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Milbury K, Rosenthal DI, Li Y, Ngo-Huang AT, Mallaiah S, Yousuf S, Fuller CD, Lewis C, Bruera E, Cohen L. Dyadic Yoga for Head and Neck Cancer Patients Undergoing Chemoradiation and their Family Caregivers. J Pain Symptom Manage 2024; 67:490-500. [PMID: 38447621 DOI: 10.1016/j.jpainsymman.2024.02.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/19/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Concurrent chemoradiation to treat head and neck cancer (HNC) may result in debilitating toxicities. Targeted exercise such as yoga therapy may buffer against treatment-related sequelae; thus, this pilot RCT examined the feasibility and preliminary efficacy of a yoga intervention. Because family caregivers report low caregiving efficacy and elevated levels of distress, we included them in this trial as active study participants. METHODS HNC patients and their caregivers were randomized to a 15-session dyadic yoga program or a waitlist control (WLC) group. Prior to randomization, patients completed standard symptom (MDASI-HN) and patients and caregivers completed quality of life (SF-36) assessments. The 15-session program was delivered parallel to patients' treatment schedules. Participants were re-assessed at patients' last day of chemoradiation and again 30 days later. Patients' emergency department visits, unplanned hospital admissions and gastric feeding tube placements were recorded over the treatment course and up to 30 days later. RESULTS With a consent rate of 76%, 37 dyads were randomized. Participants in the yoga group completed a mean of 12.5 sessions and rated the program as "beneficial." Patients in the yoga group had clinically significantly less symptom interference and HNC symptom severity and better QOL than those in the WLC group. They were also less likely to have a hospital admission (OR = 3.00), emergency department visit (OR = 2.14), and/or a feeding tube placement (OR = 1.78). CONCLUSION Yoga therapy appears to be a feasible, acceptable, and possibly efficacious behavioral supportive care strategy for HNC patients undergoing chemoradiation. A larger efficacy trial is warranted.
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Affiliation(s)
- Kathrin Milbury
- Department of Behavioral Science (K.M., S.Y.), 1155 Pressler St., Houston, Texas 77030, USA.
| | - David I Rosenthal
- Department of Radiation Oncology (D.I.R., C.D.F.), 1515 Holcombe Blvd., Houston, Texas 77030, USA
| | - Yisheng Li
- Department of Biostatistics (Y.L.), 1515 Holcombe Blvd., Houston, Texas 77030, USA
| | - An Thuy Ngo-Huang
- Department of Palliative, Rehabilitation & Integrative Medicine (A.T.N.-H., S.M., E.B.,L.C.), 1515 Holcombe Blvd., Houston, Texas 77030, USA
| | - Smitha Mallaiah
- Department of Palliative, Rehabilitation & Integrative Medicine (A.T.N.-H., S.M., E.B.,L.C.), 1515 Holcombe Blvd., Houston, Texas 77030, USA
| | - Sania Yousuf
- Department of Behavioral Science (K.M., S.Y.), 1155 Pressler St., Houston, Texas 77030, USA
| | - Clifton D Fuller
- Department of Radiation Oncology (D.I.R., C.D.F.), 1515 Holcombe Blvd., Houston, Texas 77030, USA
| | - Carol Lewis
- Department of Head and Neck Surgery (C.L.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation & Integrative Medicine (A.T.N.-H., S.M., E.B.,L.C.), 1515 Holcombe Blvd., Houston, Texas 77030, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation & Integrative Medicine (A.T.N.-H., S.M., E.B.,L.C.), 1515 Holcombe Blvd., Houston, Texas 77030, USA
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MiriMoghaddam M, Bohlouli B, Lai H, Ganatra S, Amin M. Healthcare Utilization of Oral and Oropharyngeal Cancer Patients in Emergency Department and Outpatient Settings: An 8-year Population-Based Study. Head Neck 2024; 46:1439-1449. [PMID: 38558155 DOI: 10.1002/hed.27753] [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] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION This study aimed to determine trends in the healthcare utilization by Oral Cavity and Oropharyngeal cancer patients across emergency department (ED) and outpatient settings in Alberta and examine the predictors of ED visits. METHODS This is a retrospective, population-based, cohort study using administrative data collected by all healthcare facilities between 2010 and 2019 in Alberta, Canada. Trend of visits to different facilities, patients' primary diagnosis, and predictors of ED visits were analyzed. RESULTS In total, 34% of patients had at least one cancer-related ED visit. With a rise of 31% in cancer incidence, there was a notable upswing in visits to outpatient clinics and community offices, while ED visits decreased. Cancer stage, rural residence, high material deprivation score, and treatments were found as predictors of ED visits. CONCLUSION Improved symptom management and better care access for disadvantaged and rural oral cancer patients may decrease avoidable ED visits.
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Affiliation(s)
- Masoud MiriMoghaddam
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Babak Bohlouli
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hollis Lai
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Seema Ganatra
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryam Amin
- Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Irigaray MMM, Santana LF, Pott A, do Nascimento VA, de Cássia Avellaneda Guimarães R, de Souza AS, de Cássia Freitas K. Nutritional Prognosis of Patients Submitted to Radiotherapy and Its Implications in Treatment. Nutrients 2024; 16:1363. [PMID: 38732610 PMCID: PMC11085617 DOI: 10.3390/nu16091363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 05/13/2024] Open
Abstract
Oncological patients show intense catabolic activity, as well as a susceptibility to higher nutritional risk and clinical complications. Thus, tools are used for monitoring prognosis. Our objective was to analyze the nutrition prognosis of patients who underwent radiotherapy, correlating it with outcomes and complications. We performed a retrospective transversal study based on secondary data from hospital records of patients who started radiotherapy between July 2022 and July 2023. We established Prognostic Scores through a combination of Prognostic Nutritional Index (PNI) and a Subjective Global Assessment (SGA), assessed at the beginning and end of treatment. Score 3 patients, with PNI ≤ 45.56 and an SGA outcome of malnutrition, initially presented a higher occurrence of odynophagia, later also being indicative of reduced diet volume, treatment interruption, and dysphagia. SGA alone showed sensitivity to altered diet volume, dysphagia, and xerostomia in the second assessment. Besides this, PNI ≤ 45.56 also indicated the use of alternative feeding routes, treatment interruption, and hospital discharge with more complications. We conclude that the scores could be used to indicate complications; however, further studies on combined biomarkers are necessary.
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Affiliation(s)
- Mariana Maroso Molina Irigaray
- Graduate Program in Health and Development in the Central-West Region of Brazil, Federal University of Mato Grosso do Sul, Campo Grande 79079-900, Brazil; (V.A.d.N.); (R.d.C.A.G.); (A.S.d.S.); (K.d.C.F.)
| | | | - Arnildo Pott
- Laboratory of Botany, Institute of Biociências, Federal University of Mato Grosso do Sul, Campo Grande 79070-900, Brazil;
| | - Valter Aragão do Nascimento
- Graduate Program in Health and Development in the Central-West Region of Brazil, Federal University of Mato Grosso do Sul, Campo Grande 79079-900, Brazil; (V.A.d.N.); (R.d.C.A.G.); (A.S.d.S.); (K.d.C.F.)
| | - Rita de Cássia Avellaneda Guimarães
- Graduate Program in Health and Development in the Central-West Region of Brazil, Federal University of Mato Grosso do Sul, Campo Grande 79079-900, Brazil; (V.A.d.N.); (R.d.C.A.G.); (A.S.d.S.); (K.d.C.F.)
| | - Albert Schiaveto de Souza
- Graduate Program in Health and Development in the Central-West Region of Brazil, Federal University of Mato Grosso do Sul, Campo Grande 79079-900, Brazil; (V.A.d.N.); (R.d.C.A.G.); (A.S.d.S.); (K.d.C.F.)
| | - Karine de Cássia Freitas
- Graduate Program in Health and Development in the Central-West Region of Brazil, Federal University of Mato Grosso do Sul, Campo Grande 79079-900, Brazil; (V.A.d.N.); (R.d.C.A.G.); (A.S.d.S.); (K.d.C.F.)
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MiriMoghaddam M, Bohlouli B, Lai H, Viegas S, Amin M. Trends and predictors of unplanned hospitalization among oral and oropharyngeal cancer patients; an 8-year population-based study. Oral Oncol 2024; 151:106742. [PMID: 38460285 DOI: 10.1016/j.oraloncology.2024.106742] [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: 01/21/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE The incidence of oral cancers, particularly HPV-related oropharyngeal cancer, is steadily increasing worldwide, presenting a significant healthcare challenge. This study investigates trends and predictors of unplanned hospitalizations for oral cavity cancer (OCC) and oropharyngeal cancer (OPC) patients in the province of Alberta, Canada. METHODS This retrospective, population-based, cohort study used administrative data collected from all hospitals in the province. Using the Alberta Cancer Registry (ACR), a cohort of adult patients diagnosed with a single primary OCC or OPC between January 2010 and December 2017 was identified. Linking this cohort with the Discharge Abstract Database (DAD), trends in hospitalizations, primary diagnoses, and predictors of unplanned hospitalization (UH) and 30-day unplanned readmission were analyzed. RESULTS Of 1,721 patients included, 1,244 experienced 2,228 hospitalizations, with 48 % being categorized as UH. The UHs were significantly associated with a higher mortality rate, 18.5 % as compared to 4.6 % for planned, and influenced by sex, age groups, comorbidities, cancer types, stages, and treatment modalities. The rate of UH per patient decreased from 0.69 to 0.54 visits during the study period (P = 0.02). Common diagnoses for UH were palliative care and post-surgical convalescence, while surgery-related complications such as infection and hemorrhage were frequent in 30-day unplanned readmissions. Predictors of UH included cancer stage, material deprivation, and treatment, while cancer type and comorbidity predicted readmissions. CONCLUSION The rate of UHs showed a noteworthy decline in this study, which could be a result of enhanced care coordination. Furthermore, identified primary diagnosis and predictors associated with UHs and readmissions, provide valuable insights for enhancing the quality of care for cancer patients.
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Affiliation(s)
- Masoud MiriMoghaddam
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Babak Bohlouli
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Hollis Lai
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Shefali Viegas
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Maryam Amin
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada.
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Choi YC, Chan PC, Cheung KWA, Huang JJ, Wong KLA, Doescher J, Lam TC. Impact of weight loss on treatment interruption and unplanned hospital admission in head and neck cancer patients undergoing curative (chemo)-radiotherapy in Hong Kong. Support Care Cancer 2023; 31:487. [PMID: 37486576 DOI: 10.1007/s00520-023-07952-8] [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: 02/05/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Malnutrition is highly prevalent in head and neck cancer (HNC) patients, with weight loss being one of the major nutritional indicators. The objective of this study was to investigate the impact of weight loss on treatment interruptions and unplanned hospital admissions in HNC patients undergoing radiotherapy (RT) with or without chemotherapy. METHODS In this retrospective cohort study, consecutive HNC patients who started RT between January 2011 and December 2019 were included. Data from a total of 1086 subjects with 747 (68.8%) nasopharyngeal carcinomas (NPCs) and 31.2% (N=339) non-NPC patients were analysed. Body weight (BW) was measured before, during, and after RT treatment. Factors associated with ≥10% weight loss, treatment interruption, and unplanned admissions were analysed using multivariate logistic regression. RESULTS The prevalence of ≥10% weight loss was 26.8% (N=288), with 32.7% (N=243) in NPC and 13.5% (N=45) in non-NPC patients. The prevalence of RT delay in patients with ≥10% vs. <10% weight loss was 6.2% vs. 7.0% (p=0.668) in NPC patients and 42.2% vs. 50.5% (p=0.300) in non-NPC patients. The prevalence of unplanned admissions in patients with ≥10% vs. <10% weight loss was 51.9% vs. 25.3% (p<0.001) in NPC patients and 68.9% vs. 27.0% (p<0.001) in non-NPC patients. CONCLUSION In our study, ≥10% weight loss was found to be associated with a higher rate of unplanned admissions but not with RT delay or chemotherapy interruption. CLINICAL IMPLICATIONS With the knowledge of the impact of weight loss on hospital admissions and the characteristics of patients with weight loss, nutritional intervention can be effectively focused on the stratification of patients for intensive nutritional support to reduce weight loss.
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Affiliation(s)
- Ying-Chu Choi
- Department of Dietetics, Tuen Mun Hospital, Hong Kong, China.
| | - Po-Chung Chan
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | | | - Jia-Jie Huang
- Quality and Services Department, Tuen Mun Hospital, Hong Kong, China
| | | | - Johannes Doescher
- Department of Otolaryngology, Augsburg University Hospital, Augsburg, Germany
| | - Tai-Chung Lam
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
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Fahy E, Brooker RC, Fleming JC, Patterson JM. A review of unplanned admissions in head and neck cancer patients undergoing oncological treatment. Support Care Cancer 2023; 31:328. [PMID: 37154829 PMCID: PMC10165288 DOI: 10.1007/s00520-023-07770-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: 01/16/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
AIM Non-surgical treatment for head and neck cancer (HNC) often results in severe toxicities, which are detrimental to a patient's health and quality of life. There is limited published UK data on unplanned hospital admissions and reasons associated with admission. We aim to identify frequencies and reasons for unplanned hospital admissions, highlighting those patient groups who are most vulnerable. METHODS A retrospective study of unplanned hospital admissions of HNC patients receiving non-surgical treatment was completed. An inpatient admission was defined as ≥ 1 night spent in the hospital. To test potential demographic and treatment predictors of inpatient admission, a multiple regression model was constructed using the endpoint measure (unplanned admission), as the dependent variable. RESULTS A cohort of 216 patients was identified over a 7-month period, and 38 of these patients (17%) required an unplanned admission. Treatment type was the only statistically significant predictor of in-patient admission. The majority of admissions were patients receiving chemoradiotherapy (CRT) (58%) with predominant reasons for admission being nausea and vomiting (25.5%) and decreased oral intake/dehydration (30%). Of the patients admitted, 12 had a prophylactic PEG placed pre-treatment, and 18 of 26 admitted without prophylactic PEG required nasogastric tube feeding during their admission. DISCUSSION Almost one-fifth of HNC patients over this time period required hospital admission; the majority of which can be attributed to treatment toxicities when receiving CRT. This is concurrent with other studies which review the impact of radiotherapy versus CRT. Increased support and monitoring, particularly focused on nutrition, are required for patients with HNC who receive CRT. KEY MESSAGE This article describes a retrospective review of a patient undergoing non-surgical treatment for head and neck cancer. These patients frequently require unplanned hospital admission. The results indicate that patients undergoing (chemo)radiotherapy are most vulnerable to deterioration and additional support focused on nutrition for these patients is indicated.
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Affiliation(s)
- Emer Fahy
- Speech and Language Therapy, The Clatterbridge Cancer Centre NHS Foundation Trusts, 65 Pembroke Place, Liverpool, L7 8YA, UK.
| | - Rachel C Brooker
- The Clatterbridge Cancer Centre NHS Foundation Trusts, Liverpool, UK
| | - Jason C Fleming
- Liverpool Head & Neck Centre, Head and Neck Surgery, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Liverpool, L9 7AL, UK
| | - Joanne M Patterson
- School of Health Sciences, Institute of Population Health/Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
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Feasibility of Using Wearables for Home Monitoring during Radiotherapy for Head and Neck Cancer-Results from the OncoWatch 1.0 Study. Cancers (Basel) 2023; 15:cancers15020422. [PMID: 36672370 PMCID: PMC9857313 DOI: 10.3390/cancers15020422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Background: Consumer wearables allow objective health data monitoring, e.g., of physical activity and heart rate, which might change over a cancer treatment course. Patients with head and neck cancer (HNC) receiving radiotherapy (RT) with curative intent typically experience side effects such as pain, decreased appetite, and dehydration, which may lead to hospitalizations. Therefore, health data monitoring could be important to understand a patient’s condition outside the hospital. The OncoWatch 1.0 study investigated the feasibility of using smartwatches for patients with HNC receiving RT. Methods: This study was a prospective, single-cohort feasibility study. The inclusion criteria were patients ≥ 18 years of age who planned to receive curatively intended radiotherapy for HNC. Consenting patients were asked to wear a smartwatch during RT and until two weeks after the end of RT. The primary endpoint was adherence. The secondary endpoints were data acquisition and variations in heart rate and physical activity. Results: Ten patients were included, with a median age of 62 years and eight males. The adherence rate for wearing the watch >12 h/d over the study period was 31%. The data acquisition rate was 61%. Conclusions: Although the primary endpoint was not reached, new knowledge has been established, including the secure data setup and key points that need to be addressed in future studies.
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Patel S, Rich BJ, Schumacher LED, Sargi ZB, Masforroll M, Washington C, Kwon D, Rueda-Lara MA, Freedman LM, Samuels SE, Abramowitz MC, Samuels MA, Carmona R, Azzam GA. ED visits, hospital admissions and treatment breaks in head/neck cancer patients undergoing radiotherapy. Front Oncol 2023; 13:1147474. [PMID: 36937396 PMCID: PMC10014878 DOI: 10.3389/fonc.2023.1147474] [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: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 03/05/2023] Open
Abstract
Objectives Radiation therapy (RT) is an integral part of treatment of head/neck cancer (HNC) but is associated with many toxicities. We sought to evaluate sociodemographic, pathologic, and clinical factors associated with emergency department (ED) visits, hospital admissions (HA), and RT breaks in HNC patients undergoing curative-intent RT. Methods We completed a Level 3 (Oxford criteria for evidence-based medicine) analysis of a cohort of HNC patients who underwent curative-intent RT at our institution from 2013 to 2017. We collected demographic characteristics and retrospectively assessed for heavy opioid use, ED visits or HA during RT as well as RT breaks. Treatment breaks were defined as total days to RT fractions ratio ≥1.6. Multivariable stepwise logistic regression analyses were done to determine the association of various sociodemographic, pathologic, and clinical characteristics with ED visits, HA and RT treatment breaks. Results The cohort included 376 HNC patients (294 male, 82 female, median age 61). On multivariable analysis, significant factors associated with ED visits during RT were heavy opioid use and black race. Receipt of concomitant chemotherapy was the only factor associated with hospital admissions during RT. Advanced age, lower socioeconomic class, glandular site, and receipt of chemotherapy were all independently associated with RT breaks. Lower cancer stage and lack of substance abuse history were independently associated with lack of treatment breaks. Conclusion HNC patients with factors such as heavy opioid use, Black race, receipt of concomitant chemotherapy, and lower socioeconomic class may require closer monitoring during RT.
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Affiliation(s)
- Shareen Patel
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Benjamin J. Rich
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Leif-Erik D. Schumacher
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Zoukaa B. Sargi
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Melissa Masforroll
- Department of Medicine, Florida International University, Miami, FL, United States
| | - Cyrus Washington
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Deukwoo Kwon
- Department of Public Health Sciences, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Maria A. Rueda-Lara
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Laura M. Freedman
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Stuart E. Samuels
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Matthew C. Abramowitz
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michael A. Samuels
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ruben Carmona
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gregory A. Azzam
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
- *Correspondence: Gregory A. Azzam,
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Morey T, Hodge J, Stern C, Krishnan S, Foreman A. Correlation between radiologic and pathologic extranodal extension in HPV-associated oropharyngeal cancer: Systematic review. Head Neck 2022; 44:2875-2885. [PMID: 36071683 PMCID: PMC9826216 DOI: 10.1002/hed.27183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023] Open
Abstract
Pretreatment determination of extranodal extension (ENE) has significant clinical implications in human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Unfortunately there is no gold-standard imaging modality for radiological assessment of ENE in HPV+ OPSCC, leading to subjective assessments and complex decision making concerning ENE. A systematic review of diagnostic test accuracy was therefore undertaken, with five databases systemically searched to evaluate the diagnostic performance of an imaging modality for detection of ENE in HPV+ OPSCC. A meta-analysis was conducted on four CT studies using a random-effects model. While a narrative synthesis was provided for the studies using PET/CT and "CT and MRI." Out of 1772 hits, six studies were included in the review. Meta-analysis on four CT studies showed CT had an overall sensitivity of 77% and specificity of 60%. PET/CT had a sensitivity of 37.5% and specificity of 97%. "CT and MRI" had a sensitivity of 62% and specificity of 78%. Further diagnostic studies involving CT, PET/CT and MRI are ultimately required.
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Affiliation(s)
- Tristan Morey
- JBI, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - John‐Charles Hodge
- Department of Otolaryngology ‐ Head and Neck SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Cindy Stern
- JBI, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Suren Krishnan
- Department of Otolaryngology ‐ Head and Neck SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Andrew Foreman
- Department of Otolaryngology ‐ Head and Neck SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
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The Benefit of Supplemental Vitamin E to Reduce Radiation-Induced Oral Side Effects in Head and Neck Cancer. TOP CLIN NUTR 2022. [DOI: 10.1097/tin.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sher DJ, Radpour S, Shah JL, Pham NL, Jiang S, Vo D, Sumer BD, Day AT. Pilot Study of a Wearable Activity Monitor During Head and Neck Radiotherapy to Predict Clinical Outcomes. JCO Clin Cancer Inform 2022; 6:e2100179. [PMID: 35333597 PMCID: PMC8970084 DOI: 10.1200/cci.21.00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Given the established associations between performance status and survival in a variety of cancers, there is significant interest in using a biometric wearable device (WD) to predict outcomes in the oncology population. In this pilot study, we investigated the ability of a WD to predict meaningful clinical end points in patients undergoing head and neck radiotherapy. METHODS Patients receiving head and neck definitive chemoradiotherapy or postoperative radiotherapy/chemoradiotherapy were enrolled in this pilot study, designed to show 90% compliance with using the device. Individuals were asked to wear the WD for 23 hours a day, and hospital admissions, pain medication usage, and FACT-G quality-of-life (QoL) score were prospectively recorded. RESULTS Fifty-one patients were enrolled and started using the WD, but eight patients stopped wearing it, resulting in a compliance probability of only 84%. There were 15 hospital admissions, 13 of which were planned for feeding tube placement. There was no step count threshold that predicted the need for admission or more pain medications. However, among the 25 patients with a significant reduction in FACT-G score, the average reductions in daily steps during the week and weekend before the decline were 988 (P = .005) and 1,311 (P = .018), respectively, and the odds of a QoL reduction were more than 4-fold higher among patients experiencing a week-to-week reduction of at least 1,000 daily steps. There was no association between heart rate and any end point. CONCLUSION Although not meeting the compliance goal, the majority of patients did use the WD. The WD signal could not identify patients requiring hospitalization or significantly more pain medication, but the finding of reduced step counts before a significant reduction in QoL is provocative.
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Affiliation(s)
- David J. Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
- David J. Sher, MD, MPH, Department of Radiation Oncology, UT Southwestern Medical Center, 2280 Inwood Dr, Dallas, TX 75390; e-mail:
| | - Sepeadeh Radpour
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Jennifer L. Shah
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Nhat-Long Pham
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Steve Jiang
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Dat Vo
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Baran D. Sumer
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, TX
| | - Andrew T. Day
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, TX
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Factors impacting posttraumatic growth in head-and-neck cancer patients with oncologic emergencies. Support Care Cancer 2022; 30:4515-4525. [PMID: 35112211 DOI: 10.1007/s00520-021-06772-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify factors associated with posttraumatic growth (PTG) of head-and-neck cancer squamous cancer (HNC) patients with oncologic emergencies (OE) within the first six months post-treatment. METHODS We conducted a cross-sectional study of HNC patients in Taiwan from May 2019 to April 2021 using patient-reported outcomes. Patients were assessed for symptom distress, anxiety, fear of recurrence (FCR), and PTG. Multiple regression analysis was conducted to identify factors associated with PTG. The independent-samples t-test was used to compare PTG and its five specific domains in patients with low FCR, high FCR, low anxiety, and high anxiety. RESULTS Of the 114 patients surveyed, 46.5% reported little-to-no PTG, and 53.5% had moderate-to-high PTG. Greater PTG was associated with greater FCR, longer time since OE, less anxiety, having a cancer recurrence, and greater educational attainment. These factors explained 38.6% of the variance in PTG. CONCLUSION A notable proportion of HNC patients with OE-reported PTG but almost half-reported little-to-no PTG. PTG occurred most in the domain of appreciation of life. The study results also suggest that training patients in coping skills and inviting them to group growth experiences can help them increase PTG and cope with cancer-related psychological threats related to OE.
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13
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Saravia A, Kong KA, Roy R, Barry R, Guidry C, McDaniel LS, Raven MC, Pou AM, Mays AC. Referral Patterns of Outpatient Palliative Care among the Head and Neck Cancer Population. Int Arch Otorhinolaryngol 2022; 26:e538-e547. [DOI: 10.1055/s-0041-1741436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Patients with head and neck cancer (HNC) experience unique physical and psychosocial challenges that impact their health and quality of life. Early implementation of palliative care has been shown to improve various health care outcomes.
Objective The aim of the present study was to evaluate the patterns of referral of patients with HNC to outpatient palliative care as they relate to utilization of resources and end-of-life discussions.
Methods We performed a retrospective review of 245 patients with HNC referred to outpatient palliative care services at two Louisiana tertiary care centers from June 1, 2014, to October 1, 2019. The control group consisted of those that were referred but did not follow-up. Reasons for referral were obtained, and outcome measures such as emergency department (ED) visits, hospital readmissions, and advance care planning (ACP) documentation were assessed according to predictive variables.
Results There were 177 patients in the treatment group and 68 in the control group. Patients were more likely to follow up to outpatient palliative care services if referred for pain management. Hospital system, prior inpatient palliative care, and number of outpatient visits were associated with an increased likelihood for ED visits and hospital readmissions. Those in the palliative care treatment group were also more likely to have ACP discussions.
Conclusion Early implementation of outpatient palliative care among patients with HNC can initiate ACP discussions. However, there are discrepancies in referral reasons to palliative care and continued existing barriers to its effective utilization.
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Affiliation(s)
- Ari Saravia
- Louisiana State University School of Medicine, New Orleans, Louisiana, United States
| | - Keonho Albert Kong
- Department of Otolaryngology, University of North Carolina-Chapel Hill , Chapel Hill, North Carolina USA
| | - Ryan Roy
- Louisiana State University School of Medicine, New Orleans, Louisiana, United States
| | - Rachel Barry
- Barry Ear Nose and Throat. 4212 W Congress St, Suite 1500, Lafayette, Louisiana, USA
| | - Christine Guidry
- Department of Palliative Medicine, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States
| | - Lee S. McDaniel
- Department of Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
| | - Mary C. Raven
- Department of Palliative Medicine, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States
| | - Anna M. Pou
- Oschner Health System, New Orleans, Louisiana, USA
| | - Ashley C. Mays
- Department of Otolaryngology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
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14
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Comparative cost analysis between definitive radiotherapy and transoral surgery for oropharyngeal squamous cell carcinoma: A SEER-Medicare analysis. Oral Oncol 2020; 112:105029. [PMID: 33142225 DOI: 10.1016/j.oraloncology.2020.105029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Primary radiotherapy (RT) and transoral surgery (TOS) are effective local therapy treatments for oropharyngeal squamous cell carcinoma (OPSCC), but their cost profiles differ. We compared the one-year costs of these competing treatments using a large claims-based database. METHODS Eligible individuals were patients in the SEER-Medicare registry diagnosed with OPSCC between 2000 and 2011. Patients were categorized as receiving either primary RT +/- chemotherapy, or TOS +/- adjuvant RT or chemoradiotherapy (CRT), and all treatment costs from 1 month prior to diagnosis to 1 year after diagnosis were calculated. Univariable and multivariable linear regression models were used to determine predictors of payer expenditure. Patient-borne pharmacy costs were also analyzed. RESULTS The cohort included 3497 patients (73% RT, 27% TOS), of whom 73% were locally advanced. The mean total 13 month costs for RT alone, CRT, TOS alone, TOS + RT and TOS + CRT were $39,083, $63,537, $25,468, $36,592, and $99,919, respectively, for early-stage patients. For locally advanced individuals, the mean costs were $45,049, $68,099, $40,626, $53,729, and $71,397, respectively. On multivariable analysis, the adjusted increase in total costs versus RT alone were $21,844, -$5431, $7984, and $28,581 for CRT, TOS alone, TOS + RT, and TOS + CRT, respectively. The difference between CRT and TOS + RT became non-significant for TOS patients undergoing transoral surgery plus neck dissection. Cisplatin was associated with significant less cost than cetuximab and taxane-based chemotherapy. CONCLUSION In this population of elderly patients, transoral surgery was generally associated with less expensive treatment, with the addition of chemotherapy serving as the main driver of increased cost.
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González-Rodríguez M, Villar-Taibo R, Fernández-Pombo A, Pazos-Couselo M, Sifontes-Dubón MA, Ferreiro-Fariña S, Cantón-Blanco A, Martínez-Olmos MA. Early versus conventional nutritional intervention in head and neck cancer patients before radiotherapy: benefits of a fast-track circuit. Eur J Clin Nutr 2020; 75:748-753. [PMID: 33097829 DOI: 10.1038/s41430-020-00786-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 07/27/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Radiotherapy (RT) is a component of therapy for head and neck cancer (HNC) with a negative nutritional impact. Our aim was to compare an early versus a conventional nutritional intervention. SUBJECTS AND METHODS Retrospective study of HNC patients undergoing RT. Evolution before and after the establishment of a fast-track circuit was evaluated. A conventional group (CG) made up of patients submitted to the nutrition unit during RT after nutritional deterioration, was compared to an early group (EG) represented by patients included in a fast-track circuit, starting nutritional follow-up before the beginning of RT. Only patients with preserved oral intake were involved. Demographic, nutritional and clinical variables were analyzed. Data of hospitalizations and deaths were collected up to three months after RT. RESULTS 135 subjects constituted the EG and 39 the CG. At baseline, the prevalence of malnutrition was lower in the EG (31.9% vs 69.5%, p = 0.0001), as was the need for nutritional supplements (40% vs 79.5%, p = 0.0001) or nasogastric tube (0% vs 12.8%, p = 0.0001) in comparison to the CG. Three months after RT, there were less patients with oral nutritional support in the EG (79.1% vs 96.9%, p = 0.018), and the number of emergency visits (0.75 vs 1.1 episodes per patient, p = 0.021) and hospitalizations was also lower in this group (29% vs 59%, p = 0.044). CONCLUSIONS The fast-track approach made early intervention possible. Therefore, patients maintained a better nutritional status, needed less nutritional support and their evolution improved, with a significant decrease in hospitalizations.
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Affiliation(s)
- M González-Rodríguez
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - R Villar-Taibo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.
| | - A Fernández-Pombo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - M Pazos-Couselo
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.,Psychiatry, Radiology and Public Health Department, University of Santiago de Compostela, A Coruña, Spain
| | - M A Sifontes-Dubón
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - S Ferreiro-Fariña
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - A Cantón-Blanco
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - M A Martínez-Olmos
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain.,Psychiatry, Radiology and Public Health Department, University of Santiago de Compostela, A Coruña, Spain.,CIBERObn, Instituto de Salud Carlos III, Madrid, Spain
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Noel CW, Forner D, Wu V, Enepekides D, Irish JC, Husain Z, Chan KKW, Hallet J, Coburn N, Eskander A. Predictors of surgical readmission, unplanned hospitalization and emergency department use in head and neck oncology: A systematic review. Oral Oncol 2020; 111:105039. [PMID: 33141060 DOI: 10.1016/j.oraloncology.2020.105039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To identify predictors of unplanned hospitalization and emergency department (ED) use among head and neck oncology patients. METHODS Peer reviewed publications were identified through a systematic search of MEDLINE, Embase and Cochrane CENTRAL. Studies describing a cohort of HNC patients that detailed predictors of unplanned hospitalization or ED use in risk-adjusted models were eligible for inclusion. The methodologic quality of included studies was assessed using the Quality In Prognostic Studies (QUIPS) tool and an adapted version of the GRADE framework. RESULTS Of the 932 articles identified, 39 studies met our inclusion criteria with 31/39 describing predictors of surgical readmission and 10/39 describing predictors of ED use or unplanned hospitalization during radiation/chemoradiation treatment. Risk factors were classified into either 'patient-related', 'cancer severity' or 'process' factors. In the subset of studies looking at readmission following surgery wound complications (10/14 studies), presence of comorbidity (16/28 studies), low socioeconomic status (8/17 studies), cancer stage (9/14 studies), and prolonged hospital stay (7/18 studies) were the variables most frequently associated with readmission on multivariable analysis. Presence of comorbidity (6/10) and chemotherapy use (4/10) were more frequently associated with ED use and unplanned hospitalization. CONCLUSIONS Several consistent predictors have been identified across a variety of studies. This work is a critical first step towards the development of readmission and ED prediction models. It also enables meaningful comparison of hospital readmission rates with risk adjustment in HNC patients.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Natalie Coburn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
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Chen WC, Teckie S, Somerstein G, Adair N, Potters L. Guidelines to Reduce Hospitalization Rates for Patients Receiving Curative-Intent Radiation Therapy During the COVID-19 Pandemic: Report From a Multicenter New York Area Institution. Adv Radiat Oncol 2020; 5:621-627. [PMID: 32395672 PMCID: PMC7212958 DOI: 10.1016/j.adro.2020.04.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 01/08/2023] Open
Abstract
As the coronavirus disease 2019 pandemic spreads around the globe, access to radiation therapy remains critical for patients with cancer. The priority for all radiation oncology departments is to protect the staff and to maintain operations in providing access to those patients requiring radiation therapy services. Patients with tumors of the aerodigestive tract and pelvis, among others, often experience toxicity during treatment, and there is a baseline risk that adverse effects may require hospital-based management. Routine care during weekly visits is important to guide patients through treatment and to mitigate against the need for hospitalization. Nevertheless, hospitalizations occur and there is a risk of nosocomial severe acute respiratory syndrome coronavirus-2 spread. During the coronavirus disease 2019 pandemic, typical resources used to help manage patients, such as dental services, interventional radiology, rehabilitation, and others are limited or not at all available. Recognizing the need to provide access to treatment and the anticipated toxicity of such treatment, we have developed and implemented guidelines for clinical care management with the hope of avoiding added risk to our patients. If successful, these concepts may be integrated into our care directives in nonpandemic times.
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Affiliation(s)
- William C. Chen
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sewit Teckie
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Gayle Somerstein
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
| | - Nilda Adair
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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18
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Han HR, Hermann GM, Ma SJ, Iovoli AJ, Wooten KE, Arshad H, Gupta V, McSpadden RP, Kuriakose MA, Markiewicz MR, Chan JM, Platek ME, Ray AD, Gu F, Hicks WL, Repasky EA, Singh AK. Matched pair analysis to evaluate the impact of hospitalization during radiation therapy as an early marker of survival in head and neck cancer patients. Oral Oncol 2020; 109:104854. [PMID: 32559724 PMCID: PMC7738364 DOI: 10.1016/j.oraloncology.2020.104854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/26/2020] [Accepted: 06/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Complications from radiotherapy (RT) alone or combined with surgery and/or chemotherapy for head and neck cancer (HNC) sometimes necessitate hospitalization. Our aim was to evaluate the frequency, cause, and survival outcomes associated with hospitalizations in patients undergoing RT for HNC. PATIENTS AND METHODS Using a retrospective single-institution database, we reviewed hospitalization records of HNC patients treated at Roswell Park Comprehensive Cancer Center with definitive or post-operative RT between 2003 and 2017. Patients who were admitted during treatment and within 90-days post-RT were identified. Multivariate analyses, Kaplan-Meier statistics, and analysis on propensity score matching were performed to obtain matched-pair, after matching baseline characteristics, such as age, gender, smoking, tumor staging, p16 status, and treatments received. RESULTS 839 patients were eligible for analysis. Median follow-up was 34.8 months (Interquartile range [IQR] 15.6-64.8). 595 (71%) received definitive RT and 244 (29%) received adjuvant RT. Chemotherapy was used in 671 patients (80%). 171 patients (20%) had at least one hospitalization. Dehydration (40%) and fever (29%) were the most frequent causes of admission. Hospitalized patients had significantly worse overall survival (OS) (Hazards ratio [HR] 1.61, 95% CI 1.26-2.07, p < 0.001) and cancer-specific survival (CSS) (HR 1.45, 95% CI 1.07-1.95, p = 0.02). 163 matched pairs had median follow-up of 58.6 months (IQR 37.6-85.0). Median OS was 34.5 months (IQR 13.3-58.0) for hospitalized versus 44.2 months (IQR 20.3-78.7) for non-hospitalized patients (p = 0.01). CONCLUSION This study reveals significantly worse OS and CSS for patients hospitalized during RT for HNC. Hospitalization may be an early marker for worse survival.
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Affiliation(s)
- Hye Ri Han
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA.
| | - Gregory M Hermann
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Austin J Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Kimberly E Wooten
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Hassan Arshad
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Vishal Gupta
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Ryan P McSpadden
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Moni A Kuriakose
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Michael R Markiewicz
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, 3435 Main Street, Buffalo, NY 14214, USA; Department of Neurosurgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA; Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Jon M Chan
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Mary E Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; Department of Dietetics, D'Youville College, 270 Porter Avenue, Buffalo, NY 14201, USA.
| | - Andrew D Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Fangyi Gu
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Wesley L Hicks
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Elizabeth A Repasky
- Department of Immunology, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA.
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Noor A, Mintz J, Patel S, Bajic N, Boase S, Sethi N, Foreman A, Krishnan S, Hodge J. Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma. J Med Imaging Radiat Oncol 2019; 63:500-509. [DOI: 10.1111/1754-9485.12888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Anthony Noor
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Jack Mintz
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Sandy Patel
- Department of Radiology Royal Adelaide Hospital Adelaide South Australia Australia
| | - Nicholas Bajic
- Department of Radiology Royal Adelaide Hospital Adelaide South Australia Australia
| | - Sam Boase
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Neeraj Sethi
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Andrew Foreman
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - Suren Krishnan
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
| | - John‐Charles Hodge
- Department of Otolaryngology, Head and Neck Surgery Royal Adelaide Hospital University of Adelaide Adelaide South Australia Australia
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