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Manduchi B, Che Z, Ringash JG, Fitch MI, Howell D, Martino R. Patient-reported outcome measures for dysphagia in head and neck cancer: A systematic review and appraisal of content validity and internal structure. Head Neck 2024; 46:951-972. [PMID: 38356437 DOI: 10.1002/hed.27693] [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: 09/21/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
Dysphagia is a major head and neck cancer (HNC) issue. Dysphagia-related patient-reported outcome measures (PROMs) are critical for patient-centred assessment and intervention tailoring. This systematic review aimed to derive a comprehensive inventory of HNC dysphagia PROMs and appraise their content validity and internal structure. Six electronic databases were searched to February 2023 for studies detailing PROM content validity or internal structure. Eligible PROMs were those developed or validated for HNC, with ≥20% of items related to swallowing. Two independent raters screened citations and full-text articles. Critical appraisal followed COSMIN guidelines. Overall, 114 studies were included, yielding 39 PROMs (17 dysphagia-specific and 22 generic). Of included studies, 33 addressed PROM content validity and 78 internal structure. Of all PROMs, only the SOAL met COSMIN standards for both sufficient content validity and internal structure. Notably, the development of 18 PROMs predated the publication of COSMIN standards. In conclusion, this review identified 39 PROMs addressing dysphagia in HNC, of which only one met COSMIN quality criteria. Given that half of PROMs were developed prior to COSMIN guidelines, future application of current standards is needed to establish their psychometric quality.
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Affiliation(s)
- Beatrice Manduchi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
| | - Zhiyao Che
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
| | - Jolie G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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In ’t Veld M, Jager DHJ, Chhangur CN, Ziesemer KA, Leusink FKJ, Schulten EAJM. Oral-Functioning Questionnaires in Patients with Head and Neck Cancer: A Scoping Review. J Clin Med 2023; 12:3964. [PMID: 37373657 PMCID: PMC10299551 DOI: 10.3390/jcm12123964] [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: 05/17/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Oral-functioning impairment can negatively affect the quality of life (QoL) of head and neck cancer (HNC) patients after receiving radiotherapy (RT). Assessment of patient-reported oral functioning throughout treatment can improve patient care. This scoping review aims to propose a definition for oral functioning for HNC patients and to map out the available questionnaires measuring patient-reported oral functioning in RT-treated HNC patients. Methods: A literature search in relevant databases was performed. Each questionnaire was scored on the domains validity, reliability, and responsiveness. Furthermore, the items from the questionnaires were analyzed to define the common denominators for oral functioning in HNC patients. Results: Of the 6434 articles assessed, 16 met the inclusion criteria and employed 16 distinct instruments to evaluate QoL. No questionnaire covered all oral-health-related QoL items nor assessed all aspects of validity, reliability, and responsiveness. Chewing, speaking, and swallowing were the common denominators for oral functioning. Conclusions: Based on the included studies, we suggest using the VHNSS 2.0 questionnaire to assess oral functioning in HNC patients. Furthermore, we suggest to more clearly define oral functioning in HNC patients by focusing on masticatory function (chewing and grinding), mouth opening, swallowing, speaking, and salivation.
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Affiliation(s)
- Matthijs In ’t Veld
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands; (D.H.J.J.); (C.N.C.); (F.K.J.L.); (E.A.J.M.S.)
| | - Derk H. J. Jager
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands; (D.H.J.J.); (C.N.C.); (F.K.J.L.); (E.A.J.M.S.)
| | - Chayenne N. Chhangur
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands; (D.H.J.J.); (C.N.C.); (F.K.J.L.); (E.A.J.M.S.)
| | - Kirsten A. Ziesemer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Library, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands;
| | - Frank K. J. Leusink
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands; (D.H.J.J.); (C.N.C.); (F.K.J.L.); (E.A.J.M.S.)
| | - Engelbert A. J. M. Schulten
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Noord-Holland, The Netherlands; (D.H.J.J.); (C.N.C.); (F.K.J.L.); (E.A.J.M.S.)
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Lee SE, Farzal Z, Ebert CS, Zanation AM. Readability of Patient-Reported Outcome Measures for Head and Neck Oncology. Laryngoscope 2020; 130:2839-2842. [PMID: 32078176 DOI: 10.1002/lary.28555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/26/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patient-reported outcome measures (PROMs) are communication tools to help patients convey their disease experience to medical providers and guide management decisions. However, the utility of healthcare outcome measures is dependent on patient literacy and readability of PROMs. If written for a more advanced literacy level, they can misestimate symptoms and add significant barriers to care, especially in the underserved. However, readability of head and neck (H&N) oncology PROMs has not been assessed. The aim of this study was to evaluate the readability of H&N oncology PROMs to assess whether they meet recommended readability levels. STUDY DESIGN Bibliometric review. METHODS Three readability measures: Gunning Fog, Simple Measure of Gobbledygook, and FORCAST were used to evaluate the readability level of commonly used H&N PROMs. PROMs with sixth grade readability level or lower were considered to meet the recommendations of health literacy experts. RESULTS Eight H&N oncology PROMs were reviewed. None of H&N PROMs met health literacy experts' and National Institutes of Health recommended reading levels. Gunning Fog consistently estimated easiest readability and FORCAST the most difficult. CONCLUSIONS PROMs are important clinical tools that drive patient-centric care in H&N oncology. All H&N PROMs are written above recommended reading levels and do not meet suggested standards. Future PROMs should be written with easier readability to accurately convey patients' H&N oncology disease experiences. LEVEL OF EVIDENCE 4 Laryngoscope, 2020.
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Affiliation(s)
- Saangyoung E Lee
- University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Zainab Farzal
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Charles S Ebert
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, U.S.A
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Verma N, Tan X, Knowles M, Bernard S, Chera B. Patient-reported outcomes for dental health, shoulder-neck dysfunction, and overall quality of life after treatment with radiation for head and neck cancer. Laryngoscope Investig Otolaryngol 2019; 4:300-306. [PMID: 31236462 PMCID: PMC6580067 DOI: 10.1002/lio2.262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/09/2019] [Accepted: 03/26/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The current exploratory cross-sectional study was designed to examine and characterize survivorship issues among patients treated with radiation for head and neck cancer with regard to dental health, shoulder-neck dysfunction, and overall quality of life (QOL). METHODS Patients (N = 58) being seen for follow-up at a radiation oncology clinic at least 1 year beyond the end of treatment completed three survey questionnaires regarding general QOL as well as dental health issues and shoulder-neck dysfunction. The questionnaires were scored and univariate analyses were performed using the variables of age, radiation dosage, definitive radiation + neck dissection versus definitive surgery + postoperative radiation, and chemotherapy. RESULTS Median follow-up was 2.5 years. Of 58 patients, 35% reported having more problems with their general dental health as compared to before treatment and 38% reported having pain at night in the neck/shoulder after treatment. With regard to pretreatment counseling, 79% of patients reported being counseled about their dental health prior to treatment, while 31% reported being counseled about possible shoulder-neck dysfunction. Patients younger than 65, patients receiving higher doses of radiation, and patients undergoing definitive surgery + postoperative radiation reported more functional and symptomatic issues. CONCLUSION Patients treated with radiation for head and neck cancer face a number of survivorship issues, including problems with dental health and shoulder-neck dysfunction, and are not necessarily thoroughly counseled about these issues prior to treatment. Patients younger than 65, patients receiving higher doses of radiation, and patients undergoing definitive surgery + postoperative radiation may experience more survivorship issues. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Neha Verma
- University of North Carolina School of MedicineChapel HillNorth CarolinaU.S.A.
| | - Xianming Tan
- Lineberger Comprehensive Cancer CenterChapel HillNorth CarolinaU.S.A.
| | - Mary Knowles
- University of North Carolina Department of Radiation OncologyChapel HillNorth CarolinaU.S.A.
| | - Stephen Bernard
- University of North Carolina Department of Hematology/OncologyChapel HillNorth CarolinaU.S.A.
| | - Bhishamjit Chera
- University of North Carolina Department of Radiation OncologyChapel HillNorth CarolinaU.S.A.
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Kamal M, Rosenthal DI, Volpe S, Goepfert RP, Garden AS, Hutcheson KA, Al Feghali KA, Meheissen MAM, Eraj SA, Dursteler AE, Williams B, Smith JB, Aymard JM, Berends J, White AL, Frank SJ, Morrison WH, Cardoso R, Chambers MS, Sturgis EM, Mendoza TR, Lu C, Mohamed ASR, Fuller CD, Gunn GB. Patient reported dry mouth: Instrument comparison and model performance for correlation with quality of life in head and neck cancer survivors. Radiother Oncol 2018; 126:75-80. [PMID: 29229507 PMCID: PMC5957088 DOI: 10.1016/j.radonc.2017.10.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/28/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To identify a clinically meaningful cut-point for the single item dry mouth question of the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). METHODS Head and neck cancer survivors who had received radiation therapy (RT) completed the MDASI-HN, the University of Michigan Hospital Xerostomia Questionnaire (XQ), and the health visual analog scale (VAS) of the EuroQol Five Dimension Questionnaire (EQ-5D). The Bayesian information criteria (BIC) were used to test the prediction power of each tool for EQ-5D VAS. The modified Breiman recursive partitioning analysis (RPA) was used to identify a cut point of the MDASI-HN dry mouth score (MDASI-HN-DM) with EQ-5D VAS, using a ROC-based approach; regression analysis was used to confirm the threshold effect size. RESULTS Two-hundred seven respondents formed the cohort. Median follow-up from the end of RT to questionnaire completion was 88 months. The single item MDASI-HN-DM score showed a linear relationship with the XQ composite score (ρ = 0.80, p < 0.001). The MDASI-HN-DM displayed improved model performance for association with EQ-5D VAS as compared to XQ (BIC of 1803.7 vs. 2016.9, respectively). RPA showed that an MDASI-HN-DM score of ≥6 correlated with EQ-5D VAS decline (LogWorth 5.5). CONCLUSION The single item MDASI-HN-DM correlated with the multi-item XQ and performed favorably in the prediction of QOL. A MDASI-HN-DM cut point of ≥6 correlated with decline in QOL.
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Affiliation(s)
- Mona Kamal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Stefania Volpe
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; University of Milan, Department of Oncology and Hemato-Oncology, Milano, Italy
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Karine A Al Feghali
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; The Naef K. Basile Cancer Institute at the American University of Beirut Medical Center, Lebanon
| | - Mohamed Ahmed Mohamed Meheissen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt
| | - Salman A Eraj
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, USA
| | - Amy E Dursteler
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, USA
| | - Bowman Williams
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Joshua B Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, USA
| | - Jeremy M Aymard
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Abilene Christian University, USA
| | - Joel Berends
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; University of Texas Health Science Center at San Antono, USA
| | - Aubrey L White
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; School of Medicine, The University of Texas Health Science Center at Houston, McGovern School of Medicine, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Richard Cardoso
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mark S Chambers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Tito R Mendoza
- Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Charles Lu
- Department of Symptom Research, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt; MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; MD Anderson Cancer Center/UTHealth Graduate School of Biomedical Sciences, Houston, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Ferris MJ, Zhong J, Switchenko JM, Higgins KA, Cassidy RJ, McDonald MW, Eaton BR, Patel KR, Steuer CE, Baddour HM, Miller AH, Bruner DW, Xiao C, Beitler JJ. Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy. Radiother Oncol 2018; 126:100-106. [PMID: 28826628 PMCID: PMC5841457 DOI: 10.1016/j.radonc.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 07/17/2017] [Accepted: 08/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Radiation (RT) dose to the central nervous system (CNS) has been implicated as a contributor to treatment-related fatigue in head and neck cancer (HNC) patients undergoing radiation therapy (RT). This study evaluates the association of RT dose to CNS structures with patient-reported (PRO) fatigue scores in a population of HNC patients. MATERIALS AND METHODS At pre-RT (baseline), 6th week of RT, and 1-month post-RT time points, Multidimensional Fatigue Inventory (MFI-20) scores were prospectively obtained from 124 patients undergoing definitive treatment for HNC. Medulla, pons, midbrain, total brainstem, cerebellum, posterior fossa, and pituitary dosimetry were evaluated using summary statistics and dose-volume histograms, and associations with MFI-20 scores were analyzed. RESULTS Maximum dose (Dmax) to the brainstem and medulla was significantly associated with MFI-20 scores at 6th week of RT and 1-month post-RT time points, after controlling for baseline scores (p<0.05). Each 1Gy increase in medulla Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p=0.026), and 0.25 (p=0.037), at the 6th week of RT and 1-month post-RT, respectively. Each 1Gy increase in brainstem Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p=0.027), and 0.25 (p=0.037) at the 6th week of RT, 1-month post-RT, respectively. Statistically significant associations were not found between dosimetry for the other CNS structures and MFI-20 scores. CONCLUSIONS In this analysis of PRO fatigue scores from a population of patients undergoing definitive RT for HNC, maximum dose to the brainstem and medulla was associated with a significantly increased risk of acute patient fatigue.
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Affiliation(s)
- Matthew J Ferris
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA.
| | - Jim Zhong
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Jeffrey M Switchenko
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Biostatistics & Bioinformatics, Emory University, Atlanta, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Richard J Cassidy
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Mark W McDonald
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Bree R Eaton
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Kirtesh R Patel
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Conor E Steuer
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, USA
| | - H Michael Baddour
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, USA
| | - Andrew H Miller
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, USA
| | - Deborah W Bruner
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - Canhua Xiao
- Winship Cancer Institute of Emory University, Atlanta, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
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Rosenthal E, Couch M, Farwell DG, Wax MK. Current concepts in microvascular reconstruction. Otolaryngol Head Neck Surg 2016; 136:519-24. [PMID: 17418245 DOI: 10.1016/j.otohns.2006.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 12/05/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Eben Rosenthal
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, USA
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Pusic A, Liu JC, Chen CM, Cano S, Davidge K, Klassen A, Branski R, Patel S, Kraus D, Cordeiro PG. A systematic review of patient-reported outcome measures in head and neck cancer surgery. Otolaryngol Head Neck Surg 2016; 136:525-35. [PMID: 17418246 DOI: 10.1016/j.otohns.2006.12.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 12/05/2006] [Indexed: 11/22/2022]
Abstract
Objective To identify, summarize, and evaluate patient-reported outcome questionnaires for use in head and neck cancer surgery with the view to making recommendations for future research. Data Sources A systematic review of the English-language literature, with the use of head-and-neck-surgery-specific keywords, was performed in the following databases: Medline, Embase, HAPI, CINAHL, Science/Social Sciences Citation Index, and PsycINFO from 1966 to March 2006. Data Extraction and Study Selection All English-language instruments identified as patient-reported outcome questionnaires that measure quality of life and/or satisfaction that had undergone development and validation in a head and neck cancer surgery population were included. Data Synthesis Twelve patient-reported outcome questionnaires fulfilled our inclusion criteria. Of these, four were developed from expert opinion alone or did not have a published development process and seven questionnaires lacked formal item reduction. Only three questionnaires (EORTC Head and Neck Module, University of Michigan Head and Neck Quality-of-life Questionnaire, and Head and Neck Cancer Inventory) fulfilled guidelines for instrument development and evaluation as outlined by the Medical Outcomes Trust. Conclusions Rigorous instrument development is important for creating valid, reliable, and responsive disease-specific questionnaires. As a direction for future instrument development, an increased focus on qualitative research to ensure patient input may help to better conceptualize and operationalize the variables most relevant to head and neck cancer surgery patients. In addition, the use of alternative methods of psychometric data analysis, such as Rasch, may improve the value of health measurement in clinical practice for individual patients.
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Affiliation(s)
- Andrea Pusic
- Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Medical marijuana use in head and neck squamous cell carcinoma patients treated with radiotherapy. Support Care Cancer 2016; 24:3517-24. [PMID: 27005465 DOI: 10.1007/s00520-016-3180-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/11/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE The purpose of the study was to better understand why patients with history of head and neck cancer (HNC) treated with radiotherapy are using medical marijuana (MM). METHODS Established HNC quality of life questionnaires and our own MM quality of life questionnaire were sent to 15 HNC patients treated at our institution who reported using MM. Patients are clinically disease free and currently using MM to manage long-term side effects after curative HNC treatment. RESULTS There was a 100 % response rate. Median time from treatment was 45 months (21-136 months). Most patients smoked marijuana (12 patients), while others reported ingestion (4 patients), vaporizing (3 patients), and use of homemade concentrated oil (1 patient). Six patients reported prior recreational marijuana use before diagnosis. MM provided benefit in altered sense, weight maintenance, depression, pain, appetite, dysphagia, xerostomia, muscle spasm, and sticky saliva. CONCLUSIONS HNC patients report MM use to help with long-term side effects of radiotherapy.
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10
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Chen XL, Qiu ZW, Gu MF, Su Y, Liu LZ, Liu Y, Mo CW, Xu Q, Sun J, Li DH. Translation and validation of the Chinese version of the Quality OF Life Radiation Therapy Instrument and the Head & Neck Module (QOL-RTI/H&N). Health Qual Life Outcomes 2014; 12:51. [PMID: 24731442 PMCID: PMC4022371 DOI: 10.1186/1477-7525-12-51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/08/2014] [Indexed: 12/03/2022] Open
Abstract
Background To translate and validate the Chinese version of the Quality Of Life Radiation Therapy Instrument and the Head & Neck Module (QOL-RTI/H&N), a disease-specific scale to measure quality of life (QOL) for patients with head and neck cancer (HNC) who received radiotherapy. Methods The QOL-RTI/H&N was translated and validated according to the standard process: a translation and back-translation procedure, pilot testing and a validation study. HNC patients were enrolled from the Cancer Center of Sun Yat-sen University and assessed using the QOL-RTI/H&N, QLQ-C30 and QLQ-H&N35. Reliability (internal consistency reliability, split-half reliability and test-retest reliability), validity (content validity, construct validity, criterion validity and discriminant validity), and responsiveness analysis were performed to evaluate the psychometric characteristics of the QOL-RTI/H&N. Results A total of 238 patients (99.2%) completed the questionnaire. Item RTI23 had 16.0% missing data. Other items had low percentages of missing data (0.4% or 0.8%) or no missing data. The average time to finish the scale was 9.8 minutes. Cronbach's alpha of the domains ranged from 0.41 to 0.77. The split-half reliability coefficients ranged from 0.43 to 0.77. All of the intra-class correlation coefficients were equal to or greater than 0.8. All of the item-own domain correlation coefficients were greater than those of the item-other domain. Confirmatory factor analysis showed that Comparative Fit Index, Normed Fit Index and Non-Normed Fit Index were equal to 1.00. Root Mean Square Error of Approximation was 0.01, with 90% CI (0.00, 0.10). The domain scores of the QOL-RTI/H&N were significantly correlated with those of the QLQ-C30 or QLQ-H&N3. All domain scores of patients in different radiotherapy stages were statistically significant (P < 0.05), apart from the speech domain. Conclusions The Chinese version of the QOL-RTI/H&N is a valid, reliable and responsive scale to measure QOL in HNC patients and can be used to assess the effects of radiotherapy treatment on these patients.
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Affiliation(s)
| | | | - Mo-fa Gu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong province, China.
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Heutte N, Plisson L, Lange M, Prevost V, Babin E. Quality of life tools in head and neck oncology. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:33-47. [DOI: 10.1016/j.anorl.2013.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/15/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
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Erickson P, Willke RJ. Examining item content and structure in health status and health outcomes instruments: toward the development of a grammar for better understanding of the concepts being measured. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:554-563. [PMID: 23796289 DOI: 10.1016/j.jval.2013.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 12/19/2012] [Accepted: 01/20/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Health outcomes instruments assess diverse health concepts. Although item-level concepts are considered fundamental elements, the field lacks structures for evaluating and organizing them for decision making. This article proposes a grammar using item stems, response options, and recall periods to systematically identify item-level concepts. The grammar uses "core concept," "evaluative component," and "recall period" as intuitive terms for communicating with stakeholders. Better characterization of concepts is necessary for classifying instrument content and linking it to treatment benefit. METHODS Items in 2 generic and 21 disease-specific instruments were evaluated to develop and illustrate the use of the grammar. Concepts were assigned International Classification of Functioning, Disability and Health codes for exploring the value that the grammar and a classification system add to the understanding of content across instruments. RESULTS The 23 instruments include many core concepts; emotional function is the only concept assessed in all instruments. Concepts in disease-specific instruments show obvious patterns; for example, arthritis instruments focus on physical function. The majority of instruments used the same response options across all items, with five-point scales being the most common. Most instruments used one recall period for all items. Shorter recall periods were used for conditions associated with "flares," such as chronic obstructive pulmonary disease and "skin disease." Every diagnosis, however, showed variation across instruments in the recall period used. CONCLUSIONS This analysis indicates the proposed grammar's potential for discerning the conceptual content within and between health outcomes instruments and illustrates its value for improving communication between stakeholders and for making decisions related to treatment benefit.
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Affiliation(s)
- Pennifer Erickson
- OLGA: The On-Line Guide to Quality-of-Life Assessment,, State College, PA 16803, USA.
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Gal TJ, Streeter M, Burris J, Kudrimoti M, Ain KB, Valentino J. Quality of life impact of external beam radiotherapy for advanced thyroid carcinoma. Thyroid 2013; 23:64-9. [PMID: 22971127 DOI: 10.1089/thy.2012.0083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND External beam radiotherapy (XRT) has an established role in the management of recurrent or advanced well-differentiated thyroid carcinoma (WDTC). The goal of this study was to investigate the impact of this additional intervention on the quality of life (QOL) compared with total thyroidectomy (TT), with or without adjuvant radioactive iodine (RAI). METHODS A cross-sectional analysis using validated QOL instruments was performed. Patients receiving XRT between 1992 and 2008 for WDTC were identified and offered study participation. The Quality of Life Radiation Therapy Instrument and the Head and Neck Companion Module were administered retrospectively (N=13). For a comparison, patients previously treated with TT (N=11) alone as well as TT with postoperative RAI (N=11) for WDTC were also evaluated. RESULTS Thirty-four patients were included in the analysis. The XRT group reported significant decreases in chewing, swallowing, and appetite, and significant increase in pain, compared with both the RAI group and the TT group. Significant differences were reported for questions with regard to peace of mind, feeling discouraged, saliva, taste, ability to eat regular food, and concerns for the appearance of the neck in both RAI and XRT groups compared with TT patients. Subscale analysis of head and neck specific questions demonstrated significant overall differences for both RAI and XRT groups compared with thyroidectomy alone, with no differences observed between RAI and XRT groups in a direct comparison. CONCLUSIONS RAI therapy results in a measurable decrease in head and neck specific QOL measures compared with TT alone. The addition of XRT results in additional measurable morbidity secondary to pain and dysphagia.
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Affiliation(s)
- Thomas J Gal
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA.
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de Almeida JR, Vescan AD, Gullane PJ, Gentili F, Lee JM, Lohfeld L, Ringash J, Thoma A, Witterick IJ. Development of a disease-specific quality-of-life questionnaire for anterior and central skull base pathology--the skull base inventory. Laryngoscope 2012; 122:1933-42. [PMID: 22777574 DOI: 10.1002/lary.23426] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/10/2012] [Accepted: 04/18/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Anterior and central skull base lesions and their surgical treatment (endoscopic or open approaches) can affect quality of life. A disease-specific instrument is needed to compare quality of life for different surgical approaches. STUDY DESIGN Items were generated using a composite strategy consisting of chart review, systematic review of skull base instruments, expert interviews, and qualitative analysis of patient focus groups. A cross-sectional survey study was performed to reduce items based on an item impact score. METHODS Charts of 138 patients who underwent skull base surgery were reviewed to identify physical items and domains. Five experts were interviewed for item and domain identification. Thirty-four patients were recruited into eight focus groups based on their surgical approach (open or endoscopic) and tumor location (anterior or central). Items were generated using a composite approach and then reduced into a final questionnaire using item impact scores. RESULTS Chart review identified 47 physical items. Systematic review revealed nine relevant instruments with 217 relevant items. Experts identified 11 domains with 69 additional items. Qualitative analysis of focus groups generated 49 items. A total of 382 items were identified and reduced to 77 items after eliminating overlapping and irrelevant items. Further item reduction using item impact scores yielded 41 items. CONCLUSIONS The Skull Base Inventory is a disease-specific quality-of-life instrument. Psychometric properties have yet to be tested. It may serve to compare quality of life for endoscopic or open procedures.
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Affiliation(s)
- John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
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Ojo B, Genden EM, Teng MS, Milbury K, Misiukiewicz KJ, Badr H. A systematic review of head and neck cancer quality of life assessment instruments. Oral Oncol 2012; 48:923-937. [PMID: 22525604 DOI: 10.1016/j.oraloncology.2012.03.025] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/23/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
Although quality of life (QOL) is an important treatment outcome in head and neck cancer (HNC), cross-study comparisons have been hampered by the heterogeneity of measures used and the fact that reviews of HNC QOL instruments have not been comprehensive to date. We performed a systematic review of the published literature on HNC QOL instruments from 1990 to 2010, categorized, and reviewed the properties of the instruments using international guidelines as reference. Of the 2766 articles retrieved, 710 met the inclusion criteria and used 57 different head and neck-specific instruments to assess QOL. A review of the properties of these utilized measures and identification of areas in need of further research is presented. Given the volume and heterogeneity of QOL measures, there is no gold standard questionnaire. Therefore, when selecting instruments, researchers should consider not only psychometric properties but also research objectives, study design, and the pitfalls and benefits of combining different measures. Although great strides have been made in the assessment of QOL in HNC and researchers now have a plethora of quality instruments to choose from, more work is needed to improve the clinical utility of these measures in order to link QOL research to clinical practice. This review provides a platform for head and neck-specific instrument comparisons, with suggestions of important factors to consider in the systematic selection of QOL instruments, and is a first step towards translation of QOL assessment into the clinical scene.
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Affiliation(s)
- Bukola Ojo
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA.
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Marita S Teng
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Kathrin Milbury
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Krzysztof J Misiukiewicz
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY, USA; Department of Medicine, Hematology and Medical Oncology, Mount Sinai School of Medicine, New York, NY, USA
| | - Hoda Badr
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY, USA
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Moreno KF, Khabbaz E, Gaitonde K, Meinzen-Derr J, Wilson KM, Patil YJ. Sexuality after treatment of head and neck cancer: findings based on modification of sexual adjustment questionnaire. Laryngoscope 2012; 122:1526-31. [PMID: 22508246 DOI: 10.1002/lary.23347] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 03/05/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Evaluate sexual dysfunction in patients after treatment for head and neck cancer. STUDY DESIGN Single-institution cross-sectional study. METHODS Our modified Sexual Adjustment Questionnaire was administered to 42 patients (mean age, 55.1 years) and included seven questions (total score, 7-35). Based on sexual satisfaction ratings, we categorized three groups as unsatisfied (7-16), satisfied (17-25), and very satisfied (26-35). Clinical information was obtained by reviewing medical records. Bivariate analysis tested associations between sexual satisfaction and patient-related factors (e.g., sex, age, site/cancer stage, treatment, time between treatment and survey, partner, alcohol/tobacco consumption). Pearson correlation was used to analyze two continuous variables, and multivariate logistic regression analysis was used to evaluate the independent impact of each factor. RESULTS All 42 patients rated that head and neck cancer negatively impacted their sexual relationships, including 21 (50%) rating effects as negative or extremely negative. Men reported higher satisfaction scores with sexual function (mean ± standard deviation) than women (19.9 ± 5.0 vs. 16.3 ± 6.5, respectively; P = .06). Respondents with partners reported higher scores than those without partners (19.9 ± 5.3 vs. 14.1 ± 4.4, respectively; P = .01). When the survey was administered (median, 12 months; range, 4-33 months) after the first treatment, mean score was 19; 57% of respondents were sexually satisfied, 31% were unsatisfied, and 12% were very satisfied. Instrument reliability was .82 (Cronbach alpha). CONCLUSIONS Patients who are male and ≤ 60 years have a higher probability of sexual satisfaction during recovery. Our sexual dysfunction questionnaire will be administered in further prospective studies in patients with head and neck cancer.
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Affiliation(s)
- Kattia F Moreno
- Brain Tumor Center at the University of Cincinnati Neuroscience Institute, Cincinnati, Ohio, USA
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Changing the perspective: current trends in the assessment of functional outcome in patients with head and neck cancer. Curr Oncol Rep 2011; 13:126-31. [PMID: 21286869 DOI: 10.1007/s11912-011-0156-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Functional outcome and quality of life have become frequent outcome measures in head and neck cancer (HNC) clinical trials. Many thoroughly validated outcome measures are available. Still, there is a low degree of standardization and comparability among measures. It seems difficult to fully translate the new insights into clinical routine. The aims of this paper are 1) to acknowledge the diversity of outcome measures and many of the past milestones that have been reached, but also 2) to capture a growing need to concentrate and reach consensus. The hypothesis is to gain more benefit from changing the perspective toward consensus rather than diversity in functional outcome assessment. The next steps are to adopt a unique "language" to describe functional outcome and implement clear end points that assist clinical decision making. The International Classification of Functioning, Disability, and Health was adopted by the WHO and offers an internationally accepted classification to describe disability in HNC.
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Speksnijder CM, van der Bilt A, Abbink JH, Merkx MAW, Koole R. Mastication in patients treated for malignancies in tongue and/or floor of mouth: A 1-year prospective study. Head Neck 2010; 33:1013-20. [PMID: 20967870 DOI: 10.1002/hed.21573] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 06/01/2010] [Accepted: 07/09/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND People confronted with oral cancer run a high risk of deteriorated masticatory performance. Reduced masticatory function may affect quality of life and food choice. An altered food choice may result in lower intakes for key nutrients and weight loss. METHODS Dental state, bite force, and masticatory performance were determined in a group of 45 patients with squamous cell carcinoma of the tongue and/or floor of mouth. Measurements were performed before surgery and at various moments after surgery and/or radiotherapy. RESULTS Surgical intervention had a large negative impact on oral function. Radiotherapy further worsened oral function. Also, the recovery of oral function 1 year after surgery was less prominent for the surgery-radiotherapy group than for the surgery group. CONCLUSION Objective determination of oral function 1 year after surgery showed that patients treated for malignancies in the tongue and/or floor of mouth had significantly deteriorated masticatory performance, bite force, and dental state.
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Affiliation(s)
- Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery, Prosthodontics, and Special Dental Care, University Medical Center Utrecht, PO Box 85.060, NL 3508 AB Utrecht, The Netherlands.
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Maguire PD, Papagikos M, Hamann S, Neal C, Meyerson M, Hayes N, Ungaro P, Kotz K, Couch M, Pollock H, Tepper J. Phase II trial of hyperfractionated intensity-modulated radiation therapy and concurrent weekly cisplatin for Stage III and IVa head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010; 79:1081-8. [PMID: 20378262 DOI: 10.1016/j.ijrobp.2009.12.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 12/12/2009] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate a novel chemoradiation regimen designed to maximize locoregional control (LRC) and minimize toxicity for patients with advanced head-and-neck squamous cell carcinoma (HNSCC). METHODS AND MATERIALS Patients received hyperfractionated intensity modulated radiation therapy (HIMRT) in 1.25-Gy fractions b.i.d. to 70 Gy to high-risk planning target volume (PTV). Intermediate and low-risk PTVs received 60 Gy and 50 Gy, at 1.07, and 0.89 Gy per fraction, respectively. Concurrent cisplatin 33 mg/m(2)/week was started Week 1. Patients completed the Quality of Life Radiation Therapy Instrument pretreatment (PRE), at end of treatment (EOT), and at 1, 3, 6, 9, and 12 months. Overall survival (OS), progression-free (PFS), LRC, and toxicities were assessed. RESULTS Of 39 patients, 30 (77%) were alive without disease at median follow-up of 37.5 months. Actuarial 3-year OS, PFS, and LRC were 80%, 82%, and 87%, respectively. No failures occurred in the electively irradiated neck and there were no isolated neck failures. Head and neck QOL was significantly worse in 18 of 35 patients (51%): mean 7.8 PRE vs. 3.9 EOT. By month 1, H&N QOL returned near baseline (mean 6.2, SD = 1.7). The most common acute Grade 3+ toxicities were mucositis (38%), fatigue (28%), dysphagia (28%), and leukopenia (26%). CONCLUSIONS Hyperfractionated IMRT with low-dose weekly cisplatin resulted in good LRC with acceptable toxicity and QOL. Lack of elective nodal failures despite very low dose per fraction has led to an attempt to further minimize toxicity by reducing elective nodal doses in our subsequent protocol.
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Affiliation(s)
- Patrick D Maguire
- Department of Radiation Oncology, New Hanover Regional Medical Center, Wilmington, NC 28401, USA.
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Murphy BA, Dietrich MS, Wells N, Dwyer K, Ridner SH, Silver HJ, Gilbert J, Chung CH, Cmelak A, Burkey B, Yarbrough WG, Sinard R, Netterville J. Reliability and validity of the Vanderbilt Head and Neck Symptom Survey: a tool to assess symptom burden in patients treated with chemoradiation. Head Neck 2010; 32:26-37. [PMID: 19626644 DOI: 10.1002/hed.21143] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We describe the development and validation of the Vanderbilt Head and Neck Symptom Survey (VHNSS), which was designed to screen for tumor- and treatment-specific symptoms in patients with head and neck cancer undergoing concurrent chemoradiation (CCR). METHODS Using a 2-step card sort method, we identified high-impact and high-frequency toxicities in patients with head and neck cancer treated with CCR. This resulted in a 28-item questionnaire which scores symptoms on a 0 to 10 scale (none to severe). The tool was validated using data collected from 5 supportive care studies comprising a total sample of 332 patients with head and neck cancer. RESULTS Responses to the VHNSS items demonstrated a very consistent pattern (Cronbach's alpha = 0.943) with each item contributing substantially to the global index. Five symptom subscales were identified including "Nutrition," "Pain," "Voice," "Swallow," and "Mucous/Dry Mouth." Each of the cluster scores demonstrated good internal consistency. The pattern of associations between the VHNSS and established tools indicated appropriate convergence and divergence. Comparison of global and subscale scores and objective measure were also in the expected direction providing further evidence of validity. CONCLUSIONS The findings provide support that the VHNSS is a valid and reliable tool to assess head and neck-specific symptom burden and function loss. Further research to evaluate this screening tool as a part of a systems approach to supportive care is warranted.
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Affiliation(s)
- Barbara A Murphy
- Department of Medicine, Vanderbilt University Medical Center, USA.
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Zachariah B, Gwede CK, James J, Ajani J, Chin LJ, Donath D, Rosenthal SA, Kane BL, Rotman M, Berk L, Kachnic LA. Octreotide acetate in prevention of chemoradiation-induced diarrhea in anorectal cancer: randomized RTOG trial 0315. J Natl Cancer Inst 2010; 102:547-56. [PMID: 20339140 DOI: 10.1093/jnci/djq063] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In anorectal cancer patients, an acute side effect of chemoradiotherapy is gastrointestinal toxicity, which often impedes treatment delivery. Based on previous trials, octreotide acetate is widely recommended for the control of chemotherapy-induced diarrhea. However, the effectiveness of octreotide in preventing or controlling radiation- and chemoradiation-induced diarrhea is not known. METHODS A randomized, double-blinded, placebo-controlled trial was designed to determine the efficacy of long-acting octreotide acetate (LAO) in preventing the onset of acute diarrhea in patients undergoing chemoradiation therapy for rectal or anal cancer. Between 4 and 7 days before the start of radiation therapy, patients received a 30-mg dose of LAO (109 patients) or placebo (106 patients) via intramuscular injection. A second dose was given on day 22 (+/-3 days) of radiation treatment. A total of 215 patients were included in the final analysis. The primary endpoint was the incidence of grade 2-4 acute diarrhea; secondary endpoints included treatment compliance, medical resource utilization, patient-reported bowel function, and quality of life (QoL). Statistical tests were one- or two-sided, as specified. RESULTS After a median follow-up time of 9.64 months, incidence rates of grades 2-4 acute diarrhea were similar in both groups (49% placebo vs 44% LAO; P = .21). No statistically significant treatment differences in chemotherapy or radiation delivery, medical resource utilization, patient-reported bowel function, or QoL were observed. CONCLUSION In this study, the prophylactic use of LAO did not prevent the incidence or reduce the severity of diarrhea and had no notable impact on patient-reported bowel function or QoL.
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Tong MCF, Lo PSY, Wong KH, Yeung RMW, van Hasselt CA, Eremenco S, Cella D. Development and validation of the functional assessment of cancer therapy nasopharyngeal cancer subscale. Head Neck 2009; 31:738-47. [DOI: 10.1002/hed.21023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
PURPOSE OF REVIEW As the discipline of supportive and palliative cancer care grows, there is increasing acknowledgement of taste and smell alterations (TSAs) as barriers to nutrient intake and detriments to the food-related quality of life and well being of the population. The focus of this brief review is to summarize the recent advances regarding the cause and nature of TSAs and patients' perceptions of TSAs and to identify promising approaches for the alleviation of TSAs. RECENT FINDINGS Individual variations in the nature of TSAs exist and chemosensory changes have been established as an important quality of life issue associated with prognosis. The development and partial recovery of radiation therapy induced TSAs have been observed in longitudinal studies. Flavor enhancement has been found to improve patient-reported taste and smell capabilities. Patient-reported tools and qualitative methodologies have provided insight into the impact of TSAs on food-related quality of life and have been used with clinical measures to relate patient's perception to objective outcomes. SUMMARY A variety of approaches to the assessment of TSAs continue to generate a description of the development, duration and recovery of distorted chemosensory perception in cancer patients. Attention to individual variation in the nature and severity of TSAs as well as nutritional support and focus on flavorful foods can enhance patients' well being and food-related quality of life.
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Chen AM, Jennelle RL, Grady V, Tovar A, Bowen K, Simonin P, Tracy J, McCrudden D, Stella JR, Vijayakumar S. Prospective Study of Psychosocial Distress Among Patients Undergoing Radiotherapy for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2009; 73:187-93. [DOI: 10.1016/j.ijrobp.2008.04.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 04/04/2008] [Accepted: 04/07/2008] [Indexed: 11/26/2022]
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Evaluation of Quality of Life and Organ Function in Head and Neck Squamous Cell Carcinoma. Hematol Oncol Clin North Am 2008; 22:1239-56, x. [DOI: 10.1016/j.hoc.2008.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Harding SA, Hodder SC, Courtney DJ, Bryson PJ. Impact of perioperative hyperbaric oxygen therapy on the quality of life of maxillofacial patients who undergo surgery in irradiated fields. Int J Oral Maxillofac Surg 2008; 37:617-24. [PMID: 18501562 DOI: 10.1016/j.ijom.2008.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 01/30/2008] [Accepted: 04/10/2008] [Indexed: 11/19/2022]
Abstract
From 2001 to 2005, 66 patients referred for perioperative hyperbaric oxygen therapy (HBO2) for debridement of necrotic tissue or prevention of radionecrosis were assessed with quality of life measures, before and after completion of HBO2 and surgery. The Medical Outcomes Short Form 36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) showed no significant changes. The European Organisation for Research and Treatment of Cancer Core (EORTC-C30) questionnaire showed significant improvement in pain, global health, and dyspnoea (p=0.011; p=0.027; p=0.008, respectively). The Head and Neck sub-module (H&N35) identified significant improvements in teeth, dry mouth and social contact (p=0.002; p=0.038; p=0.029, respectively). The University of Washington Scale (UW), showed significant changes in relation to chewing and shoulders (p=0.031; p=0.047). When sub-group analysis using 'osteoradionecrosis' and 'dental extraction or implants' was performed on the EORTC and UW data, variations in the patterns of significance were found. Adjunctive HBO2 should be considered for the treatment and prevention of some of the long-term complications of radiotherapy.
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Affiliation(s)
- S A Harding
- Hyperbaric Medical Centre, Derriford, Plymouth, Devon, UK.
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Content comparison of quality of life questionnaires used in head and neck cancer based on the international classification of functioning, disability and health: a systematic review. Eur Arch Otorhinolaryngol 2008; 265:627-37. [DOI: 10.1007/s00405-008-0641-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 02/28/2008] [Indexed: 11/12/2022]
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Lu H, Yao M. The current status of intensity-modulated radiation therapy in the treatment of nasopharyngeal carcinoma. Cancer Treat Rev 2007; 34:27-36. [PMID: 17910906 DOI: 10.1016/j.ctrv.2007.08.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 08/21/2007] [Accepted: 08/21/2007] [Indexed: 01/29/2023]
Abstract
Radiation therapy is the mainstay of treatment in nasopharyngeal carcinoma, alone or in combination with chemotherapy. In the early stage, it can be managed by radiotherapy alone. For locally advanced-stage disease, several meta-analyses have demonstrated the role of concurrent chemoradiotherapy. Conventional radiation therapy results in significant side effects, particular xerostomia, leading to poor quality of life. With the maturity of intensity-modulated radiation therapy in the recent 10 years, more and more evidences have shown the advantages of intensity-modulated radiation therapy over conventional radiation therapy, regarding the local-regional control, survival rate and quality of life. This article reviews the utilization of intensity-modulated radiation therapy in the management of nasopharyngeal carcinoma with respect to its technical advantages, clinical outcome, critical organ sparing and quality of life, and the dilemma in target delineation. In particular, an issue of treatment-related dysphagia will also be discussed.
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Affiliation(s)
- Heming Lu
- Department of Radiation Oncology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning City, PR China.
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Cheng KKF, Leung SF, Thompson DR, Tai JWM, Liang RHS, Kan AST, Ying FWO, Yeung RMW. New measure of health-related quality of life for patients with oropharyngeal mucositis: development and preliminary psychometric evaluation. Cancer 2007; 109:2590-9. [PMID: 17492684 DOI: 10.1002/cncr.22730] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Oropharyngeal mucositis (OM) causes profound impairment of patients' health-related quality of life (HQoL). The aim of the article is to describe the development and preliminary validation of an HQoL instrument, OMQoL, specifically for patients with OM. METHODS First, a qualitative phase was conducted to generate items (n = 23). Face validity was assessed by focus group interviews (n = 13). Expert content review (n = 7) was used to ensure content validity. The second step was a quantitative validation phase comprised a multicenter study (n = 210) to help identify subscales of the instrument addressing different dimensions of OM and to measure reliability. RESULTS The qualitative interview generated 171 items. Using focus group discussion and expert content review, items were reduced to 41 items. Factor and scaling analyses of these 41 items resulted in 4 subscales, contributed by 31 items, depicting problems with symptoms, diet, social function, and swallowing. The floor effect was modest. The factorial structure was satisfactory with loading >0.40 on each subscale for all items. All corrected item-total corrections were higher than 0.40 (r = 0.457-0.874). The internal consistency reliability of each subscale was high, with Cronbach alpha coefficients ranging from 0.906 to 0.934. The test-retest reliability of the individual items using weighted kappa was good (kappa values 0.610-0.895). The intraclass correlation results for the subscale totals were all in excess of 0.70 (0.864-0.934). CONCLUSIONS An initial psychometric analysis of the OMQoL was encouraging. The OMQoL could provide a valuable tool for the assessment of HQoL of patients with OM.
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Affiliation(s)
- Karis K F Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
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Murphy BA, Ridner S, Wells N, Dietrich M. Quality of life research in head and neck cancer: a review of the current state of the science. Crit Rev Oncol Hematol 2007; 62:251-67. [PMID: 17408963 DOI: 10.1016/j.critrevonc.2006.07.005] [Citation(s) in RCA: 211] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 05/31/2006] [Accepted: 07/19/2006] [Indexed: 10/23/2022] Open
Abstract
Quality of life (QOL) has become an increasingly important outcome measure for patient's undergoing treatment for a wide array of illnesses. QOL is a global construct that reflects a patient's general sense of well being. It is by definition multi-dimensional and reflective of the patient's point of view. Health related issues are among the many factors that may influence QOL. Since head and neck cancer (HNC) affects structures that are critical for normal functions such as speech and swallowing, and treatment may lead to deformities that adversely impact psychosocial functioning, there is particular interest in assessing QOL in this cohort of patients. In order to interpret the HN QOL literature, it is important to have an understanding of the significance and limitations of QOL assessments in the head and neck patient population as well as an appreciation for the currently available measurement tools. Unfortunately, the HNC QOL literature has many limitations including: small sample size, lack of prospective data and poor study design. None-the-less, important insights can be obtained by review of the current literature. First, it is important that QOL studies be reported in such a way as to provide clinically meaningful data to clinicians. Linking measurements with clinical benchmarks is one way to accomplish this goal. In addition, both general and HNC specific measures are needed in order to provide a comprehensive assessment of global health and tumor specific issues. In general, QOL declines immediately after therapy and returns toward baseline by 1 year. Several factors have been identified that may predict for worse QOL outcomes including: the presence of a feeding tube, co-morbid disease, tracheotomy, site and stage. Data correlating QOL with functional outcome and symptom burden fails to demonstrate a consistent relationship. This may be attributed to methodological issues in study design or the patient's ability to adapt to functional and symptom control problems. Whether routine use of QOL measures in the clinical setting is beneficial to patients has yet to be determined. Further studies are warranted as currently available instruments may not be valid for repeated clinical use.
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Affiliation(s)
- Barbara A Murphy
- Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, 777 Preston Research Building, Nashville, TN 37215, USA.
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Hutton JL, Baracos VE, Wismer WV. Chemosensory dysfunction is a primary factor in the evolution of declining nutritional status and quality of life in patients with advanced cancer. J Pain Symptom Manage 2007; 33:156-65. [PMID: 17280921 DOI: 10.1016/j.jpainsymman.2006.07.017] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 07/18/2006] [Accepted: 07/19/2006] [Indexed: 11/18/2022]
Abstract
Alterations in taste and smell functions have been reported in cancer patients. Although these senses are known to be particularly affected by chemotherapy, many features of chemosensory perception in cancer patients remain obscure. The relative importance of chemosensory changes in the etiology of malnutrition and wasting is not known. To assess this relationship, self-perceived taste and smell function were evaluated using a validated questionnaire in 66 patients with advanced cancer receiving palliative care (median survival 7.4 months). Participants also completed 3-day food records to assess dietary intake, and the Functional Assessment of Anorexia/Cachexia Therapy questionnaire to assess quality of life (QOL). Total chemosensory complaint scores ranged from 0 to 14 on a 16-point scale. Only 14% of the subjects reported no chemosensory complaints of any kind, whereas 86% reported some degree of chemosensory abnormality. The most common complaints were persistent bad taste in the mouth, taste distortion, and heightened sensitivity to odors. Subjects with severe chemosensory complaints showed substantially lower energy intakes (by 900-1,100 kcal/day), higher rates of weight loss, and lower QOL scores than subjects with mild or moderate chemosensory complaints. Severe chemosensory dysfunction is persistent well beyond the window of active therapy in patients with advanced cancer and represents a primary factor relating to malnutrition, wasting, and poor QOL. Further research is required to identify appropriate strategies to alleviate this important group of symptoms, to determine whether intervention will improve QOL, and to match foods and diet to the unique chemosensory profile of advanced cancer patients.
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Affiliation(s)
- Joanne L Hutton
- Department of Agricultural Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Braam PM, Roesink JM, Raaijmakers CPJ, Busschers WB, Terhaard CHJ. Quality of life and salivary output in patients with head-and-neck cancer five years after radiotherapy. Radiat Oncol 2007; 2:3. [PMID: 17207274 PMCID: PMC1779273 DOI: 10.1186/1748-717x-2-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 01/05/2007] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To describe long-term changes in time of quality of life (QOL) and the relation with parotid salivary output in patients with head-and-neck cancer treated with radiotherapy. METHODS Forty-four patients completed the EORTC-QLQ-C30(+3) and the EORTC-QLQ-H&N35 questionnaires before treatment, 6 weeks, 6 months, 12 months, and at least 3.5 years after treatment. At the same time points, stimulated bilateral parotid flow rates were measured. RESULTS There was a deterioration of most QOL items after radiotherapy compared with baseline, with gradual improvement during 5 years follow-up. The specific xerostomia-related items showed improvement in time, but did not return to baseline. Global QOL did not alter significantly in time, although 41% of patients complained of moderate or severe xerostomia at 5 years follow-up. Five years after radiotherapy the mean cumulated parotid flow ratio returned to baseline but 20% of patients had a flow ratio <25%. The change in time of xerostomia was significantly related with the change in flow ratio (p = 0.01). CONCLUSION Most of the xerostomia-related QOL scores improved in time after radiotherapy without altering the global QOL, which remained high. The recovery of the dry mouth feeling was significantly correlated with the recovery in parotid flow ratio.
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Affiliation(s)
- Pètra M Braam
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Judith M Roesink
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Wim B Busschers
- Department of Biostatistics, Utrecht University, Utrecht, The Netherlands
| | - Chris HJ Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
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Cabot I, Le May S, Besner G. Revue critique des outils d'évaluation de la douleur chez une clientèle adulte souffrant de cancer. Rech Soins Infirm 2007. [DOI: 10.3917/rsi.090.0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Lin A, Kim HM, Terrell JE, Dawson LA, Ship JA, Eisbruch A. Quality of life after parotid-sparing IMRT for head-and-neck cancer: a prospective longitudinal study. Int J Radiat Oncol Biol Phys 2003; 57:61-70. [PMID: 12909216 DOI: 10.1016/s0360-3016(03)00361-4] [Citation(s) in RCA: 280] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Parotid-sparing intensity-modulated radiotherapy (IMRT) for head-and-neck cancer reduces xerostomia compared with standard RT. To assess potential improvements in broader aspects of quality of life (QOL), we initiated a study of patient-reported QOL and its predictors after IMRT. MATERIALS AND METHODS This was a prospective longitudinal study of head-and-neck cancer patients receiving multisegmental static IMRT. Patients were given a validated xerostomia questionnaire (XQ), and a validated head-and-neck cancer-related QOL questionnaire consisting of four multi-item domains: Eating, Communication, Pain, and Emotion. The Eating domain contains one question (total of six) asking directly about xerostomia. In both questionnaires, higher scores denote worse symptoms or QOL. The questionnaires and measurements of salivary output from the major glands were completed before RT started (pre-RT) and at 3, 6, and 12 months after RT. The association between the QOL scores and patient-, tumor-, and therapy-related factors was assessed using the random effects model. RESULTS Thirty-six patients participating in the study completed the questionnaires through 12 months. The XQ scores worsened significantly at 3 months compared with the pre-RT scores, but later they improved gradually through 12 months (p = 0.003), in parallel with an increase in the salivary output from the spared salivary glands. The QOL summary scores were stable between the baseline (pre-RT) and 3 months after RT scores. Patients receiving postoperative RT (whose pre-RT questionnaires were taken a few weeks after surgery) tended to have improved scores after RT, reflecting the subsidence of acute postoperative sequelae, compared with a tendency toward worsened scores in patients receiving definitive RT. After 3 months, statistically significant improvement was noted in the summary QOL scores for all patients, through 12 months after RT (p = 0.01). The salivary flow rates, tumor doses, mean oral cavity dose, age, gender, sites or stages of tumor, surgery, and use of chemotherapy were not associated with the QOL scores at any point. The mean dose to the parotid glands correlated with the QOL scores at 3 months (p = 0.05) but not at other post-RT periods. The XQ and QOL summary scores did not correlate before RT but were significantly correlated at each post-RT point (p < 0.01), with a linear correlation coefficient (r) of 0.59, 0.72, and 0.67 at 3, 6, and 12 months, respectively. At these points, the XQ scores also correlated significantly with the scores of each of the individual QOL domains (p < or = 0.01), including the domains Pain and Emotion, which did not contain any xerostomia-related question. CONCLUSION After parotid-sparing IMRT, a statistically significant correlation was noted between patient-reported xerostomia and each of the domains of QOL: Eating, Communication, Pain, and Emotion. Both xerostomia and QOL scores improved significantly over time during the first year after therapy. These results suggest that the efforts to improve xerostomia using IMRT may yield improvements in broad aspects of QOL.
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Affiliation(s)
- Alexander Lin
- Department of Radiation Oncology, Hospital of the University of Michigan, Ann Arbor, MI 48109-0010, USA
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Morton RP. Studies in the quality of life of head and neck cancer patients: results of a two-year longitudinal study and a comparative cross-sectional cross-cultural survey. Laryngoscope 2003; 113:1091-103. [PMID: 12838004 DOI: 10.1097/00005537-200307000-00001] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine quality-of-life (QL) changes that occur over time among patients treated for head and neck cancer and to compare QL outcomes in two geographically separate and culturally distinct populations. STUDY DESIGN A prospective, observational longitudinal study was made of QL changes over time in head and neck cancer patients, and a matched-pairs cross-sectional study was conducted for comparison of QL outcomes between groups of head and neck cancer patients from two different sociocultural environments. METHODS Patients attending a tertiary head and neck cancer center in Auckland, New Zealand, were interviewed using a validated questionnaire before treatment and at 3, 12, and 24 months after treatment. Changes over time were assessed according to gender, site and stage of primary tumor, and type of treatment received. A second group of patients from Toronto, Ontario, Canada, were matched to the first group for age, gender, site and stage of tumor, and time since treatment and interviewed using the same questionnaire. The group comparison was followed by a matched-pairs analysis for the 12-month follow-up interval. RESULTS In the longitudinal study, combined modality treatment resulted in greater physical and somatic dysfunction than single modality treatment. Patients learned to cope well with dysfunction and disability and with adjusting their lifestyle so that overall QL was not related to treatment received. Even so, pain scores and measures of psychological distress were related to overall QL. Otherwise there was no consistent correlation between specific symptoms and QL. An illustration of patients' adaptation to dysfunction was evident in scores for perceived difficulty swallowing, which decrease despite the ongoing need for a soft or liquid diet. In the comparative study, significantly different global QL scores were evident in the two clinical groups studied, despite similar social, somatic, and physical functioning. There was also a significant but inconstant difference in emotional functioning. Although the clinical groups received significantly different treatment regimens, the observed differences in global QL were independent of treatment received. CONCLUSIONS Patients with head and neck cancer generally managed well despite disability and dysfunction after treatment. Patients' expectations, emotional responses, and desired outcomes seemed to be determined by sociocultural factors, causing different patient groups to view their overall QL outcome somewhat differently.
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Affiliation(s)
- Randall P Morton
- Department of Otolaryngology-Head & Neck Surgery, Green Lane Hospital, Green Lane West 3, Auckland, New Zealand.
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Affiliation(s)
- Marcy A List
- University of Chicago Cancer Research Center, Chicago, IL 60637, USA
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Wijers OB, Levendag PC, Braaksma MMJ, Boonzaaijer M, Visch LL, Schmitz PIM. Patients with head and neck cancer cured by radiation therapy: a survey of the dry mouth syndrome in long-term survivors. Head Neck 2002; 24:737-47. [PMID: 12203798 DOI: 10.1002/hed.10129] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Xerostomia can have a significant impact on the quality of life of patients treated by radiation therapy (RT) for cancer in the head and neck. The first aim of the study was to evaluate the degree of xerostomia in 39 long-term survivors treated between 1965-1995 by conventional two-dimensional radiation therapy and currently without evidence of disease. The second aim was to develop a concise instrument to evaluate the subjective aspects of xerostomia. METHODS A newly developed questionnaire and a visual analog scale (VAS) were used in analyzing the degree of dry mouth and xerostomia-related problems. The radiation dose received by the major salivary glands was estimated by analyzing two-dimensional simulation films. RESULTS Sixty-four percent of the patients experienced a moderate to severe degree of xerostomia. In the multivariate analysis, three questions regarding dry mouth, eating, and speech were particularly discriminatory for establishing the degree of xerostomia as expressed by the VAS score. CONCLUSIONS In this survey, 64% of the long-term survivors, after treatment by conventional two-dimensional radiation therapy for a malignancy in the head and neck region, still experienced a moderate to severe degree of permanent xerostomia. A simplified instrument to evaluate xerostomia subjectively can consist of the VAS score and three graded questions.
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Affiliation(s)
- Oda B Wijers
- Department of Radiation Oncology, University Hospital Rotterdam-Daniel, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands
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Schliephake H, Jamil MU. Prospective evaluation of quality of life after oncologic surgery for oral cancer. Int J Oral Maxillofac Surg 2002; 31:427-33. [PMID: 12361079 DOI: 10.1054/ijom.2001.0194] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of the present study was to assess the quality of life (QoL) in patients undergoing surgical therapy for cancer of the lower region of the oral cavity (floor of the mouth and adjacent regions such as the tongue, alveolus, buccal sulcus, and oropharynx). A total of 83 patients were enrolled into the study. QoL was assessed using the core questionnaire and the head and neck module of the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30 and EORTC H&N35). The questionnaires were distributed to the patients preoperatively on the day of hospital admission and 3 months, 6 months and 12 months postoperatively. The changes in the scores were tested longitudinally for statistical significance using a repeated measures analysis of variance (ANOVA). The effect of gender, tumour stage, and prognosis (recurrent disease/non-survival) were tested at the individual intervals additionally by ANOVA procedures. Results showed that surgical treatment of oral cancer of the floor of the mouth led to a temporary deterioration of physical function and role function 3 months after surgery. These changes were accompanied by a significant decrease in oral function with reduced body image and reduced ability and willingness for social contact. The levels of these scores improved until the end of the first year after treatment. Pain, emotional function and the feeling of being ill constantly improved during 1 year. Patients with advanced stage of the disease (Stages III and IV) showed lower values in role function, social function, pain- and site-specific effects such as swallowing and nutritional aspects.
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Affiliation(s)
- H Schliephake
- Abteilung für Mund-, Kieferund Geschtschirurgie Robert Koch, Göttingen, Germany.
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Schliephake H, Jamil MU. Impact of intraoral soft-tissue reconstruction on the development of quality of life after ablative surgery in patients with oral cancer. Plast Reconstr Surg 2002; 109:421-30; discussion 431-2. [PMID: 11818814 DOI: 10.1097/00006534-200202000-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this prospective study was to assess the impact of intraoral soft-tissue reconstruction on the development of quality of life after ablative surgery for oral cancer. A total of 107 patients were enrolled in the study during the period between 1997 and 1999. Quality of life was assessed by using the quality-of-life core questionnaire and the head and neck module of the European Organization for Research and Treatment of Cancer. The questionnaires were distributed to the patients preoperatively on the day of hospital admission and 3 months, 6 months, and 12 months postoperatively. A total of 53 patients filled in all questionnaires and were available for complete longitudinal analysis. The changes in the scores and the impact of defect size, location, and anatomy, the extent of mandibular resection, and the mode of soft-tissue reconstruction were tested longitudinally for statistical significance by using repeated-measures analysis of variance procedures. Of all parameters tested, the mode of soft-tissue reconstruction had the most profound impact on the development of quality of life after ablative surgery for oral cancer in that it was associated with statistically significant changes in the most domains or items associated with postoperative quality of life. In contrast to local flaps, revascularized soft-tissue repair with forearm flaps was associated with an intermittent deterioration of physical and functional scores but was followed by improvement until the end of the first year, and it even surpassed the preoperative baseline level in oral functional and social domains. In large-volume defects, which required repair by myocutaneous grafts, quality of life was not restored to the same extent, and physical, functional, and social domains remained significantly lower.
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Affiliation(s)
- Henning Schliephake
- Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Medizinische Hochschule Hannover, Germany
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Peterman A, Cella D, Glandon G, Dobrez D, Yount S. Mucositis in head and neck cancer: economic and quality-of-life outcomes. J Natl Cancer Inst Monogr 2002:45-51. [PMID: 11694566 DOI: 10.1093/oxfordjournals.jncimonographs.a003440] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Outcomes research typically assesses three major health care outcomes, including quantity of life, quality of life (QOL), and health care cost. This article highlights the impact of treatment-associated mucositis on health care costs and QOL. After a background description of the economic analyses of overall cancer treatment costs and of the incremental costs associated with other treatment side effects, data from a retrospective study of mucositis-specific costs are presented. The second half of this article reviews current knowledge about the effect that mucositis has on QOL. Because the empirical work that specifically evaluates mucositis and QOL is quite limited, studies examining proxies for mucositis grading are described. These include studies comparing the QOL of patients currently undergoing treatment, in which symptoms likely to be associated with mucositis are worse, with that of patients who have completed treatment. Also discussed are investigations examining both the relationship between specific mucositis-associated symptoms, such as pain and difficulty swallowing, and QOL and the weighting of different domains of mucositis-associated problems. Finally, several future research directions are suggested, with the intent of expanding knowledge about the economic and QOL impact of mucositis in patients treated for head and neck cancer.
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Affiliation(s)
- A Peterman
- Northwestern University, Evanston, IL, USA.
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de La Torre Tomás A, Verd Herrero JJ. [Diagnosis and management of post-radiation dryness of mucosas]. Rev Clin Esp 2001; 201:642-4. [PMID: 11786131 DOI: 10.1016/s0014-2565(01)70936-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- A de La Torre Tomás
- Servicio de Oncología Radioterápica. Hospital Universitario Clínica Puerta de Hierro
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Eisbruch A, Kim HM, Terrell JE, Marsh LH, Dawson LA, Ship JA. Xerostomia and its predictors following parotid-sparing irradiation of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2001; 50:695-704. [PMID: 11395238 DOI: 10.1016/s0360-3016(01)01512-7] [Citation(s) in RCA: 529] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess long-term xerostomia in patients receiving parotid-sparing radiation therapy (RT) for head-and-neck cancer, and to find the patient and therapy-related factors that affect its severity. PATIENTS AND METHODS From March 1994 through January 2000, 84 patients received comprehensive bilateral neck RT using conformal and multisegmental intensity-modulated RT (IMRT) aiming to spare the major salivary glands. Before RT and periodically through 2 years after the completion of RT, salivary flow rates from each of the major salivary glands were selectively measured. At the same time intervals, each patient completed an 8-item self-reported xerostomia-specific questionnaire (XQ). To gain a relative measure of the effect of RT on the minor salivary glands, whose output could not be measured, the surfaces of the oral cavity (extending to include the surface of the base of tongue) were outlined in the planning CT scans. The mean doses to the new organ ("oral cavity") were recorded. Forty-eight patients receiving unilateral neck RT were similarly studied and served as a benchmark for comparison. Factors predicting the XQ scores were analyzed using a random-effects model. RESULTS The XQ was found to be reliable and valid in measuring patient-reported xerostomia. The spared salivary glands which had received moderate doses in the bilateral RT group recovered to their baseline salivary flow rates during the second year after RT, and the spared glands in the unilateral RT group, which had received very low doses, demonstrated increased salivary production beyond their pre-RT levels. The increase in the salivary flow rates during the second year after RT paralleled an improvement in xerostomia in both patient groups. The improvement in xerostomia was faster in the unilateral compared with the bilateral RT group, but the difference narrowed at 2 years. The major salivary gland flow rates had only a weak correlation with the xerostomia scores. Factors found to be independently associated with the xerostomia scores were the pre-RT baseline scores, the time since RT, and the mean doses to the major salivary glands (notably to the submandibular glands) and to the oral cavity. CONCLUSION An improvement over time in xerostomia, occurring in tandem with rising salivary production from the spared major salivary glands, suggests a long-term clinical benefit from their sparing. The oral cavity mean dose, representing RT effect on the minor salivary glands, was found to be a significant, independent predictor of xerostomia. Thus, in addition to the major salivary glands, sparing the uninvolved oral cavity should be considered as a planning objective to further reduce xerostomia.
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Affiliation(s)
- A Eisbruch
- Department of Radiation Oncology, University of Michigan Hospital, Ann Arbor, MI 48109, USA.
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Abstract
BACKGROUND Quality of life (QOL) is an important treatment outcome for head and neck cancer. Our purpose was to critically review published disease-specific QOL instruments. METHODS Medline and Cancerlit were searched from 1966-1999. Eight disease-specific QOL instruments were identified, described, and appraised for development, sensibility, reliability, validity and responsiveness to change. RESULTS Several of the available instruments have been well-developed and characterized. No one instrument is ideal for all purposes. When selecting a disease-specific QOL instrument for head and neck cancer patients, careful consideration must be given to disease subsite, treatment, timing of assessment, clinical setting, study purpose and research question. CONCLUSION Validation of QOL instruments is an ongoing process. Direct comparisons of different instruments may help to establish the most appropriate questionnaire for each situation. Efforts should be focused on the evaluation of existing instruments, rather than the development of new questionnaires.
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Affiliation(s)
- J Ringash
- Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Ontario, Canada
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Bjordal K, de Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, Ahlner-Elmqvist M, Maher EJ, Meyza JW, Brédart A, Söderholm AL, Arraras JJ, Feine JS, Abendstein H, Morton RP, Pignon T, Huguenin P, Bottomly A, Kaasa S. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group. Eur J Cancer 2000; 36:1796-807. [PMID: 10974628 DOI: 10.1016/s0959-8049(00)00186-6] [Citation(s) in RCA: 563] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study tests the reliability and validity of the European Organization for Research and Treatment of Cancer (EORTC) head and neck cancer module (QLQ-H&N35) and version 3.0 of the EORTC Core Questionnaire (QLQ-C30) in 622 head and neck cancer patients from 12 countries. The patients completed the QLQ-C30, the QLQ-H&N35 and a debriefing questionnaire before antineoplastic treatment or at a follow-up. 232 patients receiving treatment completed a second questionnaire after treatment. Compliance was high and the questionnaire was well accepted by the patients. Multitrait scaling analysis confirmed the proposed scale structure of the QLQ-H&N35. The QLQ-H&N35 was responsive to differences between disease status, site and patients with different Karnofsky performance status, and to changes over time. The new physical functioning scale (with a four-point response format) of version 3.0 of the QLQ-C30 was shown to be more reliable than previous versions. Thus, the QLQ-H&N35, in conjunction with the QLQ-C30, appears to be reliable, valid and applicable to broad multicultural samples of head and neck cancer patients.
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Affiliation(s)
- K Bjordal
- The Department of Radiotherapy and Oncology, The Norwegian Radium Hospital, Montebello, N-0310, Oslo, Norway.
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Metges JP, Eschwege F, de Crevoisier R, Lusinchi A, Bourhis J, Wibault P. Radiotherapy in head and neck cancer in the elderly: a challenge. Crit Rev Oncol Hematol 2000; 34:195-203. [PMID: 10838265 DOI: 10.1016/s1040-8428(00)00061-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Elderly patients represent the most rapidly growing subgroup of the patient population in France and in the majority of industrialized countries. The effect of age in terms of the prognosis and response to treatment remains unclear. The management strategy (curative versus palliative) for head and neck cancer in the elderly has given vent to divergent opinions and controversies in several respects (the type and quality of treatment, quality of life and economic consequences). This review only focuses on the radiotherapy schedule and head and neck cancers. We compare aged patients with head and neck cancer to younger patients in terms of clinical features, tumor biology, type of treatment, side effects and response. We conclude that if the patient is in a good general condition following a complete evaluation of the cancer, physicians should propose curative treatment with radiotherapy because retrospective trials demonstrate that response in older patients when treated aggressively is comparable to that of younger patients. However, specific trials concerning aged patients with head and neck cancer, quality of life and radiotherapy are warranted.
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Affiliation(s)
- J P Metges
- Department of Radiotherapy, Institut Gustave-Roussy avenue Camille Desmoulins, 94805 Cedex, Villejuif, France.
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Abstract
The quest for improved fractionation and combined modality regimens in head and neck cancer has also yielded progressively higher rates of toxicity. Time compression of dose delivery in accelerated fractionation has produced high rates of severe mucositis including the early stoppage of two randomized trials. The addition of chemotherapy has introduced systemic toxicity and can exacerbate local tissue reactions when used concurrent with radiotherapy. Mucositis is recognized as the principal impediment to efforts at further treatment intensification. The development and utilization of standardized toxicity grading criteria and accepted reporting standards has lagged toxicity production, impeding a full appreciation of the true extent of both acute and late toxicity. Objective data regarding acute and chronic effects on organ function are also sorely lacking. A better characterization of the frequency, severity, and duration of the various toxicities encountered in head and neck cancer will also allow the rational development of toxicity interventions. New methods are needed to summarize the global or aggregate toxicity of a treatment program. Further research into the assessment and analysis of toxicity is not only crucial to improvements in quality of life (QOL), but perhaps, improved rates of disease control as well.
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Affiliation(s)
- A Trotti
- Division of Radiation Oncology, H. Lee Moffitt Cancer Center at the University of South Florida, Tampa, FL, USA.
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