American Cancer Society Head and Neck Cancer Survivorship Care Guideline

Effect of enhanced recovery after radiotherapy (ERAR) on the quality of life in patients with nasopharyngeal carcinoma after radiotherapy: A randomized controlled trial

Nasopharyngeal carcinoma is prevalent in Southern China and Southeast Asia, which is effectively managed through chemoradiotherapy for locoregionally advanced cases (LA-NPC). Despite current guidelines endorsing various rehabilitation regimens for surgery, evidence supporting the benefits of rehabilitation during systemic radiotherapy is scarce. Thus we introduce the Enhanced Recovery After Radiotherapy (ERAR) concept. We enrolled patients with stage III to IVA LA-NPC in this study. The ERAR group received comprehensive interventions encompassing nursing, oral care, psychology support, rehabilitation, nutrition, and skin health throughout their radiotherapy. The standard care group received conventional radiotherapy rehabilitation. Outcomes were evaluated at baseline, the 17th and 33rd radiotherapy sessions. Generalized estimating equations were used to evaluate group by time effects on the outcomes, controlling for key covariates. A total of 104 LA-NPC patients with a mean age of 49.2 ± 10.9 years were enrolled in the study group from August 2021 to September 2023. The ERAR group showed significant improvements in quality of life (P = 0.014), Hospital Anxiety and Depression Scale (HADS) anxiety (P < 0.001), HADS depression (P < 0.001), distress thermometer (P = 0.049), NRS2002 (P = 0.040), weight loss (P < 0.001), and Oral Health Impact Profile-14 (OHIP-14) (P = 0.040) scores outperforming the standard care group at all measured time points. The ERAR protocol significantly mitigates acute radiation-induced toxicities in LA-NPC patients. This study is anticipated to serve as a reference for clinicians and encourage the adoption of a standardized protocol aimed at facilitating rapid recovery post-radiotherapy.

Exploring Quantitative MRI Biomarkers of Head and Neck Post-Radiation Lymphedema and Fibrosis: Post Hoc Analysis of a Prospective Trial

BACKGROUND

Quantifying head and neck lymphedema and fibrosis (HN-LEF) is crucial in the investigation and management of treatment sequelae in head and neck cancer (HNC).

METHODS

The T1- and T2-weighted MRI signal intensity (SI) was examined in relation to HN-LEF categories per physical/tactile examination (No-LEF, A-B = edema, C = edema + fibrosis, D = fibrosis), and MRI structural volumes were examined in relation to a novel 10-point HN-LEF score in the intraoral and submental regions.

RESULTS

We identified differences in ranks among HN-LEF categories in relation to the MRI SI (A-B and C are higher than D and No-LEF for T2 SI, and A-B is the highest for T1). Furthermore, six pairs of FOM volumes on MRI demonstrated a strong negative correlation (p < 0.05) with the HN-LEF score at adjacent palpable sites.

CONCLUSION

Both MRI SI and structural volumes can potentially be imaging biomarkers of edematous soft tissue states in HNC patients.

Survivorship therapy needs after radiotherapy for head and neck cancer: surveying opportunities for growth (STRONG)

INTRODUCTION

Patients with head and neck squamous cell carcinoma (HNSCC) are at risk for long-term side effects and require thorough survivorship care following completion of radiation therapy (RT). We aimed to identify survivorship interest and needs following RT.

METHODS

Patients with HNSCC who completed RT from Jan 2013 to April 2023 completed questions based on the five-domain Cancer Survivorship Framework (physical effects, psychosocial effects, cancer screening, chronic conditions, health promotion) and the Consolidated Framework for Implementation Research (interest, knowledge, barriers).

RESULTS

Of 1,123 patients, 317 participated (response rate 28%). Patients were 64% (n = 203) male with a mean age of 64 years (SD 12), with 66% (n = 209) finishing treatment > 2-years prior. 36% (n = 115) were interested in, 34% (n = 108) prioritized, and 28% (n = 88) had information related to survivorship. For survivorship domains, within physical effects, dry mouth (40%, n = 126) and trouble swallowing (24%, n = 75) were most bothersome. For psychosocial, 15% (n = 46) reported current depression (mean PHQ2 score ≥ 3) and 71% (n = 226) felt mental health needs were not addressed during treatment. Forty-two percent felt that diet, exercise, and smoking were not addressed (n = 134). Seventy-six percent (n = 240) understood the importance of cancer screening. Most patients wished to address survivorship topics in one long visit (45%, n = 142) and preferred in-person visits (60%, n = 190). Potential barriers included insurance coverage and scheduling concerns.

CONCLUSION

In post-RT HNSCC survivors, survivorship interest and knowledge were limited. There is a need for education on survivorship.

IMPLICATIONS

These findings provide a foundation for developing robust survivorship care programs that meet the diverse needs of this patient population.

Risk Classification of Oral Cancer Surgical Margins: Margin to Depth of Invasion Ratio Analysis

BACKGROUND

A high-risk margin is a recurrence risk factor in oral squamous cell carcinoma (OSCC), but its exact definition is debated. The effectiveness of the margin-to-depth-of-invasion ratio (MDR) in identifying high-risk margin remains to be determined.

METHODS

Patients who had a diagnosis of pT1-4N0 OSCC with negative margins (margin > 1 mm) recorded in the Taiwan Cancer Registry between January 2018 and December 2021 were reviewed. All patients were categorized into two groups: MDR < 0.5 and MDR ≥ 0.5.

RESULTS

The study analyzed 7420 OSCC patients without a positive margin. Of these 7420 patients, 4669 (62.92%) had an MDR ≥ 0.5, and 2751 (37.08%) had an MDR < 0.5. The group with an MDR < 0.5 exhibited significantly poorer 3-year disease-free survival (DFS, 74% vs 86%) and overall survival (OS, 79% vs 89%) than the group with an MDR ≥ 0.5. Despite a higher rate of postoperative radiotherapy (PORT) in the group with an MDR < 0.5, multivariate Cox analysis showed that patients with a margin < 5 mm and an MDR ≥ 0.5 had a significantly better DFS than those with a margin < 5 mm and an MDR < 0.5 (p = 0.001). Treatment with PORT improved DFS and OS for the patients with an MDR < 0.5, but worsened outcomes for the patients with an MDR ≥ 0.5.

CONCLUSION

For OSCC patients without positive margin, an MDR < 0.5 was associated with worse survival and higher locoregional recurrence risk. The patients with an MDR < 0.5 may benefit from PORT, whereas those with an MDR ≥ 0.5 could experience worse outcomes. An MDR < 0.5 could serve as a criterion for high-risk OSCC margin.

Social functioning of people with head and neck cancer after treatment: A qualitative study

PURPOSE

People with head and neck cancer face changes in appearance, difficulties swallowing, and communication challenges, which can limit their social functioning and impact interpersonal relationships, self-esteem, and work performance. The literature on how post-treatment changes affect social functioning remains limited. This study aims to explore the social functioning experiences of people with head and neck cancer after treatment.

METHOD

A qualitative research design with purposive sampling was employed to recruit head and neck cancer patients from a medical center in central Taiwan. Face-to-face in-depth interviews were conducted using semi-structured interview guides. Data were analyzed through qualitative content analysis.

RESULTS

Twenty participants were recruited, with treatment completion ranging from 10 months to 8 years and 9 months prior. Five themes were identified: (1) influence on willingness to participate in society, (2) interpersonal relationships and interaction, (3) giving back to society, (4) taking care of oneself, and (5) challenges in maintaining employment.

CONCLUSIONS

Post-treatment adjustments in behavior and communication are necessary for social reintegration. Treatment-related changes reduce patients' willingness to participate socially, but community involvement and personal adjustments help rebuild self-worth. Tailored support programs are recommended.

Tongue tumor and prognostic factors: Could a diagnostic procedure influence patient outcomes?

OBJECTIVES

Diagnosis of tongue tumors is often performed in primary care centers with an incisional biopsy using stitches in the lesion at the end of the procedure. We hypothesize that stitches placed in tumor tissue could potentially increase local inflammation and significantly affect the tumor microenvironment, influencing the cancer spread and local relapses.

MATERIALS AND METHODS

We conducted a retrospective study involving a consecutive series of 299 patients with Oral Tongue Squamous Cell Carcinoma (OTSCC). The study population was divided into two groups: Group 1 consisting of patients who did not receive stitches during the biopsy and, Group 2 composed by patients who had stitches placed in the tumor at the time of diagnosis. All data collected were statistically analyzed.

RESULTS

The use of stitches during biopsy was associated with a negative prognostic role in Disease Free Survival (DFS), Disease Specific Survival (DSS) and a worsening trend in cause specific overall survival (cs-OS) for early stages (I-II) OTSCC. This negative prognostic impact was confirmed in the cumulative multivariable analyses of the DFS and DSS curves for stages I-II. The negative prognostic impact was not observed for patients with advanced-stage carcinoma and for OS.

CONCLUSION

Our analysis suggested that the placement of stitches during biopsy in patients with early OTSCC may worsen outcomes in terms of DFS and DSS. We recommend evaluating whether stitches are truly necessary during biopsy or if they could be avoided altogether by using less invasive biopsy techniques.

Impact of an oral care intervention protocol on oral health outcomes in head and neck cancer patients undergoing radiation or chemoradiation therapy

BACKGROUND

Head and neck cancer patients receiving chemotherapy and radiation therapy may experience a notable and frequently sudden decline in their oral health. These alterations include oral mucositis that develops during and shortly after treatment, candida infections, trouble speaking, difficulty eating, bleeding gums, and tissue fibrosis.

MATERIALS AND METHODS

This study aimed to determine the effectiveness of oral care intervention protocol (OCIP) on oral health and oral complications. The experimental group received a structured oral care protocol, and the control group received oral care as per the standard of care of the study setting. These patients were observed every week for up to 6 weeks until the completion of radiation therapy/chemoradiation. An experimental design using a randomized controlled trial was adopted for the study. After providing informed consent, the data were collected from 80 head and neck cancer patients.

RESULTS

The maximum number of patients, i.e., 42.5% in the experimental group and 32.5% in the control group, were diagnosed with tongue cancer. Most of the participants, i.e., 57.5% in the experimental group and 67.5% in the control group, received chemoradiation as the treatment plan. Among all the oral complications, the median days to develop mucositis (p =.015), swallowing difficulty (p =.009), and chewing difficulty (p =.032) were significantly different from those of the control, indicating that the intervention was effective. As treatment progressed over the weeks, the severity of the oral problems increased in both groups (p =.001). Compared with routine care, oral care intervention improved oral health scores among cancer patients receiving head and neck radiation therapy/chemoradiation [F (401.982), p =.001].

CONCLUSION

These data suggest that the OCIP is clinically helpful in maintaining overall oral health among cancer patients receiving head and neck radiation/chemoradiation. The OCIP effectively delays the incidence of oral complications arising from head and neck radiation therapy/chemotherapy but does not prevent them. The findings of this study can also contribute to providing evidence for the use of an oral care kit, including all evidence-based interventions for patients receiving head and neck radiation/chemoradiation.

Treatment summaries for head and neck cancer survivors: a pilot study to improving patient recall and survivorship care plans

BACKGROUND

The treatment summary (TS) remains underused in head and neck cancer (HNC). We determine if receiving a personalized TS following a definitive HNC treatment improves patient recall of treatment details.

METHOD

A history questionnaire was administered to assess patient accuracy in reporting diagnosis and treatment-related details at baseline (pre-TS) and 1-month follow-up (post-TS). Statistical significance of accuracy changes was assessed using McNemar's chi squared test.

RESULTS

One hundred participants were enrolled between January and December 2022. Ninety-one completed all surveys. Significant improvement in correct responses was noted for questions regarding cancer diagnosis type (94.5% post-TS, 78.0% pre-TS, p = 0.002), cancer diagnosis date (75.8% post-TS, 40.7% pre-TS, p < 0.001), T-stage (82.4% post-TS, 28.6% pre-TS, p < 0.001), and lymph node status (91.2% post-TS, 63.7% pre-TS, p < 0.001).

CONCLUSION

TS may improve HNC survivors' recall about their diagnosis and treatment in the short term. Patients view TS as beneficial to their survivorship care plans.

IMPLICATIONS FOR CANCER SURVIVORS

TS in survivorship care plans are understudied in HNC patients. This investigation will serve as a meaningful contribution to the literature, promote additional investigation, and encourage improvement of informative resources available to HNC survivors.

Exploratory multimodal nonlinear microscopy: Coherent anti-stokes Raman scattering, second harmonic generation, and differential interference contrast for oral squamous cell carcinoma diagnosis

OBJECTIVE

We applied multimodal nonlinear optical microscopy and Raman Spectroscopy to rapidly image Oral Squamous Cell Carcinoma (OSCC), comparing results with Hematoxylin-Eosin (H&E) stained to explore supplementary diagnostic methods.

STUDY DESIGN

With ethical approval and patient informed consent, we processed primary tumor resection tissues, preparing frozen sections. Slice 1 was stained with H&E-stained, while Slice 2 was unstained and imaged using Coherent anti-Stokes Raman Scattering (CARS), Second-Harmonic Generation (SHG), Differential Interference Contrast (DIC), and Raman spectroscopy. These were analyzed alongside H&E-stained sections to assess diagnostic capabilities.

RESULTS

Raman spectroscopy revealed distinct differences at 646, 798, 1006, 1091, 1157, 1190, 1450, 1520, and 1660 cm-1. CARS imaging showed unique cancer nest structures, and SHG highlighted collagen fiber distribution.

CONCLUSIONS

Multimodal nonlinear imaging, combining CARS, SHG, and DIC, shows potential as a supplementary diagnostic tool for oral squamous cell carcinoma, aiding in the characterization of pathological features and providing valuable clinical diagnostic information.

Novel Survivorship Paradigms in Head/Neck Cancer

Long-term care for head and neck cancer (HNC) survivors is complex. Despite an improvement in survival and the evolution of treatment paradigms (de-escalation, targeted therapy), notably in the context of human papillomavirus (HPV)-related oropharyngeal cancers, HNC survivors still experience a wide range of side effects and needs, which impact their functionality, quality of life, survival and require concerted, coordinated survivorship care. In this review, we perform an overview of existing HNC survivorship recommendations within the context of novel evidence, our current understanding of survivorship care, and incorporate them into the Nekhluydov Survivorship Care Framework. This framework provides a novel way to appreciate and comprehensively address all aspects of HNC survivorship care. Further research is crucial to develop evidence-based, patient-centered personalized approaches to survivorship care in different HNC populations and understand barriers to successful implementation.

Cancer neuroscience in head and neck: interactions, modulation, and therapeutic strategies

Head and neck cancer (HNC) is an aggressive malignancy with significant effects on the innervation. Not only is it at the top of the cancer spectrum with a dismal prognosis, but it also imposes considerable stress on patients and society owing to frequent neurological symptoms. With progress in cancer neuroscience, the interactions between HNC and the nervous system, as well as the underlying mechanisms, have become increasingly clear. Compelling evidence suggests communication of information between cancer and nerve cells and devastation of the neurological system with tumor growth. However, the thorough grasp of HNC in cancer neuroscience has been severely constrained by the intricacy of HNC and fragmented research. This review comprehensively organizes and summarizes the latest research on the crosstalk between HNC and the nervous system. It aims to clarify various aspects of the neurological system in HNC, including the physiology, progression, and treatment of cancer. Furthermore, the opportunities and challenges of cancer neuroscience in HNC are discussed, which offers fresh perspectives on the neurological aspects of HNC diagnosis and management.

Artificial intelligence in dysphagia assessment: evaluating lingual muscle composition in head and neck cancer

PURPOSE

Oropharyngeal dysphagia is a common and debilitating condition in head and neck cancer (HNC) patients. This study aimed to evaluate the relationship between tongue muscle composition (quantity and quality) and the risk of dysphagia in non-surgically treated HNC patients, using artificial intelligence (AI) analysis of pretreatment computed tomography (CT) scans.

METHODS

A prospective analysis was conducted on 41 non-surgically treated HNC patients under-going curative radiotherapy. Tongue muscle quantity was measured as cross-sectional area (cm2) and as a percentage of body composition using AI-based segmentation of CT images. Muscle quality was assessed through Hounsfield Units (HU), representing muscle density. Dysphagia risk was evaluated with the validated EAT-10 questionnaire, considering scores ≥ 3 as indicative of increased risk.

RESULTS

A significant association was found between EAT-10 categorical scores and dysphagia risk (Chi2 = 26.07, p < 0.0001). However, no significant correlation was observed between the percentage of tongue muscle and density (R = 0.081, p = 0.07). Patients with EAT-10 scores ≥ 3 had significantly larger percentages of tongue muscle area (mean 61.17 ± 10.44 cm2) compared to those with EAT-10 < 3 (mean 56.58 ± 5.77 cm2; p = 0.004). Additionally, higher tongue muscle density (HU) was associated with increased dysphagia risk (p = 0.046). A significant association was also observed between pre-treatment and post-treatment dysphagia, with patients who reported pre-treatment dysphagia (EAT-10 ≥ 3) continuing to experience higher post-treatment dysphagia (p = 0.009, R = 0.411). Biologically Effective Dose (BED) (p = 0.0042), advanced tumor stage (p = 0.004), and systemic treatment (p = 0.027) were further associated with increased post-treatment dysphagia risk.

CONCLUSIONS

The study demonstrates that non-surgically treated HNC patients with increased tongue area percentages and higher muscle density are at greater risk of dysphagia. Additionally, pre-treatment dysphagia was found to be a strong predictor of post-treatment dysphagia. The use of AI-based CT analysis provides a precise method for identifying patients at risk, allowing for timely interventions to improve swallowing function and quality of life.

Protocol for a multisite, parallel-group, randomized clinical trial comparing a brief tele-cognitive behavioral therapy intervention (BRIGHT) with attention control for the reduction of body image-related distress among head and neck cancer survivors

One in four head and neck cancer (HNC) survivors experience clinically significant body image distress (BID), a devastating psychosocial morbidity that adversely affects quality of life. To date, effective interventions for these patients are lacking. BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment), a brief cognitive behavioral treatment (CBT), has shown potential efficacy as a novel treatment paradigm for HNC survivors with BID. The primary objective of this randomized clinical trial (RCT) is to test the hypothesis that BRIGHT improves BID among HNC survivors relative to an Attention Control (AC) intervention. In this multisite RCT, N = 180 HNC survivors with BID will be randomized 1:1 to six weeks of BRIGHT or AC of dose and delivery-matched survivorship education. Outcomes are assessed at baseline and 2, 3, 6, and 9-months post-randomization. The primary endpoint is the IMAGE-HN (Inventory to Measure and Assess imaGe disturbancE-Head and Neck) score, a validated patient-reported outcome of HNC-related BID. Secondary endpoints include the HN Shame and Stigma Scale, the PROMIS SF v1.0-Depression 8a, Anxiety 8a, and Ability to Participate in Social Activities 8a, the Beck Scale for Suicidal Ideation, and the EORTC QLQ-HN35 Trouble with Social Eating and Trouble with Social Contact subscales. The trial will also evaluate whether the effect of BRIGHT on BID is mediated through improvements in automatic thinking and body image coping strategies. Findings from this multisite RCT will provide a rigorous test of the efficacy of BRIGHT as the first evidence-based strategy to manage BID among HNC survivors. TRIAL REGISTRATION ID: NCT05442957.

An exploration of nursing and Allied Health Professional (AHP)-led post-treatment surveillance and survivorship care for people with head and neck cancer-a scoping review

A scoping literature review was undertaken to identify the current evidence base on the role of nursing and allied health professionals (AHPs) in delivering surveillance and survivorship services within head and neck cancer (HNC) care following treatment.

METHOD

This review was undertaken according to the Joanna Briggs Institute (JBI) guidance on the conduct of scoping reviews. An initial database search was undertaken between December 2023 and February 2024 and then repeated in November 2024. Databases included CINAHL, EMBASE, and MEDLINE. A focused grey literature search targeting other material including conference abstracts was also completed. Articles were included which were written in English. The search was not restricted to year of publication/production or methodology to ensure the greatest scope of materials. Relevant articles were reviewed, and narratives summarised.

RESULTS

A total of 144 articles were identified through initial database screening and subsequently 29 were eligible for full text review with 3 meeting the inclusion criteria. All 3 investigated follow-up care led by nurses or AHPs for people treated for HNC. Two of these articles described alternative models of surveillance/survivorship care. One article aimed to investigate professional's perceptions on post-treatment disease surveillance by nurses and AHPs. Outcome measures included quantitative results on quality of life measures (QoL) and disease re-sectability and qualitative data obtained via an online survey which included free text response options. Limited results demonstrated that people were satisfied that nurse or AHP led care could meet their needs and improve psychosocial adjustment and QoL. There was no evidence to suggest the rate of cancer recurrence detection is reduced when a nurse or AHP is the lead professional involved in follow up surveillance. No articles explored the experience of people receiving this model of care in detail.

CONCLUSION

A small body of evidence suggests that nursing and AHP professionals can provide an effective and safe service of follow-up care in HNC management. Clinics led by advanced practitioners (AP) may provide an opportunity to deliver enhanced care and meet QoL needs. Within a rapidly developing and changing landscape of post-treatment surveillance nurses and AHPs are well placed to provide advice, support and interventions for treatment effects. More evidence is needed to develop new models of risk stratified nursing/AHP surveillance and the competencies required to ensure the complex holistic needs of individuals are safely and effectively met.

Palliative care utilization among head and neck cancer patients: A population-based analysis

PURPOSE

Head and neck cancer (HNC) patients face substantial morbidity and mortality. Despite the potential benefits of palliative care (PC) in improving quality of life, many HNC patients do not receive these services. This study aimed to quantify the proportion of HNC patients receiving PC, the timing of PC referrals, and the mental health and clinical outcomes of this population.

METHODS

A retrospective cohort study was conducted using the TriNetX database with de-identified electronic medical records. HNC patients were categorized based on whether they had at least one PC encounter. We examined time to first PC encounter, mortality rates, mental health diagnoses, and access to ACP and supportive care.

RESULTS

Of 304,404 HNC patients, only 22,470 (7.4 %) had at least one PC encounter. The median time from cancer diagnosis to initial PC referral was 318 days. After propensity score matching, the cohorts consisted of 24,916 patients each. Those who received PC had a significantly higher risk of mortality (RR 3.05, 95 % CI 2.97-3.14), depression (RR 1.38, 95 % CI 1.33-1.45), anxiety (RR 1.47, 95 % CI 1.42-1.53), failure to thrive (RR 3.26, 95 % CI 3.03-3.51), and were more likely to engage in advance care planning (RR 4.97, 95 % CI 4.39-5.62) and access supportive care services compared to patients who did not receive PC.

CONCLUSIONS

PC utilization among HNC patients is low, with patients often waiting nearly a year before their first PC encounter. This delay highlights a significant unmet need for early integrated PC in this population.

Efficacy of a brief cognitive behavioral therapy for head and neck cancer survivors with body image distress: secondary outcomes from the BRIGHT pilot randomized clinical trial

PURPOSE

Body image distress (BID) among head and neck cancer (HNC) survivors leads to depression, social isolation, stigma, and poor quality of life. BRIGHT (Building a Renewed ImaGe after Head and neck cancer Treatment) is a brief, tailored cognitive behavioral therapy (CBT) that reduces HNC-related BID. This trial examines the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID.

METHODS

In this pilot randomized trial, HNC survivors with clinically significant BID were randomized to 5 weekly psychologist-led tele-CBT sessions (BRIGHT) or dose and delivery-matched survivorship education (attention control [AC]). Secondary psychosocial outcomes were assessed using validated patient-reported outcomes at baseline and 1 and 3-month post-intervention.

RESULTS

Among 44 HNC survivors with BID, BRIGHT resulted in a greater reduction in depression relative to AC (mean model-based 1-month difference in Δ PROMIS SF v1.0-Depression 8a score, -3.4; 90% CI, -6.4 to -0.4; 3-month difference, -4.3; 90% CI, -7.8 to -0.8). BRIGHT also decreased shame and stigma relative to AC (mean model-based 3-month difference in Δ Shame and Stigma Scale score, -9.7; 90% CI, -15.2 to -4.2) and social isolation (mean model-based 3-month difference in Δ PROMIS SF v2.0 Social Isolation 8a score, -2.9; 90% CI, -5.8 to -0.1).

CONCLUSIONS

In this planned secondary analysis of a pilot RCT, BRIGHT improved a broad array of psychosocial outcomes among HNC survivors with BID.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03831100 .

IMPLICATIONS FOR CANCER SURVIVORS

These promising preliminary data suggest the need for a large efficacy trial evaluating the effect of BRIGHT on psychosocial outcomes among HNC survivors with BID.

Impact of Tobacco, Marijuana, and Alcohol Use on Overall Survival in Recurrent Metastatic Head and Neck Cancer Patients Treated With Immune Checkpoint Inhibitors

AIM

The response rates to immune checkpoint inhibitors (ICI) remain low (13%-20%) in metastatic head and neck cancer patients, indicating an urgent need to better understand factors predictive of response to these agents. This study explored the impact of smoking status, marijuana use, and alcohol consumption on treatment outcomes in recurrent-metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients treated with ICI.

METHODS

A retrospective analysis was performed on 201 R/M HNSCC patients treated with ICI between January 15th 2016 and April 9th 2020 at a single institution.

RESULTS

Gender: 154 male (77%), 47 female (23%). Median age 61 (IQR: 55-68). ICI drug: pembrolizumab 100 (50%), nivolumab 91 (45%), nivolumab + ipilimumab 10 (5%). Line of therapy: first: 98 (49%), second and beyond: 103 (51%). Tumor site: oropharynx 84 (42%), oral cavity 45 (22%), larynx 26 (13%), other sites 46 (23%). p16 tumor status: negative 132 (66%), positive 69 (34%). Smoking status: former 111 (55%), never 54 (27%), current 36 (18%), median pack-year 18 (IQR: 0-37). Alcohol use: yes 110 (55%), no 91 (54%). Marijuana use: yes 47 (23%), no 154 (77%). Overall response rate: 36 (18%). Median OS: 12 months (95% CI: 9.4-14.8). Tobacco: former (HR: 0.75, 95% CI: 0.50, 1.11), current (HR: 0.58, 95% CI: 0.33, 1.02). Marijuana: yes (HR: 0.93, 95% CI: 0.58, 1.49). Alcohol: yes (HR: 1.04, 95% CI: 0.72, 1.49).

CONCLUSION

In our cohort, smoking status, marijuana use, and alcohol consumption did not have a statistically significant impact on OS in patients with R/M HNSCC treated with ICI.

Symptom Burden and Quality of Life in Long-Term Survivors with Head and Neck Cancer

Objectives: In this study, long-term survivors of head and neck cancer (HNC) were evaluated regarding their symptom burden and quality of life (QoL). Methods: This prospective study was performed during the regular follow-up consultations at one of Germany's largest tertiary referral centers for HNC. The assessment included demographic, clinical, and oncological data, as well as the MIDOS(2) and the University of Washington Quality of Life Questionnaire (UW QoL) questionnaires. Patients were subdivided based on their disease stage, that is, early cancer stages (UICC I/II) and advanced cancer stages UICC (III/IV). Results: Between January 1, 2019 and December 31, 2019, 212 HNC patients with a mean follow-up of 46.36 ± 43.64 months were included (120 patients UICC stage I/II (22.5% female, mean age 61.93 ± 12.38 years) versus 92 patients UICC stage III/IV (25.0% female, mean age 63.73 ± 11.74 years)). For all patients evaluated (UICC I/II versus III/IV), the three most common symptoms were tiredness (47.5 vs 60.9%, P = .073, r = .123), anxiety (35.8 vs 32.6%, P = .624, phi = .034) and drowsiness (35.0 vs 44.6%, P = .157, phi = .097). Patients diagnosed with UICC III/IV stages reported loss of appetite significantly more frequently and with a high level of severity (15.0 vs 32.6%, P = .002, phi = .157; 0.23 ± 0.60 vs 0.47 ± 0.78, P = .003, r = .203). The overall symptom burden was low with a severity sum score (min 0-max 30) of 3.04 ± 3.29 versus 3.58 ± 3.38 (P = .143, r = .100). All patients rated their QoL as good (65.67 ± 20.93 vs 59.56 ± 22.00, P = .043, r = .139). Conclusion: The overall symptom burden of long-term survivors of HNC is encouragingly low.Trial registration: The study was registered in the German Registry for Clinical Studies (application No.: 00017122). Date of registration: 15.08.2019. https://drks.de/search/de/trial/DRKS00017122.

In vivo, online label-free monitoring of heterogenous oxygen utilization during phototherapy with real-time ultrasound-guided photoacoustic imaging

Understanding the tumor microenvironment, particularly the vascular density and the availability of oxygen, is key in individualizing treatment approaches and determining their efficacy. While there are many therapies including radiotherapy that are ineffective in hypoxic tumor microenvironments, here we demonstrate the heterogeneous oxygen consumption during photodynamic therapy (PDT), a non-invasive treatment method using localized light to activate a photosensitive drug in the presence of oxygen that has shown high effectiveness in the treatment of various types of tumors, including those presented in head and neck cancer (HNC) patients. While our previous work has demonstrated that blood oxygen saturation (StO2) mapped before and after treatment with ultrasound-guided photoacoustic imaging (US-PAI) can be used as a surrogate marker for the regionalized long-term efficacy of PDT, real-time monitoring of StO2 during PDT could provide additional insights on oxygen consumption and inform dose design for "on the spot" treatment decisions. Specifically, in this work, we integrated the US-PAI transducer probe with PDT light delivery fibers. We tested the setup on murine tumor models intravenously injected with liposomal benzoporphyrin derivative (BPD) photosensitizer at 0.5 mg/kg dose and photodynamic illumination at 100 and 400 mW/cm2 fluence rate. As expected, we observed with our US-PAI StO2 images that the rate of oxygen utilization increases when using a high fluence rate (HFR) light dose. Particularly in the higher fluence rate group, we observed StO2 reaching a minimum mid-light dose, followed by some degree of reoxygenation. US-PAI added the advantage of spatial information to StO2 monitoring, which allowed us to match regions of re-oxygenation during therapy to retained vascular function with immunohistochemistry. Overall, our results have demonstrated the potential of US-PAI for applications in online dosimetry for cancer therapies such as PDT, using oxygen changes to detect regionalized physiological vascular response in the tumor microenvironment.

Exploring the use of rehabilitation in individuals with head and neck cancer undergoing treatment: a scoping review

PURPOSE

Explore the use, characteristics, feasibility, and functional outcomes of rehabilitation interventions used for individuals with head and neck cancer (HNC) during treatment.

METHODS

Searches were conducted in four databases from Jan 2011 to Dec 31, 2022. Included studies had to include adults with HNC undergoing treatment, a rehabilitation intervention, an assessment of functional outcome(s) addressed by the International Classification of Functioning Framework (ICF) and be published in English language. Title and abstract screening, full-text review, and data extraction were completed independently, in duplicate. Descriptive statistics and a qualitative synthesis summarized findings.

RESULTS

Twenty-seven studies were included in this review. The majority of studies were randomized controlled trials (70%). Most individuals represented in the included studies were males (92% of all participants) between 50 and 60 years of age. Interventions led by a speech language pathologist (33%) were most commonly described. Sixteen studies (59%) described primary outcomes that fit the ICF "impairment" domain.

CONCLUSIONS

We identified few studies that explored the use, feasibility, and effectiveness of rehabilitation interventions for individuals with HNC during treatment. Future research should assess the effectiveness of rehabilitation interventions on functional outcomes beyond the ICF body function and structure domain.

Associations between hypopharyngeal defect closure and quality of life in long-term total laryngectomy survivors

BACKGROUND

Few studies have examined health-related quality of life (HRQOL) outcomes in long-term total laryngectomy survivors in relation to the type of hypopharyngeal defect.

METHODS

A cross-sectional study was performed in long-term total laryngectomy survivors, treated between 2000 and 2020. The primary outcome was HRQOL, assessed using the FACE-Q Head and Neck Cancer Module, in relation to the type of hypopharyngeal closure (primary closure, partial or circumferential reconstruction).

RESULTS

Seventy-nine survivors were included with a median follow-up of 92.1 months (IQR 75.6-140.2 months). Patients requiring partial hypopharyngeal reconstruction (n = 18) scored significantly worse than patients with primary closure (n = 51) on 4 of 13 FACE-Q domains: functional domains of eating (p = 0.03), speech (p = 0.05), and swallowing (p = 0.03), and the psychological domain of speaking-related distress (p = 0.02). No statistically significant differences were found between the circumferential hypopharyngeal defect reconstruction group (n = 10). Stricture occurrence was the only clinical factor associated with worse eating, speaking, swallowing, eating-related distress, and cancer worry in multivariable analyses.

CONCLUSION

Several functional and psychological domains were significantly worse following partial hypopharyngeal reconstruction than in patients who received primary closure. Efforts to reduce stricture rates to enhance reconstructive outcomes following total laryngectomy merit further research.

Is Acupuncture an Effective Treatment for Radiation-Induced Xerostomia of Patients with Head and Neck Cancer? A Systematic Review and Meta-Analysis

Background: Radiation-induced xerostomia (RIX) stands out as one of the most severe side effects among patients with head and neck cancer (HNC). Given the varied conclusions in previous studies concerning the association between acupuncture, sham acupuncture, or acupuncture combined with standard oral care and therapeutic effects, our aim is to conduct a systematic review to assess the effectiveness and safety of acupuncture in managing RIX in patients with HNC. Methods: Six databases (Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure, Chongqing VIP, and WanFang Database) were electronically searched, following the Cochrane manual and adhering to reported Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines, from their inception dates to July 1, 2024. Primary randomized clinical trials included in systematic reviews or meta-analyses were identified, with the Xerostomia Questionnaire and Xerostomia Inventory designated as the primary outcomes. Salivary flow rates (unstimulated or stimulated) were defined as secondary outcomes. Results: Eight clinical trials involving 1273 participants were analyzed, with six studies included in the meta-analysis. The results indicate that acupuncture demonstrated a significant improvement in patient-reported xerostomia scores (standardized mean difference [SMD] = -0.20, 95% confidence interval [95% CI] [-0.38, -0.02], I2 = 0%) in comparison to standard care, but did not significantly improve oral dryness symptoms compared with sham acupuncture (SMD = -0.06, 95% CI [-0.29, 0.16], I2 = 25.8%). The merged total showed negative result (SMD = -0.13, 95% CI [-0.27, 0.01], I2 = 8.2%). Additionally, there was no significant difference in stimulated salivary flow rate (SMD = -0.22, 95% CI [-0.58, 0.13], I2 = 0%) and unstimulated salivary flow rate (SMD = -0.19, 95% CI [-0.11, 0.72], I2 = 67.2%). In general, the acupuncture did not cause serious adverse effects. Conclusion: As far as current research is concerned, acupuncture treatment for RIX symptoms in patients with HNC still lacks strong and convincing evidence support. The more scientific research methods and more clinical trials are still needed.

Role of primary care in opioid prescribing for older head and neck cancer survivors

BACKGROUND

Older head and neck cancer (HNC) survivors have concerning rates of potentially unsafe opioid prescribing. Identifying the specialties of opioid prescribers for HNC survivors is critical for targeting the settings for opioid safety interventions. This study hypothesized that oncology and surgery providers are primarily responsible for opioid prescriptions in the year after treatment but that primary care providers (PCPs) are increasingly involved in prescribing over time.

METHODS

Using linked Surveillance, Epidemiology, and End Results-Medicare data, a retrospective analysis was conducted of adults aged >65 years diagnosed between 2014 and 2017 with stage I-III HNC and who had ≥6 months of treatment-free follow-up through 2019. Starting at treatment completion, opioid fills were assigned to a prescriber specialty: oncology, surgery, primary care, pain management, or other. Prescriber patterns were summarized for each year of follow-up. Multinomial logistic regression models captured the likelihood of opioids being prescribed by each specialty.

RESULTS

Among 5135 HNC survivors, 2547 (50%) had ≥1 opioid fill (median, 2.1-year follow-up). PCPs prescribed 47% of all fills (42%-55% each year). PCPs prescribed opioids to 45% of survivors with ≥1 opioid fill, which was a greater share than other specialties. PCPs prescribed longer supplies of opioids (median, 20 days/fill; median, 30 days/year) than oncologists or surgeons. The likelihood of an opioid being prescribed by an oncology provider was four times lower than that of it being prescribed by a PCP.

CONCLUSIONS

PCP involvement in opioid prescribing remains high throughout HNC survivorship. Interventions to improve the safety of opioid prescribing should target primary care, as is typical for opioid reduction efforts in the noncancer population.

Comparative analysis of the expression of р16, PD-L1 in squamous cell carcinoma of the oropharynx and CUP syndrome

Introduction. metastases in the absence of a primary tumor (cancer of unknown primary (Cup) syndrome) are diagnosed in 2–4 % of malignant tumor cases. This pathology is characterized by early metastatic dissemination, weak response to conventional chemotherapy, and aggressive progression. The use of checkpoint inhibitors targeting programmed cell death protein 1 (pD-1) and its ligand (pD-L1) has shown good results in treatment of various cancers including oropharyngeal squamous cell carcinoma (OpSCC). In Cup syndrome, the effectiveness of checkpoint inhibitors is rarely investigated, and pD-L1 expression is often not measured.Aim. To compare the frequency of p16 and pD-L1 hyperexpression in OpSCC and Cup syndrome, and to analyze dependency of survival rates on the level of expression of p16, the most important prognostic marker.Materials and methods. The study included 121 patients (59 with OpSCC and 62 with Cup syndrome) who received medical treatment in the multidisciplinary medical Center “medical City” (Tyumen) and Chelyabinsk Oncological Center of Oncology and Nuclear medicine between 2019 and 2023. Immunohistochemical examination was performed using the vENTANA Benchmark gX with primary antibodies against pD-L1 (clone Sp263, uSA) and р16 (uS Biological, uSA). Statistical analysis of the data was performed using SpSS 26 software. Long-term treatment outcomes were evaluated using 1-, 3-, 5-year survival rates and median survival. Overall survival was analyzed using the kaplan-meier method. Statistical significance of the differences was evaluated using the Cox model.Results. The studied groups did not differ by sex (p = 0.472), age (р = 0.640), and N stage (р = 0.262). patient age in the whole population varied between 42 and 81 years (median age 61.89 ± 11.9 years; mean age 60.81 ± 9.8 years). pD-L1 expression rate was higher in Cup syndrome at 92 % compared to 73 % in OpSCC (statistically significant difference; р = 0.01). Analysis of the association of ORSCC and Cup syndrome with human papilloma virus showed statistically significant difference in p16 hyperexpression: patients with OpSCC had p16-positive status more frequently (53 % of cases) while patients with Cup syndrome mostly had p16-negative status (73 % of cases). mean life expectancy of patients with OpSCC and p16-positive status was 62.65 months (95 % confidence interval 54.98–70.31), minimal observation period was 12 months, maximal was 70 months. mean life expectancy of patients with Cup syndrome and positive p16 status was 66.22 months (95 % confidence interval 56.35–76.10), minimal observation period was 12 months, maximal was 70 months. No statistically significant differences in survival rates of patients with OpSCC and Cup syndrome were found (р = 0.999).Conclusion. The study showed higher pD-L1 expression in patients with Cup syndrome compared to patients with OpSCC: 92 and 73 %, respectively (р = 0.01). The obtained results highlight the importance of routine pD-L1 expression evaluation in patients with Cup syndrome. The frequency of p16 hyperexpression was higher in OpSCC compared to Cup syndrome: 53 % versus 27 % (р = 0.02) which agrees with the worldwide epidemiological data: among all malignant neoplasms of the head and neck, Hpv infection is most common in OpSCC. Therefore, it serves as an important sign of hidden oropharyngeal cancer in Cup syndrome.

Assessing the use of the novel tool Claude 3 in comparison to ChatGPT 4.0 as an artificial intelligence tool in the diagnosis and therapy of primary head and neck cancer cases

OBJECTIVES

Head and neck squamous cell carcinoma (HNSCC) is a complex malignancy that requires a multidisciplinary tumor board approach for individual treatment planning. In recent years, artificial intelligence tools have emerged to assist healthcare professionals in making informed treatment decisions. This study investigates the application of the newly published LLM Claude 3 Opus compared to the currently most advanced LLM ChatGPT 4.0 for the diagnosis and therapy planning of primary HNSCC. The results were compared to that of a conventional multidisciplinary tumor board; (2) Materials and Methods: We conducted a study in March 2024 on 50 consecutive primary head and neck cancer cases. The diagnostics and MDT recommendations were compared to the Claude 3 Opus and ChatGPT 4.0 recommendations for each patient and rated by two independent reviewers for the following parameters: clinical recommendation, explanation, and summarization in addition to the Artificial Intelligence Performance Instrument (AIPI); (3) Results: In this study, Claude 3 achieved better scores for the diagnostic workup of patients than ChatGPT 4.0 and provided treatment recommendations involving surgery, chemotherapy, and radiation therapy. In terms of clinical recommendations, explanation and summarization Claude 3 scored similar to ChatGPT 4.0, listing treatment recommendations which were congruent with the MDT, but failed to cite the source of the information; (4) Conclusion: This study is the first analysis of Claude 3 for primary head and neck cancer cases and demonstrates a superior performance in the diagnosis of HNSCC than ChatGPT 4.0 and similar results for therapy recommendations. This marks the advent of a newly launched advanced AI model that may be superior to ChatGPT 4.0 for the assessment of primary head and neck cancer cases and may assist in the clinical diagnostic and MDT setting.

BANF1 is a novel prognostic biomarker linked to immune infiltration in head and neck squamous cell carcinoma

Background

Barrier-to-autointegration factor 1 (BANF1) is an abundant and ubiquitously expressed postnatal mammalian protein that is overexpressed in numerous human cancers and can promote cancer cell proliferation. However, the role of BANF1 in prognosis remains unclear in head and neck squamous cell carcinoma (HNSCC).

Methods

BANF1 expression data were obtained from the GEO and TCGA databases. We used Cox regression and Kaplan-Meier curves to assess the prognostic potential of BANF1. The role of BANF1-related genes was investigated using Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analyses. In addition, we explored the link between BANF1, drug sensitivity, and the tumor immune microenvironment. Finally, functional in vitro and in vivo assays were used to explore the effects of BANF1 on tumor growth and metastasis of HNSCC.

Results

BANF1 was markedly overexpressed in HNSCC and was correlated with clinicopathological characteristics. According to survival analysis, BANF1 can be inversely correlated with patient survival and can act as a prognostic risk indicator. IC50 values for chemotherapeutic treatments indicated that the group with high BANF1 expression was more responsive to most antitumor treatments. Furthermore, higher TIDE scores were observed in the low BANF1 expression group, indicating a decline in the efficacy of immune checkpoint inhibitor therapy. Functionally, the malignant biological behavior of HNSCC cell lines was inhibited when BANF1 expression was knocked down.

Conclusion

BANF1 can promote tumor progression in patients with HNSCC. BANF1 shows great promise as a potential biomarker to assess the prognosis.

The impact of different timing of mouth opening exercises on trismus in postoperative radiotherapy patients with oral cancer

OBJECTIVE

To compare the effects of starting mouth opening exercises at two different times on trismus in postoperative radiotherapy patients with oral cancer.

METHODS

Through a prospective randomized controlled trial, purposive sampling was used to select 76 patients undergoing postoperative radiotherapy for oral cancer from March 2023 to January 2024 at the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Patients were randomly divided into an experimental group (n = 38) and a control group (n = 38) using a random number table at a ratio of 1:1. The experimental group began mouth opening exercises in the second week after surgery (before radiotherapy), while the control group began in the fourth week after surgery (at the start of radiotherapy). The primary outcome measure was maximum interincisal opening (MIO). Secondary outcome measures included pain visual analog scale (VAS) scores and quality of life scores (UW-QOL), assessed at baseline, the second week post-surgery (before radiotherapy), the fourth week post-surgery (at the start of radiotherapy), the ninth week post-surgery (end of radiotherapy), and the twelfth week post-surgery (three weeks after the end of radiotherapy).

RESULTS

A total of 72 patients completed all assessments, with 36 in each group, resulting in an overall sample attrition rate of 5.26 % (less than 15 %). There were no statistically significant differences in general demographic and clinical characteristics between the two groups. Repeated measures ANOVA showed significant differences in MIO, VAS, and UW-QOL scores between groups, over time, and in group-time interactions (P < 0.001). From the fourth week post-surgery (at the start of radiotherapy), the experimental group had significantly higher MIO (P < 0.001), significantly lower VAS scores (P < 0.001), and significantly higher UW-QOL scores (P < 0.001) compared to the control group. These differences persisted at subsequent assessment points.

CONCLUSION

Initiating mouth opening exercises in the second week post-surgery (before radiotherapy) can significantly improve mouth opening, reduce pain, and enhance the quality of life in postoperative radiotherapy patients with oral cancer. This provides important evidence for clinical practice, although further research is needed to verify the long-term effects.

Impacts of Employment Status, Partnership, Cancer Type, and Surgical Treatment on Health-Related Quality of Life in Irradiated Head and Neck Cancer Survivors

Objectives: This study aimed to examine the relationship between health-related quality of life (HRQoL) and sociodemographic and clinical variables in survivors of head and neck cancer (HNC) treated with radiotherapy, with or without surgery. Materials and Methods: HRQoL was measured using the functional assessment of cancer therapy-head and neck (FACT-H&N) in a cross-sectional survey involving 150 patients. Of these, 60 had nasopharyngeal cancer (NPC), treated exclusively with radiotherapy, while 90 had oral cavity squamous cell cancer (OSCC), undergoing radical surgery followed by adjuvant radiotherapy. Key variables included cancer type, age, gender, partnership status, education, and employment, with additional clinical variables assessed in patients with OSCC. Statistical analyses included multiple regression, ANOVA, and t-tests to explore relationships between variables and HRQoL. Results: Cancer type, surgical treatment, and employment status emerged as significant independent predictors of HRQoL in HNC patients. Patients with NPC reported better HRQoL on three FACT-H&N subscales-social/family well-being, functional well-being, and additional concerns-compared to patients with OSCC. Unemployed individuals exhibited lower HRQoL on four subscales. In patients with OSCC, partnership status and segmental mandibulectomy were found to predict HRQoL independently. Conclusions: This study concludes that cancer type, surgical intervention, and employment status notably influence HRQoL among HNC patients undergoing radiotherapy. In addition, partnership status is a key factor affecting HRQoL in patients with OSCC.

Barriers and facilitators to cancer rehabilitation for patients with head and neck or lung cancer-a scoping review mapping structural and healthcare professionals' perspectives

PURPOSE

Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer.

MATERIALS AND METHODS

Two systematic searches were conducted in five databases mapping peer-reviewed research literature.

RESULTS

In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation.

CONCLUSION

From structural and healthcare professionals' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer.Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options.Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options.It is important that healthcare professionals take the individual patient's resources into account when navigating aspects of access, referral, and participation in rehabilitation.

Vaccination uptake among post-treatment cancer survivors: A multi-vaccine scoping review

BACKGROUND

Our goal was to provide an overview of uptake rates across vaccine types and factors associated with vaccine uptake among cancer survivor populations.

METHODS

A literature search was conducted using Ovid MEDLINE® ALL (Wolters Kluwer), Embase (Elsevier) and CINAHL Complete (EBSCO) databases and according to PRISMA guidelines. Eligible articles were limited to those examining vaccination uptake among cancer survivors who had completed treatment, reported factors associated with uptake (e.g., barriers and facilitators), and published in English between 2011 and 2021. Two independent reviewers screened citations for inclusion and two performed data abstraction, verified by an arbiter.

RESULTS

The search returned 4,215 total articles, and 271 duplicates were removed. During abstract/title screening, 212 articles were identified. Following full-text screening, 47 articles/abstracts were found to meet inclusion criteria, 16 articles/abstracts were removed, and 31 studies were included in the review. Among the 31 studies, participant age ranged from 9 years to adults of all ages. Vaccine types included: influenza (n = 18), human papillomavirus (n = 10), pneumococcal (n = 8), hepatitis A/B (n = 1), shingles (n = 1), measles (n = 1), tetanus/diphtheria (n = 1), and haemophilus influenza B (n = 1). Vaccine uptake varied greatly across studies, vaccine types, and participant populations. Factors affecting vaccination uptake included sociodemographic variables and social determinants of health, health beliefs/attitudes/knowledge, provider recommendation, and cancer treatment/clinical variables.

CONCLUSIONS

Our findings highlight the need for further examining factors associated with vaccine uptake, the need for clinical guidelines that specifically address vaccination among cancer survivors, and potential targets for multi-level interventions to improve vaccination rates among cancer survivor populations.

Chronic shoulder pain due to spinal accessory nerve palsies present opportunities for improved care integration

Aim: Chronic shoulder pain due to iatrogenic spinal accessory nerve (SAN) injury continues to be under-recognized, resulting in delayed time-to-diagnosis and poorer outcomes. Solutions are needed to improve the management of this condition, which can be challenging as care needs to be coordinated across pain management, neurophysiology, rehabilitation and reconstructive surgery.Cases: We present a series of six patients with shoulder pain refractory to conservative pain treatments to highlight how SAN injuries continued to be missed and treatment delayed, even at advanced care centers. The time to diagnosis of SAN palsy took an average of 21 months and treatment was inconsistent for all patients.Discussion: None of the six cases had initial suspicion of SAN palsy and only one patient received targeted SAN injury care. SAN treatment should be started as early as possible so that patients can be referred for prompt surgical evaluation if they fail conservative management. Integrated care pathways may be a solution for formalizing multidisciplinary team involvement and improving SAN injury outcomes.Conclusion: Systemic processes, such as integrated care pathways, are needed to optimize early recognition and targeted treatment of SAN injury and may be beneficial for other underdiagnosed and undertreated neuropathic pain conditions.

Evidence summary on the rehabilitative management of dysphagia during radiotherapy for head and neck cancer patients

Objective

To retrieve, extract, integrate and evaluate evidence on the rehabilitation of dysphagia in patients undergoing radiotherapy for head and neck cancer (HNC), and to provide a basis for the development of a rehabilitation management protocol for dysphagia in patients undergoing radiotherapy for HNC.

Methods

An evidence-based systematic search of the literature related to the rehabilitation of dysphagia in patients with HNC during radiotherapy was conducted from January 2013 to March 2023, and the corresponding evaluation tools were selected according to the different types of literature for quality evaluation. "The Joanna Briggs Institute (JBI) evidence pre-grading system was used to evaluate the quality of the evidence.

Results

A total of 17 articles were included, including 3 guidelines, 5 expert articles, 1 clinical decision, 1 practice recommendation, 2 evidence summaries and 5 systematic evaluations. A final total of 28 pieces of evidence were summarised, including 6 areas of swallowing disorder screening and assessment, physiotherapy, preventive swallowing function training, feeding management, pain control, and oral care.

Conclusion

This study forms a multidisciplinary collaborative evidence summary for the rehabilitation management of dysphagia in patients undergoing radiotherapy for HNC, but the application of some of the evidence needs to be carried out in the context of the clinical setting and patient-specific circumstances for the rehabilitation evidence selected for patients' dysphagia to improve their swallowing function and their swallowing-related quality of life and reduce the occurrence of related complications.

Assessing the role of advanced artificial intelligence as a tool in multidisciplinary tumor board decision-making for recurrent/metastatic head and neck cancer cases - the first study on ChatGPT 4o and a comparison to ChatGPT 4.0

Background

Recurrent and metastatic head and neck squamous cell carcinoma (HNSCC) is characterized by a complex therapeutic management that needs to be discussed in multidisciplinary tumor boards (MDT). While artificial intelligence (AI) improved significantly to assist healthcare professionals in making informed treatment decisions for primary cases, an application in the even more complex recurrent/metastatic setting has not been evaluated yet. This study also represents the first evaluation of the recently published LLM ChatGPT 4o, compared to ChatGPT 4.0 for providing therapy recommendations.

Methods

The therapy recommendations for 100 HNSCC cases generated by each LLM, 50 cases of recurrence and 50 cases of distant metastasis were evaluated by two independent reviewers. The primary outcome measured was the quality of the therapy recommendations measured by the following parameters: clinical recommendation, explanation, and summarization.

Results

In this study, ChatGPT 4o and 4.0 provided mostly general answers for surgery, palliative care, or systemic therapy. ChatGPT 4o proved to be 48.5% faster than ChatGPT 4.0. For clinical recommendation, explanation, and summarization both LLMs obtained high scores in terms of performance of therapy recommendations, with no significant differences between both LLMs, but demonstrated to be mostly an assisting tool, requiring validation by an experienced clinician due to a lack of transparency and sometimes recommending treatment modalities that are not part of the current treatment guidelines.

Conclusion

This research demonstrates that ChatGPT 4o and 4.0 share a similar performance, while ChatGPT 4o is significantly faster. Since the current versions cannot tailor therapy recommendations, and sometimes recommend incorrect treatment options and lack information on the source material, advanced AI models at the moment can merely assist in the MDT setting for recurrent/metastatic HNSCC.

Carotid ultrasound to identify head and neck cancer survivors with high cardiovascular risk after radiation therapy: rationale and design of a prospective, cross-sectional pilot study

Background: Radiation therapy is an integral component of treatment that can predispose to carotid artery stenosis (CAS) and increase the risk of cerebrovascular events for head and neck cancer survivors. The utility of screening for CAS with carotid ultrasound in asymptomatic head and neck cancer survivors is unclear.Methods: In this prospective, cross-sectional pilot study, 60 patients who have no evidence of cancer at least 2 years from completion of RT will undergo screening carotid ultrasound to identify patients with high risk of cardiovascular events.Results: Outcomes will include clinically significant CAS, carotid intima-media thickness, acceptability/feasibility of screening, barriers to care and preliminary data on changes to medical management because of screening. Correlative multi-omics analyses will examine biomarkers of CAS after radiation therapy.Conclusion: The results of this study will provide valuable data on the prevalence of CAS and preliminary patient-centered data that will inform the design of a future large-scale, multi-site clinical trial.Clinical Trial Registration: NCT05490875 (ClinicalTrials.gov).

Treatment Complications Associated With Hospital Admission in Oropharyngeal Cancer Patients

BACKGROUND

Oropharyngeal cancer (OPC) survivorship is a nursing priority because patients are living longer while significant short-term and long-term treatment complications that require nursing care are increasing. Hospital readmission is costly and reflects the quality of care patients receive.

OBJECTIVES

This secondary analysis aimed to determine the prevalence of treatment complications resulting in hospital admissions among persons with OPC and examine the relationship between treatment complications resulting in hospital admission among persons with OPC and all other persons with head and neck cancer.

METHODS

Using the National Inpatient Survey 2008-2019 database, we identified persons with relevant head and neck cancer diagnoses using specific International Classification of Disease ICD-9 and ICD-10 codes. Complications were operationalized by diagnosis-related codes; persons with codes for major elective surgery were excluded as our focus was posttreatment symptoms requiring hospitalization. Descriptive statistics were used to characterize persons with OPC hospitalized between 2008 and 2019. Binary logistic regression was used to assess complications using crude comparisons. The Elixhauser Comorbidity Index was used for controlling for comorbidities.

RESULTS

The final analysis samples included 751,533: 164,770 persons with OPC and 586,763 with other head and cancers. The most prevalent diagnoses observed in those with OPC were esophagitis, nutrition disorder, hematological disorder, and renal failure; the least common diagnoses were sepsis, respiratory tract infection, and pneumonia. Binary regression revealed that persons with OPC experienced significantly more esophagitis, nutrition disorders, hematological disorders, and renal failure compared to persons with other head and neck cancers.

DISCUSSION

Treatment of survivors of OPC requires more intensive monitoring for early symptoms associated with treatment, including esophagitis, nutrition disorders, bleeding disorders, and renal failure, than persons with other head and neck cancers. Monitoring laboratory values and clinical manifestations of these conditions is imperative. Nurses may encounter persons with OPC in emergency departments, outpatient radiology, or inpatient general medicine floors to manage swallowing difficulties, dehydration, malnutrition, and bleeding. Delayed or ineffective treatment of these conditions contributes to readmission, financial burden, and impairment of patient's quality of life. Future research should investigate the relationship between targeted treatment for expected complications and readmission rates in persons with OPC.

Dysphagia in Head and Neck Cancer

Dysphagia is a common symptom in patients with head and neck cancer that can significantly impact health outcomes and quality of life. The origin of dysphagia in these patients is often multifactorial, making diagnosis and management especially complex. The evaluating otolaryngologist should be well versed with the patient's neoplasm, comorbidities, and treatment history alongside dysphagia-specific imaging modalities. Management is often dynamic, requiring frequent monitoring, interprofessional collaboration, and a variety of supportive and invasive measures to achieve optimal outcomes.

Developing national cancer survivorship standards to inform quality of care in the United States using a consensus approach

PURPOSE

To develop United States (US) standards for survivorship care that informs (1) essential health system policy and process components and (2) evaluation of the quality of survivorship care.

METHODS

The National Cancer Institute and the Department of Veterans Affairs led a review to identify indicators of quality cancer survivorship care in the domains of health system policy, process, and evaluation/assessment. A series of three virtual consensus meetings with survivorship care and research experts and advocates was conducted to rate the importance of the indicators and refine the top indicators. The final set of standards was developed, including ten indicators in each domain.

RESULTS

Prioritized items were survivor-focused, including processes to both assess and manage physical, psychological, and social issues, and evaluation of patient outcomes and experiences. Specific indicators focused on developing a business model for sustaining survivorship care and collecting relevant business metrics (e.g., healthcare utilization, downstream revenue) to show value of survivorship care to health systems.

CONCLUSIONS

The National Standards for Cancer Survivorship Care can be used by health systems to guide development of new survivorship care programs or services or to assess alignment and enhance services in existing survivorship programs. Given the variety of settings providing care to survivors, it is necessary for health systems to adapt these standards based on factors including age-specific needs, cancer types, treatments received, and health system resources.

IMPLICATIONS FOR CANCER SURVIVORS

With over 18 million cancer survivors in the United States, many of whom experience varied symptoms and unmet needs, it is essential for health systems to have a comprehensive strategy to provide ongoing care. The US National Standards for Survivorship Care should serve as a blueprint for what survivors and their families can anticipate after a cancer diagnosis to address their needs.

MASCC/ISOO Clinical Practice Statement: Management of salivary gland hypofunction and xerostomia in cancer patients

PURPOSE

A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise tool for clinicians that concentrates practical information needed for the management of oral complications of cancer patients. This CPS is focused on the management of salivary gland hypofunction and xerostomia in cancer patients.

METHODS

This CPS was developed based on critical evaluation of the literature followed by a structured discussion of a group of leading experts, members of the Oral Care Study Group of MASCC/ISOO. The information is presented in the form of succinct bullets and tables to generate a short manual about the best standard of care.

RESULTS

Salivary gland hypofunction and xerostomia in cancer patients are managed by (i) stimulating saliva production of salivary glands with residual secretory capacity or (ii) artificial wetting of the oral and lip surfaces which can be achieved by pharmacological or non-pharmacological interventions. Pharmacological interventions encompass the use of sialagogues and sialolytics, while non-pharmacological interventions involve the use of moistening agents, mechanical, gustatory, or electrostimulation of the salivary glands. Additional treatment modalities may be incorporated in practice based on local availability and the clinician's experience.

CONCLUSION

The information presented in this CPS offers clinicians convenient access to the dosages and regimens of different interventions for managing salivary gland hypofunction or xerostomia to facilitate clinical efficiency and conserve valuable time for clinicians.

Gaps in Access to Medically Necessary Dental Care for Patients Living With and Beyond Cancer: We Must Do Better

Delivery of high-quality, evidence-based oral care for those living with and beyond cancer needed!

Factors influencing physical activity in individuals with head and neck cancer: a scoping review

OBJECTIVES

Higher physical activity (PA) levels are associated with better quality of life in people with head and neck cancer (HNC). Despite this positive association, most individuals with these cancer types have a sedentary or low-activity lifestyle. Limited knowledge exists regarding the factors that influence PA in this group. Therefore, we reviewed and mapped the available literature on factors that may influence PA in people with HNC.

DESIGN

We conducted a scoping review based on the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline extension for scoping reviews.

DATA SOURCES

CINHAL, the Cochrane Library, EMBASE, PsycINFO, MEDLINE and Scopus were searched from inception to July 2023.

ELIGIBILITY CRITERIA

We included qualitative and quantitative studies that stated factors such as barriers, facilitators, beliefs, perceptions and views influencing PA in individuals with HNC. Furthermore, views and recommendations of healthcare professionals involved in the care of people affected by HNC and researchers in this domain were eligible for data extraction.

DATA EXTRACTION AND SYNTHESIS

Data were extracted and synthesised by one reviewer according to the predefined items including characteristics, barriers, facilitators, beliefs, perceptions and views of people being affected and views and recommendations of experts. Quantitative data were charted descriptively, and qualitative data were analysed and summarised using a basic content analysis approach.

RESULTS

Of the 1351 publications, we included 19 in our review. Publications mainly focused on barriers to PA, with some studies reporting facilitators and collecting data on patients' and healthcare professionals' views on PA. Most research teams made recommendations for promoting PA in people with HNC.Characteristics associated with activity levels included age, cancer type and stage, morbidity level and attitude towards being active. Prevalent barriers consisted of health-related factors, including fatigue, pain and nutritional issues, alongside personal and environmental impediments such as time constraints, lack of interest or motivation. Facilitating factors for PA included perceived or experienced mental and health-related benefits. Consensus among patients, healthcare professionals and researchers highlighted the necessity for enhanced information and education, emphasising individualised approaches to promote PA throughout the cancer continuum.

CONCLUSIONS

Numerous factors affect PA in individuals with HNC. Future research should concentrate on screening and addressing risk factors for sedentary behaviour and activity barriers and on optimal design and delivery of interventions to incorporate PA promotion into the care pathway.

Evaluating the Efficacy of Adjuvant Radiotherapy in the Management of Advanced Oral Cancer Cases

Background

Because of its high rates of morbidity and death, especially in its late stages, oral cancer poses a serious threat to world health. Even with improvements in surgical and chemotherapeutic techniques, advanced oral cancer is still difficult to treat and frequently has unfavorable results.

Methods

Information on demographics, tumor features, treatment options, and results were gathered from medical records. Patients were categorized according to whether they underwent surgery alone or adjuvant radiation treatment after initial surgical resection. For the survival analysis, Kaplan-Meier curves and Cox proportional hazards models were employed.

Results

There were 150 patients in all, 75 in each group, who took part in the trial. Comparing adjuvant radiation to surgery alone resulted in considerably better overall survival (P < 0.001) and disease-free survival (P < 0.001). However, problems connected to the adjuvant radiation group affected a portion of the patient population.

Conclusion

In conclusion, patients with advanced oral cancer can improve their overall and disease-free survival with adjuvant radiation, a successful therapeutic option. To maximize results, nevertheless, cautious patient selection and effective management of treatment-related problems are crucial. To improve treatment algorithms and investigate cutting-edge therapeutic techniques for this difficult condition, further research is necessary.

Clinical validation of the nursing outcome "Swallowing status: pharyngeal phase" in patients with laryngeal cancer

AIMS AND OBJECTIVES

This study aimed to clinically validate the nursing outcome "Swallowing status: pharyngeal phase" (1013).

METHODS

A two-stage study was designed: (1) Chinese translation and cultural adaptation and (2) clinical validation. Internal consistency and interrater reliability tests were performed on 285 patients with laryngeal cancer, and an additional 130 patients were randomly selected from the 285 patients as an independent sample. Criterion-related validity tests were performed using the standardized swallowing assessment (SSA). Nursing outcome sensitivity was detected by scoring two time points.

RESULTS

The Cronbach's alpha coefficients were 0.951 for the nursing outcome and 0.942-0.965 for each indicator. The interclass correlation coefficient (ICC) values for each indicator ranged from 0.73 to 0.929. The scores of the nursing outcome were negatively correlated with the SSA scores (r = -0.555, p < 0.01). With the exception of two indicators, there was a significant difference (p < 0.05) between the total scores of the scale and its 11 indicator scores for the two time points. The results indicated that the nursing outcome "Swallowing status: pharyngeal phase" (1013) exhibited satisfactory psychometric properties and high sensitivity to change.

CONCLUSIONS

The nursing outcome "Swallowing status: pharyngeal phase" (1013) demonstrated good reliability, validity, and sensitivity in patients with laryngeal cancer.

IMPLICATIONS FOR NURSING PRACTICE

The nursing outcome "Swallowing status: pharyngeal phase" (1013) can be used to assess swallowing function in patients with laryngeal cancer and provide guidance for the development of rehabilitation intervention plans and nursing care.

Dihydroartemisinin inhibits HNSCC invasion and migration by controlling miR-195-5p expression

Objectives

Dihydroartemisinin (DHA), an artemisinin derivative extracted from the traditional Chinese medicinal herb Artemisia annua, has the potential to suppress head and neck squamous cell carcinoma (HNSCC) progression. However, the mechanisms underlying these effects remain unclear. Therefore, we aimed to examine the mechanisms underlying the effects of DHA on tumor invasion and migration.

Methods

Human HNSCC cell lines CAL-27 and FaDu were exposed to varying DHA concentrations (0, 5, 20, and 80 μM) for 24 h. Cell proliferation, invasion, and migration were assessed using CCK8, transwell, and wound-healing assays, respectively. Quantitative real-time PCR, western blotting, and immunofluorescence were used to assess the expression levels of the target genes and proteins.

Results

DHA suppressed the invasion and migration of CAL-27 and FaDu cells. Additionally, miR-195-5p suppressed the invasion and migration of HNSCC cells. This study revealed significant differences in the expression of miR-195-5p and TENM2 between clinical samples and multiple public databases. DHA treatment and miR-195-5p overexpression significantly reduced TENM2 expression in HNSCC cells, which suggested that miR-195-5p overexpression enhanced the inhibitory effect of DHA on TENM2.

Conclusions

This study provides the first evidence that DHA inhibits cell invasion and migration by regulating the miR-195-5p/TENM2 axis in HNSCC cells, suggesting it as a potentially effective treatment strategy for HNSCC.

Evaluation and Management of Shoulder Dysfunction in Cancer Survivors

Purpose of Review

Shoulder dysfunction widely affects function and quality of life of cancer survivors. This paper discusses the etiology, identification, evaluation, and management of the common shoulder impairments seen in cancer survivors, particularly those with breast cancer, head and neck cancer, and Hodgkin lymphoma.

Recent Findings

Shoulder dysfunction can be caused by a wide range of sources, often as a sequelae of cancer treatments including surgery, systemic therapy, and radiation therapy. These can change the shoulder biomechanics leading to musculoskeletal disorders such as rotator cuff disease and adhesive capsulitis. Other etiologies include neuromuscular complications, such as post-breast surgery pain syndrome and radiation fibrosis syndrome, and lymphovascular disorders such as lymphedema and axillary web syndrome. Metastatic bone disease and primary bone cancer should be considered for those with intense shoulder pain. Detailed history and physical exam, and in some cases, imaging can assist with evaluation of shoulder issues. Exercise, physical and occupation therapy are essential in managing shoulder dysfunction.

Summary

Shoulder dysfunction can limit function and quality of life for cancer survivors. It is important to consider the possible etiologies as accurate diagnosis is critical for optimal treatment.

Lymphovenous Anastomosis for the External and Internal Types of Head and Neck Lymphedema: A Case Series and Preliminary Clinical Results

Background

Head and neck lymphedema (HNL), including external and internal types, could be a possible consequence for patients who have received neck dissection and radiotherapy for head and neck cancer. Initially, the common presentations are heaviness or tightness, followed by swelling in appearance, or difficulty speaking and swallowing in internal edema cases. Lymphovenous anastomosis (LVA) is an established approach to treat extremity lymphedema. We hereby present our preliminary experience in using LVA to treat HNL.

Methods

Between March 2021 and January 2024, six patients with HNL were treated with LVA via a preauricular or submandibular incision of the obstructed side. Lymphedema Symptom Intensity and Distress Surveys-Head and Neck (LSIDS-H&N) were used for evaluation. In addition, for the external type, MD Anderson Cancer Center Head and Neck Lymphedema (MDACC HNL) rating scale was used for evaluation. For the internal type, Swallowing Quality of Life was used for evaluation.

Results

With an average follow-up period of 15.4 ± 15.9 months, LSIDS-H&N improved from 1.11 ± 0.54 to 0.44 ± 0.66 (P = 0.02). For patients with the external type, within an average follow-up period of 15 ± 16.1 months, the MDACC HNL rating scale improved from level 2 to 0 or 1a (P = 0.008). For patients with the internal type, within an average follow-up period of 21 ± 17.3 months, Swallowing Quality of Life improved from 130.5 ± 9.2 to 151 ± 19.8 (P = 0.5).

Conclusions

Based on our preliminary results, LVA could be a potential solution to both external and internal HNL.

Managing lymphoedema following treatment for head and neck cancer: is complete decongestive therapy an effective intervention to improve dysphagia outcomes?

PURPOSE OF REVIEW

The purpose of this review is to summarize current evidence regarding management of head and neck lymphoedema (HNL) to improve dysphagia outcomes following head and neck cancer (HNC) treatment. This review aims to support complete decongestive therapy (CDT) comprising compression, manual lymphatic drainage (MLD), exercises and skincare as an adjunct of dysphagia rehabilitation.

RECENT FINDINGS

Research in the limbs supports the use of CDT to improve lymphoedema outcomes. Emerging evidence supports the use of CDT for the head and neck, though, there is no consensus on optimal treatment required to improve dysphagia outcomes. Current evidence is limited due to a paucity of randomized controlled trials, case series or cohort studies with small participant numbers, and a lack of functional and instrumental dysphagia outcome measures. This provides a foundation to design and test an individually tailored programme of HNL intervention to evaluate swallowing outcomes post CDT.

SUMMARY

As the incidence of HNC is increasing with HPV, with patients living for longer with late effects of HNC treatment, it is vital to understand how the presence of HNL impacts on the swallow, and if functional dysphagia outcomes improve following treatment of HNL. Prospective, longitudinal research with objective and functional outcome measures are required to help determine optimal management of HNL and its impact on the swallow.

Usnic acid alleviates inflammatory responses and induces apoptotic signaling through inhibiting NF-ĸB expressions in human oral carcinoma cells

Usnic acid (UA) is a unique bioactive substance in lichen with potential anticancer properties. Recently, we have reported that UA can reduce 7,12-dimethylbenz[a] anthracene-induced oral carcinogenesis by inhibiting oxidative stress, inflammation, and cell proliferation in a male golden Syrian hamster in vivo model. The present study aims to explore the relevant mechanism of cell death induced by UA on human oral carcinoma (KB) cell line in an in vitro model. We found that UA can induce apoptosis (cell death) in KB cells by decreasing cell viability, increasing the production of reactive oxygen species (ROS), depolarizing mitochondrial membrane potential (MMP) levels, causing nuclear fragmentation, altering apoptotic morphology, and causing excessive DNA damage. Additionally, UA inhibits the expression of Bcl-2, a protein that promotes cell survival, while increasing the expression of p53, Bax, Cytochrome-c, Caspase-9, and 3 proteins in KB cells. UA also inhibits the expression of nuclear factor-κB (NF-κB), a protein that mediates the activation of pro-inflammatory cytokines such as TNF-α and IL-6, in KB cells. Furthermore, UA promotes apoptosis by enhancing the mitochondrial-mediated apoptotic mechanism through oxidative stress, depletion of cellular antioxidants, and an inflammatory response. Ultimately, the findings of this study suggest that UA may have potential as an anticancer therapeutic agent for oral cancer treatments.

Dyadic Yoga for Head and Neck Cancer Patients Undergoing Chemoradiation and their Family Caregivers

OBJECTIVES

Concurrent chemoradiation to treat head and neck cancer (HNC) may result in debilitating toxicities. Targeted exercise such as yoga therapy may buffer against treatment-related sequelae; thus, this pilot RCT examined the feasibility and preliminary efficacy of a yoga intervention. Because family caregivers report low caregiving efficacy and elevated levels of distress, we included them in this trial as active study participants.

METHODS

HNC patients and their caregivers were randomized to a 15-session dyadic yoga program or a waitlist control (WLC) group. Prior to randomization, patients completed standard symptom (MDASI-HN) and patients and caregivers completed quality of life (SF-36) assessments. The 15-session program was delivered parallel to patients' treatment schedules. Participants were re-assessed at patients' last day of chemoradiation and again 30 days later. Patients' emergency department visits, unplanned hospital admissions and gastric feeding tube placements were recorded over the treatment course and up to 30 days later.

RESULTS

With a consent rate of 76%, 37 dyads were randomized. Participants in the yoga group completed a mean of 12.5 sessions and rated the program as "beneficial." Patients in the yoga group had clinically significantly less symptom interference and HNC symptom severity and better QOL than those in the WLC group. They were also less likely to have a hospital admission (OR = 3.00), emergency department visit (OR = 2.14), and/or a feeding tube placement (OR = 1.78).

CONCLUSION

Yoga therapy appears to be a feasible, acceptable, and possibly efficacious behavioral supportive care strategy for HNC patients undergoing chemoradiation. A larger efficacy trial is warranted.

The Acceptability of Behavioural Swallowing Interventions for Head and Neck Cancer Patients During Radiotherapy: A Qualitative Study Exploring Experiences of Clinical Trial Speech-Language Pathologists

The PRO-ACTIVE randomized clinical trial offers 3 swallowing therapies to Head and Neck Cancer (HNC) patients during radiotherapy (RT) namely: reactive, proactive low- ("EAT-RT" only) and high-intensity ("EAT-RT + exercises"). Understanding the experiences of the trial Speech-Language Pathologists (SLPs) will be useful to inform clinical implementation. This study assessed SLP opinions of acceptability and clinical feasibility of the 3 trial therapies. 8 SLPs from 3 Canadian PRO-ACTIVE trial sites participated in individual interviews. Using a qualitative approach, data collection and thematic analysis were guided by the Theoretical Framework of Acceptability. Member checking was conducted through a follow-up focus group with willing participants. Seven themes were derived: intervention coherence, burden, barriers/facilitators, self-efficacy, attitude, ethicality, and perceived effectiveness. SLPs felt all 3 therapies had potential benefit yet perceived more advantages of proactive therapies compared to reactive. Compared to exercises, SLPs particularly endorsed the EAT-RT component. A major barrier was keeping patients motivated, which was impacted by acute toxicity and sometimes conflicting instructions from the healthcare team. Strategies utilized by to overcome barriers included: scaling exercises and/or diet up/down according to the changing patient needs and communicating therapy goals with healthcare team. A model was derived describing the perceived acceptability of the swallowing therapies according to SLPs, based on the interconnection of main themes. Proactive therapies were perceived as more acceptable to trial SLPs, for facilitating patient engagement. The perceived acceptability of the swallowing therapies was related to seven interconnected aspects of providers' experience. These findings will inform the implementation and potential uptake of the PRO-ACTIVE swallowing therapies in clinical practice.

Assessing the role of advanced artificial intelligence as a tool in multidisciplinary tumor board decision-making for primary head and neck cancer cases

Background

Head and neck squamous cell carcinoma (HNSCC) is a complex malignancy that requires a multidisciplinary approach in clinical practice, especially in tumor board discussions. In recent years, artificial intelligence has emerged as a tool to assist healthcare professionals in making informed decisions. This study investigates the application of ChatGPT 3.5 and ChatGPT 4.0, natural language processing models, in tumor board decision-making.

Methods

We conducted a pilot study in October 2023 on 20 consecutive head and neck cancer patients discussed in our multidisciplinary tumor board (MDT). Patients with a primary diagnosis of head and neck cancer were included. The MDT and ChatGPT 3.5 and ChatGPT 4.0 recommendations for each patient were compared by two independent reviewers and the number of therapy options, the clinical recommendation, the explanation and the summarization were graded.

Results

In this study, ChatGPT 3.5 provided mostly general answers for surgery, chemotherapy, and radiation therapy. For clinical recommendation, explanation and summarization ChatGPT 3.5 and 4.0 scored well, but demonstrated to be mostly an assisting tool, suggesting significantly more therapy options than our MDT, while some of the recommended treatment modalities like primary immunotherapy are not part of the current treatment guidelines.

Conclusions

This research demonstrates that advanced AI models at the moment can merely assist in the MDT setting, since the current versions list common therapy options, but sometimes recommend incorrect treatment options and in the case of ChatGPT 3.5 lack information on the source material.