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Fatima J, Fatima E, Mehmood F, Ishtiaq I, Khan MA, Khurshid HMS, Kashif M. Comprehensive Analysis of Oral Squamous Cell Carcinomas: Clinical, Epidemiological, and Histopathological Insights With a Focus on Prognostic Factors and Survival Time. Cureus 2024; 16:e54394. [PMID: 38505442 PMCID: PMC10949903 DOI: 10.7759/cureus.54394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Oral squamous cell carcinoma (OSCC) is one of the most common malignancies in the head and neck region. Particularly, high incidence rates are observed in South and Southeast Asia, attributed to the widespread use of the carcinogenic areca nut. This study aimed to investigate the clinical, epidemiological, and histopathological features of OSCC, identify prognostic factors impacting disease-free survival, and determine a post-diagnosis disease-free survival time of OSCC patients. METHODOLOGY Employing a descriptive cross-sectional design, the study conducted a thorough examination of the clinical, epidemiological, and histopathological aspects of OSCC among patients seeking care at a tertiary healthcare facility. Participants were personally interviewed if available, while information for unreachable or deceased individuals was extracted from archival patient records in the Oral and Maxillofacial Surgery Department, Bakhtawar Amin Medical and Dental College, Multan, Pakistan. Data analysis was performed with a significance level set at p ≤ 0.05. RESULTS The mean age of the patients was 54.16 ± 11.1, with a notable concentration in the 41 years and above age group, indicating a significant prevalence of OSCC in this population. The data revealed a gender bias toward males, and a substantial proportion of patients, particularly those aged 41 years and above, had unfortunately passed away. Statistical analysis using the Fisher exact test showed a significant association between age groups and patients' current living status (p-value < 0.05). CONCLUSION Histopathologically, moderately differentiated OSCC was the most frequently encountered grade, and surgery emerged as the predominant treatment modality. The majority of patients studied had a survival period of three years or less, emphasizing the need for further exploration of factors influencing prognosis and treatment outcomes in OSCC.
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Affiliation(s)
- Jia Fatima
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Ehda Fatima
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Fatima Mehmood
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Iman Ishtiaq
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Muhammad Athar Khan
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | | | - Muhammad Kashif
- Oral Pathology, Bakhtawar Amin Medical and Dental College, Multan, PAK
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2
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Kis AM, Watz CG, Motofelea AC, Chiriac S, Poenaru M, Dehelean CA, Borza C, Ionita I. Challenges of Pharyngeal Cancer Screening in Lower-Income Countries during Economic and Social Transitions: A Population-Based Analysis. Eur J Investig Health Psychol Educ 2023; 13:2226-2237. [PMID: 37887158 PMCID: PMC10606512 DOI: 10.3390/ejihpe13100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
Background and Objectives: The rate of head and neck cancer (HNC) is expected to increase by 30% by 2030. However, there are many similarities between the symptomatology of a benign and a malign diagnosis; thus, a protocol for conducting a full head and neck examination is of high importance since the absence of adenopathy does not exclude a malignant diagnosis and also a favorable prognosis. Material and methods: The current study presents a retrospective study on 515 adult patients who underwent a biopsy for possible head and neck tumor pathology. Results: The patients identified with cancer were older than the rest of the group, with a higher developing trend in men than in women. However, the top 10 symptomatology patterns were identical in the malign and benign groups, meaning that new HNC may be missed due to the common symptomatology between benign and malign outcomes. Conclusions: The importance of a full ear, nose, and throat (ENT) examination may be of significant relevance for a proper diagnosis that can improve the overall prognosis of a patient with cancer. The absence of routine screening tests and screening guidelines for oral and pharyngeal cancers represents a significant barrier to secondary HNC prevention.
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Affiliation(s)
- Andreea M. Kis
- Department of ENT, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., No. 2, 300041 Timișoara, Romania; (A.M.K.); (M.P.)
| | - Claudia G. Watz
- Department of Pharmaceutical Physics, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq., No. 2, 300041 Timișoara, Romania
- Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq., No. 2, 300041 Timisoara, Romania;
| | - Alexandru C. Motofelea
- Department of Internal Medicine, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq., No. 2, 300041 Timișoara, Romania;
| | - Sorin Chiriac
- Department of General Surgery, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Marioara Poenaru
- Department of ENT, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, 2nd Eftimie Murgu Sq., No. 2, 300041 Timișoara, Romania; (A.M.K.); (M.P.)
| | - Cristina A. Dehelean
- Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq., No. 2, 300041 Timisoara, Romania;
- Department of Toxicology, Faculty of Pharmacy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq., No. 2, 300041 Timișoara, Romania
| | - Claudia Borza
- Department of Physiopathology, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq., No. 2, 300041 Timișoara, Romania;
| | - Ioana Ionita
- Department of Hematology, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, Eftimie Murgu Sq., No. 2, 300041 Timișoara, Romania;
- Multidisciplinare Research Center for Malignant Hemopathies (CMCHM), “Victor Babes” University of Medicine and Pharmacy, Sq., No. 2, 300041 Timișoara, Romania
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3
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Schar MS, Omari TI, Woods CM, Footner LR, Marshall N, Cock C, Thompson A, Nguyen T, Athanasiadis T, Ooi EH. Pharyngeal tongue base augmentation for dysphagia therapy: A prospective case series in patients post head and neck cancer treatment. Head Neck 2022; 44:1871-1884. [PMID: 35665556 DOI: 10.1002/hed.27104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/03/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dysphagia post head and neck cancer (HNC) multimodality treatment is attributed to reduced pharyngeal strength. We hypothesized that pharyngeal tongue base augmentation for dysphagia (PAD therapy) would increase pharyngeal pressures during swallowing thereby improving swallow symptoms. METHODS Adults with moderate-severe dysphagia post-HNC treatment had PAD therapy using a temporary filler (hyaluronic acid [HA]), with follow-up long-lasting lipofilling. Swallowing preprocedure and postprocedure was assessed with the Sydney Swallow Questionnaire (SSQ), High-Resolution Pharyngeal Manometry (HRPM), and Videofluoroscopic Swallowing Study (VFSS). Statistical comparison utilized paired tests. RESULTS Six participants (all male; median age 64 years [IQR 56, 71]) underwent PAD therapy at a median of 47 [IQR 8, 95] months post-treatment. SSQ scores reduced from baseline (mean 1069 [95%CI 703, 1434]) to post-HA (mean 579 [76, 1081], p > 0.05), and post-lipofilling (491 [95%CI 913, 789], p = 0.003, n = 4). Individual participants demonstrated reduced Swallow Risk Index, Bolus Presence Time, and increased Upper Esophageal Sphincter opening, but mesopharyngeal contractile pressures were unchanged. VFSS measures of aspiration, residue, and severity were unchanged. CONCLUSIONS Novel PAD therapy is safe and improves dysphagia symptoms. Biomechanical swallowing changes are suggestive of more efficacious bolus propulsion with conservative filler volume, but this was unable to resolve residue or aspiration measures.
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Affiliation(s)
- Mistyka S Schar
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Taher I Omari
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Charmaine M Woods
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lauren R Footner
- Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nicholas Marshall
- Department of Plastics & Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Charles Cock
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Alison Thompson
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Thi Nguyen
- South Australian Medical Imaging, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Theodore Athanasiadis
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Eng H Ooi
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
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4
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Brennan K, Hall S, Yoo J, Rohland S, Theurer J, Peng P. Routine follow-up care for head and neck cancer after curative treatment: A 3-year experience of measuring patients' self-reported needs, preferences, quality of life and attitudes towards follow-up. Eur J Cancer Care (Engl) 2022; 31:e13581. [PMID: 35343002 DOI: 10.1111/ecc.13581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/24/2022] [Accepted: 03/02/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate and describe attitudes, quality of life (Qol), needs and preferences of patients with head and neck cancer after 3 years of follow-up care. METHODS This is an exploratory prospective study of recurrence-free patients. Survey results were compared between 1-, 2- and 3-year post-treatment and by disease characteristics. RESULTS A total of 116 patients were included with 46% oropharyngeal cancer, 66% early stage disease and 41% having had surgery. After 3 years, most patients reported good to excellent health (88%), however expressed uncertainty regarding recurrence (66%), multiple needs (information on prognosis 91%, long-term sequalae 72%) and wanted to continue with follow-up (96%). Few changes were observed over time, with exceptions. Patients with more advanced disease, oral cancer or who had surgery experienced declining Qol (p < 0.050). Women experienced improvements in Qol domains (pain p = 0.028, speech p = 0.009) over time. Attitudes towards communication with oncologists demonstrated improved patient comfort (p = 0.044) over the 3 years; however, patients' beliefs about their prognosis did not (71% vs. 73% vs. 77% did not believe they were cured, p = 0.581). CONCLUSION Although patients' needs, preferences and attitudes towards follow-up did not change drastically, important needs persist. This work supports identifying individual patient needs and the challenges in addressing prognostic expectations.
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Affiliation(s)
- Kelly Brennan
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Stephen Hall
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Susan Rohland
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Julie Theurer
- Department of Otolaryngology-Head and Neck Surgery and School of Communication Sciences and Disorders, Western University and Lawson Health Research Institute, London, Ontario, Canada
| | - Paul Peng
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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5
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McDowell L, Rischin D, Gough K, Henson C. Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer. Front Oncol 2022; 12:834068. [PMID: 35242716 PMCID: PMC8885992 DOI: 10.3389/fonc.2022.834068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the most common cancer involving the mucosal surfaces of the head and neck and is associated with a number of etiological factors, including cigarette smoking, alcohol and betel nut consumption and exposure to high-risk human papillomavirus. The risk of HNSCC increases with age, peaking in the seventh and eighth decade, but this varies by anatomical and histological subtype. While several advancements have been made in the treatment of head and neck cancer (HNC) in recent decades, undertaking curative treatment still subjects the majority of HNSCC patients to substantial treatment-related toxicity requiring patients to tolerate a gamut of physical, psychological, and emotional demands on their reserves. In conjunction with other patient-related factors, clinicians involved in treating patients with HNSCC may incorporate advancing chronological age into their decision-making process when determining treatment recommendations. While advancing chronological age may be associated with increased concerns regarding physical treatment tolerability, clinicians may also be concerned about heightened vulnerability in various health and wellbeing outcomes. The available literature, however, does not provide evidence of this vulnerability in patients with advancing age, and, in many instances, older patients self-report greater resilience compared to their younger counterparts. While this data is reassuring it is limited by selection bias and heterogeneity in trial and study design and the absence of a consistent definition of the elderly patient with HNSCC. This narrative review article also includes a review of the measures used to assess HRQL, psychosocial outcomes and unmet needs in elderly or older patients with HNSCC.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
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6
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Hoyle JM, Correya TA, Kenzik K, Francisco L, Spencer SA, Willey CD, Bonner JA, Snider JW, Boggs DH, Carroll WR, Bhatia S, McDonald AM. Factors associated with loss to follow-up after radiation therapy for head and neck cancer. Head Neck 2022; 44:943-951. [PMID: 35080075 PMCID: PMC8904314 DOI: 10.1002/hed.26986] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/27/2021] [Accepted: 01/12/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Head and neck cancer (HNC) patients are at high risk for late occurring radiation-related morbidity and recurrence, necessitating close long-term medical surveillance. This study identified factors associated with becoming lost to follow-up (LTFU) at a comprehensive cancer center. MATERIALS AND METHODS Patients were drawn from survivors who received radiation for HNC at a single institution between 2001 and 2018. LTFU was defined as living patients without a clinical encounter within 2 years of the data query. RESULTS In total, 537 patients met the inclusion criteria and 57 (10.6%) were identified as LTFU. Individual comparisons identified time since completing radiation, non-White race and being unmarried as associated with LTFU. Multiple regression identified time since treatment and being unmarried as factors associated with LTFU. A decision tree correctly sorted 89.4% using time, distance, and marital status. CONCLUSION Time since radiation, distance to clinic, and being unmarried were factors associated with becoming LTFU.
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Affiliation(s)
- John M Hoyle
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tanya A Correya
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelly Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Liton Francisco
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sharon A Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher D Willey
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James A Bonner
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James W Snider
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Drexell Hunter Boggs
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William R Carroll
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew M McDonald
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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7
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Farrugia M, Erickson K, Wendel E, Platek ME, Ji W, Attwood K, Ma SJ, Gu F, Singh AK, Ray AD. Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy. Cancers (Basel) 2021; 13:cancers13071638. [PMID: 33915867 PMCID: PMC8037640 DOI: 10.3390/cancers13071638] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Quality of life (QoL) scores and frailty status are becoming increasingly important criterion with implications on both how patients are treated and survival in head and neck cancer (HNC). Despite this, physicians lack tools to identify patients who are at risk of suffering declines in QoL and becoming frail following treatment. Therefore, we investigated whether functional decline, as measured by a series of physical tests called the Short Physical Performance Battery (SPPB), correlated with a reduction in QoL and increased risk of frailty. In the current study, patients who experienced a decline in SPPB scores were significantly more likely to have changes in physical functioning QoL measures as well as transition to frail status following treatment. In conclusion, the SPPB may be a useful tool to identify patients who may benefit from additional rehabilitation in future studies. Abstract Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in HNC and was the focus of this investigation. Methods: Patients who underwent radiation therapy for HNC from 2018 to 2020 were evaluated as a prospective observational cohort. Functional decline, QoL, and the frailty phenotype were measured via the Short Physical Performance Battery (SPPB), European Organization for Research and Treatment of Cancer (EORTC) qlq-C30, and Fried Frailty index, respectively. Results: A total of 106 HNC patients were included, 75 of which received concurrent chemoradiation therapy (CCRT) and 31 received radiation alone, both with and without surgery. There was a decrease in SPPB overall (p < 0.001) from the beginning to the end of treatment in the CCRT group but not the radiation group (p = 0.43). Change in overall SPPB points following treatment correlated with the decline in physical QoL for both groups (p < 0.05) as well as transition frail status in the CCRT group (p < 0.001) with a trend in the radiation group (p = 0.08). Conclusions: Change in SPPB correlates with QoL and transition to frailty status in patients undergoing definitive CCRT for HNC with similar trends in those receiving radiation alone. Decline in SPPB could potentially be useful in identification of those who may benefit from rehabilitation in future studies.
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Affiliation(s)
- Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Kayleigh Erickson
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Elizabeth Wendel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Dietetics, D’Youville College, Buffalo, NY 14203, USA
| | - Wenyan Ji
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Fangyi Gu
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Andrew D. Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Rehabilitation Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
- Correspondence: ; Tel.: +1-716-845-2381; Fax: +1-716-845-8487
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8
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Johnson DE, Burtness B, Leemans CR, Lui VWY, Bauman JE, Grandis JR. Head and neck squamous cell carcinoma. Nat Rev Dis Primers 2020; 6:92. [PMID: 33243986 PMCID: PMC7944998 DOI: 10.1038/s41572-020-00224-3] [Citation(s) in RCA: 1564] [Impact Index Per Article: 391.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 02/07/2023]
Abstract
Most head and neck cancers are derived from the mucosal epithelium in the oral cavity, pharynx and larynx and are known collectively as head and neck squamous cell carcinoma (HNSCC). Oral cavity and larynx cancers are generally associated with tobacco consumption, alcohol abuse or both, whereas pharynx cancers are increasingly attributed to infection with human papillomavirus (HPV), primarily HPV-16. Thus, HNSCC can be separated into HPV-negative and HPV-positive HNSCC. Despite evidence of histological progression from cellular atypia through various degrees of dysplasia, ultimately leading to invasive HNSCC, most patients are diagnosed with late-stage HNSCC without a clinically evident antecedent pre-malignant lesion. Traditional staging of HNSCC using the tumour-node-metastasis system has been supplemented by the 2017 AJCC/UICC staging system, which incorporates additional information relevant to HPV-positive disease. Treatment is generally multimodal, consisting of surgery followed by chemoradiotherapy (CRT) for oral cavity cancers and primary CRT for pharynx and larynx cancers. The EGFR monoclonal antibody cetuximab is generally used in combination with radiation in HPV-negative HNSCC where comorbidities prevent the use of cytotoxic chemotherapy. The FDA approved the immune checkpoint inhibitors pembrolizumab and nivolumab for treatment of recurrent or metastatic HNSCC and pembrolizumab as primary treatment for unresectable disease. Elucidation of the molecular genetic landscape of HNSCC over the past decade has revealed new opportunities for therapeutic intervention. Ongoing efforts aim to integrate our understanding of HNSCC biology and immunobiology to identify predictive biomarkers that will enable delivery of the most effective, least-toxic therapies.
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Affiliation(s)
- Daniel E. Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Barbara Burtness
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - C. René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Vivian Wai Yan Lui
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Julie E. Bauman
- Department of Medicine-Hematology/Oncology, University of Arizona, Tucson, AZ, USA
| | - Jennifer R. Grandis
- Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, CA, USA,
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9
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Rogers SN, Lowe D. Health-related quality of life after oral cancer treatment: 10-year outcomes. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:144-149. [PMID: 32493685 DOI: 10.1016/j.oooo.2020.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/16/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to report 10-year health-related quality of life (HRQOL) outcomes after treatment of oral squamous cell carcinoma (OSCC). STUDY DESIGN Cross-sectional HRQOL surveys collated over a 13-year period for patients treated from 1992 yielded a cohort of 674 patients with OSCC who had undergone treatment with curative intent. HRQOL closest to 2 and 10 years was measured by using the University of Washington Quality of Life (UW-QOL) questionnaire. RESULTS UW-QOL data were available for 67% (154) of 230 patients alive at 10 years. Three-quarters reported their overall quality of life (QOL) as good, very good, or outstanding. Free-flap surgery was the strongest predictor of overall QOL being less than good at 10 years. A significant problem or dysfunction, ranging from 7% to 13% across the 12 UW-QOL domains, was reported by a minority of patients. At the group level, the changes from 2 years to 10 years were minimal, with some improvement observed in appearance, chewing, mood and anxiety, and deterioration in swallowing. There was considerable scatter in individual changes over time. CONCLUSIONS At the group level, HRQOL at 10 years was similar to that at 2 years; however, at the individual-patient level, the domains were not so stable.
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Affiliation(s)
- Simon N Rogers
- Professor, Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, St Helens Road, Ormskirk, UK; Consultant Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK.
| | - Derek Lowe
- Professor, Medical Statistician, Director, Astraglobe Ltd, Congleton, Cheshire, UK
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10
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Haderlein M, Speer S, Ott O, Lettmaier S, Hecht M, Semrau S, Frey B, Scherl C, Iro H, Kesting M, Fietkau R. Dose Reduction to the Swallowing Apparatus and the Salivary Glands by De-Intensification of Postoperative Radiotherapy in Patients with Head and Neck Cancer: First (Treatment Planning) Results of the Prospective Multicenter DIREKHT Trial. Cancers (Basel) 2020; 12:cancers12030538. [PMID: 32110958 PMCID: PMC7139715 DOI: 10.3390/cancers12030538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/07/2020] [Accepted: 02/20/2020] [Indexed: 02/06/2023] Open
Abstract
Aim: Evaluating radiotherapy treatment plans of the prospective DIREKHT trial (ClinicalTrials.gov, NCT02528955) investigating de-intensification of radiotherapy in patients with head and neck cancer. Patients and Methods: The first 30 patients from the DIREKHT trial of the leading study centre were included in this analysis. Standard treatment plans and study treatment plans derived from the protocol were calculated for each patient. Sizes of planning target volumes (PTVs) and mean doses to organs at risk were compared using the Student’s t-test with paired samples. Results: Mean PTV3 including primary tumor region and ipsilateral elective neck up to a dose of 50 Gy in the study treatment plans was 662 mL (+/− 165 mL standard deviation (SD)) and therefore significantly smaller than those of the standard treatment plans (1166 mL (+/− 266 mL SD). In the medial and inferior constrictor muscles, cricopharyngeal muscle, glottic and supraglottic laryngeal areas, arytenoid cartilages, contralateral major salivary glands highly significant dose reductions (p < 0.0001) of more than 10 Gy were achieved in study treatment plan compared to standard treatment plan. Conclusion: De-intensification of radiotherapy led to smaller planning target volumes and clinical relevant dose reductions in the swallowing apparatus and in the contralateral salivary glands.
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Affiliation(s)
- Marlen Haderlein
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
- Correspondence: ; Tel.: +49-9131-8543-025; Fax: +49-9131-8535-969
| | - Stefan Speer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Oliver Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Sebastian Lettmaier
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Markus Hecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Sabine Semrau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
| | - Claudia Scherl
- Department of Otorhinolaryngology, Universitätsklinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
- Department of Otorhinolaryngology, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Heinrich Iro
- Department of Otorhinolaryngology, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, Universitätsklinikum, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (S.S.); (O.O.); (S.L.); (M.H.); (S.S.); (B.F.); (R.F.)
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11
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Richardson AE, Broadbent E, Morton RP. A systematic review of psychological interventions for patients with head and neck cancer. Support Care Cancer 2019; 27:2007-2021. [PMID: 30937599 DOI: 10.1007/s00520-019-04768-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/21/2019] [Indexed: 01/30/2023]
Abstract
AIM The purpose of this systematic review is to identify psychological interventions that have been effective at improving quality of life and reducing psychological distress (depression and anxiety) in patients with head and neck cancer. METHODS All relevant peer-reviewed articles published between March 1980 and March 2017 were identified through an electronic search of five databases: Medline, Embase, PsycINFO, Scopus, and Academic Search Complete. Risk of bias was independently assessed by two reviewers using the Crowe Critical Appraisal Tool (CCAT). Following this, a narrative synthesis of the findings was completed. RESULTS Twenty-one unique intervention studies were identified. Interventions tested included cognitive behavioural therapy (CBT), psychoeducation, meditation/mindfulness, group therapy, and telehealth initiatives. Ten studies utilised a randomised controlled design. Five of these investigated CBT and three examined psychoeducation, with the greatest empirical support found for these intervention types. However, the majority of studies were underpowered to detect significant effects and did not examine whether improvements in quality of life and psychological well-being were sustained over time. CONCLUSIONS Further research is needed to investigate the effects of psychological interventions among patients with head and neck cancer, using randomised controlled designs, adequately powered samples, and long-term follow-up. This would allow evidence-based recommendations to be made regarding the most appropriate interventions to implement in clinical practice. TRIAL REGISTRATION CRD42017069851.
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Affiliation(s)
- Amy E Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Randall P Morton
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Long-term health-related quality of life after mandibular resection and reconstruction. Eur Arch Otorhinolaryngol 2019; 276:1501-1508. [PMID: 30879194 DOI: 10.1007/s00405-019-05371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare short- and long-term quality of life (QOL) scores in patients undergoing mandibular resection and reconstruction. MATERIALS AND METHODS All the patients who underwent resection and reconstruction of the mandible between 2000 and 2015 at a large tertiary center were retrospectively reviewed. Their QOL was measured by the University of Washington QOL questionnaire. Between 12 and 189 months (median 83.5 months) had elapsed since the end of treatment. The QOL of the short-term (< 5 years) and long-term (> 5 years) follow-up groups was compared and analyzed. RESULTS Fifty-eight patients completed the questionnaire. The scores for physical function, emotional function, activity, recreation, and taste domains were significantly higher for the long-term follow-up group. The activity and pain domains posed a significant problem for significantly more patients in the short-term follow-up group. CONCLUSION Comparison of the short- and long-term QOL scores of patients undergoing mandibular resection and reconstruction revealed that the scores for the latter were significantly higher in several domains. This finding might be indicative of a cumulative effect of time on patients' QOL, even many years post-treatment.
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Is there a patient population with squamous cell carcinoma of the head and neck region who might benefit from de-intensification of postoperative radiotherapy? : A monocentric retrospective analysis of a previously defined low-risk patient population treated with standard-of-care radiotherapy. Strahlenther Onkol 2019; 195:482-495. [PMID: 30610355 DOI: 10.1007/s00066-018-1415-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/11/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the clinical outcome of a previously defined low-risk patient population with completely resected (R0) squamous cell carcinoma of the oral cavity, oropharynx, larynx (pT1-3, pN0-pN2b), hypopharynx (pT1-2, pN0-pN1), and the indication for postoperative radio(chemo)therapy. PATIENTS AND METHODS According to predefined criteria, 99 patients with head and neck squamous cell carcinoma (SCC) who were treated at our institution from January 1, 2005 to December 31, 2014, were available for analysis. The Kaplan-Meier method was used for calculating survival and incidence rates. For univariate comparative analysis, the log-rank test was used for analyzing prognostic clinicopathologic parameters. RESULTS Median follow-up was 67 months. Cumulative overall (OS) and disease-free survival (DFS) were 97.9%/94.7%/88.0% and 96.9%/92.6%/84.7% after 1, 2, and 5 years, respectively. Cumulative incidence of loco-regional recurrence (LRR), distant metastases (DM), and second cancer (SC) were 1.0%/1.0%/4.9%, 0.0%/3.4%/5.8%, and 2.1%/4.2%/13.1%, respectively. In univariate comparative analysis, location of the primary tumor in the oropharynx was a significant predictor for increased OS (p = 0.043) and DFS (p = 0.048). CONCLUSION Considering the low disease relapse rates and high rates of therapy-induced late side effects, as well as the increased risk of developing SC, a prospective multicentric trial investigating de-escalation of radiotherapy in this clearly defined low-risk patient population was started and is still recruiting patients (DIREKHT-Trial, NCT02528955).
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14
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Huang WK, Juang YY, Chung CC, Chang SH, Chang JWC, Lin YC, Wang HM, Chang HK, Chen JS, Tsai CS, Yu KH, Kuo CF, See LC. Timing and risk of mood disorders requiring psychotropics in long-term survivors of adult cancers: A nationwide cohort study. J Affect Disord 2018; 236:80-87. [PMID: 29723766 DOI: 10.1016/j.jad.2018.04.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/08/2018] [Accepted: 04/08/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The increasing number of long-term cancer survivors over the past few decades poses the challenge of mental health care needs. However, little is known about risks of mood disorders in long-term cancer survivors. METHODS Long-term survivors (≥5 years) of adult cancers (LSAC) (n = 190,748) newly diagnosed between January 1, 2000 and December 31, 2007 were matched with one control. The primary outcome was diagnosis of mood disorders requiring psychotropics. Cumulative incidences and sub-hazard ratios (SHR) were calculated and multivariate analyses were conducted after accounting for mortality. RESULTS The mood disorder risk was significantly higher in the LSAC cohort than in the control cohort (adjusted SHR = 1.16, 95% confidence interval [CI] = 1.13-1.18, P < 0.001). Patients with certain cancer types were at increased risk, particularly in the first 2 years after diagnosis. However, patients with head and neck cancers or esophageal cancers had a higher risk after the 5-year follow-up period. Multivariate analysis indicated that being female, aged 40-59 years, with more than two primary cancers, receiving two or more treatment modalities, having CCI scores higher than 3, a higher urbanization level, and lower monthly income were independently associated with an increased risk of mood disorders. LIMITATIONS Some potential confounders such as lifestyle factors were not available in the study. CONCLUSION These findings call for increased mental health awareness not only in the early years after the cancer diagnosis, but also during long-term follow-up for certain cancer subtypes.
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Affiliation(s)
- Wen-Kuan Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Yeong-Yuh Juang
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chia-Chi Chung
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hao Chang
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - John Wen-Cheng Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Chang Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsien-Kun Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chieh-Sheng Tsai
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan; Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.
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15
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van der Meulen IC, May AM, Koole R, Ros WJG. A Distress Thermometer Intervention for Patients With Head and Neck Cancer
. Oncol Nurs Forum 2018; 45:E14-E32. [PMID: 29251296 DOI: 10.1188/18.onf.e14-e32] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the feasibility of an intervention using the National Comprehensive Cancer Network Distress Thermometer and Problem List with nurse-guided follow-up and the effect on depressive symptoms, health-related quality of life, and worry of cancer in patients with head and neck cancer.
. SAMPLE & SETTING 110 patients with head and neck cancer in a two-arm randomized, controlled trial in an outpatient clinic of a university hospital.
. METHODS & VARIABLES Patients were randomized to usual care (n = 57) or the intervention group (n = 53), which consisted of screening with the Distress Thermometer and Problem List plus nurse-guided follow-up lasting about 20 minutes three to four times during 12 months. Intention-to-treat analysis was performed using linear mixed models with outcomes at 6 and 12 months and baseline adjustment.
. RESULTS The intervention showed moderate compliance and acceptable session duration. Intervention participants were satisfied with nurses' care. Depressive symptoms, health-related quality of life, and worry of cancer were not significantly different in the two treatment groups. The intervention seemed feasible in clinical practice, but no effects on patient outcomes were seen.
. IMPLICATIONS FOR NURSING Patients with head and neck cancer appreciated the opportunity to discuss their problems and challenges with a nurse. Nurses supported patients with basic psychosocial care, minor interventions, and referral possibilities.
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A Self-Regulatory Intervention for Patients with Head and Neck Cancer: Pilot Randomized Trial. Ann Behav Med 2018; 51:629-641. [PMID: 28244003 DOI: 10.1007/s12160-017-9885-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Research is yet to investigate whether psychological interventions delivered early after diagnosis can benefit patients with head and neck cancer (HNC). PURPOSE The aim of this study was to investigate the effectiveness of a brief self-regulatory intervention (targeting illness perceptions and coping) at improving HNC patient health-related quality of life (HRQL). METHODS A pilot randomized controlled trial was conducted, in which 64 patients were assigned to receive three sessions with a health psychologist in addition to standard care or standard care alone. Participants completed questionnaires assessing HRQL, general distress, and illness perceptions at baseline and again 3 and 6 months later. RESULTS Compared to the control group, patients who received the intervention had increased treatment control perceptions at 3 months (p = .01), and increased social quality of life at 6 months (p = .01). The intervention was particularly helpful for patients exhibiting distress at baseline. CONCLUSION A brief psychological intervention following HNC diagnosis can improve patient perceptions of treatment and social quality of life over time. Such interventions could be targeted to patients who are distressed in order to confer the greatest benefit. TRIAL REGISTRATION NUMBER 12614000813684.
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Main B, McNair A, Haworth S, Rooshenas L, Hughes C, Tierney P, Donovan J, Thomas S, Blazeby J. Core information set for informed consent to surgery for oral or oropharyngeal cancer: A mixed-methods study. Clin Otolaryngol 2017; 43:624-631. [DOI: 10.1111/coa.13037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 11/29/2022]
Affiliation(s)
- B.G. Main
- School of Social and Community Medicine; University of Bristol; Bristol UK
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - A.G.K. McNair
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - S. Haworth
- School of Social and Community Medicine; University of Bristol; Bristol UK
- School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - L. Rooshenas
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - C.W. Hughes
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
- School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - P. Tierney
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
| | - J.L. Donovan
- School of Social and Community Medicine; University of Bristol; Bristol UK
| | - S.J. Thomas
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
- School of Oral and Dental Sciences; University of Bristol; Bristol UK
| | - J.M. Blazeby
- School of Social and Community Medicine; University of Bristol; Bristol UK
- University Hospitals Bristol NHS Foundation Trust; Bristol UK
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Astrup GL, Rustøen T, Hofsø K, Gran JM, Bjordal K. Symptom burden and patient characteristics: Association with quality of life in patients with head and neck cancer undergoing radiotherapy. Head Neck 2017; 39:2114-2126. [PMID: 28766791 DOI: 10.1002/hed.24875] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 05/09/2017] [Accepted: 05/30/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) experience diminished quality of life (QOL) during and after treatment. This study examined which characteristics were associated with QOL over time. METHODS One hundred thirty-three patients with HNC from a study of 534 oncology patients rated physical and mental QOL using the Short Form-12 5 times from the initiation of radiotherapy (RT) through the following 6 months. Linear mixed model analyses examined changes over time and associated characteristics. RESULTS The QOL deteriorated during RT and gradually improved after completion. Less social support was negatively associated with both physical and mental QOL. Older age, more comorbidities, more psychological symptoms, and concomitant chemotherapy (CTX) were negatively associated with physical QOL. Male sex, less physical symptoms, surgery before RT, and concomitant chemotherapy were positively associated with mental QOL. CONCLUSION Clinicians can use knowledge on time course and associated characteristics to identify and inform patients at higher risk for diminished QOL.
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Affiliation(s)
- Guro Lindviksmoen Astrup
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Norway.,Lovisenberg Diaconal University College, Oslo, Norway
| | - Jon Michael Gran
- Oslo Centre for Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo and Oslo University Hospital, Norway
| | - Kristin Bjordal
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.,Research Support Services, Oslo University Hospital, Norway
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Daugaard R, Kjaer T, Johansen C, Christiansen J, Andersen E, Nielsen AL, Dalton SO. Association between late effects assessed by physicians and quality of life reported by head-and-neck cancer survivors. Acta Oncol 2017; 56:342-347. [PMID: 28079429 DOI: 10.1080/0284186x.2016.1267873] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Many survivors of head-and-neck cancer (HNC) suffer from late effects. Their overall quality of life deteriorates during treatment, followed by a slow recovery up to five years after treatment. We examined the association between the severity of physician-assessed late effects and the health-related quality of life (HRQoL) reported by survivors of HNC. MATERIAL AND METHODS The analysis was based on data collected during follow-up for 136 survivors of cancer in the oral cavity, pharynx, larynx, or salivary glands. Physicians' assessments of dysphagia, xerostomia, fibrosis, and hoarseness, derived from reports to of the Danish Head and Neck Cancer Group database and patient-reported overall quality of life and social, role, emotional, cognitive, and physical functioning reported on the European Organization for Research and Treatment of Cancer questionnaire. Linear regression models were used to examine the association between the severity of each late effect and HRQoL. RESULTS Quality of life was decreased among patients with moderate to severe dysphagia compared to patients without dysphagia (-16 points; 95% CI -21;-3). Also role functioning (-20 points; 95% CI -38;-2), emotional functioning (-19 points; 95% CI -34;-4) and social functioning (-27 points; 95% CI -41;-13) decreased compared with patients without dysphagia. Mild dysphagia was also associated with decreased overall quality of life (-12 points; 95% CI -21;-3). Moderate to severe hoarseness was significantly associated with poorer social functioning (-25 points; 95% CI -41;-10). There was no association between fibrosis or xerostomia and HRQoL. CONCLUSION Physician-assessed moderate to severe hoarseness and mild, moderate, or severe dysphagia are associated with clinically relevant decreases in patient-reported quality of life and functioning. Fibrosis and xerostomia of any severity were not associated with changes in any scale of functioning in this study population.
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Affiliation(s)
- Rikke Daugaard
- Copenhagen Centre for Cancer and Health, Copenhagen, Denmark
| | - Trille Kjaer
- Unit of Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Unit of Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Jane Christiansen
- Department of Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Elo Andersen
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | | | - Susanne O. Dalton
- Unit of Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
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Quality of life in long-term oral cancer survivors: an 8-year prospective study in China. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:67-75. [DOI: 10.1016/j.oooo.2016.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/09/2016] [Accepted: 09/14/2016] [Indexed: 11/20/2022]
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21
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Coping strategies predict post-traumatic stress in patients with head and neck cancer. Eur Arch Otorhinolaryngol 2016; 273:3385-91. [DOI: 10.1007/s00405-016-3960-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/01/2016] [Indexed: 11/25/2022]
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Psychological Distress and Health-Related Quality of Life among Head and Neck Cancer Patients during the First Year after Treatment. TUMORI JOURNAL 2015; 102:96-102. [DOI: 10.5301/tj.5000448] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/20/2022]
Abstract
Purpose Patients treated for head and neck cancer present some of the most significant posttreatment morbidity of any group of patients with cancer. Our aim is to describe quality of life and psychological distress after different treatments among head and neck cancer patients during the first year after treatment. Methods A total of 86 patients treated for head and neck cancer were evaluated within 1 year of the end of treatment by means of the Distress Thermometer (DT) and EORTC C30 and H&N35 questionnaires. Type of treatment was classified into 3 groups: surgery, chemo-/radiotherapy, and combined treatment. Results Forty-one percent of patients showed a high level of distress (DT >5). Distress was higher in patients with a tracheotomy or with previous cancer in another district. Quality of life was homogeneous across treatment types after adjustment for stage and time since end of treatment, except for higher levels of suffering related to sensory problems, social eating, and dry mouth among patients treated with combined therapy. Conclusions The DT and EORTC questionnaires proved to be effective and easy tools to monitor distress and quality of life in patients with head and neck cancer. Monitoring the quality of life perceived by each patient during his/her course of treatment could be useful in planning the rehabilitation process while performing follow-up visits.
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Kovács AF, Stefenelli U, Thorn G. Long-term quality of life after intensified multi-modality treatment of oral cancer including intra-arterial induction chemotherapy and adjuvant chemoradiation. Ann Maxillofac Surg 2015; 5:26-31. [PMID: 26389030 PMCID: PMC4555943 DOI: 10.4103/2231-0746.161055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Quality of life (QoL) studies are well established when accompanying trials in head and neck cancer, but studies on long-term survivors are rare. Aims: The aim was to evaluate long-term follow-up patients treated with an intensified multi-modality therapy. Setting and Design: Cross-sectional study, tertiary care center. Patients and Methods: A total of 135 oral/oropharyngeal cancer survivors having been treated with an effective four modality treatment (intra-arterial induction chemotherapy, radical surgery, adjuvant radiation, concurrent systemic chemotherapy) filled European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and HN35 questionnaires. Mean distance to treatment was 6.1 (1.3–16.6) years. Results were compared with a reference patient population (EORTC reference manual). In-study group comparison was also carried out. Statistical Analysis: One-sample t-test, Mann–Whitney-test, Kruskal–Wallis analysis. Results: QoL scores of both populations were well comparable. Global health status, cognitive and social functioning, fatigue, social eating, status of teeth, mouth opening and dryness, and sticky saliva were significantly worse in the study population; pain and need for pain killers, cough, need for nutritional support, problems with weight loss and gain were judged to be significantly less. Patients 1-year posttreatment had generally worse scores as compared to patients with two or more years distance to treatment. Complex reconstructive measures and adjuvant (chemo) radiation were main reasons for significant impairment of QoL. Conclusion Subjective disease status of patients following a maximized multi-modality treatment showed an expectable high degree of limitations, but was generally comparable to a reference group treated less intensively, suggesting that the administration of an intensified multi-modality treatment is feasible in terms of QoL/effectivity ratio.
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Affiliation(s)
| | | | - Gerrit Thorn
- Private Practice Ziegelhüttenweg 1-3, Frankfurt am Main, Germany
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The eating experience after treatment for head and neck cancer: A review of the literature. Oral Oncol 2015; 51:634-42. [PMID: 25935370 DOI: 10.1016/j.oraloncology.2015.04.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/13/2015] [Accepted: 04/18/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE Research has identified significant challenges that patients experience following treatment for head and neck cancer (HNC). These include the physical and emotional impacts of the diagnosis and treatment, which compound weight loss and negatively impact eating ability. There is limited research about the lived experience and the changed meaning of food, eating and the eating experience after treatment for patients with HNC. The purpose of this review was to explore available research pertinent to the lived experiences of patients in regards to the changed meaning of food, eating and the eating experience after treatment for HNC. PRINCIPAL RESULTS The review identified a limited number of studies that focused on the eating experience and/or the changed meaning of food after a HNC diagnosis. However, the findings do highlight that there are physical, psychological/emotional and social losses associated with the changed meaning of food and eating within the HNC population. CONCLUSIONS The eating experience is impacted after treatment for HNC. Physical, emotional and social losses in regards to the eating experience have been identified. Acknowledging the significance of eating challenges and the changed meaning of food is necessary to ensure patients receive the appropriate management and support to best manage these challenges in a timely manner.
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The eating experience in long-term survivors of head and neck cancer: a mixed-methods study. Support Care Cancer 2015; 23:3257-68. [DOI: 10.1007/s00520-015-2730-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/29/2015] [Indexed: 01/23/2023]
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Wissinger E, Griebsch I, Lungershausen J, Byrnes M, Travers K, Pashos CL. The humanistic burden of head and neck cancer: a systematic literature review. PHARMACOECONOMICS 2014; 32:1213-1229. [PMID: 25145800 DOI: 10.1007/s40273-014-0199-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Head and neck cancer (HNC) and its treatment can affect communication, nutrition, and physical appearance, and the global impact of this disease on patients' quality of life may be substantial. OBJECTIVE The aim of this systematic literature review was to describe the impact of HNC and its treatment on the physical, emotional, and social well-being of patients over time, by examining longitudinal studies of patient-reported outcomes (PRO) evaluating these domains. METHODS Databases (MEDLINE and Embase) were searched to identify studies published in English between January 2004 and January 2014 analyzing the humanistic aspects of HNC in adult patients. Additional relevant publications were identified through manual searches of abstracts from recent conference proceedings. RESULTS Of 1,566 studies initially identified, 130 met the inclusion criteria and were evaluated in the assessment. Investigations using a variety of PRO instruments in heterogeneous patient populations consistently reported that PRO scores decrease significantly from diagnosis through the treatment period, but generally recover to baseline in the first year post-treatment. This trend was observed for many functional domains, although some side effects, such as xerostomia, persisted well beyond 1 year. In addition, considerable evidence exists that baseline PRO scores can predict clinical endpoints such as overall and progression-free survival. CONCLUSIONS Many aspects of HNC, both disease and treatment specific, profoundly affect patients' quality of life. Improved knowledge of these effects on PRO may allow for more informed treatment decisions and can help physicians to better prepare patients for changes they may experience during therapy. Furthermore, the predictive value of baseline PRO data may enable healthcare providers to identify at-risk patients in need of more intensive intervention.
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van Nieuwenhuizen AJ, Buffart LM, Brug J, Leemans CR, Verdonck-de Leeuw IM. The association between health related quality of life and survival in patients with head and neck cancer: a systematic review. Oral Oncol 2014; 51:1-11. [PMID: 25262163 DOI: 10.1016/j.oraloncology.2014.09.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/31/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study was to systematically review available evidence on the association between health-related quality of life (HRQoL) and survival in patients with head and neck cancer (HNC), adjusted for important clinical, demographic and lifestyle-related factors. A systematic literature search in four electronic bibliographic databases was conducted in January 2014. We included studies that provided data on HRQoL, survival, and the association between HRQoL and survival among HNC patients. Two researchers independently rated the quality of the included studies. A best evidence synthesis was applied to draw conclusions. Nineteen studies were included, of which twelve focused on all subscales of a HRQoL questionnaire and seven focused on selected subscales. The mean (SD) quality score was 72 (17)% and 11 (58)% studies were of high quality. According to the best evidence synthesis, we found strong evidence for a positive association between pre-treatment physical functioning and survival and between change in global QoL from pre-treatment to 6 months after treatment and survival. Due to inconsistent findings, we found insufficient evidence for an association with survival of other HRQoL domains, including role, emotional, cognitive and social functioning, mental health and well-being. Future high quality studies with a longitudinal design are needed to examine the complex association between HRQoL and survival.
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Affiliation(s)
- Annette J van Nieuwenhuizen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes Brug
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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van Nieuwenhuizen AJ, Buffart LM, Smit JH, Brakenhoff RH, Braakhuis BJM, de Bree R, Leemans CR, Verdonck-de Leeuw IM. A comprehensive assessment protocol including patient reported outcomes, physical tests, and biological sampling in newly diagnosed patients with head and neck cancer: is it feasible? Support Care Cancer 2014; 22:3321-30. [PMID: 25110298 PMCID: PMC4218976 DOI: 10.1007/s00520-014-2359-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Large cohort studies are needed taking into account cancer-related, personal, biological, psychobehavioral, and lifestyle-related factors, to guide future research to improve treatment and supportive care. We aimed to evaluate the feasibility of a comprehensive baseline assessment of a cohort study evaluating the course of quality of life (QoL). METHODS Newly diagnosed head and neck cancer (HNC) patients were asked to participate. Assessments consisted of questionnaires (635 items), a home visit (including a psychiatric interview, physical tests, and blood and saliva collection), and tissue collection. Representativeness of the study sample was evaluated by comparing demographics, clinical factors, depression, anxiety, and QoL between responders and non-responders. Feasibility was evaluated covering the number of questions, time investment, intimacy, and physical burden. RESULTS During the inclusion period (4 months), 15 out of 26 (60 %) patients agreed to participate. Less women participated, 13 % in responders group versus 63 % in non-responders group (p = 0.008). No other differences were found between responders and non-responders. Responders completed more than 95 % of the questionnaires' items and rated the number of questions, time investment and intimacy as feasible, and the physical and psychological burden as low. It took on average 3 h to complete the questionnaires and 1.5 h for the home visit. CONCLUSIONS This study reveals that a comprehensive assessment including various questionnaires, physical measurements, and biological assessments is feasible according to patients with newly diagnosed HNC. A large prospective cohort study has started aiming to include 739 HNC patients and their informal caregivers in the Netherlands.
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Affiliation(s)
- Annette J van Nieuwenhuizen
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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Thomas AA, Timmons A, Molcho M, Pearce A, Gallagher P, Butow P, O'Sullivan E, Gooberman-Hill R, O'Neill C, Sharp L. Quality of life in urban and rural settings: a study of head and neck cancer survivors. Oral Oncol 2014; 50:676-82. [PMID: 24731737 DOI: 10.1016/j.oraloncology.2014.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/12/2014] [Accepted: 03/23/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Urban-rural variation in cancer incidence, treatment, and clinical outcomes has been well researched. With the growing numbers and longer lifespan of cancer survivors, quality of life (QOL) is now a critical issue. The present study investigates the QOL of head and neck cancer (HNC) survivors in Ireland, paying special attention to urban and rural variation. METHODS From the population-based National Cancer Registry Ireland, we identified 991 survivors of HNC (ICD10 C00-C14, C32), who were at least eight months post-diagnosis, and invited them to complete a postal survey. We used self-reported data and information from the Registry to create a composite variable classifying respondents' current area of residence as "urban" or "rural." Respondents self-reported QOL using the Functional Assessment for Cancer Therapy with Head and Neck module (FACT-HN). We used bootstrap linear regression to control for confounding variables, while estimating the association of urban and rural residence to FACT-HN domain scores. RESULTS We obtained survey and Registry data from 583 HNC survivors. Controlling for demographic and clinical variables, rural survivors reported higher physical (coefficient 1.27, bias-corrected and accelerated 95% confidence interval 0.54, 2.43), emotional (coef. 0.99, 95% CI 0.21, 2.02), and HNC-specific (coef. 1.55, 95% CI 0.32, 3.54) QOL than their urban counterparts. Social and functional QOL did not differ significantly. CONCLUSIONS These findings add to growing evidence of important differences in life experiences of cancers survivors in urban and rural settings. Results such as these will allow health professionals, policy makers and service providers to better serve these populations.
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Affiliation(s)
- Audrey Alforque Thomas
- Health Promotion Research Centre, Aras na Coiribe, National University of Ireland, Galway, Ireland.
| | - Aileen Timmons
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland
| | - Michal Molcho
- National University of Ireland, School of Health Sciences, Galway, Ireland
| | - Alison Pearce
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - Phyllis Butow
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia
| | | | - Rachael Gooberman-Hill
- School of Clinical Sciences, University of Bristol, Southmead Hospital BS10 5NB, United Kingdom
| | - Ciaran O'Neill
- School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Linda Sharp
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland
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Oral tongue squamous cell carcinoma in young women: a matched comparison-do outcomes justify treatment intensity? ISRN OTOLARYNGOLOGY 2014; 2014:529395. [PMID: 24734200 PMCID: PMC3964833 DOI: 10.1155/2014/529395] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 02/03/2014] [Indexed: 11/23/2022]
Abstract
Background. The incidence of oral tongue squamous cell carcinoma (OTSCC) in young women is increasing with uncertain outcomes compared to traditional patients. Published outcomes data are at odds in this cohort of young women. Methods. Retrospective analysis comparing demographic, clinicopathologic, and outcomes data of women OTSCC patients younger than 45 years old matched 1 : 2 by stage with men both younger and older than 45 and women older than 45. Results. No disease-free or overall survival differences were found between cohorts. Young women were significantly more likely to receive radiation therapy, particularly in stage I disease, even when controlling for common pathologic indications. Conclusions. OTSCC in young women was not associated with worse outcomes compared to a matched cohort of other patients. Increased frequency of radiation treatment for this cohort may not be justified.
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van der Meulen IC, May AM, de Leeuw JRJ, Koole R, Oosterom M, Hordijk GJ, Ros WJG. Long-term effect of a nurse-led psychosocial intervention on health-related quality of life in patients with head and neck cancer: a randomised controlled trial. Br J Cancer 2014; 110:593-601. [PMID: 24280999 PMCID: PMC3915114 DOI: 10.1038/bjc.2013.733] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/24/2013] [Accepted: 10/30/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Head and neck cancer (HNC) patients are prone to have a poor health-related quality of life after cancer treatment. This study investigated the effect of the nurse counselling and after intervention (NUCAI) on the health-related quality of life and depressive symptoms of HNC patients between 12 and 24 months after cancer treatment. METHODS Two hundred and five HNC patients were randomly allocated to NUCAI (N=103) or usual care (N=102). The 12-month nurse-led NUCAI is problem-focused and patient-driven and aims to help HNC patients manage with the physical, psychological and social consequences of their disease and its treatment. Health-related quality of life was evaluated with the EORTC QLQ-C30 and QLQ H&N35. Depressive symptoms were evaluated with the CES-D. RESULTS At 12 months the intervention group showed a significant (P<0.05) improvement in emotional and physical functioning, pain, swallowing, social contact, mouth opening and depressive symptoms. At 18 months, global quality of life, role and emotional functioning, pain, swallowing, mouth opening and depressive symptoms were significantly better in the intervention group than in the control group, and at 24 months emotional functioning and fatigue were significantly better in the intervention group. CONCLUSION The NUCAI effectively improved several domains of health-related quality of life and depressive symptoms in HNC patients and would seem a promising intervention for implementation in daily clinical practice.
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Affiliation(s)
- I C van der Meulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
- Departments of Oral Maxillofacial Surgery and Otorhinolaryngology, University Medical Center Utrecht, G05. 129, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - A M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - J R J de Leeuw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - R Koole
- Departments of Oral Maxillofacial Surgery and Otorhinolaryngology, University Medical Center Utrecht, G05. 129, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - M Oosterom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - G-J Hordijk
- Departments of Oral Maxillofacial Surgery and Otorhinolaryngology, University Medical Center Utrecht, G05. 129, PO Box: 85500, 3508GA Utrecht, The Netherlands
| | - W J G Ros
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Street 6.131, PO Box: 85500, 3508GA Utrecht, The Netherlands
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Bornbaum CC, Doyle PC, Skarakis-Doyle E, Theurer JA. A critical exploration of the International Classification of Functioning, Disability, and Health (ICF) framework from the perspective of oncology: recommendations for revision. J Multidiscip Healthc 2013; 6:75-86. [PMID: 23526147 PMCID: PMC3596126 DOI: 10.2147/jmdh.s40020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In 2001, the World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) framework in an effort to attend to the multidimensional health-related concerns of individuals. Historically, although the ICF has frequently been used in a rehabilitation-based context, the World Health Organization has positioned it as a universal framework of health and its related states. Consequently, the ICF has been utilized for a diverse array of purposes in the field of oncology, including: evaluating functioning in individuals with cancer, guiding assessment in oncology rehabilitation, assessing the comprehensiveness of outcome measures utilized in oncology research, assisting in health-related quality of life instrument selection, and comparing the primary concerns of health professionals with those of their patients. DISCUSSION Examination of the ICF through the lens of cancer care highlights the fact that this framework can be a valuable tool to facilitate comprehensive care in oncology, but it currently possesses some areas of limitation that require conceptual revision; to this end, several recommendations have been proposed. Specifically, these proposed recommendations center on the following three areas of the ICF framework: (1) the replacement of the term "health condition" with the more inclusive and dynamic term "health state;" (2) the continuing development and refinement of the personal factors component to ensure issues such as comorbidities can be accounted for appropriately; and (3) the inclusion of a mechanism to account for the subjective dimension of health and functioning (eg, quality of life). SUMMARY It is through the expansion of these conceptual parameters that the ICF may become more relevant and applicable to the field of oncology. With these important revisions, the ICF has the potential to provide a broader biopsychosocial perspective of care that captures the diverse range of concerns that arise throughout the continuum of care in oncology.
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Affiliation(s)
- Catherine C Bornbaum
- Graduate Program in Health and Rehabilitation Sciences, The University of Western Ontario, London, ON, Canada
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Shuman AG, Terrell JE, Light E, Wolf GT, Bradford CR, Chepeha D, Jiang Y, McLean S, Ghanem TA, Duffy SA. Predictors of pain among patients with head and neck cancer. ACTA ACUST UNITED AC 2013; 138:1147-54. [PMID: 23165353 DOI: 10.1001/jamaoto.2013.853] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine predictors of pain 1 year after the diagnosis of head and neck cancer. DESIGN Prospective, multisite cohort study. SETTING Three academically affiliated medical centers. PATIENTS The study population comprised 374 previously untreated patients with carcinoma of the upper aerodigestive tract. MAIN OUTCOME MEASURES Participants were surveyed before treatment and 1 year thereafter. Multivariate analyses were conducted to determine predictors of the 36-Item Short-Form Instrument (SF-36) bodily pain score 1 year after diagnosis. RESULTS The mean SF-36 bodily pain score at 1 year was 65, compared with 61 at the time of diagnosis (P = .004), and 75, the population norm (lower scores indicate worse pain). Variables independently associated with pain included pretreatment pain score (P < .001), less education (P = .02), neck dissection (P = .001), feeding tube (P = .05), xerostomia (P < .001), depressive symptoms (P < .001), taking more pain medication (P < .001), less physical activity (P = .02), and poor sleep quality (P = .006). The association between head and neck cancer pain and current smoking and problem drinking did not reach significance (P = .07 and P = .08, respectively). CONCLUSIONS Aggressive pain management may be indicated for patients with head and neck cancer who undergo neck dissections, complain of xerostomia, require feeding tubes, and have medical comorbidities. Treatment of modifiable risk factors such as depression, poor sleep quality, tobacco use, and alcohol abuse may also reduce pain and improve quality of life among patients with head and neck cancer.
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Oskam IM, Verdonck-de Leeuw IM, Aaronson NK, Witte BI, de Bree R, Doornaert P, Langendijk JA, Leemans CR. Prospective evaluation of health-related quality of life in long-term oral and oropharyngeal cancer survivors and the perceived need for supportive care. Oral Oncol 2013; 49:443-8. [PMID: 23318122 DOI: 10.1016/j.oraloncology.2012.12.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate long-term changes in health related quality of life (HRQOL) in oral/oropharyngeal cancer survivors and their need for and use of supportive care. METHODS Between 1999 and 2001, 80 advanced oral or oropharyngeal cancer patients treated with free-flap reconstruction and postoperative radiotherapy were included in a prospective study of whom 27 patients were long-term survivors (mean 9.2 years, range 8-11 years). The HRQOL of 26 patients (response rate 96%) was assessed with the EORTC QLQ-C30 and QLQ-H&N35 questionnaires at four points in time: pretreatment (baseline), and at 6 months, 12 months (short term) and 8-11 years (long-term) follow up. A study specific questionnaire was developed to evaluate the need for and use of supportive care (allied health services, peer contact, psychosocial care, and complementary care) and was completed at the period of treatment and at long-term follow up. RESULTS A number of HRQOL domains worsened significantly (p < 0.01) in the long-term: emotional functioning, social functioning, swallowing, speech, taste/smell, dry mouth, sticky saliva and coughing assessed by the mixed effects statistical model. At time of treatment, the need for supportive care was the highest for a dental hygienist (77%), a physical therapist (73%), a speech therapist (42%), a dietician (38%), and a special diet (62%). At long-term follow up, the need for supportive care was limited to a dental hygienist (46%) and a physical therapist (23%). Only small differences were observed between the perceived need for and actual use of supportive care. CONCLUSION A range of HRQOL domains in head and neck cancer survivors were deteriorated in the long-term compared to baseline and to the first year after treatment. At time of treatment and less frequently at long-term follow up, patients reported needing and using a variety of supportive care services.
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Affiliation(s)
- Inge M Oskam
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Reeve BB, Cai J, Zhang H, Choi J, Weissler MC, Cella D, Olshan AF. Health-related quality of life differences between African Americans and non-Hispanic whites with head and neck cancer. Head Neck 2012; 35:1255-64. [PMID: 22907719 DOI: 10.1002/hed.23115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancers of the head and neck are associated with detriments in health-related quality of life (HRQOL); however, little is known about different experiences between African Americans and non-Hispanic whites. METHODS HRQOL was measured by the Functional Assessment of Cancer Therapy - Head and Neck (FACT-H&N) approximately 5 months postdiagnosis among 222 patients with cancer from North Carolina. Higher scores represent better HRQOL. Regression models included sociodemographic characteristics and clinical factors. RESULTS African Americans reported higher physical well-being than whites (adjusted means, 23.1 vs 20.9). African Americans with incomes <$20,000 reported higher emotional well-being (21.4) and fewer head and neck symptoms (22.0). Non-Hispanic whites making <$20,000 reported the poorest emotional well-being (17.3), whereas African Americans making >$20,000 reported the most head and neck symptoms (18.7). CONCLUSIONS Further investigation is needed to explore variation in HRQOL experiences among different race and socioeconomic groups that may inform resource allocation to improve cancer care.
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Affiliation(s)
- Bryce B Reeve
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7411, USA.
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Thomas L, Moore EJ, Olsen KD, Kasperbauer JL. Long-term quality of life in young adults treated for oral cavity squamous cell cancer. Ann Otol Rhinol Laryngol 2012; 121:395-401. [PMID: 22737962 DOI: 10.1177/000348941212100606] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES We assessed the long-term quality of life (QOL) in patients who survived oral cavity squamous cell cancer when they were young and looked for any clinical factors that might adversely affect function and QOL. METHODS We performed a retrospective case series and questionnaire survey in a tertiary care center. The subjects were consecutive patients treated for oral cancers during a 25-year period, when they were 40 years of age or less. The patients completed the University of Washington Quality of Life questionnaire and the M. D. Anderson Dysphagia Inventory (MDADI). We made an overall descriptive report of swallowing and QOL measures in the study population and looked for any clinical factors associated with functional outcomes. RESULTS Among the 62 patients treated over the course of 25 years, 46 were alive and disease-free. Twenty-six participated. The median follow-up duration was 14.7 years (range, 3 to 27 years). Age at diagnosis and duration of follow-up did not correlate with overall QOL or health-related QOL. Seventy-seven percent rated their overall QOL as outstanding, very good, or good. The key domains affected by cancer were appearance, mood, saliva, and shoulder function. Radiotherapy significantly adversely affected the QOL. The median MDADI scores on all 4 subscales were at least 85%. Higher T-stage and radiotherapy were significantly associated with lower scores on all subscales. CONCLUSIONS The long-term health-related QOL in this cohort was quite good. Radiotherapy and tumor stage correlated with swallowing outcomes, and only radiotherapy seemed to adversely affect the overall QOL.
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Affiliation(s)
- Ligy Thomas
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Fear of recurrence significantly influences quality of life in oral cancer patients. Oral Oncol 2012; 48:1276-80. [PMID: 22818822 DOI: 10.1016/j.oraloncology.2012.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 06/21/2012] [Accepted: 06/25/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Besides survival time quality of life (QoL) is the most important criterion for measuring the success of the therapy and rehabilitation of patients with carcinoma of the oral cavity. Interestingly, assessments by doctors sometimes differ from those of patients concerning QoL and level of information. Particularly the probability of cancer recurrence is unclear for many patients. MATERIAL AND METHODS Fear of recurrence (FOR) data were gathered from a total collective of 1761 patients from 38 hospitals within the German-language area of Germany, Austria and Switzerland (DÖSAK-REHAB-STUDIE) yielding 1652 patient questionnaires containing 147 items which were evaluated. They refer to periods at least 6 months after therapy. QoL was determined by the patient and ranges from 0% to 100% and FOR was measured using a Likert scale. Statistical analysis was performed using SPSS 19.0. RESULTS FOR affected 80% of the patients to a varying degree and influenced QoL very significantly. Patients with a high level of FOR were also more mentally instable. Their functional impairment in particular contributed to a reduced QoL. They felt less informed by their doctors about their illness and rehabilitation. The medical parameters had a smaller influence on FOR and QoL. CONCLUSION The patients' knowledge of their medical situation must be improved to make patient assessment of QoL more realistic, particularly when patients with good prospects indicate low QoL. The patients' subjective evaluations have to be more strongly integrated into the concept of the multi-disciplinary team in establishing a comprehensive therapy and rehabilitation plan.
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Payakachat N, Ounpraseuth S, Suen JY. Late complications and long-term quality of life for survivors (>5 years) with history of head and neck cancer. Head Neck 2012; 35:819-25. [DOI: 10.1002/hed.23035] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2012] [Indexed: 11/12/2022] Open
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Morton RP. Toward Comprehensive Multidisciplinary Care for Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2012; 147:404-6. [DOI: 10.1177/0194599812450856] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article discusses how quality-of-life assessment in patients with head and neck cancer might be weighed against survival and how such assessment might be applied in clinical practice. While survival is understandably considered to be the outcome of primary interest, there are several clinical scenarios in which quality of life can be considered as a primary outcome. Quality-adjusted survival is also an important consideration and needs to be incorporated into the results of treatment. However, quality-of-life assessment has hitherto been virtually only a research tool and not been incorporated into clinical practice. Nowadays, speech pathologists and dietitians are integral to the multidisciplinary team that treats patients with head and neck cancer. The main point of this article is to provide a rationale for the proposition that the health psychologist—who is best able to understand and manage the psychosocial issues—should also be included as one of the team.
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Affiliation(s)
- Randall P. Morton
- Department of Otolaryngology, Counties-Manukau District Health Board, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Mitchell O, Durrani A, Price R. Rehabilitation of patients following major head and neck cancer surgery. ACTA ACUST UNITED AC 2012; 21:S31-7. [DOI: 10.12968/bjon.2012.21.sup10.s31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Amer Durrani
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge
| | - Richard Price
- Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge
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Longacre ML, Ridge JA, Burtness BA, Galloway TJ, Fang CY. Psychological functioning of caregivers for head and neck cancer patients. Oral Oncol 2011; 48:18-25. [PMID: 22154127 DOI: 10.1016/j.oraloncology.2011.11.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 11/11/2011] [Accepted: 11/15/2011] [Indexed: 12/30/2022]
Abstract
Patients with head and neck squamous cell carcinoma (HNSCC) often require assistance from family caregivers during the treatment and post-treatment period. This review article sought to summarize current findings regarding the psychological health of HNSCC caregivers, including factors that may be associated with poorer psychological health. Online databases (PUBMED, MEDLINE and PSYCINFO) were searched for papers published in English through September 2010 reporting on the psychological health of caregivers of HNSCC patients. Eleven papers were identified. Caregivers experience poorer psychological health, including higher levels of anxious symptoms, compared to patients and to the general population. Fear of patient cancer recurrence is evident among caregivers and is associated with poorer psychological health outcomes. The 6-month interval following diagnosis is a significant time of stress for caregivers. Greater perceived social support may yield positive benefits for the psychological health of caregivers. To date, there have been relatively few reports on the psychological health of caregivers of HNSCC patients. Well designed, prospective, longitudinal studies are needed to enhance our understanding of how caregiver psychological health may vary over the cancer trajectory and to identify strategies for improving caregiver outcomes.
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Ackerstaff AH, Rasch CRN, Balm AJM, de Boer JP, Wiggenraad R, Rietveld DHF, Gregor RT, Kröger R, Hauptmann M, Vincent A, Hilgers FJM. Five-year quality of life results of the randomized clinical phase III (RADPLAT) trial, comparing concomitant intra-arterial versus intravenous chemoradiotherapy in locally advanced head and neck cancer. Head Neck 2011; 34:974-80. [DOI: 10.1002/hed.21851] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 04/08/2011] [Accepted: 05/19/2011] [Indexed: 11/12/2022] Open
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Maciejewski O, Smeets R, Gerhards F, Kolk A, Kloss F, Stein JM, Kasaj A, Koch F, Grosjean M, Riediger D, Yekta SS. Gender specific quality of life in patients with oral squamous cell carcinomas. Head Face Med 2010; 6:21. [PMID: 20727183 PMCID: PMC2931465 DOI: 10.1186/1746-160x-6-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 08/20/2010] [Indexed: 01/22/2023] Open
Abstract
Background The goal of this study was to evaluate the somatic and psychological effects by means of QUALITY OF LIFE (QOL) of surgical treatment of patients with oral squamous cell carcinoma. The factors gender, age, nicotine consumption, and tumour stage were taken into consideration. Methods 54 patients after surgical resection of oral squamous cell carcinomas (OSCC) were analysed from 01.09.2005 to 31.05.2008. Inclusion criteria for the study were: age at least 18 years, no indication or treatment of synchronous and metachronous tumours. German translations of the EORTC H&N-35 and EORTC QLQ-C-30 questionnaires, as well as a general socioeconomic patient history were used as measuring instruments. The questionnaires were completed independently by the patients. The answers were translated into scale values for statistical evaluation using appropriate algorithms. Results Analysis of the EORTC-QLQ-C-30 questionnaires demonstrated a tendency of more negative assessment of emotional function among the female participants, and a more negative evaluation of social function among the male participants. Greater tumour sizes showed significantly lower bodily function (p = 0.018). While a smaller tumour size was significantly associated with lower cognitive functioning (p = 0.031). Other cofactors such as age, nicotine consumption, and tumour stage only showed a tendency to influence the quality of sleep and daily life. Conclusions The data obtained within this investigation demonstrated that gender had the most significant power on the subjectively perceived postoperative quality of life. This factor is important e.g. in preoperative decision making regarding immediate microvascular reconstruction after e.g. mandibular resection and therefore QOL assessment should become integral component of the care of patients with OSCC.
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Affiliation(s)
- Oliver Maciejewski
- University Hospital Aachen, Department of Oral and Maxillofacial Surgery, Aachen, Germany
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Sherman AC, Simonton S. Advances in Quality of Life Research Among Head and Neck Cancer Patients. Curr Oncol Rep 2010; 12:208-15. [DOI: 10.1007/s11912-010-0092-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Klass CM, Choe MS, Hurwitz SJ, Tighiouart M, Zhang X, Chen ZG, Shin DM. Sequence dependence of cell growth inhibition by EGFR-tyrosine kinase inhibitor ZD1839, docetaxel, and cisplatin in head and neck cancer. Head Neck 2009; 31:1263-73. [PMID: 19399750 DOI: 10.1002/hed.21103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study was to explore whether the efficacy of the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor ZD1839 (Z, Iressa, gefitinib) plus chemotherapeutic agents docetaxel (D) and cisplatin (P) may benefit from sequencing of the combination. METHODS Three head and neck cancer cell lines were used to study the effect of various combinations of and relative sequencing of D, P, and Z in cell growth inhibition. A population pharmacokinetic stimulation study was conducted on Z in silico and used together with the growth inhibition data to derive principles for future in vivo use of this drug combination. RESULTS The inhibitory effects of Z on combinations of D and P were sequence dependent. Treatment simultaneously with DPZ or with DP followed by Z (DP-->Z) showed synergistic effects in all 3 cell lines. However, sequencing with Z followed by DP (Z-->DP), gave an antagonistic effect, suggesting that D and P should be administered when the effect of Z is low. The induction of apoptosis was also sequence dependent. The in silico pharmacokinetic study suggested the feasibility of deriving a 5-day-on/2-day-off regimen for Z, in which D and P administration commences when levels of Z are low, allowing levels of Z to accumulate sufficiently during the remainder of the cycle. CONCLUSION These data suggests that it is feasible to design clinical trials with these settings to maximize the efficacy of this combined drug regimen.
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Affiliation(s)
- Carmen M Klass
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, Georgia 30322, USA
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Eades M, Chasen M, Bhargava R. Rehabilitation: long-term physical and functional changes following treatment. Semin Oncol Nurs 2009; 25:222-30. [PMID: 19635401 DOI: 10.1016/j.soncn.2009.05.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the life altering issues that survivors of a head and neck cancer report post treatment and discuss multidimensional rehabilitation approaches. DATA SOURCES Published journal articles, literature reviews, research reports, book chapters. CONCLUSION Survivors and their family caregivers encounter many changes during the first 3 months following treatment for head and neck cancer, placing them at risk of multiple adjustment difficulties. Progressive weight loss, loss of energy, strength, muscle endurance and decreased functioning severely compromise healthy adjustment and quality of life. IMPLICATIONS FOR NURSING PRACTICE Nurses can help patients and family identify survivorship issues to be managed at home. Planning, exploring, coaching, practicing skills with survivors and their family caregivers, providing specific information, and linking them with resources can help them bridge this transition into extended survivorship.
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Affiliation(s)
- Margaret Eades
- McGill University Health Centre, Royal Victoria Hospital site, Montreal, Quebec, Canada.
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Rogers LQ, Rao K, Malone J, Kandula P, Ronen O, Markwell SJ, Courneya KS, Robbins KT. Factors associated with quality of life in outpatients with head and neck cancer 6 months after diagnosis. Head Neck 2009; 31:1207-14. [DOI: 10.1002/hed.21084] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bower W, Vlantis A, Chung T, Cheung S, Bjordal K, van Hasselt C. Quality of life in head and neck cancer patients after surgical resection: translation into Cantonese and validation of the EORTC QLQ-H&N35. Acta Otolaryngol 2009; 129:779-85. [PMID: 18767001 DOI: 10.1080/00016480802398970] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION High convergent and discriminant validity between subscales was achieved after the translation of EORTC QLQ-H&N35 into Cantonese. Most subscales were assessing distinct components of quality of life (QoL). OBJECTIVES The study aimed to translate the EORTC QLQ-H&N35 cancer module into Cantonese and to confirm validity and reliability for use in a Hong Kong head and neck (H&N) cancer population. SUBJECTS AND METHODS An ethnocentric forward-backward translation of EORTC QLQ-H&N35 was conducted by bilingual head and neck health professionals. Discrepancies were identified and problematic wording and concepts revised. Further review preceded pilot testing in 119 postoperative H&N cancer patients. Internal consistency within each subscale, convergent and discriminant validity to check the item relevance and item representativeness within and between subscales were examined. Mean and standard deviations of each subscale and single item and Cronbach's alpha coefficients for subscales were calculated. RESULTS Six of seven subscales achieved standard reliability (Cronbach's alpha coefficient >0.7). Correlation coefficients between an item and its own subscale were significantly higher than the coefficients with other subscales. Scaling success was found in all subscales. Pearson's correlation coefficient between subscales was <0.70, except between the subscales swallowing and trouble with social eating (r = 0.795), and speech problems and social contact (r = 0.754).
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Evaluation of Quality of Life and Organ Function in Head and Neck Squamous Cell Carcinoma. Hematol Oncol Clin North Am 2008; 22:1239-56, x. [DOI: 10.1016/j.hoc.2008.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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