radiotherapy. We discuss conventional treatment approaches, the emergence of therapy adjuncts and current service delivery models. The impact of adherence on therapy outcomes is highlighted. Despite treatment advancements, patients continue to present with dysphagia which is resistant to existing intervention approaches. There is wide variation in treatment programmes, with a paucity of evidence to support optimal type, timing and intensity of treatment. We discuss the need for further research, including exploration of the impact of radiotherapy on the central nervous system (CNS), the link between sarcopenia and radiotherapy-induced dysphagia and the benefits of visual biofeedback in rehabilitation.
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Affiliation(s)
- Roganie Govender
- Head & Neck Academic Centre& UCL Division of Surgery & Interventional ScienceGround Floor Central, University College London Hospital, 250 Euston Road, London, NW1 2PQ, UK.
| | - Nicky Gilbody
- North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - Ceri Robertson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Emma Stuart
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
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Hong YR, Wang R, Case S, Jo A, Turner K, Ross KM. Association of food insecurity with overall and disease-specific mortality among cancer survivors in the US. Support Care Cancer 2024; 32:309. [PMID: 38664265 DOI: 10.1007/s00520-024-08495-2] [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: 10/30/2023] [Accepted: 04/10/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To investigate the association of food insecurity with overall and disease-specific mortality among US cancer survivors. METHODS Data from the National Health and Nutrition Examination Survey (NHANES 1999-2018) were used to examine the impact of food insecurity on mortality risks among cancer survivors in the US. Study participants aged ≥ 20 years who had a history of cancer and completed the Adult Food Security Survey Module were included. Mortality data [all-cause, cancer, and cardiovascular (CVD) specific] through December 31, 2019 were obtained through linkage to the National Death Index. Using multivariable Cox proportional hazard regression, hazard ratios of mortality based on food security status were estimated. RESULTS Among 5032 cancer survivors (mean age 62.5 years; 58.0% women; 86.2% non-Hispanic White), 596 (8.8%) reported food insecurity. Overall, 1913 deaths occurred (609 cancer deaths and 420 CVD deaths) during the median follow-up of 6.8 years. After adjusting for age, food insecurity was associated with a higher risk of overall (HR = 1.93; 95% CI = 1.56-2.39), CVD-specific (HR = 1.95; 95% CI = 1.24-3.05), and cancer-specific (HR = 1.70; 95% CI = 1.20-2.42) mortality (P < 0.001). However, after adjusting for socioeconomic characteristics and health-related factors (physical activity, diet quality measured by healthy eating index), the association between food insecurity and overall mortality was no longer statistically significant. CONCLUSIONS Food insecurity was associated with a greater risk of overall mortality among cancer survivors. Further studies are needed to confirm these findings and evaluate whether the observed association represents a causal phenomenon and, if so, whether the effect is modifiable with food assistance programs.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
| | - Ruixuan Wang
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Stuart Case
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Ara Jo
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Salz T, Chimonas S, Jinna S, Brens J, Kriplani A, Salner A, Rabinowits G, Currier B, Daly B, Korenstein D. Pain management for post-treatment survivors of complex cancers: a qualitative study of opioids and cannabis. Pain Manag 2024; 14:87-99. [PMID: 38318666 PMCID: PMC10918509 DOI: 10.2217/pmt-2023-0067] [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: 07/11/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024] Open
Abstract
Aim: We aimed to understand experiences with opioids and cannabis for post-treatment cancer survivors. Patients & methods: We conducted seven focus groups among head and neck and lung cancer survivors, using standard qualitative methodology to explore themes around 1) post-treatment pain and 2) utilization, perceived benefits and perceived harms of cannabis and opioids. Results & conclusion: Survivors (N = 25) experienced addiction fears, stigma and access challenges for both products. Opioids were often perceived as critical for severe pain. Cannabis reduced pain and anxiety for many survivors, suggesting that anxiety screening, as recommended in guidelines, would improve traditional pain assessment. Opioids and cannabis present complex harms and benefits for post-treatment survivors who must balance pain management and minimizing side effects.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Susan Chimonas
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Sankeerth Jinna
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Jessica Brens
- Memorial Sloan Kettering Cancer Center, Department of Advanced Practice Providers, New York, NY 10065, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY 10065, USA
| | - Andrew Salner
- Hartford Hospital, Department of Radiation Oncology, Hartford, CT 06106, USA
| | - Guilherme Rabinowits
- Moffit Cancer Center, Department of Head and Neck-Endocrine Oncology, Tampa, FL 33612, USA
| | - Beatriz Currier
- Miami Cancer Institute, Department of Medicine, Miami, FL 33176, USA
| | - Bobby Daly
- Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY 10065, USA
| | - Deborah Korenstein
- Mount Sinai Hospital, Department of Internal Medicine, New York, NY 10001, USA
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Huynh TTM, Dale E, Falk RS, Hellebust TP, Astrup GL, Malinen E, Edin NFJ, Bjordal K, Herlofson BB, Kiserud CE, Helland Å, Amdal CD. Radiation-induced long-term dysphagia in survivors of head and neck cancer and association with dose-volume parameters. Radiother Oncol 2024; 190:110044. [PMID: 38061420 DOI: 10.1016/j.radonc.2023.110044] [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: 05/31/2023] [Revised: 11/19/2023] [Accepted: 11/29/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Although dysphagia is a common side effect after radiotherapy (RT) of head and neck cancer (HNC), data on long-term dysphagia is scarce. We aimed to 1) compare radiation dose parameters in HNC survivors with and without dysphagia, 2) investigate factors associated with long-term dysphagia and its possible impact on health-related quality of life (HRQoL), and 3) investigate how our data agree with existing NTCP models. METHODS This cross-sectional study conducted in 2018-2020, included HNC survivors treated in 2007-2013. Participants attended a one-day examination in hospital and filled in patient questionnaires. Dysphagia was measured with the EORTC QLQ-H&N35 swallowing scale. Toxicity was scored with CTCAE v.4. We contoured swallowing organs at risk (SWOAR) on RT plans, calculated dose-volume histograms (DVHs), performed logistic regression analyses and tested our data in established NTCP models. RESULTS Of the 239 participants, 75 (31%) reported dysphagia. Compared to survivors without dysphagia, this group had reduced HRQoL and the DVHs for infrahyoid SWOAR were significantly shifted to the right. Long-term dysphagia was associated with age (OR 1.07, 95% CI 1.03-1.10), female sex (OR 2.75, 95% CI 1.45-5.21), and mean dose to middle pharyngeal constrictor muscle (MD-MPCM) (OR 1.06, 95% CI 1.03-1.09). NTCP models overall underestimated the risk of long-term dysphagia. CONCLUSIONS Long-term dysphagia was associated with higher age, being female, and high MD-MPCM. Doses to distally located SWOAR seemed to be risk factors. Existing NTCP models do not sufficiently predict long-term dysphagia. Further efforts are needed to reduce the prevalence and consequences of this late effect.
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Affiliation(s)
- Thuy-Tien Maria Huynh
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway.
| | - Einar Dale
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Taran Paulsen Hellebust
- Department of Physics, University of Oslo, Oslo, Norway; Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | | | - Eirik Malinen
- Department of Physics, University of Oslo, Oslo, Norway; Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | | | - Kristin Bjordal
- Faculty of Medicine, University of Oslo, Oslo, Norway; Research support services, Oslo University Hospital, Oslo, Norway
| | - Bente Brokstad Herlofson
- Faculty of Dentistry, University of Oslo, Oslo, Norway; Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Åslaug Helland
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Cecilie Delphin Amdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway; Research support services, Oslo University Hospital, Oslo, Norway
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Wang Y, Hou L, Wang M, Xiang F, Zhao X, Qian M. Autologous Fat Grafting for Functional and Aesthetic Improvement in Patients with Head and Neck Cancer: A Systematic Review. Aesthetic Plast Surg 2023; 47:2800-2812. [PMID: 37605032 DOI: 10.1007/s00266-023-03331-0] [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: 02/15/2023] [Accepted: 03/15/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION The efficacy and safety of autologous fat grafting for use in oncology patients are controversial. Patients with head and neck cancer have complex anatomy and require reconstructive repair of the head and neck after comprehensive treatment. The limited additional aesthetic and functional studies on the use of autologous fat fillers in patients with head and neck cancer are unclear. This study systematically evaluates the additional function of autologous fat fillers in the head and neck and systematically reviews issues related to autologous fat grafting after comprehensive head and neck cancer treatment, including current indications, techniques, potential complications, graft survival, and patient satisfaction. METHODS A systematic literature review was performed using PubMed, The Cochrane Library, EMBASE, and Web of Science (last accessed on January 9, 2023). RESULTS A total of 249 cases of autologous fat fillers in patients with head and neck cancer were reported in 10 clinical publications. Observations were based mainly on subjective physician and patient evaluation indicators, and all studies reported the beneficial effects of autologous fat fillers on aesthetics and function after treatment for head and neck cancer. CONCLUSIONS Autologous fat fillers are effective in improving the aesthetics and function of head and neck cancer, and due to the limitations of the original study, future studies with large samples are needed to support this. PROSPERO registration number is CRD42020222870. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yu Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, Sichuan, China.
- Nursing Department, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Lili Hou
- Nursing Department, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Mingyi Wang
- Department of Oral Maxillofacial and Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Fuping Xiang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, Sichuan, China
- Nursing Department, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xiaomei Zhao
- Department of Oral Maxillofacial and Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Meizhen Qian
- Department of Oral Maxillofacial and Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
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Granström B, Isaksson J, Westöö N, Holmlund T, Tano K, Laurell G, Tiblom Ehrsson Y. Perceptions of life and experiences of health care support among individuals one year after head and neck cancer treatment - An interview study. Eur J Oncol Nurs 2023; 66:102383. [PMID: 37506610 DOI: 10.1016/j.ejon.2023.102383] [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: 03/02/2023] [Revised: 06/09/2023] [Accepted: 07/01/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE To examine how individuals treated for head and neck cancer perceive life one year after the end of treatment and how they experience supportive efforts from health care. METHODS A semi-structured interview study of 21 patients was performed one year after the end of treatment. The patients gave their views concerning physical, psychological, and return-to-work issues, and their experiences concerning rehabilitative efforts from health care and particularly the contact nurse were captured. A thematic analysis was conducted. RESULTS One year after treatment the patients were still suffering from side effects and from fear of recurrence, but they strived to live as they did before the cancer diagnosis, such as having returned to work and resuming leisure activities. Moreover, the rehabilitative efforts from health care had ended. Having access to a contact nurse, also known as a clinical nurse specialist, was positive, however, the participants lacked regular long-term follow-ups with the contact nurse regarding rehabilitation needs. Improvement possibilities were seen in clarifying the role of the contact nurse and that the contact nurse should show engagement and make the initial contact with the patients. CONCLUSION Despite the sequelae from treatment, the patients strived to live as before their diagnosis. By regular, engaged, and long-term follow-ups by the contact nurse, remaining needs may be uncovered, and appropriate individualized support and rehabilitation can be offered.
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Affiliation(s)
- Brith Granström
- Department of Clinical Science, Otorhinolaryngology, Umeå University, Umeå, Sweden.
| | - Joakim Isaksson
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Nilla Westöö
- Ear, Nose, and Throat Clinic, Uppsala University Hospital, Uppsala, Sweden
| | - Thorbjörn Holmlund
- Department of Clinical Science, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Krister Tano
- Department of Clinical Science/ENT/Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Ylva Tiblom Ehrsson
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
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Huynh TTM, Aass HCD, Falk RS, Astrup GL, Helland Å, Bjøro T, Bjordal K, Dale E, Hellebust TP, Herlofson BB, Malinen E, Kiserud CE, Osnes T, Amdal CD. Associations between patient-reported late effects and systemic cytokines in long-term survivors of head and neck cancer treated with radiotherapy. J Cancer Surviv 2023; 17:1082-1093. [PMID: 36350483 PMCID: PMC9643919 DOI: 10.1007/s11764-022-01273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE Head and neck cancer (HNC) treatment may lead to late effects and impaired health-related quality of life of survivors. Knowledge on long-term late effects after radiotherapy (RT) and potential underlying biological mechanisms is lacking. We assessed the prevalence of xerostomia, dysphagia, and chronic fatigue (CF) in HNC survivors ≥ 5 years post-RT, and examined associations between pro-inflammatory cytokines and late effects. METHODS In a cross-sectional study, 263 HNC survivors treated between 2007 and 2013 were enrolled. They completed validated questionnaires assessing xerostomia and dysphagia (the EORTC QLQ-H&N35), and CF (the Fatigue Questionnaire), and underwent blood sampling and clinical examination. Pro-inflammatory cytokines were analyzed in 262 survivors and 100 healthy age- and gender-matched controls. RESULTS Median time since treatment was 8.5 years. The proportions of survivors reporting xerostomia, dysphagia, and CF were 58%, 31%, and 33%, respectively, with a preponderance of females. We found no significant associations between IL-6, IL-8, IP-10, TARC, TNF, or ENA-78 and the three late effects. The odds of having elevated levels of IL-6 and IP-10 were significantly higher in the survivors compared to the controls. CONCLUSIONS More than one-third of long-term HNC survivors experienced xerostomia, dysphagia, and CF. Persistent inflammation, with elevated systemic cytokines, was not associated with these late effects, although HNC survivors had higher levels of some cytokines than the controls. IMPLICATIONS FOR CANCER SURVIVORS This study provides new knowledge on late effects that can serve as grounds for informing patients with HNC about risk of late effects more than 5 years after RT.
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Affiliation(s)
- T T M Huynh
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway.
| | - H C D Aass
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - R S Falk
- Research Support Services, Oslo University Hospital, Oslo, Norway
| | - G L Astrup
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - Å Helland
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - T Bjøro
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - K Bjordal
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Support Services, Oslo University Hospital, Oslo, Norway
| | - E Dale
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - T P Hellebust
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - B B Herlofson
- Faculty of Dentistry, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - E Malinen
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - C E Kiserud
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - T Osnes
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - C D Amdal
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
- Research Support Services, Oslo University Hospital, Oslo, Norway
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de Maar JS, Zandvliet MMJM, Veraa S, Tobón Restrepo M, Moonen CTW, Deckers R. Ultrasound and Microbubbles Mediated Bleomycin Delivery in Feline Oral Squamous Cell Carcinoma—An In Vivo Veterinary Study. Pharmaceutics 2023; 15:pharmaceutics15041166. [PMID: 37111651 PMCID: PMC10142092 DOI: 10.3390/pharmaceutics15041166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023] Open
Abstract
To investigate the feasibility and tolerability of ultrasound and microbubbles (USMB)-enhanced chemotherapy delivery for head and neck cancer, we performed a veterinary trial in feline companion animals with oral squamous cell carcinomas. Six cats were treated with a combination of bleomycin and USMB therapy three times, using the Pulse Wave Doppler mode on a clinical ultrasound system and EMA/FDA approved microbubbles. They were evaluated for adverse events, quality of life, tumour response and survival. Furthermore, tumour perfusion was monitored before and after USMB therapy using contrast-enhanced ultrasound (CEUS). USMB treatments were feasible and well tolerated. Among 5 cats treated with optimized US settings, 3 had stable disease at first, but showed disease progression 5 or 11 weeks after first treatment. One cat had progressive disease one week after the first treatment session, maintaining a stable disease thereafter. Eventually, all cats except one showed progressive disease, but each survived longer than the median overall survival time of 44 days reported in literature. CEUS performed immediately before and after USMB therapy suggested an increase in tumour perfusion based on an increase in median area under the curve (AUC) in 6 out of 12 evaluated treatment sessions. In this small hypothesis-generating study, USMB plus chemotherapy was feasible and well-tolerated in a feline companion animal model and showed potential for enhancing tumour perfusion in order to increase drug delivery. This could be a forward step toward clinical translation of USMB therapy to human patients with a clinical need for locally enhanced treatment.
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Affiliation(s)
- Josanne S. de Maar
- Imaging and Oncology Division, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Maurice M. J. M. Zandvliet
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Stefanie Veraa
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Mauricio Tobón Restrepo
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Chrit T. W. Moonen
- Imaging and Oncology Division, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
| | - Roel Deckers
- Imaging and Oncology Division, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, The Netherlands
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10
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Ebersole BM, McMillan H, Hutcheson K. Evaluation and Management of Speech and Swallowing Issues in RFS. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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Caetano RS, Lima FF, Gomes EP, Volpato LE. Quality of Life of Patients After Treatment for Cancer in the Head and Neck Region: A Case-Control Study. Cureus 2022; 14:e25800. [PMID: 35822149 PMCID: PMC9270949 DOI: 10.7759/cureus.25800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction: It is known that side effects caused by antineoplastic therapy can affect patients' quality of life (QOL). However, the long-term effects on patients’ quality of life are not well known. This study aimed to evaluate patients' quality of life who underwent radiotherapy for head and neck cancer lasting more than six months compared to individuals who did not experience treatment. Methods: Thirty-three patients who underwent treatment for cancer in the head and neck region for at least six months and sixty-six individuals without cancer matched for age and sex were given the European Organization for Research and Treatment of Cancer QLQ-C30/QLQ-H & N35 questionnaires. Other pertinent information from patients was taken from the hospital chart. The Mann-Whitney nonparametric test was applied to verify the statistical significance of the difference in means between the groups, and a significance of 5% was considered. Results: Group 1 consisted of 33 patients with a mean age of 63.42 ± 11.25 years; 81.8% were smokers; 84.8% were drinkers; the sites most affected by cancer were the palate/oropharynx and the floor of the mouth (7 cases), and the most common type was epidermoid carcinoma (78.79%). The overall quality of life was 61.62. Among group 2 patients, the average age was 64.27; 84.85% were smokers, and 65.15% were drinkers. The overall quality of life was 71.46 in group 2. There was a group of variables in which the scores of patients without cancer were statistically lower (better quality of life) than those presented by cancer patients, namely, loss of appetite, pain, swallowing, cognitive problems, speech problems, problems eating in public, sexuality, teeth, mouth opening, dry mouth, sticky saliva, nutritional supplements, feeding tube, and weight gain. Conclusion: Patients who underwent antineoplastic treatment for more than six months had a worse overall quality of life than individuals who did not experience such treatment. These patients had worse results in the components of appetite loss, pain, swallowing, cognitive problems, speech problems, problems with public eating, sexuality, teeth, mouth opening, dry mouth, sticky saliva, nutritional supplement, feeding tube, and weight gain.
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Vermaire JA, Raaijmakers CPJ, Monninkhof EM, Leeuw IMVD, Terhaard CHJ, Speksnijder CM. Factors associated with masticatory function as measured with the Mixing Ability Test in patients with head and neck cancer before and after treatment: a prospective cohort study. Support Care Cancer 2022; 30:4429-4436. [PMID: 35106658 PMCID: PMC8942951 DOI: 10.1007/s00520-022-06867-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022]
Abstract
Purpose After treatment for head and neck cancer (HNC), patients often experience major problems in masticatory function. The aim of this prospective cohort study among patients with HNC was to investigate which personal and clinical factors are associated with masticatory function from diagnosis up to 2 years after treatment with curative intent. Methods Masticatory function was measured using the Mixing Ability Test (MAT) before treatment (baseline), and 3, 6, 12, and 24 months after treatment. A linear mixed-effects model with a random intercept and slope was conducted to investigate changes over time and the association with personal (sex, age) and clinical (tumor site, tumor stage, treatment modality) factors as measured at baseline. Result One-hundred-twenty-five patients were included. The prevalence of masticatory dysfunction was estimated at 29% at M0, 38% at M3, 28% at M6, 26% at M12, and 36% at M24. A higher (worse) MAT score was associated with age, tumor stage, tumor site, timing of assessment, and the interaction between assessment moment and tumor site. Conclusion In patients with HNC, masticatory function changed over time and dysfunction was associated with a higher age, a tumor in the oral cavity, a higher tumor stage, and a shorter time since treatment. The prevalence of masticatory dysfunction ranged from 26 to 38%. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-06867-0.
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Affiliation(s)
- Jorine A Vermaire
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis P J Raaijmakers
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Evelyn M Monninkhof
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Chris H J Terhaard
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, G05.122, P.O. Box 85.500, 3508 GA, Utrecht, the Netherlands. .,Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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Translation and Validation of University of Washington Quality of Life Questionnaire in Malayalam, an Indian Language. J Maxillofac Oral Surg 2021. [DOI: 10.1007/s12663-021-01573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ebersole B, McCarroll L, Ridge JA, Liu JC, Bauman J, Donnelly S, Galloway TJ. Identification and management of late dysfunction in survivors of head and neck cancer: Implementation and outcomes of an interdisciplinary quality of life (IQOL) clinic. Head Neck 2021; 43:2124-2135. [PMID: 33749012 DOI: 10.1002/hed.26681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/27/2021] [Accepted: 03/09/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Identifying and treating late dysfunction in survivors of head and neck cancer (HNC) is important; however, an effective way to do so is not established. METHODS A quality improvement initiative altering our HNC survivorship clinic to include surveillance by rehabilitation providers was undertaken. The nature of dysfunction identified, along with the number and type of referrals to ancillary/support services were collected and compared to baseline. RESULTS The baseline, single-provider, clinic evaluated 61 patients and referred 2 (3%) to ancillary/support services. Fifty-seven patients were evaluated in the interdisciplinary clinic, with 36 (63%) referred to at least one ancillary/support service for new/progressive dysfunction. Of 59 referrals made, 22 (37%) were for dysphagia, 17(29%) were for neck/shoulder dysfunction, and 28 (47%) were attended by the patient. CONCLUSION Many HNC survivors exhibit late dysfunction appropriate for referral to ancillary/support services. A survivorship clinic including surveillance by rehabilitation specialists may optimize identification of dysfunction.
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Affiliation(s)
- Barbara Ebersole
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Speech Pathology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Liane McCarroll
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Speech Pathology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - John A Ridge
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Jeffrey C Liu
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Jessica Bauman
- Department of Hematology Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Steven Donnelly
- Department of Surgical Oncology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
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Progress in the treatment of cancer patients - don't forget the gut feeling! Best Pract Res Clin Gastroenterol 2020; 48-49:101704. [PMID: 33317792 DOI: 10.1016/j.bpg.2020.101704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 01/31/2023]
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