Oral health related quality of life in long-term survivors of head and neck cancer compared to a general population from the seventh Tromsø study

Assessing oral and dental health-related quality of life in head and neck cancer patients at 1, 5, and 10 years: a comparison of the EORTC QLQ43, FACT H&N, and the Orthognathic-QLQ questionnaires

PURPOSE

Numerous health-related quality of life (HRQoL) questionnaires are available to assess oral HRQoL in patients undergoing treatment for head and neck (H&N) cancer. These multidimensional instruments should have the capacity to detect meaningful clinical oral function/dental changes at different time points. However, the optimal instrument-or combination of instruments-for assessing oral health and dental needs is not clear. We administered three questionnaires (FACT H&N, EORTC QLQ-H&N43, Orthognathic-QLQ) to assess oral and dental HRQoL in a cohort of H&N cancer patients at 1-, 5- and 10-year post-treatment. A secondary aim was to compare these questionnaires to determine which provides the most useful assessment of oral HRQoL and dental care needs.

METHODS

Prospective, single-center study of patients (n = 82) with H&N cancer grouped according to the follow-up time (1, 5, or 10 years). HRQoL was assessed by telephone with the Functional Assessment of Cancer Therapy (FACT H&N), the European Organization for Research and Treatment (EORTC QLQ-H&N43), and the Orthognathic Questionnaire (OQLQ). Analyses were performed to assess differences between groups.

RESULTS

Eighty-two patients (fifty-nine men) were included. The mean age was 61.9 years. On the EORTC QLQ-H&N43, significant between-group differences (1 year vs. 5 and 10 years) were observed on five multi-item scales (mouth pain, senses, body image, anxiety, and shoulder problems) and on three single-item scales (neurological problems, neck swelling, and weight loss), indicating that QoL for those domains was more negatively impacted at 1-year post-treatment. Adjusted mean scores on most items on the EORTC QLQ-H&N43 were similar in the 5- and 10-year groups. On the other two scales (FACT H&N and OQLG), there were no significant between-group (1, 5, 10 years) differences in adjusted mean scores.

CONCLUSION

These results show that the negative impact of H&N cancer on HRQoL is most evident at 1-year versus 5- or 10-year post-treatment. The combined administration of the EORTC QLQ-H&N43 and the OQLQ appear to provide the most useful assessment of HRQoL.

Reliability generalization meta-analysis of Cronbach's alpha of the oral impacts on daily performance (OIDP) questionnaire

OBJECTIVE

To evaluate the pooled estimates of Cronbach's alpha of the Oral Impacts on Daily Performance (OIDP) questionnaire and explore the moderators that could have influenced the overall estimate.

MATERIALS AND METHODS

A systematic search of common databases such as PubMed, Scopus, EMBASE, and CINAHL was performed from inception till 13th December 2024. Studies in English and those that reported Cronbach's alpha values for the OIDP questionnaire were included. Studies reported as letters, conference proceedings, or abstracts; secondary analysis of the previous data; studies with alpha values reported for pilot studies; modified versions of the OIDP questionnaires; induced reliability estimates; retracted articles; short communications; and commentaries were excluded. Two review authors independently screened the publications. The information collected included year of publication, country, sample size, age, sex distribution, target population, language of administration, mode of administration, study setting, study design, patient selection, Cronbach's alpha, and the number of items in the questionnaire. The risk of bias assessment was performed via the COSMIN checklist. Reliability Generalization Meta-analysis was performed via the random effects model (restricted maximum likelihood method) to obtain a pooled untransformed Cronbach's alpha.

RESULTS

A total of 1069 publications were available for screening, and 54 publications yielded 63 estimates with a sample size of 92,564 (sample size range: 47-12647). The overall pooled Cronbach's alpha was 0.82 (95% CI = 0.8-0.84), with high heterogeneity (I2 = 99.75%; Q = 26702.91). Meta-regression revealed no effects of moderators such as sex (coefficient: 0.02), age (coefficient: 0), language (coefficient: 0), population type (coefficient: 0), continent (coefficient: -0.02), or mode of administration (coefficient: -0.03) on the overall estimate.

CONCLUSION

The overall estimate of the Cronbach alpha for OIDP questionnaire was above the accepted benchmark. There was no effect of moderators such as sex, age, language, population type, continent, or mode of administration on the overall estimate.

The EORTC QLQ43 and FACT H&N questionnaires of quality of life at 1 and 5 years after treatment and dental care in head and neck cancer patients: a pilot study

PURPOSE

This study aimed to examine health-related quality of life (HRQoL) in head and neck cancer patients at 1 and 5 years after successful treatment of their tumors, and to explore the usefulness of 2 instruments for assessing the need of dental care services.

METHODS

This cross-sectional pilot study included 20 adult patients with head and neck cancer who completed the Functional Assessment of Cancer Therapy-Head and Neck (FACT H&N) Symptom Index and the European Organization for Research and Treatment of Cancer Quality of Life Head and Neck Module (EORTC QLQ-H&N43) after 1 and 5 years of treatment.

RESULTS

Mean (standard deviation, SD) scores of the FACT H&N Symptom Index were higher (better HRQoL) at 5 years than at 1 year (24.1 [4.4] vs. 21.1 [6.4]; p = 0.236). Only three of the ten items of FACT H&N (swallow, pain in mouth/throat or neck, and solid foods) evaluated oral health. In the EORTC QLQ-H&N43 questionnaire, scores were lower at 5 years (better HRQoL) in almost all multi- and single-item symptoms. This questionnaire includes four multi-item scales (pain in the mouth, social eating, swallowing, and problems with teeth) measuring dental and orthodontic needs.

CONCLUSION

HRQoL in patients with head and neck cancer improved with the length of follow-up. The EORTC QLQ-H&N43 has more items addressing oral health compared to the FACT H&N Symptom Index and may be more adequate to assess the need of dental therapy in clinical practice.

Gingival acquired lymphangiectasia as a long-term effect of post-oncology intervention: A 20-year institutional audit

Background

Gingiva is a keratinised mucosa akin to the skin and is exposed in all modalities of treatment of oral cancer. Acquired lymphangiectasia are acquired dilatations of lymphatic channels secondary to an external cause. They are extremely rare in the oral cavity despite that oral cancers are treated with different treatment modalities.

Methods

The archives of the Oral and Maxillofacial Pathology Department of our institute were retrospectively reviewed from 2001 to 2021. Of the 9566 cases of oral biopsies, 4596 were confirmed cases of oral cancer including salivary gland carcinoma. These cases were followed up for the presence of post-neoplastic and post-therapeutic gingival lesions.

Results

Of the 4596 patients, <10% patients reported recurrence or new primary of squamous cell carcinoma in the gingiva. Two patients were histopathologically diagnosed with acquired lymphangiectasia of gingiva after 12 years following surgery and radiation therapy as treatment for oral squamous cell carcinoma and mucoepidermoid carcinoma, which has been described in our report for the first time in the literature.

Conclusion

Even though acquired lymphangiectasia of gingiva is very rare, lymphatic malformations should be included in the clinical differential diagnosis of post-therapeutic gingival proliferative pathologies in order to ensure appropriate treatment and prevent over-diagnosis of this benign condition.

Eating and speech problems in oral and pharyngeal cancer survivors - Associations with treatment-related side-effects and time since diagnosis

AIMS

The aim of this cross-sectional study was to find factors associated with problems with the ability to eat and speak in oral and pharyngeal cancer (OPC) survivors and to evaluate if the panorama of oral problems varied with time since diagnosis.

METHODS AND RESULTS

A questionnaire assessing cancer diagnosis and treatment, oral health-related quality of life, and presence of treatment-related side-effects was sent to members of the Norwegian Head and Neck Cancer Association. Three-quarters (n = 117) of the respondents experienced xerostomia, and 51% (n = 79) had dysphagia. Prevalence of dysphagia, trismus, and dysphonia was lowest among respondents diagnosed within the last 5-10 years prior to the study. Eating problems were reported by 75% (n = 121) of the OPC survivors and were associated with xerostomia, dysphagia, trismus, having removed part of the tongue, cancer diagnosis within 5 years prior to the study and having little problems with caries and tooth fracture. Speaking problems were experienced by 60% (n = 93) of the OPC survivors, and were associated with dysphonia, dysphagia, and trismus.

CONCLUSION

Our study shows a high prevalence of oral problems among OPC survivors and points to targets for interventions for eating and speech impairments that may improve oral health-related quality of life.

Self-reported outcomes on oral health and oral health-related quality of life in long-term childhood cancer survivors-A DCCSS-LATER 2 Study

PURPOSE

The present study aimed to determine the prevalence of self-reported oral problems and the oral health-related quality of life (OHRQoL) in childhood cancer survivors (CCS).

METHODS

Patient and treatment characteristics of CCS have been collected in a cross-sectional study, part of the multidisciplinary DCCSS-LATER 2 Study. To assess self-reported oral health problems and dental problems, CCS filled out the 'Toegepast-Natuurwetenschappelijk Onderzoek' (TNO) oral health questionnaire. OHRQoL was assessed by the Dutch version of the Oral Health Impact Profile-14 (OHIP-14). Prevalences were compared with two comparison groups from the literature. Univariable and multivariable analyses were performed.

RESULTS

A total of 249 CCS participated in our study. The OHIP-14 total score had a mean value of 1.94 (sd 4.39), with a median score of 0 (range 0-29). The oral problems 'oral blisters/aphthae' (25.9%) and 'bad odor/halitosis' (23.3%) were significantly more often reported in CCS than in comparison groups (12% and 12%, respectively). The OHIP-14 score was significantly correlated with the number of self-reported oral health problems (r = .333, p<0.0005) and dental problems (r = .392, p <0.0005). In multivariable analysis, CCS with a shorter time since diagnosis (10-19 years vs. ≥30 years) had a 1.47-fold higher risk of ≥1 oral health problem.

CONCLUSION

Though the perceived oral health is relatively good, oral complications following childhood cancer treatment are prevalent in CCS. This underlines that attention to impaired oral health and awareness on this topic is mandatory and regular visits to the dentist should be a part of long-term follow-up care.

Nutri-PEITC Jelly Significantly Improves Progression-Free Survival and Quality of Life in Patients with Advanced Oral and Oropharyngeal Cancer: A Blinded Randomized Placebo-Controlled Trial

TP53 mutation is associated with cancer progression. Novel strategies to reboot p53 are required to stabilize the disease and improve survival. This randomized placebo-controlled trial investigated safety and efficacy of Nutri-PEITC Jelly (a texture-modified nutritious diet fortified with β-phenethyl isothiocyanate (PEITC) on oral cancer. Seventy-two patients with advanced-staged oral or oropharyngeal cancer were randomly assigned to study and control groups, who consumed 200 g of Nutri-Jelly with and without 20 mg of PEITC, respectively, 5 days/week for 12 weeks. Outcomes, including adverse events, health-related quality of life (HRQOL), progression-free survival (PFS), tumor response, serum p53, and cytochrome c, were measured at 0, 1, and 3 months. Results show that the study group had a higher proportion of participants with improved HRQOL, stable disease, and increased serum p53 levels than those in the control group (p < 0.001). The PFS time in the study group was significantly longer than that of the control group (p < 0.05). Serum cytochrome c levels were non-significantly decreased in the study group. No serious intervention-related adverse events occurred in either group. In conclusion, Nutri-PEITC Jelly intake for 3 months is safe, stabilizes the disease, improves quality of life and progression-free survival, and might re-activate p53 in advanced-stage oral and oropharyngeal cancer patients.