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Hutcheson KA, Lewin JS. Functional outcomes after chemoradiotherapy of laryngeal and pharyngeal cancers. Curr Oncol Rep 2012; 14:158-65. [PMID: 22249533 DOI: 10.1007/s11912-012-0216-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Organ preservation regimens that combine chemotherapy and radiotherapy (chemoradiotherapy) are increasingly used as the primary treatment of laryngeal and pharyngeal cancers. Meta-analytic data show a survival benefit with combined modality therapy, but the functional sequelae can be significant. Dysphagia is recognized as a common and often devastating late effect of chemoradiotherapy. This review examines functional outcomes after chemoradiotherapy for laryngeal and pharyngeal cancers, with a particular emphasis on dysphagia. Topics examined include the burden of dysphagia after chemoradiation, pathophysiology of dysphagia, baseline functioning, recommendations to improve long-term function, and voice outcomes.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Wagner LI, Wenzel L, Shaw E, Cella D. Patient-Reported Outcomes in Phase II Cancer Clinical Trials: Lessons Learned and Future Directions. J Clin Oncol 2007; 25:5058-62. [DOI: 10.1200/jco.2007.11.7275] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
With increasing limits on the resources available to conduct cancer clinical trials, the inclusion of patient-reported outcomes (PROs) in treatment and symptom management trials must be prioritized. Although it has been suggested on occasion that phase III trials should take precedence over phase II trials, we argue that there is a clear and important role for PRO assessment in phase II trials going forward. To illustrate the value realized from including PROs in phase II trials, we provide case examples from cancer treatment and supportive care. The benefits of including PROs in symptom management intervention research are exemplified using phase II trials targeting cognitive impairment. The inclusion of PROs in phase II cancer clinical trials adds important information about the impact of treatment in health-related quality of life, and advances the science of PRO measurement. These contributions significantly enhance the design of phase III trials, ultimately leading to the efficient utilization of clinical trial resources.
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Affiliation(s)
- Lynne I. Wagner
- From the Center on Outcomes, Research and Education, Evanston Northwestern Healthcare and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Center for Health Policy and Research, University of California, Irvine, CA; and Clinical Research Program, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Lari Wenzel
- From the Center on Outcomes, Research and Education, Evanston Northwestern Healthcare and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Center for Health Policy and Research, University of California, Irvine, CA; and Clinical Research Program, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - Edward Shaw
- From the Center on Outcomes, Research and Education, Evanston Northwestern Healthcare and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Center for Health Policy and Research, University of California, Irvine, CA; and Clinical Research Program, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
| | - David Cella
- From the Center on Outcomes, Research and Education, Evanston Northwestern Healthcare and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Center for Health Policy and Research, University of California, Irvine, CA; and Clinical Research Program, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC
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