[French national standard for the treatment of squamous cell carcinoma of upper aero-digestive tract - General principles of treatment]

OBJECTIVES

The management of upper aerodigestive tract cancers is a complex specialty. It is essential to provide an update to establish optimal care. At the initiative of the INCa and under the auspices of the SFORL, the scientific committee, led by Professor Béatrix Barry, Dr. Gilles Dolivet, and Dr. Dominique De Raucourt, decided to develop a reference framework aimed at defining, in a scientific and consensus-based manner, the general principles of treatment for upper aerodigestive tract cancers applicable to all sub-locations.

METHODOLOGY

To develop this framework, a multidisciplinary team of practitioners was formed. A systematic analysis of the literature was conducted to produce recommendations classified by grades, in accordance with the standards of the French National Authority for Health (HAS).

RESULTS

The grading of recommendations according to HAS standards has allowed the establishment of a reference for patient care based on several criteria. In this framework, patients benefit from differentiated care based on prognostic factors they present (age, comorbidities, TNM status, HPV status, etc.), conditions of implementation, and quality criteria for indicated surgery (operability, resectability, margin quality, mutilation, salvage surgery), as well as quality criteria for radiotherapy (target volume, implementation time, etc.). The role of medical and postoperative treatments was also evaluated based on specific criteria. Finally, supportive care must be organized from the beginning and throughout the patients' care journey.

CONCLUSION

All collected data have led to the development of a comprehensive framework aimed at harmonizing practices nationally, facilitating decision-making in multidisciplinary consultation meetings, promoting equality in practices, and providing a state-of-the-art and reference practices for assessing the quality of care. This new framework is intended to be updated every 5 years to best reflect the latest advances in the field.

Assessment of nasal septoplasty using NOSE and RhinoQoL questionnaires

The objective was to assess outcomes of nasal septoplasty without turbinectomy using validated subjective instruments and to correlate results with patient satisfaction. The prospective observational study was conducted in a tertiary referral center. The method included the use of NOSE and RhinoQoL questionnaires to assess patients before and 6 months after Cottle septoplasty without turbinectomy. Patient satisfaction was measured on a visual analog scale. Data were compared by the non-parametric Wilcoxon test. Minimal Clinically Important Differences (MCIDs) were calculated. Correlations between post-operative scores and patient satisfaction were assessed using the Spearman test. Univariate analysis was performed to assess predictors of improvement. One hundred patients were enrolled. Their mean age was 43.4 years and 28% had allergic rhinitis. There was a highly significant improvement in each score at 6 months (p < 0.00001). The MCID for the NOSE was comprised between 5 and 7.5, whereas the mean change was 35.2 points. They ranged from 3.8 to 6.1 for RhinoQoL scores, whereas mean changes were comprised between 12.6 and 20.9. Allergic rhinitis was a predictive factor of less improvement (NOSE p = 0.04-RhinoQoL p = 0.0001). Mean patient satisfaction was 8.2 ± 1.8. Post-operative NOSE and RhinoQoL frequency scores were moderately correlated (r = 0.380; r = 0.356, respectively) whereas bothersomeness and impact scores were highly correlated with patient satisfaction (r = 0.459; r = 0.443, p < 0.00001, respectively). This study shows that the NOSE and RhinoQoL questionnaires can be used in English- and French-speaking populations to perform pre- and post-therapeutic assessment. These validated instruments show that septoplasty without turbinectomy allows management of nasal obstruction and its burden.

French Validation of the NOSE and RhinoQOL Questionnaires in the Management of Nasal Obstruction

Objective. Until now, there has been no validated and specific questionnaire in French allowing the assessment of nasal obstruction and its consequences on quality of life. The aim of this study was to validate the French translation and sociocultural adaptation of the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinosinusitis Quality of Life Survey (RhinoQOL) self-questionnaires.

Study Design. Prospective instrument validation study.

Setting. French tertiary referral center.

Subjects and Methods. The questionnaires were translated into French and then translated back into English. The final version was administered twice to an asymptomatic control population (n = 50) and once to a population with symptomatic septal deviation (n = 50). The psychometric properties (reliability, reproducibility, validity, responsiveness) were assessed by test-retest procedure, internal consistency, correlation intra- and interscores, and response sensitivity between both populations.

Results. There was no statistical difference in both responses obtained from the control population after the test-retest procedure. Internal consistency was 0.86 for the NOSE and 0.57, 0.67, and 0.83 for the scores of the RhinoQOL (frequency, bothersomeness, and impact, respectively). There was always a strong correlation between all NOSE variables and RhinoQOL scores ( r > 0.40; P < 10−3). Effect size showed a high sensitivity to change.

Conclusion. The French versions of both questionnaires appear to be as reliable, valid, and sensitive to change as the English versions. Their association was strong, allowing assessment of nasal obstruction in all its dimensions.