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Maggio A, Rancati T, Gatti M, Cante D, Avuzzi B, Bianconi C, Badenchini F, Farina B, Ferrari P, Giandini T, Girelli G, Landoni V, Magli A, Moretti E, Petrucci E, Salmoiraghi P, Sanguineti G, Villa E, Waskiewicz JM, Guarneri A, Valdagni R, Fiorino C, Cozzarini C. Quality of Life Longitudinal Evaluation in Prostate Cancer Patients from Radiotherapy Start to 5 Years after IMRT-IGRT. Curr Oncol 2024; 31:839-848. [PMID: 38392056 PMCID: PMC10887595 DOI: 10.3390/curroncol31020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The purpose of this study is to study the evolution of quality of life (QoL) in the first 5 years following Intensity-modulated radiation therapy (IMRT) for prostate cancer (PCa) and to determine possible associations with clinical/treatment data. MATERIAL AND METHODS Patients were enrolled in a prospective multicentre observational trial in 2010-2014 and treated with conventional (74-80 Gy, 1.8-2 Gy/fr) or moderately hypofractionated IMRT (65-75.2 Gy, 2.2-2.7 Gy/fr). QoL was evaluated by means of EORTC QLQ-C30 at baseline, at radiation therapy (RT) end, and every 6 months up to 5 years after IMRT end. Fourteen QoL dimensions were investigated separately. The longitudinal evaluation of QoL was analysed by means of Analysis of variances (ANOVA) for multiple measures. RESULTS A total of 391 patients with complete sets of questionnaires across 5 years were available. The longitudinal analysis showed a trend toward the significant worsening of QoL at RT end for global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. QoL worsening was recovered within 6 months from RT end, with the only exception being physical functioning. Based on ANOVA, the most impaired time point was RT end. QoL dimension analysis at this time indicated that acute Grade ≥ 2 gastrointestinal (GI) toxicity significantly impacted global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. Acute Grade ≥ 2 genitourinary (GU) toxicity resulted in lower role functioning and higher pain. Prophylactic lymph-nodal irradiation (WPRT) resulted in significantly lower QoL for global health, fatigue, appetite loss, and diarrhoea; lower pain with the use of neoadjuvant/concomitant hormonal therapy; and lower fatigue with the use of an anti-androgen. CONCLUSIONS In this prospective, longitudinal, observational study, high radiation IMRT doses delivered for PCa led to a temporary worsening of QoL, which tended to be completely resolved at six months. Such transient worsening was mostly associated with acute GI/GU toxicity, WPRT, and higher prescription doses.
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Affiliation(s)
- Angelo Maggio
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Marco Gatti
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Domenico Cante
- Ospedale di Ivrea, A.S.L. TO4, 10015 Ivrea, Italy; (D.C.); (E.P.)
| | - Barbara Avuzzi
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Cinzia Bianconi
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
| | - Fabio Badenchini
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Bruno Farina
- Ospedale degli Infermi, 13875 Biella, Italy; (B.F.); (G.G.)
| | - Paolo Ferrari
- Comprensorio Sanitario di Bolzano, 39100 Bolzano, Italy; (P.F.); (J.M.W.)
| | - Tommaso Giandini
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | | | - Valeria Landoni
- IRCCS Istituto Tumori Regina Elena, 00144 Roma, Italy; (V.L.); (G.S.)
| | | | | | - Edoardo Petrucci
- Ospedale di Ivrea, A.S.L. TO4, 10015 Ivrea, Italy; (D.C.); (E.P.)
| | | | | | - Elisa Villa
- Cliniche Gavazzeni-Humanitas, 24121 Bergamo, Italy; (P.S.); (E.V.)
| | | | - Alessia Guarneri
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Riccardo Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milano, Italy
| | - Claudio Fiorino
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
| | - Cesare Cozzarini
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
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Carlstrom LP, Van Gompel JJ, Choby G. Olfactory Neuroblastoma: Treatment Strategies for Advanced Disease. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023. [DOI: 10.1007/s40136-023-00447-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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van der Weijst L, Azria D, Berkovic P, Boisselier P, Briers E, Bultijnck R, Chang-Claude J, Choudhury A, Defraene G, Demontois S, Elliott RM, Ennis D, Faivre-Finn C, Franceschini M, Giandini T, Giraldo A, Gutiérrez-Enríquez S, Herskind C, Higginson DS, Kerns SL, Johnson K, Lambrecht M, Lang P, Ramos M, Rancati T, Rimner A, Rosenstein BS, De Ruysscher D, Salem A, Sangalli C, Seibold P, Sosa Fajardo P, Sperk E, Stobart H, Summersgill H, Surmont V, Symonds P, Taboada-Valladares B, Talbot CJ, Vega A, Veldeman L, Veldwijk MR, Ward T, Webb A, West CML, Lievens Y. The correlation between pre-treatment symptoms, acute and late toxicity and patient-reported health-related quality of life in non-small cell lung cancer patients: Results of the REQUITE study. Radiother Oncol 2022; 176:127-137. [PMID: 36195214 PMCID: PMC10404651 DOI: 10.1016/j.radonc.2022.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/16/2022] [Accepted: 09/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the association between clinician-scored toxicities and patient-reported health-related quality of life (HRQoL), in early-stage (ES-) and locally-advanced (LA-) non-small cell lung cancer (NSCLC) patients receiving loco-regional radiotherapy, included in the international real-world REQUITE study. MATERIALS AND METHODS Clinicians scored eleven radiotherapy-related toxicities (and baseline symptoms) with the Common Terminology Criteria for Adverse Events version 4. HRQoL was assessed with the European Organization for Research and Treatment of Cancer core HRQoL questionnaire (EORTC-QLQ-C30). Statistical analyses used the mixed-model method; statistical significance was set at p = 0.01. Analyses were performed for baseline and subsequent time points up to 2 years after radiotherapy and per treatment modality, radiotherapy technique and disease stage. RESULTS Data of 435 patients were analysed. Pre-treatment, overall symptoms, dyspnea, chest wall pain, dysphagia and cough impacted overall HRQoL and specific domains. At subsequent time points, cough and dysphagia were overtaken by pericarditis in affecting HRQoL. Toxicities during concurrent chemo-radiotherapy and 3-dimensional radiotherapy had the most impact on HRQoL. Conversely, toxicities in sequential chemo-radiotherapy and SBRT had limited impact on patients' HRQoL. Stage impacts the correlations: LA-NSCLC patients are more adversely affected by toxicity than ES-NSCLC patients, mimicking the results of radiotherapy technique and treatment modality. CONCLUSION Pre-treatment symptoms and acute/late toxicities variously impact HRQoL of ES- and LA-NSCLC patients undergoing different treatment approaches and radiotherapy techniques. Throughout the disease, dyspnea seems crucial in this association, highlighting the additional effect of co-existing comorbidities. Our data call for optimized radiotherapy limiting toxicities that may affect patients' HRQoL.
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Affiliation(s)
- Lotte van der Weijst
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium.
| | - David Azria
- Federation Universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, Univ Montpellier, IRCM Inserm U1194, ICM, Montpellier, France
| | - Patrick Berkovic
- Department of Radiotherapy-oncology, Leuvens Kanker Instituut, UZ Leuven, Leuven, Belgium
| | - Pierre Boisselier
- Federation Universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, Univ Montpellier, IRCM Inserm U1194, ICM, Montpellier, France
| | | | - Renée Bultijnck
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium; Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Germany
| | - Ananya Choudhury
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, United Kingdom
| | - Gilles Defraene
- Laboratory of Experimental Radiotherapy, Department of Oncology, KULEUVEN, Leuven, Belgium
| | - Sylvian Demontois
- Federation Universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, Univ Montpellier, IRCM Inserm U1194, ICM, Montpellier, France
| | - Rebecca M Elliott
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, United Kingdom
| | - Dawn Ennis
- Royal Derby Hospital, Derby DE22 3NE, United Kingdom
| | - Corinne Faivre-Finn
- University of Manchester, UK, The Christie NHS Foundation Trust, United Kingdom
| | - Marzia Franceschini
- Unit of Radiation Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tommaso Giandini
- Unit of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alexandra Giraldo
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel S Higginson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States
| | - Sarah L Kerns
- Departments of Radiation Oncology and Surgery, University of Rochester Medical Center, Rochester, New York, NY, United States
| | - Kerstie Johnson
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Maarten Lambrecht
- Department of Radiotherapy-oncology, Leuvens Kanker Instituut, UZ Leuven, Leuven, Belgium
| | - Philippe Lang
- Federation Universitaire d'oncologie radiothérapie d'Occitanie, ICG CHU Caremeau, Nîmes, France
| | - Mónica Ramos
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States
| | - Barry S Rosenstein
- Department of Radiation Oncology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, United States
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro), Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Ahmed Salem
- University of Manchester, UK, The Christie NHS Foundation Trust, United Kingdom; Department of Basic Medical Sciences, School of Medicine, Hashemite University, Zarqa, Jordan
| | - Claudia Sangalli
- Unit of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paloma Sosa Fajardo
- Department of Radiation Oncology, Hospital Clínico Universitario de Santiago, SERGAS.Instituto de Investigación Sanitaria de Santiago de Compostela, Spain
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Holly Summersgill
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, United Kingdom
| | - Veerle Surmont
- Department of Respiratory Medicine, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Paul Symonds
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Begoña Taboada-Valladares
- Department of Radiation Oncology, Hospital Clínico Universitario de Santiago, SERGAS.Instituto de Investigación Sanitaria de Santiago de Compostela, Spain
| | - Christopher J Talbot
- Leicester Cancer Research Centre, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Ana Vega
- Fundación Pública Galega de Medicina Xenómica, Grupo de Medicina Xenómica (USC), Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela, Spain; Biomedical Network on Rare Diseases (CIBERER), Spain
| | - Liv Veldeman
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Marlon R Veldwijk
- Department of Radiation Oncology, Universitätsklinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tim Ward
- Trustee Pelvic Radiation Disease Association, NCRI CTRad Consumer, United Kingdom
| | - Adam Webb
- Department of Genetics and Genome Biology, University of Leicester, United Kingdom
| | - Catharine M L West
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, United Kingdom
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
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Dejanovic D, Specht L, Czyzewska D, Kiil Berthelsen A, Loft A. Response Evaluation Following Radiation Therapy With 18F-FDG PET/CT: Common Variants of Radiation-Induced Changes and Potential Pitfalls. Semin Nucl Med 2022; 52:681-706. [PMID: 35835618 DOI: 10.1053/j.semnuclmed.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Radiation therapy (RT) is one of the cornerstones in cancer treatment and approximately half of all patients will receive some form of RT during the course of their cancer management. Response evaluation after RT and follow-up imaging with 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) can be complicated by RT-induced acute, chronic or consequential effects. There is a general consensus that 18F-FDG PET/CT for response evaluation should be delayed for 12 weeks after completing RT to minimize the risk of false-positive findings. Radiation-induced late side effects in normal tissue can take years to develop and eventually cause symptoms that on imaging can potentially mimic recurrent disease. Imaging findings in radiation induced injuries depend on the normal tissue included in the irradiated volume and the radiation therapy regime including the total dose delivered, dose per fraction and treatment schedule. The intent for radiation therapy should be taken in consideration when evaluating the response on imaging, that is palliative vs curative or neoadjuvant vs adjuvant RT. Imaging findings can further be distorted by altered anatomy and sequelae following surgery within the radiation field. An awareness of common PET/CT-induced changes/injuries is essential when interpreting 18F-FDG PET/CT as well as obtaining a complete medical history, as patients are occasionally scanned for an unrelated cause to previously RT treated malignancy. In addition, secondary malignancies due to carcinogenic effects of radiation exposure in long-term cancer survivors should not be overlooked. 18F-FDG PET/CT can be very useful in response evaluation and follow-up in patients treated with RT, however, variants and pitfalls are common and it is important to remember that radiation-induced injury is often a diagnosis of exclusion.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Takada T, Damen JAAG, Tambas M, Spijker R, Steenbakkers RJHM, Sharabiani M, Clementel E, Langendijk JA, Moons KGM, Schuit E. Prognostic models for radiation-induced complications after radiotherapy in head and neck cancer patients. Hippokratia 2021. [DOI: 10.1002/14651858.cd014745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Toshihiko Takada
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht, Utrecht University; Utrecht Netherlands
| | - Johanna AAG Damen
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht, Utrecht University; Utrecht Netherlands
- Cochrane Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University; Utrecht Netherlands
| | - Makbule Tambas
- Department of Radiation Oncology, University Medical Center Groningen; University of Groningen; Groningen Netherlands
| | - René Spijker
- Cochrane Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University; Utrecht Netherlands
| | - Roel JHM Steenbakkers
- Department of Radiation Oncology, University Medical Center Groningen; University of Groningen; Groningen Netherlands
| | - Marjan Sharabiani
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Brussels Belgium
| | - Enrico Clementel
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters; Brussels Belgium
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen; University of Groningen; Groningen Netherlands
| | - Karel GM Moons
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht, Utrecht University; Utrecht Netherlands
- Cochrane Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University; Utrecht Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht, Utrecht University; Utrecht Netherlands
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Ucuncu Kefeli A, Sanal-Toprak C, Asedov R, Ozen Z, Akyuz G, Dane F, Atasoy BM. Long-term neuromusculoskeletal side effects and quality of life in nasopharyngeal cancer patients receiving radiochemotherapy. Eur Arch Otorhinolaryngol 2020; 277:2325-2333. [PMID: 32236708 DOI: 10.1007/s00405-020-05932-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/17/2020] [Indexed: 12/25/2022]
Abstract
AIM In this study, we aimed to evaluate the neuromusculoskeletal late side effects and their impact on the quality of life of patients with nasopharyngeal carcinoma treated with radiochemotherapy. PATIENTS AND METHODS Twenty-seven patients were included. The mean follow-up was 61 months (range, 18-111 months). The median external radiotherapy dose applied to the nasopharynx and primary tumor was 70 Gy (range, 61-73 Gy). The mean dose received by the temporomandibular joint in the dose-volume histograms of these patients was 60.7 Gy. The maximal doses of the muscles responsible for cervical motion in different ranges were greater than 60 Gy, and the mean doses were greater than 40 Gy in the muscle groups, except for the extensor muscles. RESULTS Two patients had brachial plexus involvement, while 89% of the patients had restriction in flexion and extension movements. Of the patients, 52% had trismus. There was a significant correlation between extension restriction and general heath score and the physical subscale of the quality-of-life questionnaire (p = 0.01). There was also a correlation between trismus and pain killer usage (p = 0.004). CONCLUSION This is the first study to analyze long-term muscle and nerve toxicity and their correlation between doses in nasopharyngeal cancer patients following radiochemotherapy. Despite the advances in radiotherapy techniques, it is necessary to pay attention to the doses of the nerves and muscles for late effects.
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Affiliation(s)
- Aysegul Ucuncu Kefeli
- Faculty of Medicine, Department of Radiation Oncology, Kocaeli University, Kocaeli, Turkey
| | - Canan Sanal-Toprak
- School of Medicine, Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Ruslan Asedov
- Marmara University Pendik Education and Research Hospital Radiology Clinic, Istanbul, Turkey
| | - Zeynep Ozen
- Acıbadem Altunizade Hospital Radiation Oncology Clinic, Istanbul, Turkey
| | - Gulseren Akyuz
- School of Medicine, Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Faysal Dane
- School of Medicine, Department of Internal Medicine Division of Medical Oncology, Marmara University, Istanbul, Turkey
| | - Beste M Atasoy
- School of Medicine, Department of Radiation Oncology, Marmara University, Istanbul, Turkey. .,S.B.-M.Ü. Pendik Egitim ve Arastırma Hastanesi Radyasyon Onkolojisi Klinigi, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad. No: 6 Pendik 34899, Istanbul, Turkey.
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Götzl R, Sterzinger S, Semrau S, Vassos N, Hohenberger W, Grützmann R, Agaimy A, Arkudas A, Horch RE, Beier JP. Patient's quality of life after surgery and radiotherapy for extremity soft tissue sarcoma - a retrospective single-center study over ten years. Health Qual Life Outcomes 2019; 17:170. [PMID: 31703704 PMCID: PMC6842193 DOI: 10.1186/s12955-019-1236-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/22/2019] [Indexed: 01/12/2023] Open
Abstract
Background and objectives The purpose of this study is to analyze major complication rates and different aspects of health-related quality of life (HRQoL) in extremity soft tissue sarcoma (STS) patients treated with or without radio (chemo) therapy and surgery. Methods We performed a retrospective analysis of all patients who underwent Extremity STS excision from 2004 to 2014 (182 patients included). Patients’ data were collected from patients’ records. HRQoL was assessed by using EORTC QLQ-C30. Results A total of 182 patients underwent sarcoma resection. After neoadjuvant radiochemotherapy (RCT), the major-complication rate amounted to 28% (vs. 7%, no radiotherapy, p < 0.001). Major-complication rates after adjuvant radiotherapy (RT) occurred in 8% (vs. 7%, no radiotherapy, p = 0.265). Comparison QoL scores between treating with neoadjuvant RCT or without RT revealed significant worse scores with neoadjuvant RCT. Further stratification of disease control of these patients showed significant reduced scores in the group of disease-free patients with neoadjuvant RCT compared to irradiated disease-free patients. Discussion To date, there have only been a few investigations of QoL in STS. Retrospective study on quality of life have limitations, like a lack of baseline evaluation of QoL. Patient candidated to radiation therapy could have had worse QoL baseline due to more advanced disease. Disease status of the patients who answered the questionnaires could have been an influence of QoL and we could show reduced scores in the group of disease-free patients with neoadjuvant RCT, but not for the patients with recurrence or metastasis, so it is very hard to discriminate whether radiation therapy could really have an impact or not. Conclusion This study might assist in further improving the understanding of QoL in STS patients and may animate for prospective studies examining the oncological therapies impact on HRQoL.
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Affiliation(s)
- Rebekka Götzl
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, Universitiy Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany. .,Present Address: Department of Plastic Surgery, Hand and Burn Surgery, University Hospital of Aachen, RWTH University of Aachen, Aachen, Germany.
| | - Sebastian Sterzinger
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, Universitiy Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sabine Semrau
- Department of Radiation Oncology, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Nikolaos Vassos
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Werner Hohenberger
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robert Grützmann
- Department of Surgery, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Abbas Agaimy
- Department of Pathology, Comprehensive Cancer Center, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, Universitiy Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, Universitiy Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Justus P Beier
- Department of Plastic and Hand Surgery, Comprehensive Cancer Center, Universitiy Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Present Address: Department of Plastic Surgery, Hand and Burn Surgery, University Hospital of Aachen, RWTH University of Aachen, Aachen, Germany
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Singer S, Amdal CD, Hammerlid E, Tomaszewska IM, Castro Silva J, Mehanna H, Santos M, Inhestern J, Brannan C, Yarom N, Fullerton A, Pinto M, Arraras JI, Kiyota N, Bonomo P, Sherman AC, Baumann I, Galalae R, Fernandez Gonzalez L, Nicolatou-Galitis O, Abdel-Hafeez Z, Raber-Durlacher J, Schmalz C, Zotti P, Boehm A, Hofmeister D, Krejovic Trivic S, Loo S, Chie WC, Bjordal K, Brokstad Herlofson B, Grégoire V, Licitra L. International validation of the revised European Organisation for Research and Treatment of Cancer Head and Neck Cancer Module, the EORTC QLQ-HN43: Phase IV. Head Neck 2019; 41:1725-1737. [PMID: 30636188 DOI: 10.1002/hed.25609] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/25/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We validated the new European Organisation for Research and Treatment of Cancer Quality of Life Head and Neck Module (EORTC QLQ-HN43). METHODS We enrolled 812 patients with head and neck cancer from 18 countries. Group 1 completed the questionnaire before therapy, and 3 and 6 months later. In group 2 (survivors), we determined test-retest reliability using intraclass correlation coefficients (ICC). Internal consistency was assessed using Cronbach's Alpha, the scale structure with confirmatory factor analysis, and discriminant validity with known-group comparisons. RESULTS Cronbach's alpha was >0.70 in 10 of the 12 multi-item scales. All standardized factor loadings exceeded 0.40. The ICC was >0.70 in all but two scales. Differences in scale scores between known-groups were >10 points in 17 of the 19 scales. Sensitivity to change was found to be sufficient in 18 scales. CONCLUSIONS Evidence supports the reliability and validity of the EORTC QLQ-HN43 as a measure of quality of life.
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Affiliation(s)
- Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Centre of Johannes Gutenberg University, Mainz, Germany
| | | | - Eva Hammerlid
- Department of Otolaryngology and Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden
| | - Iwona M Tomaszewska
- Department of Medical Didactics, Jagiellonian University Medical College, Krakow, Poland
| | - Joaquim Castro Silva
- Department of Otolaryngology, Head and Neck Surgery, Instituto Português de Oncologia Francisco Gentil do Porto, Porto, Portugal
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
| | - Marcos Santos
- Radiation Oncology Department, Brasilia University Hospital, Brasilia, Brazil
| | - Johanna Inhestern
- Clinic of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Christine Brannan
- Lynda Jackson Macmillan Centre, East & North Hertfordshire NHS Trust incorporating Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel-Hashomer, Israel and School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amy Fullerton
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Monica Pinto
- Supportive Care Department, Istituto Nazionale Tumori -IRCCS- Fondazione G. Pascale, Naples, Italy
| | - Juan I Arraras
- Oncology Departments, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital Cancer Center, Kobe, Japan
| | - Pierluigi Bonomo
- Radiation Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Allen C Sherman
- Behavioral Medicine Division, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ingo Baumann
- Department of Otolaryngology, Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany
| | - Razvan Galalae
- Department of Radiation Oncology, EVK Gelsenkirchen, University Duisburg-Essen, Gelsenkirchen, Germany
| | | | - Ourania Nicolatou-Galitis
- Clinic of Hospital Dentistry, Dental Oncology Unit, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Judith Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (location AMC) and Department of Oral Medicine ACTA, University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Claudia Schmalz
- Department of Radiation Therapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Paola Zotti
- Department of Psychology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Andreas Boehm
- Department of Otolaryngology Head and Neck Surgery, St. Georg Hospital, Leipzig, Germany
| | - Dirk Hofmeister
- Department of Medical Psychology, University Hospital Leipzig, Leipzig, Germany
| | - Sanja Krejovic Trivic
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Suat Loo
- Department of Oncology, Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom
| | - Wei-Chu Chie
- Department of Family Medicine, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kristin Bjordal
- Department of Research Support Services, Oslo University Hospital, and University of Oslo, Oslo, Norway
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, University of Oslo, and Department of Otorhinolaryngology - Head and Neck Surgery Division for Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Vincent Grégoire
- Radiation Oncology Dept & Center for Molecular Imaging and Experimental Radiotherapy, Université Catholique de Louvain and St-Luc University Hospital, Brussels, Belgium
| | - Lisa Licitra
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milano, and University of Milan, Milan, Italy
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Álvarez-Camacho M, Gonella S, Campbell S, Scrimger RA, Wismer WV. A systematic review of smell alterations after radiotherapy for head and neck cancer. Cancer Treat Rev 2017; 54:110-121. [PMID: 28242521 DOI: 10.1016/j.ctrv.2017.02.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/30/2017] [Accepted: 02/05/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the current knowledge on radiotherapy associated olfactory dysfunction among head and neck cancer (HNC) patients. METHODS A systematic review of RT-related olfactory dysfunction in HNC was performed. Searches were conducted in several databases (Medline, EMBASE, CINAHL, CAB Abstracts, SCOPUS, Proquest Dissertations and Theses, PROSPERO, ALLEBM Reviews - Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED). Publications investigating olfactory dysfunction as an explicit side effect of Radiotherapy (RT, or RT-chemo or RT-monoclonal antibodies) were eligible, no limits were applied. RESULTS Two hundred and twenty-nine papers were screened and 23 met inclusion criteria. CONCLUSIONS Odor detection, identification and discrimination are olfactory functions impaired after RT for HNC. An RT dose-effect has been calculated for odor identification and odor discrimination. There were no studies of the effect of olfactory dysfunction on weight loss or energy intake among RT-treated HNC patients. To improve our understanding of RT associated olfactory dysfunction among HNC patients, future studies should include a multi-dimensional assessment of olfactory function in a longitudinal design, track other conditions affecting olfaction, assess retronasal olfactory perception, adopt validated self-report tools and explore the impact of olfactory dysfunction on the eating experience of HNC patients.
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Affiliation(s)
- M Álvarez-Camacho
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - S Gonella
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Italy
| | - S Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - R A Scrimger
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - W V Wismer
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada.
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Dysphagia, Speech, Voice, and Trismus following Radiotherapy and/or Chemotherapy in Patients with Head and Neck Carcinoma: Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6086894. [PMID: 27722170 PMCID: PMC5045989 DOI: 10.1155/2016/6086894] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/01/2016] [Indexed: 01/19/2023]
Abstract
Introduction. Patients with head and neck cancer suffer from various impairments due to the primary illness, as well as secondary consequences of the oncological treatment. This systematic review describes the effects of radiotherapy and/or chemotherapy on the functions of the upper aerodigestive tract in patients with head and neck cancer. Methods. A systematic literature search was performed by two independent reviewers using the electronic databases PubMed and Embase. All dates up to May 2016 were included. Results. Of the 947 abstracts, sixty articles met the inclusion criteria and described one or more aspects of the sequelae of radiotherapy and/or chemotherapy. Forty studies described swallowing-related problems, 24 described voice-related problems, seven described trismus, and 25 studies described general quality of life. Only 14 articles reported that speech pathologists conducted the interventions, of which only six articles described in detail what the interventions involved. Conclusion. In general, voice quality improved following intervention, whereas quality of life, dysphagia, and oral intake deteriorated during and after treatment. However, as a consequence of the diversity in treatment protocols and patient characteristics, the conclusions of most studies cannot be easily generalised. Further research on the effects of oncological interventions on the upper aerodigestive tract is needed.
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Xu L, Yang X, Chen J, Ge X, Qin Q, Zhu H, Zhang C, Sun X. Simvastatin attenuates radiation-induced salivary gland dysfunction in mice. Drug Des Devel Ther 2016; 10:2271-8. [PMID: 27471375 PMCID: PMC4948692 DOI: 10.2147/dddt.s105809] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective Statins are widely used lipid-lowering drugs, which have pleiotropic effects, such as anti-inflammation, and vascular protection. In our study, we investigated the radioprotective potential of simvastatin (SIM) in a murine model of radiation-induced salivary gland dysfunction. Design Ninety-six Institute of Cancer Research mice were randomly divided into four groups: solvent + sham irradiation (IR) (Group I), SIM + sham IR (Group II), IR + solvent (Group III), and IR + SIM (Group IV). SIM (10 mg/kg body weight, three times per week) was administered intraperitoneally 1 week prior to IR through to the end of the experiment. Saliva and submandibular gland tissues were obtained for biochemical, morphological (hematoxylin and eosin staining and Masson’s trichrome), and Western blot analysis at 8 hours, 24 hours, and 4 weeks after head and neck IR. Results IR caused a significant reduction of salivary secretion and amylase activity but elevation of malondialdehyde. SIM remitted the reduction of saliva secretion and restored salivary amylase activity. The protective benefits of SIM may be attributed to scavenging malondialdehyde, remitting collagen deposition, and reducing and delaying the elevation of transforming growth factor β1 expression induced by radiation. Conclusion SIM may be clinically useful to alleviate side effects of radiotherapy on salivary gland.
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Affiliation(s)
- Liping Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xi Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jiayan Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiaolin Ge
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Qin Qin
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Hongcheng Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Chi Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Xinchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
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Peisker A, Raschke GF, Guentsch A, Roshanghias K, Eichmann F, Schultze-Mosgau S. Longterm quality of life after oncologic surgery and microvascular free flap reconstruction in patients with oral squamous cell carcinoma. Med Oral Patol Oral Cir Bucal 2016; 21:e420-4. [PMID: 27031070 PMCID: PMC4920454 DOI: 10.4317/medoral.21111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/21/2016] [Indexed: 01/19/2023] Open
Abstract
Background Quality of life (QoL) has become increasingly important in cancer treatment. It refers to the patient’s perception of the effects of the disease and therapy, and their impact on daily functioning and general feeling of well being. Material and Methods n this prospective study, a total of 100 patients treated at our institution, completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and the specific EORTC QLQ-H&N35 module. The questionnaires were distributed to the patients between 12 and 60 months postoperatively. Results Global QoL score was 58.3 and mean score for functioning scale was 76.7. Fatigue (28.7 ± 26.1), followed by financial problems (27.7 ± 33.5), insomnia (26.7 ± 34.5) and pain (26.3 ± 29.9) had highest symptom score on QLQ-C30. Fatigue (r=-0.488), insomnia (r=-0.416) and pain (r =-0.448) showed highest value for significantly negative correlation to global QoL. In the H&N35 module, restriction of mouth opening (43.3 ± 38.6), dry mouth (40.7 ± 36.9), sticky saliva (37.3 ± 37.1) and eating in public (33.8 ± 31.9) were the four worst symptoms. Swallowing problem (r=-0.438), eating in public (r=-0.420) and persistent severe speech (r=-0.398) ranked as the three worst symptoms with highest value for significantly negative correlation to global QoL. Conclusions Longterm QoL after oncologic surgery and microvascular free flap reconstruction in patients with oral cancer is satisfactory. Measuring QoL should be considered as part of the evaluation of cancer treatment. Key words:Longterm quality of life, oral cancer, oncologic surgery, microvascular free flap reconstruction.
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Affiliation(s)
- A Peisker
- Department of Cranio-Maxillofacial & Plastic Surgery, Jena University Hospital, 07747 Jena, Germany,
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13
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Teymoortash A, Pfestroff A, Wittig A, Franke N, Hoch S, Harnisch S, Schade-Brittinger C, Hoeffken H, Engenhart-Cabillic R, Brugger M, Strauch K. Safety and Efficacy of Botulinum Toxin to Preserve Gland Function after Radiotherapy in Patients with Head and Neck Cancer: A Prospective, Randomized, Placebo-Controlled, Double-Blinded Phase I Clinical Trial. PLoS One 2016; 11:e0151316. [PMID: 26991494 PMCID: PMC4798778 DOI: 10.1371/journal.pone.0151316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 02/24/2016] [Indexed: 11/27/2022] Open
Abstract
This prospective, randomized, placebo-controlled, double-blinded phase I clinical trial investigates safety and efficacy of botulinum toxin (BoNT) to preserve gland function after radiotherapy in patients with head and neck cancer. Twelve patients with advanced head and neck cancer were injected with BoNT into the submandibular glands prior to primary radiochemotherapy. Six patients received BoNT/A and 6 patients BoNT/A and B, half of each subgroup into their left and the other half into their right gland. As an internal control, sodium chloride was injected into the respective contralateral gland (placebo). For the evaluation of the salivary gland function, technetium pertechnetate salivary gland scintigraphy was performed before and after the end of radiotherapy. BoNT/A and B were well tolerated. Analysis of the scintigraphic data revealed no statistically significant difference between BoNT and placebo regarding the scintigraphic uptake difference (pBoNT/A = 0.84 and pBoNT/A-B = 0.56 for BoNT/A vs. placebo and BoNT/A-B vs. placebo, respectively). We also found no significant difference in treatment between BoNT and placebo in terms of salivary excretion fraction (pBoNT/A = 0.44; pBoNT/A-B = 0.44). This study demonstrates that BoNT can be safely combined with radiochemotherapy. Dosing and timing of BoNT injection should be further investigated for efficacy analysis.
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Affiliation(s)
- Afshin Teymoortash
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
- * E-mail:
| | - Andreas Pfestroff
- Department of Nuclear Medicine, Philipp University, Marburg, Germany
| | - Andrea Wittig
- Department of Radiotherapy and Radio-Oncology, Philipp University, Marburg, Germany
| | - Nora Franke
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Stephan Hoch
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - Susanne Harnisch
- Center for Clinical Trials, Philipp University, Marburg, Germany
| | | | - Helmut Hoeffken
- Department of Nuclear Medicine, Philipp University, Marburg, Germany
| | | | - Markus Brugger
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
| | - Konstantin Strauch
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Biometry and Epidemiology, Philipp University, Marburg, Germany
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Alvarez-Camacho M, Gonella S, Ghosh S, Kubrak C, Scrimger RA, Chu KP, Wismer WV. The impact of taste and smell alterations on quality of life in head and neck cancer patients. Qual Life Res 2015. [PMID: 26589527 DOI: 10.1007/s11136‐015‐1185‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE Taste and smell alterations (TSAs) are among the most frequent and troublesome symptoms reported by head and neck cancer (HNC) patients after treatment. Little is known about the relationship between TSAs and quality of life (QoL) among HNC patients. The aim of this study was to determine the effect of TSAs on overall QoL among tube-fed and orally fed HNC patients before treatment, at end of treatment and at 2.5-month follow-up. METHODS Data were collected in a longitudinal study prior to treatment (n = 126), at end of treatment (n = 100) and at 2.5-month follow-up (n = 85). Chemosensory Complaint Score (CCS) and the University of Washington Quality of Life Questionnaire version 3 were used to assess TSAs and QoL, respectively. Generalized estimated equation modeling was used to estimate the effect of CCS on QoL. RESULTS At end of treatment, QoL and CCS had declined for both tube-fed and orally fed patients and thereafter improved, but not to pre-treatment levels. Neither QoL nor CCS mean scores were different between the two groups at any time point. CCS was a significant predictor of overall QoL (β = -1.82, p < 0.0001), social-emotional (β = -1.76, p < 0.0001), physical (β = -1.12, p < 0.0001) and overall functions (β = -1.15, p < 0.0001) at a multivariate level. Taste was reported as an important symptom for both tube-fed and orally fed groups at end of treatment and follow-up. CONCLUSIONS TSAs are an important symptom and an independent predictor of QoL for both tube-fed and orally fed HNC patients. HNC patients need support to manage TSAs, regardless of the method of nutritional intake.
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Affiliation(s)
- M Alvarez-Camacho
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - S Gonella
- Dipartimento di Sanità Pubblica e Medicina di Comunità, Università degli Studi di Verona, Verona, Italy.,Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Turin, Italy
| | - S Ghosh
- Division of Medical Oncology, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - C Kubrak
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada.,Outpatient Department, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - R A Scrimger
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - K P Chu
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - W V Wismer
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada.
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The impact of taste and smell alterations on quality of life in head and neck cancer patients. Qual Life Res 2015; 25:1495-504. [PMID: 26589527 DOI: 10.1007/s11136-015-1185-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Taste and smell alterations (TSAs) are among the most frequent and troublesome symptoms reported by head and neck cancer (HNC) patients after treatment. Little is known about the relationship between TSAs and quality of life (QoL) among HNC patients. The aim of this study was to determine the effect of TSAs on overall QoL among tube-fed and orally fed HNC patients before treatment, at end of treatment and at 2.5-month follow-up. METHODS Data were collected in a longitudinal study prior to treatment (n = 126), at end of treatment (n = 100) and at 2.5-month follow-up (n = 85). Chemosensory Complaint Score (CCS) and the University of Washington Quality of Life Questionnaire version 3 were used to assess TSAs and QoL, respectively. Generalized estimated equation modeling was used to estimate the effect of CCS on QoL. RESULTS At end of treatment, QoL and CCS had declined for both tube-fed and orally fed patients and thereafter improved, but not to pre-treatment levels. Neither QoL nor CCS mean scores were different between the two groups at any time point. CCS was a significant predictor of overall QoL (β = -1.82, p < 0.0001), social-emotional (β = -1.76, p < 0.0001), physical (β = -1.12, p < 0.0001) and overall functions (β = -1.15, p < 0.0001) at a multivariate level. Taste was reported as an important symptom for both tube-fed and orally fed groups at end of treatment and follow-up. CONCLUSIONS TSAs are an important symptom and an independent predictor of QoL for both tube-fed and orally fed HNC patients. HNC patients need support to manage TSAs, regardless of the method of nutritional intake.
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16
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Bilal S, Doss JG, Cella D, Rogers SN. Quality of life associated factors in head and neck cancer patients in a developing country using the FACT-H&N. J Craniomaxillofac Surg 2014; 43:274-80. [PMID: 25555894 DOI: 10.1016/j.jcms.2014.11.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/26/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022] Open
Abstract
Health-related quality of life (HRQoL) associated factors are vital considerations prior to treatment decision-making for head and neck cancer patients. The study aimed to identify potential socio-demographic and clinical prognostic value of HRQoL in head and neck cancer patients in a developing country. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N)-V4 in Urdu language was administered among 361 head and neck cancer patients. Data were statistically tested through multivariate analysis of variance (MANOVA) and regression modeling to identify the potentially associated factors. Treatment status, tumor stage and tumor site had the strongest negative impact on patients HRQoL, with a statistically significant decrement in FACT summary scales (effect size >0.15). Moderate associated factors of HRQoL included treatment type, marital status, employment status and age (effect size range 0.06-0.15). Weak associated factors of HRQoL with a small effect size (>0.01-0.06) included tumor size and type, gender, education level and ethnicity. This study reports 12 socio-demographic and clinical variables that have a significant impact on HRQoL of head, and neck cancer patients, and that should be considered during treatment decision-making by multidisciplinary teams and also in future HRQoL studies conducted in other developing countries.
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Affiliation(s)
- Sobia Bilal
- Oral Cancer Research and Coordinating Center and Department of Community Dentistry, Faculty of Dentistry, University of Malaya, 50390 Kuala Lumpur, Malaysia; Department of Community Oral Health, School of Dentistry, International Medical University, Malaysia.
| | - Jennifer Geraldine Doss
- Oral Cancer Research and Coordinating Center and Department of Community Dentistry, Faculty of Dentistry, University of Malaya, 50390 Kuala Lumpur, Malaysia.
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Simon N Rogers
- Regional Head and Neck Unit, Aintree University Hospital, Liverpool, UK.
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The impact of radiotherapy on quality of life for cancer patients: a longitudinal study. Support Care Cancer 2014; 22:2479-87. [DOI: 10.1007/s00520-014-2235-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 03/31/2014] [Indexed: 11/12/2022]
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19
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Beetz I, Schilstra C, Visink A, van der Schaaf A, Bijl HP, van der Laan BFAM, Steenbakkers RJHM, Langendijk JA. Role of minor salivary glands in developing patient-rated xerostomia and sticky saliva during day and night. Radiother Oncol 2013; 109:311-6. [PMID: 23953752 DOI: 10.1016/j.radonc.2013.06.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/02/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this prospective study was to investigate the relationship between xerostomia during the day (XERday) and night (XERnight) and sticky saliva during the day (STICday) and night (STICnight) and dose distributions in different major and minor salivary glands among head and neck cancer (HNC) patients treated with primary radiotherapy (RT) or chemoradiation (CHRT). METHODS AND MATERIALS The study population was composed of 201 consecutive HNC patients treated with intensity modulated radiotherapy (IMRT) or 3-dimensional conformal radiotherapy (3D-CRT). All patients were included in a standard follow up programme in which acute and late side effects and quality of life (QoL) were prospectively assessed, prior to, during and after treatment. The primary endpoints were XERday, XERnight, STICday, STICnight as assessed by the Groningen Radiotherapy Induced Xerostomia questionnaire (GRIX) six months after completion of treatment. Organs at risk (OARs) potentially involved in salivary function were delineated on planning-CT, including the parotid, submandibular and sublingual glands and the minor glands in the soft palate, buccal mucosa and lips. Patients with moderate-to-severe xerostomia or moderate-to-severe sticky saliva, respectively, at baseline were excluded. In order to determine which salivary glands were most important, a multivariate logistic regression analysis with an extended bootstrapping technique was used. RESULTS In total, 29% and 19% of the cases suffered from XERday and XERnight, respectively. The multivariate analysis showed that baseline xerostomia and the mean parotid gland dose were the most important predictors for XERday and XERnight. At 6months after (CH)RT, 10% and 12% of the cases reported STICday and STICnight respectively. We were not able to identify prognostic factors related to dose distributions with regard to STICday. The mean submandibular gland dose was associated with STICnight. Baseline xerostomia and sticky saliva scores on the GRIX were associated with XERday, XERnight, STICday. Increasing age was correlated with both XERnight and STICnight. CONCLUSION Organs at risk for XERday and STICday are similar to organs at risk for XERnight and STICnight.
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Affiliation(s)
- Ivo Beetz
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
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Melo Filho MRD, Rocha BA, Pires MBDO, Fonseca ES, Freitas EMD, Martelli Junior H, Santos FBG. Quality of life of patients with head and neck cancer. Braz J Otorhinolaryngol 2013; 79:82-8. [PMID: 23503912 PMCID: PMC9450864 DOI: 10.5935/1808-8694.20130014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/27/2012] [Indexed: 11/21/2022] Open
Abstract
Patients with head and neck cancer have to deal with the impact of treatment on its functional and aesthetic aspects, and its self-report enables improvements in clinical and social support. Objective To evaluate the quality of life of patients dealing with squamous cell carcinoma of the head and neck. Method A prospective analytical study. Twenty nine patients with mean age of 57 years answered at three stages: onset, middle and end of treatment, the questionnaires: Quality of Life Core Questionnaire - Cancer 30 and the Quality of Life Questionnaire - Head and Neck, the European Organization for Research and Treatment of Cancer. We used the Friedman test at: 0.05. Results There were high mean values concerning physical, cognitive, social functions; improvements in general health and social function decline during treatment; and a significant difference in taste and smell (p = 0.020), swallowing (p = 0.040), cough (p = 0.013) and weight loss (p = 0.011). Conclusion There was a significant reduction in the quality of life for some common symptoms resulting from cancer treatment, which was not seen in the evaluation of the aspects related to physical, cognitive and social functions, and general health.
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Pierre CS, Dassonville O, Chamorey E, Poissonnet G, Ettaiche M, Santini J, Peyrade F, Benezery K, Sudaka A, Bozec A. Long-term quality of life and its predictive factors after oncologic surgery and microvascular reconstruction in patients with oral or oropharyngeal cancer. Eur Arch Otorhinolaryngol 2013; 271:801-7. [DOI: 10.1007/s00405-013-2592-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
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Singer S, Danker H, Guntinas-Lichius O, Oeken J, Pabst F, Schock J, Vogel HJ, Meister EF, Wulke C, Dietz A. Quality of life before and after total laryngectomy: Results of a multicenter prospective cohort study. Head Neck 2013; 36:359-68. [DOI: 10.1002/hed.23305] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 01/23/2023] Open
Affiliation(s)
- Susanne Singer
- University Medical Centre Mainz; Institute of Medical Biostatistics; Epidemiology and Informatics (IMBEI); Mainz Germany
- University of Leipzig; Division of Psychosocial Oncology; Leipzig Germany
| | - Helge Danker
- University of Leipzig; Department of Psychosomatic Medicine and Psychotherapy; Leipzig Germany
| | | | - Jens Oeken
- Hospital Chemnitz; Department of Otorhinolaryngology; Chemnitz Germany
| | - Friedemann Pabst
- Hospital Dresden-Friedrichstadt; Department of Otorhinolaryngology; Dresden Germany
| | - Juliane Schock
- Hospital Martha-Maria; Department of Otorhinolaryngology; Halle-Dölau Germany
| | - Hans-Joachim Vogel
- Hospital Elblandkliniken; Department of Otorhinolaryngology; Riesa Germany
| | - Eberhard F. Meister
- Community Hospital St. Georg; Department of Otorhinolaryngology; Leipzig Germany
| | - Cornelia Wulke
- Community Hospital St. Georg; Department of Otorhinolaryngology; Leipzig Germany
| | - Andreas Dietz
- University of Leipzig; Department of Otorhinolaryngology; Leipzig Germany
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Langius JAE, van Dijk AM, Doornaert P, Kruizenga HM, Langendijk JA, Leemans CR, Weijs PJM, Verdonck-de Leeuw IM. More Than 10% Weight Loss in Head and Neck Cancer Patients During Radiotherapy Is Independently Associated with Deterioration in Quality of Life. Nutr Cancer 2013; 65:76-83. [DOI: 10.1080/01635581.2013.741749] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ogama N, Ogama N. Development of an oral assessment tool to evaluate appetite in patients with head and neck cancer receiving radiotherapy. Eur J Oncol Nurs 2012; 17:474-81. [PMID: 23164924 DOI: 10.1016/j.ejon.2012.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 10/06/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The objective of this study was to develop an oral assessment tool for evaluating the appetite of patients with head and neck cancer receiving radiotherapy, who had dysgeusia, xerostomia, and oral mucositis, as well as to verify its validity and reliability. METHODS AND SAMPLE A draft oral assessment tool, which included a 5-point scale and 19 items, was prepared based on an interview survey of 30 patients. The resultant questionnaire survey was provided to 209 subjects. RESULTS On the basis of factor analysis of construct validity, 3 factors (dysgeusia and loss of favors), (salivation abnormality and loss of moisture in the oral cavity), and (pain in the oral cavity and lack of motivation) comprising 14 items were adopted for the final survey. During a review of criteria validity, a correlation was found between the scores of the three factors and overall oral assessment tool, and the scores of taste sensitivity, xerostomia, oral mucositis, and appetite with a correlation coefficient of r = 0.41-0.89 (p < 0.01). With regard to reliability, stability was determined as 0.87 (p < 0.01) according to test-retest study results. Internal consistency was confirmed by a Cronbach's alpha coefficient of 0.83 (p < 0.01) and an interclass correlation coefficient of 0.80 (p < 0.01). CONCLUSIONS On the basis of the validity and reliability of the oral assessment tool developed, it has been found to be practical for use in the assessment of appetite of patients with head and neck cancer.
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Affiliation(s)
- Norimasa Ogama
- School of Nursing, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan.
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Beetz I, Schilstra C, van der Schaaf A, van den Heuvel ER, Doornaert P, van Luijk P, Vissink A, van der Laan BFAM, Leemans CR, Bijl HP, Christianen MEMC, Steenbakkers RJHM, Langendijk JA. NTCP models for patient-rated xerostomia and sticky saliva after treatment with intensity modulated radiotherapy for head and neck cancer: the role of dosimetric and clinical factors. Radiother Oncol 2012; 105:101-6. [PMID: 22516776 DOI: 10.1016/j.radonc.2012.03.004] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/18/2012] [Accepted: 03/10/2012] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this multicentre prospective study was to develop multivariable logistic regression models to make valid predictions about the risk of moderate-to-severe patient-rated xerostomia (XER(M6)) and sticky saliva 6 months (STIC(M6)) after primary treatment with intensity modulated radiotherapy (IMRT) with or without chemotherapy for head and neck cancer (HNC). METHODS AND MATERIALS The study population was composed of 178 consecutive HNC patients treated with IMRT. All patients were included in a standard follow up programme in which acute and late side effects and quality of life were prospectively assessed, prior to, during and after treatment. The primary endpoints were XER(M6) and STIC(M6) as assessed by the EORTC QLQ-H&N35 after completing IMRT. Organs at risk (OARs) potentially involved in salivary function were delineated on planning-CT, including the parotid, submandibular and sublingual glands and the minor glands in the soft palate, cheeks and lips. Patients with moderate-to-severe xerostomia or sticky saliva, respectively, at baseline were excluded. The optimal number of variables for a multivariate logistic regression model was determined using a bootstrapping method. RESULTS Eventually, 51.6% of the cases suffered from XER(M6). The multivariate analysis showed that the mean contralateral parotid gland dose and baseline xerostomia (none vs. a bit) were the most important predictors for XER(M6). For the multivariate NTCP model, the area under the receiver operating curve (AUC) was 0.68 (95% CI 0.60-0.76) and the discrimination slope was 0.10, respectively. Calibration was good with a calibration slope of 1.0. At 6 months after IMRT, 35.6% of the cases reported STIC(M6). The mean contralateral submandibular gland dose, the mean sublingual dose and the mean dose to the minor salivary glands located in the soft palate were most predictive for STIC(M6). For this model, the AUC was 0.70 (95% CI 0.61-0.78) and the discrimination slope was 0.12. Calibration was good with a calibration slope of 1.0. CONCLUSIONS The multivariable NTCP models presented in this paper can be used to predict patient-rated xerostomia and sticky saliva. The dose volume parameters included in the models can be used to further optimise IMRT treatment.
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Affiliation(s)
- Ivo Beetz
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Macfarlane TV, Wirth T, Ranasinghe S, Ah-See KW, Renny N, Hurman D. Head and neck cancer pain: systematic review of prevalence and associated factors. J Oral Maxillofac Res 2012; 3:e1. [PMID: 24422003 PMCID: PMC3886092 DOI: 10.5037/jomr.2012.3101] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 02/23/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC. MATERIAL AND METHODS The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies. RESULTS There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43% - 70%) and after (42%, 95% CI 33% - 50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour- or treatment-related. CONCLUSIONS The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer.
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Affiliation(s)
| | - Tanja Wirth
- School of Medicine and Dentistry, University of Aberdeen, AberdeenUnited Kingdom.
- University of Bremen, BremenGermany.
| | - Sriyani Ranasinghe
- School of Medicine and Dentistry, University of Aberdeen, AberdeenUnited Kingdom.
- Postgraduate Institute of Medicine, University of ColomboSri Lanka.
| | - Kim W. Ah-See
- Department of Otolaryngology, Aberdeen Royal Infirmary, AberdeenUnited Kingdom.
| | - Nick Renny
- Department of Maxillofacial Surgery, Aberdeen Royal Infirmary, AberdeenUnited Kingdom.
| | - David Hurman
- Department of Clinical Oncology, Aberdeen Royal Infirmary, AberdeenUnited Kingdom.
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Mc Caughan E, Mc Sorley O, Prue G, Parahoo K, Bunting B, Sullivan JO, McKenna H. Quality of life in men receiving radiotherapy and neo-adjuvant androgen deprivation for prostate cancer: results from a prospective longitudinal study. J Adv Nurs 2012; 69:53-65. [PMID: 22458267 DOI: 10.1111/j.1365-2648.2012.05987.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM To report a study measuring the quality of life and side effects in men receiving radiotherapy and hormone ablation for prostate cancer up to 1 year after treatment. BACKGROUND Prostate cancer incidence is increasing with the result that more men are living longer with the disease and the side effects of treatment. It is important to know the effects this has on their quality of life. DESIGN Survey. METHOD Between September 2006-September 2007, all men who were about to undergo radical conformal radiotherapy ± neo-adjuvant androgen deprivation for localized prostate cancer were invited to participate in the study; 149 men were recruited. They completed the European Organization on Research and Treatment of Cancer quality of life questionnaire C-30 and Prostate Cancer module PR25 at four time-points. RESULTS At 4-6 weeks after radiotherapy, participants experienced the biggest relative decline in global quality of life, social, physical, and role functioning and an increase in treatment side effects. At 6 months postradiotherapy the majority of men experienced an improvement in their side effects. However, a minority of men were experiencing severe side effects of radiotherapy at 1 year post-treatment. Single men and men who had a low quality of life prior to radiotherapy, reported a lower quality of life at 1 year after treatment in comparison to married men. CONCLUSION Men with prostate cancer suffer limitations due to the symptoms they experience and disruption to their quality of life. It is essential that nurses develop and deliver follow-up care which is flexible and appropriate to the individual needs of these men.
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Güleser GN, Taşci S, Kaplan B. The experience of symptoms and information needs of cancer patients undergoing radiotherapy. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:46-53. [PMID: 21751048 DOI: 10.1007/s13187-011-0254-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim was to determine the symptoms and information needs of cancer patients undergoing radiotherapy (RT). The study population consisted of 345 RT patients accrued over 6 months. Patients' needs for information, sources of information, levels of satisfaction with information, symptoms and demographic factors were assessed by questionnaire and personal interview. Chi-square tests were used to test the correlation between patient variables and information needs/experiences. Most patients (80.9%) experienced RT side effects--fatigue, nausea, vomiting and loss of appetite were the most frequent. More than half of the patients had not received information about RT; however, patients (83.2%) who had problems during the treatment wanted to have information (P < 0.05). The majority of the patients receiving information identified doctors as the primary source. The patients' prioritized needs for information were all the aspects of their diagnosis and treatment and side effects of RT. Overall, the results indicate that most patients require information about their treatment and also experienced a variety of symptoms.
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Affiliation(s)
- Gülsüm Nihal Güleser
- Erciyes University Halil Bayraktar Health Services Vocational College, Kayseri, Turkey.
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Beetz I, Schilstra C, van Luijk P, Christianen MEMC, Doornaert P, Bijl HP, Chouvalova O, van den Heuvel ER, Steenbakkers RJHM, Langendijk JA. External validation of three dimensional conformal radiotherapy based NTCP models for patient-rated xerostomia and sticky saliva among patients treated with intensity modulated radiotherapy. Radiother Oncol 2011; 105:94-100. [PMID: 22169766 DOI: 10.1016/j.radonc.2011.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/11/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study was to investigate the ability of predictive models for patient-rated xerostomia (XER(6M)) and sticky saliva (STIC(6M)) at 6 months after completion of primary (chemo)radiation developed in head and neck cancer patients treated with 3D-conformal radiotherapy (3D-CRT) to predict outcome in patients treated with intensity modulated radiotherapy (IMRT). METHODS AND MATERIALS Recently, we published the results of a prospective study on predictive models for patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with 3D-CRT (3D-CRT based NTCP models). The 3D-CRT based model for XER(6M) consisted of three factors, including the mean parotid dose, age, and baseline xerostomia (none versus a bit). The 3D-CRT based model for STIC(6M) consisted of the mean submandibular dose, age, the mean sublingual dose, and baseline sticky saliva (none versus a bit). In the current study, a population consisting of 162 patients treated with IMRT was used to test the external validity of these 3D-CRT based models. External validity was described by the explained variation (R(2) Nagelkerke) and the Brier score. The discriminative abilities of the models were calculated using the area under the receiver operating curve (AUC) and calibration (i.e. the agreement between predicted and observed outcome) was assessed with the Hosmer-Lemeshow "goodness-of-fit" test. RESULTS Overall model performance of the 3D-CRT based predictive models for XER(6M) and STIC(6M) was significantly worse in terms of the Brier score and R(2) Nagelkerke among patients treated with IMRT. Moreover the AUC for both 3D-CRT based models in the IMRT treated patients were markedly lower. The Hosmer-Lemeshow test showed a significant disagreement for both models between predicted risk and observed outcome. CONCLUSION 3D-CRT based models for patient-rated xerostomia and sticky saliva among head and neck cancer patients treated with primary radiotherapy or chemoradiation turned out to be less valid for patients treated with IMRT. The main message from these findings is that models developed in a population treated with a specific technique cannot be generalised and extrapolated to a population treated with another technique without external validation.
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Affiliation(s)
- Ivo Beetz
- Department of Radiation Oncology University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Haisfield-Wolfe ME, McGuire DB, Soeken K, Geiger-Brown J, De Forge B, Suntharalingam M. Prevalence and correlates of symptoms and uncertainty in illness among head and neck cancer patients receiving definitive radiation with or without chemotherapy. Support Care Cancer 2011; 20:1885-93. [DOI: 10.1007/s00520-011-1291-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 09/26/2011] [Indexed: 11/30/2022]
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Head BA, Heitz L, Keeney C, Myers J, Appana SN, Studts JL, Bumpous J, Pfeifer M. The relationship between weight loss and health-related quality of life in persons treated for head and neck cancer. Support Care Cancer 2011; 19:1511-8. [PMID: 20730547 PMCID: PMC4177674 DOI: 10.1007/s00520-010-0975-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 07/29/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE This study explores the relationship between weight loss, health-related quality of life (HRQOL), and symptom burden in patients treated for head and neck cancers. METHODS Participants completed the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) and the Memorial Symptom Assessment Scale (MSAS) pre-treatment, mid-treatment, and post-treatment. Weights were recorded prior to treatment and at the post-treatment follow-up visit, and percentage weight loss was tabulated. Relationships between weight loss, HRQOL, and symptom burden were evaluated using the nonparametric Spearman rho. A simple linear regression model was developed to examine the influence weight loss has on HRQOL in a predictive manner. RESULTS Average weight loss per patient was 12 lb with a modal value of 19. Weight loss was found to be significantly correlated with decreases in physical well-being, functional well-being, the Head and Neck specific subscale, and composite QOL scores. No significant correlations were found between weight loss and symptom burden as measured by the MSAS. Linear regression suggested that a 10% decrease in baseline weight resulted in a 19% decrease in the FACT-H&N score. CONCLUSION The strong association between weight loss and HRQOL supports the importance of efforts to prevent weight loss via patient education, aggressive monitoring, and immediate intervention to stop or reverse weight loss during treatment. New approaches to the weight loss and wasting experienced by patients should be developed and tested.
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Affiliation(s)
- Barbara A Head
- University of Louisville School of Medicine, MDR Bldg., Suite 110, 511 South Floyd St., Ste. 110, Louisville, KY 40202, USA.
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Poirier P. The Impact of Fatigue on Role Functioning During Radiation Therapy. Oncol Nurs Forum 2011; 38:457-65. [DOI: 10.1188/11.onf.457-465] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Beetz I, Schilstra C, Burlage FR, Koken PW, Doornaert P, Bijl HP, Chouvalova O, Leemans CR, de Bock GH, Christianen MEMC, van der Laan BFAM, Vissink A, Steenbakkers RJHM, Langendijk JA. Development of NTCP models for head and neck cancer patients treated with three-dimensional conformal radiotherapy for xerostomia and sticky saliva: the role of dosimetric and clinical factors. Radiother Oncol 2011; 105:86-93. [PMID: 21632133 DOI: 10.1016/j.radonc.2011.05.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 03/28/2011] [Accepted: 05/03/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this multicentre prospective study was to investigate the significance of the radiation dose in the major and minor salivary glands, and other pre-treatment and treatment factors, with regard to the development of patient-rated xerostomia and sticky saliva among head and neck cancer (HNC) patients treated with primary (chemo-) radiotherapy ((CH)RT). METHODS AND MATERIALS The study population was composed of 167 consecutive HNC patients treated with three-dimensional conformal (3D-CRT) (CH) RT. The primary endpoint was moderate to severe xerostomia (XER6m) as assessed by the EORTC QLQ-H&N35 at 6 months after completing (CH)RT. The secondary endpoint was moderate to severe sticky saliva at 6 months (STIC6m). All organs at risk (OARs) potentially involved in salivary function were delineated on planning-CT, including the parotid, submandibular and sublingual glands and the minor glands in the soft palate, cheeks and lips. Patients with moderate to severe xerostomia or sticky saliva at baseline were excluded. The optimum number of variables for a multivariate logistic regression model was determined using a bootstrapping method. RESULTS The multivariate analysis showed the mean parotid dose, age and baseline xerostomia (none versus a bit) to be the most important predictors for XER6m. The risk of developing xerostomia increased with age and was higher when minor baseline xerostomia was present in comparison with patients without any xerostomia complaints at baseline. Model performance was good with an area under the curve (AUC) of 0.82. For STIC6m, the mean submandibular dose, age, the mean sublingual dose and baseline sticky saliva (none versus a bit) were most predictive for sticky saliva. The risk of developing STIC6m increased with age and was higher when minor baseline sticky saliva was present in comparison with patients without any sticky saliva complaints at baseline. Model performance was good with an AUC of 0.84. CONCLUSIONS Dose distributions in the minor salivary glands in patients receiving 3D-CRT have limited significance with regard to patient-rated symptoms related to salivary dysfunction. Besides the parotid and submandibular glands, only the sublingual glands were significantly associated with sticky saliva. In addition, reliable risk estimation also requires information from other factors such as age and baseline subjective scores. When these selected factors are included in predictive models, instead of only dose volume histogram parameters, model performance can be improved significantly.
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Affiliation(s)
- Ivo Beetz
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Beetz I, Burlage FR, Bijl HP, Hoegen-Chouvalova O, Christianen ME, Vissink A, van der Laan BF, de Bock GH, Langendijk JA. The Groningen Radiotherapy-Induced Xerostomia questionnaire: Development and validation of a new questionnaire. Radiother Oncol 2010; 97:127-31. [PMID: 20541272 DOI: 10.1016/j.radonc.2010.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 05/15/2010] [Accepted: 05/15/2010] [Indexed: 10/19/2022]
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Analysis of causal models of diet for patients with head and neck cancer receiving radiation therapy. Eur J Oncol Nurs 2010; 14:291-8. [DOI: 10.1016/j.ejon.2010.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 05/06/2010] [Accepted: 05/08/2010] [Indexed: 11/17/2022]
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Jensen SB, Pedersen AML, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NNF, Mello ALS, Muniz LV, Murdoch-Kinch CA, Nair RG, Napeñas JJ, Nogueira-Rodrigues A, Saunders D, Stirling B, von Bültzingslöwen I, Weikel DS, Elting LS, Spijkervet FKL, Brennan MT. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 2010; 18:1039-60. [PMID: 20237805 DOI: 10.1007/s00520-010-0827-8] [Citation(s) in RCA: 253] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 01/26/2010] [Indexed: 01/09/2023]
Abstract
PURPOSE This systematic review aimed to assess the literature for prevalence, severity, and impact on quality of life of salivary gland hypofunction and xerostomia induced by cancer therapies. METHODS The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. Two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results and conclusions for each article. RESULTS The inclusion criteria were met by 184 articles covering salivary gland hypofunction and xerostomia induced by conventional, 3D conformal radiotherapy or intensity-modulated radiotherapy in head and neck cancer patients, cancer chemotherapy, total body irradiation/hematopoietic stem cell transplantation, radioactive iodine treatment, and immunotherapy. CONCLUSIONS Salivary gland hypofunction and xerostomia are induced by radiotherapy in the head and neck region depending on the cumulative radiation dose to the gland tissue. Treatment focus should be on optimized/new approaches to further reduce the dose to the parotids, and particularly submandibular and minor salivary glands, as these glands are major contributors to moistening of oral tissues. Other cancer treatments also induce salivary gland hypofunction, although to a lesser severity, and in the case of chemotherapy and immunotherapy, the adverse effect is temporary. Fields of sparse literature included pediatric cancer populations, cancer chemotherapy, radioactive iodine treatment, total body irradiation/hematopoietic stem cell transplantation, and immunotherapy.
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Affiliation(s)
- S B Jensen
- Department of Oral Medicine, University of Copenhagen, Copenhagen, Denmark.
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Ogama N, Suzuki S, Umeshita K, Kobayashi T, Kaneko S, Kato S, Shimizu Y. Appetite and adverse effects associated with radiation therapy in patients with head and neck cancer. Eur J Oncol Nurs 2009; 14:3-10. [PMID: 19734089 DOI: 10.1016/j.ejon.2009.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 07/09/2009] [Accepted: 07/16/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE The relationship between radiation treatment and adverse effects resulting in changes in appetite was studied in patients with head and neck (H&N) cancer. METHODS AND SAMPLE Path analysis was used to evaluate the following factors in 117 patients receiving radiation therapy for H&N cancer: daily fluctuations in saliva production, analgesic use, frequency of oral care, subject characteristics, and appetite. RESULTS At 20 Gy of radiation, appetite was affected by Brinkman index value, age, and sensitivity to taste (R2=0.48, p<0.001); at 30 Gy of radiation, appetite was affected by frequency of oral care, xerostomia symptoms, age, sensitivity to taste, and oral mucositis (R2=0.52, p<0.001); and at 50 Gy of radiation, appetite was affected by low saliva production in the morning, frequency of oral care, xerostomia symptoms, sensitivity to taste, analgesic use, and oral mucositis (R2=0.62, p<0.001). CONCLUSIONS The results of this study suggest that care taken to avoid a decrease in appetite due to adverse effects of radiation therapy should differ according to the dosage and schedule of radiation therapy. These findings represent important data for health care professionals to understand and support appropriate dietary intake and improved quality of life for H&N cancer patients receiving radiation therapy.
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Affiliation(s)
- Norimasa Ogama
- Area of Nursing Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka Suita, Osaka 565-0871, Japan.
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Chaukar DA, Walvekar RR, Das AK, Deshpande MS, Pai PS, Chaturvedi P, Kakade A, D'Cruz AK. Quality of life in head and neck cancer survivors: a cross-sectional survey. Am J Otolaryngol 2009; 30:176-80. [PMID: 19410123 DOI: 10.1016/j.amjoto.2008.05.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/23/2008] [Accepted: 05/03/2008] [Indexed: 01/22/2023]
Abstract
PURPOSE Head and neck cancer (HNC) survivors have substantial psychological distress in addition to treatment-related side effects. This study examines the long-term quality of life (QOL) of HNC survivors in a busy tertiary care center. MATERIAL AND METHODS A prospective, cross-sectional survey was conducted studying 212 HNC survivors 1 year after completion of their treatment at a tertiary cancer center. Quality of life assessments were performed using the 2 standardized health-related QOL questionnaires: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 and The Quality of Life Questionnaire Head and Neck Cancer Module. RESULTS The overall global QOL rating for the study cohort was satisfactory. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores showed that the domains where most patients faired poorly included financial difficulties (54%), appetite loss (36%), fatigue (33%), and cough (30%). The Quality of Life Questionnaire Head and Neck Cancer Module scale identified the domains with poor scores to be dry mouth (64%), dental problems (42%), sticky saliva (40%), cough (39%), and problems with mouth opening (32%). Patients with early-stage tumors and those treated with surgery alone had significantly better QOL scores when compared with advanced stage tumors and patients receiving either radiation alone or multimodality treatment, respectively. CONCLUSIONS Quality of life questionnaires provide a medium for patients to effectively communicate with their physician in a busy tertiary care facility and provide an insight into the physical, psychological, and social problems affecting our patients which can then direct future interventions.
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Affiliation(s)
- Devendra A Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Parel, Mumbai, India.
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Teymoortash A, Müller F, Juricko J, Bieker M, Mandic R, Librizzi D, Höffken H, Pfestroff A, Werner JA. Botulinum toxin prevents radiotherapy-induced salivary gland damage. Oral Oncol 2009; 45:737-9. [PMID: 19213593 DOI: 10.1016/j.oraloncology.2008.11.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 11/20/2008] [Accepted: 11/20/2008] [Indexed: 11/28/2022]
Abstract
Radiotherapy of head and neck malignancies results in severe damage to salivary glands. Irradiation-induced sialadenitis with xerostomia leads to a significant deterioration of the quality of life which lasts life-long. Here we show in a preliminary study that intraglandular application of botulinum toxin performed prior to radiation reduces significantly the radiation induced toxicity of the glandular tissue in rats.
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Affiliation(s)
- Afshin Teymoortash
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany.
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Alicikus ZA, Akman F, Ataman OU, Dag N, Orcin E, Bakis B, Kinay M. Importance of patient, tumour and treatment related factors on quality of life in head and neck cancer patients after definitive treatment. Eur Arch Otorhinolaryngol 2008; 266:1461-8. [DOI: 10.1007/s00405-008-0889-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 12/03/2008] [Indexed: 11/30/2022]
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Takahashi T, Hondo M, Nishimura K, Kitani A, Yamano T, Yanagita H, Osada H, Shinbo M, Honda N. Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy. ACTA ACUST UNITED AC 2008; 26:396-401. [DOI: 10.1007/s11604-008-0248-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 04/10/2008] [Indexed: 11/12/2022]
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Free-Flap Head and Neck Reconstruction and Quality of Life: A 2-Year Prospective Study. Laryngoscope 2008; 118:874-80. [DOI: 10.1097/mlg.0b013e3181644abd] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE/OBJECTIVES To examine factors that might affect patients' ability to perform their usual activities during radiation therapy. DESIGN Prospective, longitudinal design. SETTING A community hospital radiation oncology department. SAMPLE 77 patients receiving radiation therapy for curative or adjuvant intent. METHODS The role function mode of the Roy Adaptation Model guided the study. Participants rated the extent to which they were performing their usual activities on a scale of 0 (not at all) to 10 (all the time). Data were collected at baseline prior to starting radiation, weekly during treatment, and one month post-treatment. Cross-sectional and longitudinal regression analyses were used to capture changes in performance of usual activities over time. MAIN RESEARCH VARIABLES Performance of usual activities, Karnofsky Performance Status (KPS), fatigue, and side effects. FINDINGS Participants maintained relatively high performance status throughout the course of treatment. The ability to perform usual activities decreased significantly from baseline to the end of treatment. Ability to perform usual activities was highly negatively correlated with fatigue and side effects. Work, sick-leave benefits, living situation, fatigue, KPS, and comorbidities were associated with ability to perform usual activities along the trajectory of radiation therapy. CONCLUSIONS Fatigue and side effects of treatment negatively affected patients' ability to carry out their usual activities during radiation therapy. IMPLICATIONS FOR NURSING Management of side effects of treatment, including fatigue, and supporting patients' need to work or not work during treatment may help patients continue to perform activities that are important to them during radiation therapy.
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Jellema AP, Slotman BJ, Doornaert P, Leemans CR, Langendijk JA. Impact of Radiation-Induced Xerostomia on Quality of Life After Primary Radiotherapy Among Patients With Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2007; 69:751-60. [PMID: 17560735 DOI: 10.1016/j.ijrobp.2007.04.021] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 04/06/2007] [Accepted: 04/06/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate the impact of xerostomia on overall quality of life (QoL) outcome and related dimensions among head and neck cancer patients treated with primary radiotherapy. METHODS AND MATERIALS A total of 288 patients with Stage I-IV disease without distant metastases were included. Late xerostomia according to the Radiation Therapy Oncology Group (RTOG-xerostomia) and QoL (European Organization for Research and Treatment of Cancer QLC-C30) were assessed at baseline and every 6th month from 6 months to 24 months after radiotherapy. RESULTS A significant association was found between RTOG-xerostomia and overall QoL outcome (effect size [ES] 0.07, p < 0.001). A significant relationship with global QoL, all functioning scales, and fatigue and insomnia was observed. A significant interaction term was present between RTOG-xerostomia and gender and between RTOG-xerostomia and age. In terms of gender, RTOG-xerostomia had a larger impact on overall QoL outcome in women (ES 0.13 for women vs. 0.07 for men). Furthermore, in women ES on individual scales were larger, and a marked worsening was observed with increasing RTOG-xerostomia. No different ES according to age was seen (ES 0.10 for 18-65 years vs. 0.08 for >65 years). An analysis of the impact of RTOG-xerostomia on overall QoL outcome over time showed an increase from 0.09 at 6 months to 0.22 at 24 months. With elapsing time, a worsening was found for these individual scales with increasing RTOG-xerostomia. CONCLUSIONS The results of this prospective study are the first to show a significant impact of radiation-induced xerostomia on QoL. Although the incidence of Grade > or =2 RTOG-xerostomia decreases with time, its impact on QoL increases. This finding emphasizes the importance of prevention of xerostomia.
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Affiliation(s)
- Anke Petra Jellema
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands.
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Jellema AP, Slotman BJ, Doornaert P, Leemans CR, Langendijk JA. Unilateral versus bilateral irradiation in squamous cell head and neck cancer in relation to patient-rated xerostomia and sticky saliva. Radiother Oncol 2007; 85:83-9. [PMID: 17391790 DOI: 10.1016/j.radonc.2007.03.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 02/11/2007] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the association between radiation technique with patient-rated moderate and severe xerostomia and sticky saliva. MATERIALS AND METHODS One hundred and fifty patients treated with bilateral or unilateral irradiation for head and neck cancer were included. The salivary glands and the oral cavity were delineated on plannings-CT scans. Xerostomia and sticky saliva were assessed using the EORTC QLQ-H&N35 questionnaire at baseline and 6 and 12 months. RESULTS At 6 months a significant association between radiation technique and the mean parotid dose (MD(parb)) and xerostomia was observed (Odds ratio (OR)-technique: 2.55; p=0.04 and OR-MD(parb): 1.04; p=0.009). Considering the individual salivary glands, only the mean dose in the contralateral parotid gland (MD(parcl)) is associated with xerostomia (OR: 1.04; p<0.0001). Moreover, the threshold dose for a 50% probability (P50) on xerostomia increased from 21 Gy with bilateral to 44 Gy for unilateral irradiation. CONCLUSIONS Both technique and MD(parb) influence the risk of xerostomia in irradiated patients. Of all individual salivary glands, only MD(parcl) is of utmost importance for xerostomia. The shift in the P50 observed for xerostomia suggests that sparing of the contralateral parotid gland is compensated by hyperfunction of the contralateral parotid gland.
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Affiliation(s)
- Anke Petra Jellema
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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Budischewski K, Fischbeck S, Mose S. Quality of life of breast cancer patients in the course of adjuvant radiotherapy. Support Care Cancer 2007; 16:299-304. [PMID: 17680279 DOI: 10.1007/s00520-007-0321-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 07/19/2007] [Indexed: 10/23/2022]
Abstract
GOALS OF THE WORK In cancer patients, there is an ongoing interest in evaluating the impact of therapeutic interventions on health-related quality of life (hrqol). However, only a few longitudinal studies are published being able to measure the influence of therapy for the patients' quality of life. Based on these data, our aim was to evaluate changes of hrqol during the course of adjuvant radiotherapy in breast cancer patients with special focus on subgroup analysis. MATERIALS AND METHODS Sixty-one women undergoing radiotherapy after breast conserving surgery were asked to answer the EORTC Quality of life questionnaire (EORTC-QOL-C30) three times: at the beginning of radiotherapy, in the forth week and 6 weeks after the end of treatment. To identify patients with changes of their qol during the observation time, the function scale "Global health status/Quality of life" was used enabling us to classify three subgroups: (1) unchanged hrqol (NC), (2) increasing hrqol (INC), (3) decreasing of hrqol (DEC). MAIN RESULTS Patients with an increasing hrqol (N = 25) demonstrated a significant increase in the role as well as in the emotional functioning scales. In patients with a decreasing hrqol (N = 15), no changes in any of the function scales were found, while a significant decrease in their cognitive functioning was observed in patients with no change in hrqol (N = 21). CONCLUSIONS Although the interpretation of these data is difficult because only a few data are available to compare our results, it could be demonstrated that emotional support and the ability to maintain a daily routine in additionally irradiated breast cancer patients is important to optimise hrqol. If hrqol decreases during the course of radiotherapy, the function scales of the EORTC-QOL-C30 seem to be insensitive to reflect this decrease.
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Affiliation(s)
- K Budischewski
- SRH University of Applied Sciences, Ludwig-Guttmann-Strasse 6, Heidelberg, Germany.
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Mohan A, Mohan C, Bhutani M, Pathak AK, Pal H, DAS C, Guleria R. Quality of life in newly diagnosed patients with lung cancer in a developing country: is it important? Eur J Cancer Care (Engl) 2006; 15:293-8. [PMID: 16882127 DOI: 10.1111/j.1365-2354.2006.00654.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
There are no data regarding quality of life (QoL) assessments in lung cancer in developing countries like India. Quality of life was evaluated in 76 newly diagnosed lung cancer patients by using the World Health Organization Quality of Life questionnaire in Hindi (WHOQoL-Bref) (men 87%). The mean age was 55 years (SD = 10). Cough, dyspnoea, chest pain and haemoptysis were present in 83%, 72%, 66% and 43% of patients respectively. The median duration of symptoms was 5.9 months (range 1-13). Eighty-nine per cent had non-small cell lung cancer. The median pack-years smoked was 23 (range 0.5-88). Most patients (53%) had a Karnofsky's Performance Status (KPS) of 70 and 83% had stage III or IV disease. Quality of life did not correlate with age, gender, presence or duration of symptoms, histological type, stage of disease or degree of smoking. The physical and psychological domains of QoL correlated significantly with the KPS (P = 0.001 and P = 0.01 respectively). Patients with a KPS of 80 had better physical (P < 0.001), psychological (P < 0.01) and social (P < 0.05) QoL than those with a KPS of 70. In conclusion, patients with lung cancer in a developing country like India have an unsatisfactory QoL. The Karnofsky's Performance Scale is a simple and reliable surrogate marker for assessing QoL in these patients. Larger multi-centric studies may help in providing a more comprehensive evaluation of the effect of various demographic and clinical variables on QoL in this setting.
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Affiliation(s)
- A Mohan
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Poirier P. The relationship of sick leave benefits, employment patterns, and individual characteristics to radiation therapy-related fatigue. Oncol Nurs Forum 2006; 33:593-601. [PMID: 16676015 DOI: 10.1188/06.onf.593-601] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the relationship among sick leave benefits, employment patterns, individual characteristics, and fatigue in patients receiving radiation therapy. DESIGN Prospective, longitudinal design. SETTING A community hospital radiation oncology department. SAMPLE 77 patients receiving radiation therapy to the breast, chest, head and neck, pelvis, or prostate. All were employed at the time of diagnosis. METHODS The Piper Integrated Fatigue Model guided the study. The Revised Piper Fatigue Scale (PFS), Brief Fatigue Inventory, and a single-item scale were used to measure five dimensions of subjective fatigue. Sick leave, employment, individual characteristics, and fatigue were measured at baseline, weekly during treatment, and at one month post-treatment. MAIN RESEARCH VARIABLES Employment patterns, availability of sick leave benefits, and fatigue. FINDINGS Mean total fatigue scores on the PFS ranged from 0-4.77 at baseline (mean = 0.46, SD = 0.93), 0-8.77 at the completion of treatment (mean = 2.84, SD = 2.40), and 0-4.82 at one month post-treatment (mean = 0.77, SD = 1.20). Side effects, education, living situation, age, treatment site, and work were associated with fatigue along the trajectory of radiation therapy. Study participants who were working at the end of radiation had lower fatigue scores than those who were not. Availability of sick leave benefits was associated with employment patterns during treatment. CONCLUSIONS Work may have benefits during radiation therapy but may be affected by radiation therapy-related fatigue. IMPLICATIONS FOR NURSING Management of treatment side effects, including fatigue, may help patients remain in the workforce during radiation.
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Teymoortash A, Simolka N, Schrader C, Tiemann M, Werner JA. Lymphocyte subsets in irradiation-induced sialadenitis of the submandibular gland. Histopathology 2005; 47:493-500. [PMID: 16241997 DOI: 10.1111/j.1365-2559.2005.02256.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS Irradiation-induced sialadenitis is a significant cause of morbidity in head and neck cancer patients receiving radiotherapy. Neither the exact aetiopathology of chronic irradiation-induced sialadenitis nor the mechanisms leading to atrophy of the glandular cells associated with an increase in extracellular matrix are understood. The aim of our study was to determine the phenotype of the inflammatory infiltrate and to study its distribution in the affected submandibular glands. METHODS AND RESULTS Paraffin-embedded submandibular glands from a homogeneous group of 19 patients with advanced oropharyngeal cancer who received conventional radiotherapy to the primary site and upper neck were analysed. In all patients the radiation dose and field were approximately equal. The submandibular glands were obtained during neck dissection. To characterize the lymphoid infiltrate, all tissue sections were immunostained for T cells (CD3, CD4, CD8), cytotoxic T cells (granzyme B), B cells (CD20), and macrophages (Ki-M1p). A histopathological classification into four grades was established based on the degree of glandular atrophy, fibrosis and lymphocytic infiltration. Phenotypic analysis of submandibular gland sections revealed that the great majority of lymphocytic infiltrates were cytotoxic T cells associated with acinar cell destruction. CONCLUSIONS The significantly elevated frequencies of cytotoxic cells in the submandibular glands of patients with irradiation-induced sialadenitis suggest that cell-mediated immune mechanisms may play a part in the pathogenesis of this disease.
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Affiliation(s)
- A Teymoortash
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany.
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Poirier P. Policy implications of the relationship of sick leave benefits, individual characteristics, and fatigue to employment during radiation therapy for cancer. Policy Polit Nurs Pract 2005; 6:305-18. [PMID: 16443985 DOI: 10.1177/1527154405283411] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Undergoing a course of radiation therapy for cancer does not preclude the need to work during treatment. This study examines the impact of sick leave benefits, individual characteristics, and fatigue on employment during radiation therapy. The conceptual model of nursing and health policy (CMNHP) and the Piper integrated fatigue model (IFM) guided this study. Seventy-seven study participants receiving radiation therapy were recruited from one community hospital. The study employed a prospective, longitudinal design. Data were collected at baseline prior to starting radiation therapy, weekly during treatment, and at the 1-month follow-up visit. Only 49% of study participants had paid sick leave benefits available at the start of radiation. Age, pain, gender, side effects, availability of sick leave benefits, and fatigue were associated with work along the trajectory of radiation therapy. Further research addressing the impact of paid leave policies on the relation between work and cancer-related fatigue is warranted.
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