Media Commercials Conveying Awareness Regarding Prevention of Head and Neck Cancer by Focusing on Stigmatized Perspective of Disease: Right or Wrong?

Diagnostic and Prognostic Accuracy of MMPs and TIMPs in Oral Cancer Patients on Enzyme-Linked Immunosorbent Assay (ELISA) as Compared to Immunohistochemistry (IHC)

Oral cancer is one of most common noncommunicable diseases that imposed significant burden on healthcare around the globe including India. Several molecular markers have been extensively researched for their potential as diagnostic and prognostic biomarkers for oral cancer. Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) found to play a crucial role in cytoskeleton dynamics and thus tumor growth and metastasis. The present study aims to analyze the MMP (MMP-1, MMP-3, MMP-9, and MMP-13) and TIMP (TIMP-1 and TIMP-3) expression in the oral cancer patients as compared to healthy controls. We also aim to compare the diagnostic accuracy of MMPs and TIMPs on enzyme-linked immunosorbent assay (ELISA) with respect to the immunohistochemistry (IHC). A total of 15 oral cancer patients and 14 healthy controls were enrolled in this study. Blood sample from oral cancer patients and healthy controls was obtained to analyze the MMP and TIMP expression levels in serum sample using ELISA. Tumor tissue sample from patients for IHC analysis was obtained by biopsy under local anesthesia. Data were compared between ELISA and IHC for sensitivity and specificity analysis. The mean age of the patients was 47.07 ± 15.74 years with the highest incidence of disease found in male gender (86.7%). MMPs and TIMPs exhibited higher expression in oral cancer patients as compared to healthy controls and the difference was statistically significant in case of MMP-13. MMPs and TIMPs showed stronger expression at advanced stages of cancer on IHC with MMP-9 exhibiting the highest expression level. The highest sensitivity and specificity on ELISA with respect to IHC were exhibited by the MMP-3 followed by MMP-13, TIMP-1, TIMP-3, and MMP-1. MMP-3 and MMP-13 were found to be reliable in terms of diagnostic marker for oral cancer as they found to have the highest sensitivity and specificity on ELISA with respect to IHC. MMP-9 was found to be reliable as a prognostic marker as it expresses highest on IHC at advanced stages of oral cancer.

Shame and Stigma Over Long-Term Survival in Postoperative Cases of Head and Neck Cancer

Background

Surgical excision of the tumor remains the primary choice for the treatment of head and neck cancer patients, but it often leads to facial disfigurement, which further causes mutilation in the patients. Mutilation causes shame and stigma, which imparts significant psychological strain on patients, and tends to impair their quality of life.

Objective

The present study aimed to assess the shame and stigma over long-term postoperative survival duration in head and neck cancer patients.

Methodology

Total 100 postoperative patients of head and neck cancer were recruited from the outpatient department of the host institute, and shame and stigma was assessed using the Hindi version of the shame and stigma scale.

Results

The global shame and stigma score was 22.67 ± 16.22, with the highest perceived stigma due to changes in appearance (11.94 ± 8.805), followed by impaired speech (4.490 ± 3.243), feeling of regret (3.950 ± 3.313), and feeling of stigma (4.490 ± 3.243). The shame and stigma was found to be significantly higher in maxillary cancer patients (33.22 ± 16.60), followed by larynx cancer patients (22.06 ± 13.41) and oral cancer patients (21.53 ± 16.49). Patients with stage III and stage IV of cancer were found to perceive higher shame and stigma (35.91 ± 22.23 and 27.36 ± 14.71, respectively) compared to the patients having stage I and stage II cancer (9.583 ± 9.709 and 16.44 ± 11.82, respectively). A significantly declining linear trend was found between shame and stigma and postoperative survival duration.

Conclusion

We concluded that shame and stigma act as important determinants of quality of life over long-term survival in head and neck cancer patients, and should be considered while designing psychological interventions and surgical reconstruction protocols. The present study will help clinicians to assess the mutilation among head and neck cancer patients in a better way and will help in devising new psychological strategies to manage psychological aspects associated with mutilation, which will ultimately enhance the quality of life of patients.

Serum Concentration of MMP-9 as a Predictive Biomarker for the Progression of Oral Cancer

Background

Oral cancer is the most prominent cancer subtype among all head and neck cancers, the incidence and prevalence of which has been consistently increasing in past years around the globe. At advanced stages, oral cancer imparts significant mortality, morbidity, and mutilation among the patients, and therefore, diagnosis and treatment of the disease at early stages are considered the optimum strategy for the management of the disease. Since molecular changes appear earlier than physical symptoms, several molecular biomarkers are currently being investigated for their role in diagnosing and treating disease. MMP-9 belongs to the family of proteinases that are involved in cytoskeletal degradation, which is a crucial phase of cancer progression.

Objective

In the present study, we analyzed the serum concentration of MMP-9 in oral cancer patients and tried to establish MMP-9 as a predictive biomarker for the progression of oral cancer. We also correlated the clinical, sociodemographic and biochemical parameters with the serum concentration of MMP-9 in oral cancer patients.

Methods

Serum was extracted from the blood sample of 38 oral cancer patients and was analyzed for the concentration of MMP-9 using sandwiched ELISA. Predesigned proforma was used to capture the clinical, sociodemographic and biochemical parameters. Unpaired t-test was used to compare two means, one way ANOVA was used to compare more than two means and Pearson's correlation was used to correlate the variables.

Results

The mean concentration of MMP-9 in patients of oral cancer was 816.9 ± 236.1 ng/mL. The MMP-9 expression level was higher at advanced oral cancer stages than in the early stages. No significant difference in the MMP expression was found in terms of sociodemographic risk factor and tumor site. MMP-9 exhibit significant negative correlation with the HDL and significantly positive correlation with the PTI. Rest of the biochemical parameters does not exhibit significant correlation.

Conclusion

The present study suggests that serum concentration of MMP-9 can be a predictive biomarker for the progression of oral cancer, which needs to be validated by performing further longitudinal cross-sectional studies by taking ample sample size.

Cut-off points to classify numeric values of quality of life into normal, mild, moderate, and severe categories: an update for EORTC-QLQ-H&N35

Background

Quality of life (QoL) is an important determinant of physical and mental health. QoL in head and neck cancer tends to deteriorate due to changes in the physical, functional, psychological aspects. EORTC-QLQ-H&N35 is an instrument that measure the QoL specifically in head and neck cancer patients. EORTC-QLQ-H&N35 give a numeric value to QoL of patients with high value correspond to better QoL.

Objective

The aim of present study was to find out the cut-off points of numeric values of EORTC-QLQ-H&N35 to categorize QoL impairment into different categories (normal, mild, moderate, and severe). Present study also aims analyze the QoL among head and neck cancer patients under these new categories.

Methodology

Total 205 patients of head and neck cancer visiting to the outpatient unit were enrolled in this study. Hindi version of EORTC-QLQ-H&N35 was used to evaluate the QoL. Total 9 classification schemes were created with different cut-off points to classify the global QoL score into normal, mild, moderate and severe categories. QoL data was then analyze using the scheme having highest F value in ANOVA test.

Results

Classification scheme having cut-off values 76–100 for normal QoL, 51–75 for mild QoL impairment, 26–50 for moderate and 0–25 for severe QoL impairment found to have highest F value (729.915) in ANOVA test. The mean QoL score among total 205 patients were 60.08 ± 19.06. Based on the new classification scheme, QoL was normal in 46 (22.4%) patients whereas QoL was impaired to mild level in 76 (37.1%) patients, to moderate level in 76 (37.1%) and to severe level in 7 (3.4%) patients. Role functioning, emotional functioning and social functioning was impaired to severe level in 4 (2.0%), 13 (6.3%) and 3 (1.5%) patients respectively.

Conclusion

EORTC-QLQ-H&N35 offer a comprehensive review of QoL in head and neck cancer patients. By designating the QoL score into different categories, it will become easier for clinician to have a better idea of QoL of head and neck cancer patients.

Assessment of Shame and Stigma in Head and Neck Cancer: A Meta-Analysis

Background

Head and neck cancer is the most common cancer around the globe, following lung cancer and breast cancer. Treatment at advanced stages of head and neck cancer is usually followed intense surgical procedures, which leads to mutilation among patients. Mutilation imparts a sense of disgrace and causes a feeling of shame and stigma in the patient. The feeling of shame and stigma persists over time and affects the overall long-term survival of patients by deteriorating their quality of life.

Objectives

Since shame and stigma is an important psychological domain of head and neck cancer, the present article aims toward evaluating the studies published so far for the assessment of shame and stigma in head and neck cancer and highlighting the lacunae in the existing research designs. The present study also aims to design a checklist that could be followed while developing, translating, or validating a psychometric instrument that aims to measure shame and stigma in head and neck cancer.

Methods

In the present metanalysis, all articles published in the past years on shame and stigma in head and neck cancer was compiled using a predefined data extraction matrix. The available literature was compiled for major objectives of the study, the sample size used, major findings, and critical lacunae that need to be addressed.

Results

Shame and stigma is a very important domain of psychological well-being in head and neck cancer patients, which yet not appropriately addressed and further need to be researched.

Conclusion

Future studies could be based on the lacunae highlighted in the existing literature, and the prescribed methodology checklist could be taken into consideration while conducting further studies involving developing, translating, or validating a psychometric instrument related to shame and stigma in the head and neck cancer.

Accuracy of a self-reported Measure in Psychological Assessment when the Instrument is self-administered by the Patient or when Administrated by the Clinician

Background

Self-reported measures are the questionnaire-based instrument that are routinely used in the clinical scenario to assess psychological health. Technically, the self-reported measure should be administrated by the patients themselves but due to the complexity of tools and illiteracy among patients, clinicians often tend to interview the patients.

Objective

Present article aims to compare the accuracy of a self-reported measure in the assessment of the psychological health of a patient when the instrument is self-administrated by the patient and when administrated by the clinician or researcher.

Methods

We have recruited 43 patients of oral cancer in the study who have a tumor in the buccal mucosa region. The Hindi version of the shame and stigma scale was used to analyse the shame and stigma in patients. The questionnaire was first provided to the patient for the self-administration and after that clinician administrated the questionnaire to the patient by keeping the clinician blinded to the patient self-administrated responses.

Results

There was no significant difference in the global mean score and mean score of various subdomains of shame and stigma scale in the self-administered and clinician-administered mode of interview. However, the clinician-administered mode could provide more accurate measures as it helps the patient towards a better understanding of questions.

Conclusion

It is recommended that the newly developed or translated self-reported measure should be tested for both patient administrated and clinician administrated compatibility. Questionnaires could be administrated by the clinician in the case when the patient is illiterate or in the case when the patient does not understand the language of the instrument.

Case report on surgical removal of 3.5 kg benign mesenchymal tumor from the mandible region

Background

Benign mesenchymal tumors are rare tumors accounting for 5% of all salivary gland tumors and less than 10% of submandibular or sublingual gland tumors.

Case presentation

The present case study represents a rare case of large-size benign mesenchymal tumors arising from the mandible region. The patient comes with the complaint of prominent swelling on the right side of the lower jaw. Clinical history revealed that the swelling appeared around 5 years ago and enhanced over time to form a large tumor. The patient presented with signs of anemia and hypoproteinemia, which were developed due to dysphagia and bleeding in the tumor. A worm infestation was also found during the clinical examination, and severe pain, foul smell, fungating tumor, frequent pus discharge, and bleeding were also reported. The patient was treated by surgical removal of tumors within 8 h of surgery. Right segmental mandibulectomy with wide local tumor excision was performed under general anesthesia and prophylactic tracheostomy to maintain a secure airway. A huge defect of 8 cm × 6 cm was generated on the right side of the face after tumor removal, which was repaired with the help of local advancement flap reconstruction. The tumor size was 30 cm × 20 cm with a weight of 3.5 kg.

Conclusion

To our best knowledge, the present study is the first in the literature that has reported such a large tumor in the mandible region. The success of surgery presented in the current case is very rare to achieve in developing countries. By reporting the detailed procedures, the present case study will help increase the misdiagnosis, improper treatment, treatment delays, or associated complications.