A Tool for Rapid Assessment of Functional Outcomes in Patients with Head and Neck Cancer

Outcomes of Management of Advanced oral Cavity Carcinoma (T3 and T4) Following Surgery and Chemoradiotherapy Among Rural Population in Gujarat

Oral cavity squamous cell carcinoma (OSCC) makes up 30% of head and neck cancers in India, often diagnosed late (T3/T4) due to limited rural healthcare access. This study evaluates functional outcomes after surgery and chemoradiation for advanced OSCC. To assess the functional outcomes in advanced oral cavity carcinomas following surgery and chemo radiotherapy. This prospective longitudinal study of 105 patients with advanced stage oral cavity malignancies who underwent surgical management over a period of 1 year and 6 months. Functional outcomes were assessed at 6 months post-surgery using the HNC FIT scale and analysis was done using descriptive statistics, independent t-tests and ANOVA test. (p < 0.05). Functional outcomes using the HNC FIT scale revealed significant impacts on food intake (mean score 2.33/5), neck and shoulder mobility (mean score 2.68/5), and speech outcomes (mean score 2.58/5). Conversely, improved outcomes were observed in breathing (mean score 3.83/5), mood (mean score 3.75/5), and pain (mean score 3.33/5). The study emphasizes the need for holistic care in oral cavity cancer management, focusing on pain management, psychosocial support and preserving vital functions like food intake, breathing and speech to enhance patient outcomes and satisfaction.

[Pre-implementation of electronic patient-reported outcomes at reference centers for head and neck oncology : A roadmap towards patient-centered digitalization]

BACKGROUND

Electronically captured patient reports (electronic patient-reported outcomes, ePROs) are digital questionnaires filled out by cancer patients. Despite indications of improved clinical care, the integration of ePROs into clinical head and neck oncology is uncharted territory.

OBJECTIVE

This work outlines the implementation process for ePROs at the University Hospital for Otorhinolaryngology at the Medical University of Innsbruck (ENT Innsbruck).

METHODS

The implementation is carried out by a project team in a pre-implementation phase (needs assessment, implementation planning, identification of intra-hospital barriers, prototype development, testing and adaptation, and user training), an implementation phase (implementation and user training), and a post-implementation phase (quality control and project expansion).

RESULTS

The project team at ENT Innsbruck, consisting of 10 members, identified the need for digitalization in cancer follow-up. A hybrid implementation solution (Computer-Based Health Evaluation System, CHES; Evaluation Software Development, ESD, Innsbruck, Austria) was chosen. ePROs (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - 30 items, EORTC-QLQ-C30; Head and Neck Functional Integrity Scale, HNC-FIT scale; and EORTC Head and Neck Cancer Module, EORTC H&N43) will be collected 12 times over 5.5 years. A total of 25 users rated the prototype as user friendly (patient perspective: 8.1 ± 1.6, 3-10; user perspective: 8.6 ± 1.1, 6-10). The main advantage was faster medical history taking (72%), and the main disadvantages were a lack of personnel, time, and motivation (52%).

CONCLUSION

The feedback on the ePRO prototype at ENT Innsbruck was positive. The implementation phase commenced in the first quarter of 2024. Goal achievement will be evaluated in the post-implementation phase in the fourth quarter of 2024.

Long-Term Functional Outcomes in Pediatric Head and Neck Cancer Patients: A Systematic Review

OBJECTIVE

The multimodal treatments for pediatric head and neck (H&N) malignancies can have significant long-term functional consequences for growing patients. This systematic review aims to analyze the current knowledge of functional outcomes for pediatric H&N cancer survivors.

DATA SOURCES

PubMed, Embase, Web of Science.

REVIEW METHODS

Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed, and 1356 papers were reviewed by 3 team members with conflict resolution by a senior member.

RESULTS

Fourteen studies were included. Nine of 14 (64%) papers reported issues with swallowing, characterized as either dysphagia, odynophagia, oropharyngeal fibrosis, esophageal stenosis, xerostomia, trismus, or general issues with the throat and mouth. Six of 14 papers noted nutritional and feeding deficiencies, and 5 of 14 additionally noted issues with speech and voice changes. Four of 14 (29%) reported hearing impairments and/or loss. A majority of papers (9/14) reported long-term functional characteristics as a secondary outcome. Three of 14 (21%) reported a quality of life (QoL) measure. Heterogeneity in methodology and reporting precluded analysis of any relationship between treatment type and functional outcomes. Recommendations include integration of objective measures of feeding support and swallowing, as well as regular measurements of function and QoL parameters during treatment to better understand the evolution of QoL and function throughout care.

CONCLUSION

Relatively few studies focus on functional outcomes following the treatment of pediatric H&N cancer. Swallowing difficulty is the most frequently reported deficit, but objective data is rarely reported. Standardization of functional outcome assessment could improve the quality of evidence for pediatric patients treated for H&N cancer.

Delayed Reconstruction after Major Head and Neck Cancer Resection: An Interdisciplinary Feasibility Study

A single immediate reconstruction with free tissue transfer is the method of choice after major head and neck cancer (HNC) resection, but this is frequently associated with long operating hours. Considering regulatory working hour constraints, we investigated whether a two-staged reconstructive approach with temporary defect coverage by an artificial tissue substitute would be feasible. HNC patients underwent either immediate or delayed reconstruction after tumor resection. Patients with delayed reconstruction received preliminary reconstruction with an artificial tissue substitute followed by definitive microvascular reconstruction in a separate, second procedure. Of the 33 HNC patients, 13 received delayed reconstruction and 20 received immediate reconstruction. Total anesthesia time (714 vs. 1011 min; p < 0.002) and the total duration of hospital stay (34 ± 13 vs. 25 ± 6 days; p = 0.03) were longer in the delayed reconstruction group. Perioperative morbidity (p = 0.58), functional outcome (p > 0.1) and 5-year postoperative survival rank (p = 0.28) were comparable in both groups. Delayed reconstruction after HNC resection was feasible. Perioperative morbidity, functional outcome and overall survival were comparable to immediate reconstruction.

[Oncolytic virotherapy in head and neck cancer]

OBJECTIVE

Oncolytic viruses (OV) infect and kill cancer cells and elicit an antitumoral immune response. With their potential to break through tumor immunoresistance, OV might be a future combination treatment option in patients with advanced head and neck cancer (HNC). Modes of action, biological modifications, handling and side effects of OV for treatment of HNC are reviewed. Results of preclinical and clinical trials are reported.

METHODS

Publications and clinical trials dealing with OV and HNC were searched in PubMed and international platforms for clinical study records. Studies on preclinical and clinical trials regarding oncolytic Herpes Simplex Virus (HSV), Adenovirus, Vacciniavirus and Reovirus were selected.

RESULTS

Enhanced infection and killing of tumor cells through capsid and genome modifications of OV were reported in recent preclinical studies. Most of the clinical studies were phase-I/II trials. In phase III studies, tumor regression and prolonged survival were observed after treatment with oncolytic HSV, Adenoviruses and Reoviruses. In most trials, OV were combined with chemoradiotherapy or immunotherapy.

CONCLUSION

In the published studies, OV treatment of HNC patients was safe, often well tolerated and showed promising results with regard to response and survival, especially in combination with chemoradiotherapy or checkpoint inhibitors.

Functional Outcomes in Head and Neck Cancer Patients

Simple Summary

With increasing long-term survivorship of head and neck cancer (HNC), the functional outcomes are gaining importance. Recently, a tool for the rapid clinical assessment of the functional status in HNC-patients based on observable clinical criteria, termed “HNC-Functional InTegrity (FIT) Scales, was validated. Here, the functional outcomes of 681 newly diagnosed HNC-patients were reported using the HNC-FIT Scales. A normal/near-normal outcome in all six functional domains was observed in 61% of patients, with individual scores of 79% for food intake, 89% for breathing, 84% for speech, 89% for pain, 92% for mood, and 88% for neck and shoulder mobility. Clinically relevant impairment in at least one functional domain was observed in 30% of patients, and 9% had loss of function in at least one functional domain. Thus, clinically relevant persistent functional deficits in at least one functional domain must be expected in 40% of HNC-patients. The treatment of these functional deficits is an essential task of oncologic follow-up.

Abstract

With the increase in long-term survivorship of head and neck cancer (HNC), the functional outcomes are gaining importance. We reported the functional outcomes of HNC patients using the HNC-Functional InTegrity (FIT) Scales, which is a validated tool for the rapid clinical assessment of functional status based on observable clinical criteria. Patients with newly diagnosed HNC treated at the Medical University of Innsbruck between 2008 and 2020 were consecutively included, and their status in the six functional domains of food-intake, breathing, speech, pain, mood, and neck and shoulder mobility was scored by the treating physician at oncological follow-up visits on a scale from 0 (loss of function) to 4 (full function). HNC-FIT scales were available for 681 HNC patients at a median of 35 months after diagnosis. The response status was complete remission in 79.5%, 18.1% had recurrent or persistent disease, and 2.4% had a second primary HNC. Normal or near-normal scores (3 and 4) were seen in 78.6% for food intake, 88.7% for breathing, 83.7% for speech, 89% for pain, 91.8% for mood, and 87.5% for neck and shoulder mobility. A normal or near-normal outcome in all six functional domains was observed in 61% of patients. Clinically relevant impairment (score 1–2) in at least one functional domain was observed in 30%, and 9% had loss of function (score 0) in at least one functional domain. The main factors associated with poor functional outcome in a multivariable analysis were recurrence or persistent disease, poor general health (ASA III and IV), and higher T stage. Particularly, laryngeal and hypopharyngeal tumors impaired breathing and speech function, and primary radiation therapy or concomitant systemic therapy and radiotherapy worsened food intake. Clinically relevant persistent functional deficits in at least one functional domain must be expected in 40% of the patients with HNC. The treatment of these functional deficits is an essential task of oncologic follow-up.