201
|
Awan MJ, Mohamed ASR, Lewin JS, Baron CA, Gunn GB, Rosenthal DI, Holsinger FC, Schwartz DL, Fuller CD, Hutcheson KA. Late radiation-associated dysphagia (late-RAD) with lower cranial neuropathy after oropharyngeal radiotherapy: a preliminary dosimetric comparison. Oral Oncol 2014; 50:746-52. [PMID: 24906528 PMCID: PMC4158823 DOI: 10.1016/j.oraloncology.2014.05.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/13/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Late radiation-associated dysphagia (late-RAD) is a rare delayed toxicity, in oropharyngeal cancer (OPC) survivors. Prevention of late-RAD is paramount because the functional impairment can be profound and refractory to standard therapies. The objective of this analysis is to identify candidate dosimetric predictors of late-RAD and associated lower cranial neuropathies after radiotherapy (RT) or chemo-RT (CRT) for OPC. MATERIALS AND METHODS An unmatched retrospective case-control analysis was conducted. Late-RAD cases were identified among OPC patients treated with definitive RT or CRT. Controls were selected with minimum of 6 years without symptoms of late-RAD. Dysphagia-aspiration related structures (DARS) and regions of interest containing cranial nerve paths (RCCNPs) were retrospectively contoured. Dose volume histograms were calculated. Non-parametric bivariate associations were analyzed with Bonferroni correction and multiple logistic regression models were fit. RESULTS Thirty-eight patients were included (12 late-RAD cases, 26 controls). Median latency to late-RAD was 5.8 years (range: 4.5-11.3 years). Lower cranial neuropathies were present in 10 of 12 late-RAD cases. Mean superior pharyngeal constrictor (SPC) dose was higher in cases relative to controls (median: 70.5 vs. 61.6 Gy). Mean SPC dose significantly predicted late-RAD (p = 0.036) and related cranial neuropathies (p = 0.019). RCCNPs did not significantly predict late-RAD or cranial neuropathies. CONCLUSIONS SPC dose may predict for late-RAD and related lower cranial neuropathies. These data, and those of previous studies that have associated SPC dose with classical dysphagia endpoints, suggest impetus to constrain dose to the SPCs when possible.
Collapse
|
202
|
Frank SJ, Cox JD, Gillin M, Mohan R, Garden AS, Rosenthal DI, Gunn GB, Weber RS, Kies MS, Lewin JS, Munsell MF, Palmer MB, Sahoo N, Zhang X, Liu W, Zhu XR. Multifield optimization intensity modulated proton therapy for head and neck tumors: a translation to practice. Int J Radiat Oncol Biol Phys 2014; 89:846-53. [PMID: 24867532 PMCID: PMC4171724 DOI: 10.1016/j.ijrobp.2014.04.019] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/06/2014] [Accepted: 04/11/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. METHODS AND MATERIALS Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment "spot by spot" and "layer by layer." RESULTS Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. CONCLUSIONS To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.
Collapse
|
203
|
Rao NG, Trotti A, Kim J, Schell MJ, Zhao X, Amdur RJ, Brizel DM, Chambers MS, Caudell JJ, Miyamoto C, Rosenthal DI. Phase II multicenter trial of Caphosol for the reduction of mucositis in patients receiving radiation therapy for head and neck cancer. Oral Oncol 2014; 50:765-9. [PMID: 24954065 DOI: 10.1016/j.oraloncology.2014.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE We conducted a phase II multicenter study evaluating Caphosol in patients receiving head and neck radiation (H/N RT) +/- chemotherapy or biologic sensitizer. MATERIALS/METHODS The primary endpoint of the study tested the rate of functional mucositis (WHO grade > or equal to 2) with the hypothesis that <75% of patients would develop > or equal to 2 mucositis with Caphosol compared with a historical rate of >90%. New methods were applied with higher than historic rigor. 5 Institutions were included in this study: Moffitt Cancer Center (MCC), MD Anderson Cancer Center (MDACC), Duke University Cancer Center (DUCC), University of Florida (UF) and Temple University Cancer Center (TUCC). Caphosol was taken by patients at least 4 times a day and up to 10 times per day commencing with day 1 of RT and for a total duration of 8 weeks after completion of RT. Detailed questionnaires were completed weekly by patients and a unique algorithm was used to generate the WHO grade of mucositis. RESULTS 98 Patients were enrolled in the study. 59/98 (60%) patients were evaluable for the primary endpoint giving us 80% power. All evaluable patients experienced WHO grade > or equal to 2 mucositis and the trial failed to reject the null hypothesis. > or equal to 2 mucositis rates at weeks 2, 4, 6, 11 and 15 were as follows: 45%, 90%, 98%, 71%, 50%. CONCLUSION We were unable to demonstrate that Caphosol significantly reduced WHO grade 2 or higher mucositis below a 90% historic rate. We are not surprised with this finding given our rigorous methodology in grading.
Collapse
|
204
|
Garden AS, Gunn GB, Hessel A, Beadle BM, Ahmed S, El-Naggar AK, Fuller CD, Byers LA, Phan J, Frank SJ, Morrison WH, Kies MS, Rosenthal DI, Sturgis EM. Management of the lymph node-positive neck in the patient with human papillomavirus-associated oropharyngeal cancer. Cancer 2014; 120:3082-8. [PMID: 24898672 DOI: 10.1002/cncr.28831] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 04/08/2014] [Accepted: 04/17/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The goal of the current study was to assess the rates of recurrence in the neck for patients with lymph node-positive human papillomavirus-associated cancer of the oropharynx who were treated with definitive radiotherapy (with or without chemotherapy). METHODS This is a single-institution retrospective study. Methodology included database search, and statistical testing including frequency analysis, Kaplan-Meier tests, and comparative tests including chi-square, logistic regression, and log-rank. RESULTS The cohort consisted of 401 patients with lymph node-positive disease who underwent radiotherapy between January 2006 and June 2012. A total of 388 patients had computed tomography restaging, and 251 had positron emission tomography and/or ultrasound as a component of their postradiation staging. Eighty patients (20%) underwent neck dissection, and 21 patients (26%) had a positive specimen. The rate of neck dissection increased with increasing lymph node stage, and was lower in patients who had positron emission tomography scans or ultrasound in addition to computed tomography restaging. The median follow-up was 30 months. The 2-year actuarial neck recurrence rate was 7% and 5%, respectively, in all patients and those with local control. Lymph node recurrence rates were greater in current smokers (P = .008). There was no difference in lymph node recurrence rates noted between patients who did and those who did not undergo a neck dissection (P = .4) CONCLUSIONS: A treatment strategy of (chemo)radiation with neck dissection performed based on response resulted in high rates of regional disease control in patients with human papillomavirus-associated oropharyngeal cancer.
Collapse
|
205
|
Skinner HD, Sturgis EM, Klopp AH, Ang KK, Rosenthal DI, Garden AS, Morrison WH, Gunn GB, Beadle BM. Clinical characteristics of patients with multiple potentially human papillomavirus-related malignancies. Head Neck 2014; 36:819-25. [PMID: 23720126 DOI: 10.1002/hed.23379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/25/2013] [Accepted: 05/09/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is a causative factor in squamous cell carcinomas of the anus, penis, vagina, vulva, and head and neck, and adenocarcinoma of the cervix. We examined the demographics, clinical characteristics, and timing of multiple potentially HPV-related cancers in individual patients. METHODS One hundred forty-three patients were identified with 300 potentially HPV-related cancers. The median follow-up from index and second cancer was 18.5 years and 3.2 years, respectively. RESULTS Median age at index and second cancer was 45 and 60.5 years of age, respectively, with a median interval of 11 years. Cervical cancer was the most common initial diagnosis (61.7%), whereas head and neck squamous cell carcinoma (HNSCC) was the most common second cancer (57.6%). CONCLUSION These data suggest differential patterns for development of multiple HPV-related cancers based upon clinical characteristics. Prospective longitudinal and population-based studies are warranted to understand the impact of these findings and opportunities for intervention and screening.
Collapse
|
206
|
Kocak-Uzel E, Gunn GB, Colen RR, Kantor ME, Mohamed ASR, Schoultz-Henley S, Mavroidis P, Frank SJ, Garden AS, Beadle BM, Morrison WH, Phan J, Rosenthal DI, Fuller CD. Beam path toxicity in candidate organs-at-risk: assessment of radiation emetogenesis for patients receiving head and neck intensity modulated radiotherapy. Radiother Oncol 2014; 111:281-8. [PMID: 24746582 DOI: 10.1016/j.radonc.2014.02.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/11/2014] [Accepted: 02/20/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND To investigate potential dose-response relationship between radiation-associated nausea and vomiting (RANV) reported during radiotherapy and candidate nausea/vomiting-associated regions of interest (CNV-ROIs) in head and neck (HNC) squamous cell carcinomas. METHODS AND MATERIAL A total of 130 patients treated with IMRT with squamous cell carcinomas of head and neck were evaluated. For each patient, CNV-ROIs were segmented manually on planning CT images. Clinical on-treatment RANV data were reconstructed by a review of the records for all patients. Dosimetric data parameters were recorded from dose-volume histograms. Nausea and vomiting reports were concatenated as a single binary "Any N/V" variable, and as a "CTC-V2+" variable. RESULTS The mean dose to CNV-ROIs was higher for patients experiencing RANV events. For patients receiving IMRT alone, a dose-response effect was observed with varying degrees of magnitude, at a statistically significant level for the area postrema, brainstem, dorsal vagal complex, medulla oblongata, solitary nucleus, oropharyngeal mucosa and whole brain CNV-ROIs. CONCLUSION RANV is a common therapy-related morbidity facing patients receiving HNC radiotherapy, and, for those receiving radiotherapy-alone, is associated with modifiable dose to specific CNS structures.
Collapse
|
207
|
Rosenthal DI, Mendoza TR, Fuller CD, Hutcheson KA, Wang XS, Hanna EY, Lu C, Garden AS, Morrison WH, Cleeland CS, Gunn GB. Patterns of symptom burden during radiotherapy or concurrent chemoradiotherapy for head and neck cancer: a prospective analysis using the University of Texas MD Anderson Cancer Center Symptom Inventory-Head and Neck Module. Cancer 2014; 120:1975-84. [PMID: 24711162 DOI: 10.1002/cncr.28672] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND A prospective longitudinal study to profile patient-reported symptoms during radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) for head and neck cancer was performed. The goals were to understand the onset and trajectory of specific symptoms and their severity, identify clusters, and facilitate symptom interventions and clinical trial design. METHODS Participants in this questionnaire-based study received RT or CCRT. They completed the University of Texas MD Anderson Cancer Center Symptom Inventory-Head and Neck Module before and weekly during treatment. Symptom scores were compared between treatment groups, and hierarchical cluster analysis was used to depict clustering of symptoms at treatment end. Variables believed to predict symptom severity were assessed using a multivariate mixed model. RESULTS Among the 149 patients studied, the majority (47%) had oropharyngeal tumors, and nearly one-half received CCRT. Overall symptom severity (P < .001) and symptom interference (P < .0001) became progressively more severe and were more severe for those receiving CCRT. On multivariate analysis, baseline Eastern Cooperative Oncology Group performance status (P < .001) and receipt of CCRT (P < .04) correlated with higher symptom severity. Fatigue, drowsiness, lack of appetite, problem with mouth/throat mucus, and problem tasting food were more severe for those receiving CCRT. Both local and systemic symptom clusters were identified. CONCLUSIONS The findings from this prospective longitudinal study identified a pattern of local and systemic symptoms, symptom clusters, and symptom interference that was temporally distinct and marked by increased magnitude and a shift in individual symptom rank order during the treatment course. These inform clinicians about symptom intervention needs, and are a benchmark for future symptom intervention clinical trials.
Collapse
|
208
|
Ow TJ, Hanna EY, Roberts DB, Levine NB, El-Naggar AK, Rosenthal DI, DeMonte F, Kupferman ME. Optimization of long-term outcomes for patients with esthesioneuroblastoma. Head Neck 2014; 36:524-30. [PMID: 23780581 DOI: 10.1002/hed.23327] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Esthesioneuroblastoma is a rare cancer of the anterior cranial base that arises in the region of the olfactory rootlets. The purpose of this study was to review the long-term outcomes of patients diagnosed with esthesioneuroblastoma (ENB) treated at a single institution to determine factors associated with improved disease control and survival. METHODS A retrospective review of 70 patients with ENB treated at the University of Texas MD Anderson Cancer Center between 1992 and 2007 was undertaken. Survival and recurrence was analyzed and compared using the Kaplan-Meier method and log-rank statistics. RESULTS Seventy patients were reviewed. The majority (77%) had T3 or T4 disease at presentation, 38% identified as modified Kadish stage C or D. Ninety percent of patients received surgical resection as part of their treatment, and 66% received postoperative radiation or chemoradiation. The median follow-up was 91.4 months (7.6 years). Forty-eight percent of patients developed recurrent disease and the median time to recurrence was 6.9 years. Overall and disease-specific median survival was 10.5 and 11.6 years, respectively. Patients who were treated with surgery alone had a median disease-specific survival of 87.9 months, whereas those who were treated with surgery and postoperative radiation had a median disease-specific survival of 218.5 months (p = .047). CONCLUSION Patients with ENB can achieve favorable long-term survival, even if disease is locally advanced. Survival is improved considerably when surgical resection is followed by postoperative radiation. However, recurrence rates and mortality remain high, and therefore long-term observation in these patients is warranted.
Collapse
|
209
|
Rosenthal DI, Blanco AI. Head and neck squamous cell carcinoma: optimizing the therapeutic index. Expert Rev Anticancer Ther 2014; 5:501-14. [PMID: 16001957 DOI: 10.1586/14737140.5.3.501] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The four recent noteworthy strategies aimed at improving therapeutic outcomes for the curative treatment of head and neck squamous cancers include the development of altered fractionation regimens, integration of chemotherapy, incorporation of intensity-modulated radiation therapy and introduction of targeted biologic therapy. Clinical investigations during the last 30 years have demonstrated the benefits of biologically sound altered fractionation and concurrent chemoradiation regimens in improving locoregional control and overall survival. These results have contributed to redefining the standard of care, with the caveat that proper patient selection for those who will benefit from potentially toxic combined modality treatment regimens remains controversial. These benefits have come at the expense of increased acute toxicity (i.e., mucositis) and sometimes at the expense of late toxicity (i.e., fibrosis and dysphagia). There are two additional developments that may help to further widen the therapeutic ratio. Intensity-modulated radiation therapy allows for the delivery of a highly conformal 3D radiation dose distribution around intended targets, thereby limiting the volumes of mucosa receiving a high dose per fraction and high total doses. The technical basis for intensity-modulated radiation therapy delivery reopens many fractionation questions that are still being addressed and challenges us to determine which of these is optimal for use with intensity-modulated radiation therapy alone or in combination with concurrent sensitizers. Finally, combined radiation therapy and biologic therapies directed at targets expressed predominately or exclusively by tumor cells have the promise to help increase tumor cell kill, while at least not substantially increasing normal tissue toxicity. These strategies are reviewed in a clinical context.
Collapse
|
210
|
Baron CA, Awan MJ, Mohamed ASR, Akel I, Rosenthal DI, Gunn GB, Garden AS, Dyer BA, Court L, Sevak PR, Kocak-Uzel E, Fuller CD. Estimation of daily interfractional larynx residual setup error after isocentric alignment for head and neck radiotherapy: quality assurance implications for target volume and organs-at-risk margination using daily CT on- rails imaging. J Appl Clin Med Phys 2014; 16:5108. [PMID: 25679151 PMCID: PMC5016194 DOI: 10.1120/jacmp.v16i1.5108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 10/13/2014] [Accepted: 10/08/2014] [Indexed: 12/25/2022] Open
Abstract
Larynx may alternatively serve as a target or organs at risk (OAR) in head and neck cancer (HNC) image-guided radiotherapy (IGRT). The objective of this study was to estimate IGRT parameters required for larynx positional error independent of isocentric alignment and suggest population-based compensatory margins. Ten HNC patients receiving radiotherapy (RT) with daily CT on-rails imaging were assessed. Seven landmark points were placed on each daily scan. Taking the most superior-anterior point of the C5 vertebra as a reference isocenter for each scan, residual displacement vectors to the other six points were calculated postisocentric alignment. Subsequently, using the first scan as a reference, the magnitude of vector differences for all six points for all scans over the course of treatment was calculated. Residual systematic and random error and the necessary compensatory CTV-to-PTV and OAR-to-PRV margins were calculated, using both observational cohort data and a bootstrap-resampled population estimator. The grand mean displacements for all anatomical points was 5.07 mm, with mean systematic error of 1.1 mm and mean random setup error of 2.63 mm, while bootstrapped POIs grand mean displacement was 5.09 mm, with mean systematic error of 1.23 mm and mean random setup error of 2.61 mm. Required margin for CTV-PTV expansion was 4.6 mm for all cohort points, while the bootstrap estimator of the equivalent margin was 4.9 mm. The calculated OAR-to-PRV expansion for the observed residual setup error was 2.7 mm and bootstrap estimated expansion of 2.9 mm. We conclude that the interfractional larynx setup error is a significant source of RT setup/delivery error in HNC, both when the larynx is considered as a CTV or OAR. We estimate the need for a uniform expansion of 5 mm to compensate for setup error if the larynx is a target, or 3 mm if the larynx is an OAR, when using a nonlaryngeal bony isocenter.
Collapse
|
211
|
Xiao C, Hanlon A, Zhang Q, Movsas B, Ang K, Rosenthal DI, Nguyen-Tan PF, Kim H, Le Q, Bruner DW. Risk factors for clinician-reported symptom clusters in patients with advanced head and neck cancer in a phase 3 randomized clinical trial: RTOG 0129. Cancer 2013; 120:848-54. [PMID: 24338990 DOI: 10.1002/cncr.28500] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/09/2013] [Accepted: 10/29/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Chemoradiotherapy has become the standard of care for head and neck squamous cell carcinoma; however, those patients often experience multiple treatment-related symptoms or symptom clusters. Two symptom clusters have been identified for this population. Little is known about the risk factors of these symptom clusters. METHODS Subjects comprised 684 patients who were treated with concurrent chemoradiotherapy in a phase 3 randomized clinical trial. This trial compared standard fractionation radiotherapy to accelerated fractionation radiotherapy. Symptom clusters were evaluated at the end of the first and the second cycle of chemotherapy, and 3 months after the start of radiotherapy. Mixed-effect modeling was used to observe risk factors for symptom clusters. RESULTS Race and education were independent predictors for the head and neck cluster, whereas sex and history of tobacco use were independent predictors for the gastrointestinal cluster. Primary cancer site was only significant for the head and neck cluster when other factors were not controlled: patients with oropharyngeal cancer had more severe symptoms in the head and neck clusters than did patients with laryngeal cancer. In addition, patients receiving accelerated fractionation radiotherapy experienced more symptoms of radiomucositis, pain, and nausea at 3 months after the start of radiotherapy than those receiving standard fractionation radiotherapy. CONCLUSIONS Demographic characteristics were more predictive to symptom clusters, whereas clinical characteristics, such as cancer site and treatment arms, were more significant for individual symptoms. Knowing the risk factors will enhance the capability of clinicians to evaluate patients' risk of severe symptom clusters and to personalize management strategies.
Collapse
|
212
|
Gunn GB, Mendoza TR, Fuller CD, Gning I, Frank SJ, Beadle BM, Hanna EY, Lu C, Cleeland CS, Rosenthal DI. High symptom burden prior to radiation therapy for head and neck cancer: a patient-reported outcomes study. Head Neck 2013; 35:1490-8. [PMID: 23169304 PMCID: PMC3788079 DOI: 10.1002/hed.23181] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND As a first step toward developing effective strategies to control symptoms associated with head and neck cancer (HNC) and its treatment, we sought to describe the pattern of symptoms experienced before radiation therapy. METHODS Subjects completed the MD Anderson Symptom Inventory-Head and Neck Module before beginning radiation therapy. RESULTS In all, 270 patients participated. Symptom severity and interference varied between treatment-naïve patients and those with prior treatment. Cluster analyses revealed that 33% of patients had high symptom burden. Symptoms most often rated moderate-to-severe were fatigue, sleep disturbance, distress, pain, and problems chewing and swallowing. Poorer performance status, higher T classification, and receipt of previous treatment correlated with higher symptom burden. CONCLUSIONS A substantial proportion of patients were experiencing high symptom burden. Because few interventions currently exist for several of the most problematic symptoms, research in symptom reduction that targets the pattern of symptoms described here is greatly needed.
Collapse
|
213
|
Milbury K, Rosenthal DI, El-Naggar A, Badr H. An exploratory study of the informational and psychosocial needs of patients with human papillomavirus-associated oropharyngeal cancer. Oral Oncol 2013; 49:1067-71. [PMID: 23953777 DOI: 10.1016/j.oraloncology.2013.07.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/19/2013] [Accepted: 07/24/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Although the incidence of oropharyngeal squamous cell carcinoma (OPSCC) attributable to human papillomavirus (HPV) is rapidly increasing, patients' informational and psychosocial needs related to the sexual transmission of HPV remain unexplored. The goal of this exploratory study was to assess informational and psychosocial needs of HPV+ OPSCC patients and identify psychosocial challenges associated with having an HPV+ cancer. METHODS Patients (N=62; 87% male; mean age=56years) with HPV+ OPSCC and in cohabitating relationships completed paper-pencil questionnaires assessing their HPV-related knowledge (e.g., cancer etiology), information needs (e.g., communicability), psychosocial concerns (e.g., relational consequences, self-blame) and measures of distress and health behaviors. Medical information was obtained from patients' electronic medical records. RESULTS Sixty-six percent of patients correctly identified their HPV status but only 35% of them recognized HPV as their putative cancer cause. The majority of patients disclosed their HPV status to their partner, 41% discussed transmission of the virus, and only 23% felt informed regarding potential transmission risks and precautions. Thirty-nine percent want their oncologist to discuss more about HPV-related issues and 58% sought this from other sources. Over one-third said they would be interested in more HPV-related information. Patients reported moderate levels of distress (mean=3.52, SD=2.54, possible range 0-10) and relatively low levels of self-blame (mean=2.27, SD=1.23, possible range 1-4) with distress and self-blame being significantly correlated (r=.38, p=.005). CONCLUSION Significant knowledge gaps exist regarding patients' understanding of the link between HPV and OPSCC and the implications of infectious etiology. Future research is encouraged to establish best practice guidelines.
Collapse
|
214
|
Kandula S, Zhu X, Garden AS, Gillin M, Rosenthal DI, Ang KK, Mohan R, Amin MV, Garcia JA, Wu R, Sahoo N, Frank SJ. Spot-scanning beam proton therapy vs intensity-modulated radiation therapy for ipsilateral head and neck malignancies: a treatment planning comparison. Med Dosim 2013; 38:390-4. [PMID: 23916884 DOI: 10.1016/j.meddos.2013.05.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 02/24/2013] [Accepted: 05/01/2013] [Indexed: 11/13/2022]
Abstract
Radiation therapy for head and neck malignancies can have side effects that impede quality of life. Theoretically, proton therapy can reduce treatment-related morbidity by minimizing the dose to critical normal tissues. We evaluated the feasibility of spot-scanning proton therapy for head and neck malignancies and compared dosimetry between those plans and intensity-modulated radiation therapy (IMRT) plans. Plans from 5 patients who had undergone IMRT for primary tumors of the head and neck were used for planning proton therapy. Both sets of plans were prepared using computed tomography (CT) scans with the goals of achieving 100% of the prescribed dose to the clinical target volume (CTV) and 95% to the planning TV (PTV) while maximizing conformity to the PTV. Dose-volume histograms were generated and compared, as were conformity indexes (CIs) to the PTVs and mean doses to the organs at risk (OARs). Both modalities in all cases achieved 100% of the dose to the CTV and 95% to the PTV. Mean PTV CIs were comparable (0.371 IMRT, 0.374 protons, p = 0.953). Mean doses were significantly lower in the proton plans to the contralateral submandibular (638.7 cGy IMRT, 4.3 cGy protons, p = 0.002) and parotid (533.3 cGy IMRT, 48.5 cGy protons, p = 0.003) glands; oral cavity (1760.4 cGy IMRT, 458.9 cGy protons, p = 0.003); spinal cord (2112.4 cGy IMRT, 249.2 cGy protons, p = 0.002); and brainstem (1553.52 cGy IMRT, 166.2 cGy protons, p = 0.005). Proton plans also produced lower maximum doses to the spinal cord (3692.1 cGy IMRT, 2014.8 cGy protons, p = 0.034) and brainstem (3412.1 cGy IMRT, 1387.6 cGy protons, p = 0.005). Normal tissue V10, V30, and V50 values were also significantly lower in the proton plans. We conclude that spot-scanning proton therapy can significantly reduce the integral dose to head and neck critical structures. Prospective studies are underway to determine if this reduced dose translates to improved quality of life.
Collapse
|
215
|
Gunn GB, Debnam JM, Fuller CD, Morrison WH, Frank SJ, Beadle BM, Sturgis EM, Glisson BS, Phan J, Rosenthal DI, Garden AS. The impact of radiographic retropharyngeal adenopathy in oropharyngeal cancer. Cancer 2013; 119:3162-9. [PMID: 23733178 DOI: 10.1002/cncr.28195] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/24/2013] [Accepted: 04/26/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND We performed this study to define the incidence of radiographic retropharyngeal lymph node (RPLN) involvement in oropharyngeal cancer (OPC) and its impact on clinical outcomes, neither of which has been well established to date. METHODS Our departmental database was queried for patients irradiated for OPC between 2001 and 2007. Analyzable patients were those with imaging data available for review to determine radiographic RPLN status. Demographic, clinical, and outcome data were retrieved and analyzed. RESULTS The cohort consisted of 981 patients. The median follow-up was 69 months. The base of the tongue (47%) and the tonsil (46%) were the most common primary sites. The majority of patients had stage T1 to T2 primary tumors (64%), and 94% had stage 3 to 4B disease. Intensity-modulated radiation therapy was used in 77% of patients, and systemic therapy was administered in 58% of patients. The incidence of radiographic RPLN involvement was 10% and was highest for the pharyngeal wall (23%) and lowest for the base of the tongue (6%). RPLN adenopathy correlated with several patient and tumor factors. RPLN involvement was associated with poorer 5-year outcomes on univariate analysis (P<.001 for all) for local control (79% vs 92%), nodal control (80% vs 93%), recurrence-free survival (51% vs 81%), distant metastases-free survival (66% vs 89%), and overall survival (52% vs 82%) and maintained significance on multivariate analysis for local control (P = .023), recurrence-free survival (P = .001), distant metastases-free survival (P = .003), and overall survival (P = .001). CONCLUSIONS In this cohort of nearly 1000 patients investigating [corrected] radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends [corrected] a negative influence on disease recurrence, distant relapse, and survival. In this cohort of nearly 1000 patients investigating radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends a negative influence on disease recurrence, distant relapse, and survival.
Collapse
|
216
|
Rosenthal DI. Instant replay. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2013; 1:52-4. [PMID: 26249640 DOI: 10.1016/j.hjdsi.2013.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 03/27/2013] [Accepted: 04/20/2013] [Indexed: 11/28/2022]
Abstract
With widespread adoption of electronic health records (EHRs) and electronic clinical documentation, health care organizations now have greater faculty to review clinical data and evaluate the efficacy of quality improvement efforts. Unfortunately, I believe there is a fundamental gap between actual health care delivery and what we document in the current EHR systems. This process of capturing the patient encounter, which I'll refer to as transcription, is prone to significant data loss due to inadequate methods of data capture, multiple points of view, and bias and subjectivity in the transcriptional process. Our current EHR, text-based clinical documentation systems are lossy abstractions - one sided accounts of what take place between patients and providers. Our clinical notes contain the breadcrumbs of relationships, conversations, physical exams, and procedures but often lack the ability to capture the form, the emotions, the images, the nonverbal communication, and the actual narrative of interactions between human beings. I believe that a video record, in conjunction with objective transcriptional services and other forms of data capture, may provide a closer approximation to the truth of health care delivery and may be a valuable tool for healthcare improvement.
Collapse
|
217
|
Takiar V, Ma D, Rosenthal DI, Kian Ang K, Beadle B, Frank SJ, Fuller CD, Gunn GB, Morrison WH, William WN, Pytynia KB, Garden AS, Phan J. OP064. Oral Oncol 2013. [DOI: 10.1016/j.oraloncology.2013.03.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
218
|
Xiao C, Hanlon A, Zhang Q, Ang K, Rosenthal DI, Nguyen-Tan PF, Kim H, Movsas B, Bruner DW. Symptom clusters in patients with head and neck cancer receiving concurrent chemoradiotherapy. Oral Oncol 2013; 49:360-6. [PMID: 23168337 PMCID: PMC3924732 DOI: 10.1016/j.oraloncology.2012.10.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 10/02/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study is to identify symptom clusters for head and neck (HNC) patients treated with concurrent chemoradiotherapy. PATIENTS AND METHODS A secondary data analysis of 684 HNC patients treated on the Radiation Therapy Oncology Group (RTOG) 0129 trial comparing different RT fractionation schedules with concurrent chemotherapy was used to examine clusters. Treatment-related symptoms were measured by clinicians at three time-points during and after chemoradiotherapy using the National Cancer Institute Common Toxicity Criteria v2.0. Exploratory factor analysis was applied to identify symptom clusters, which was further verified by confirmatory factor analysis. Coefficients of congruence and alpha coefficients were employed to examine generalizability of cluster structures over different time-points and in different subgroups. RESULTS Two clusters were identified. The HNC specific cluster is composed of radiodermatitis, dysphagia, radiomucositis, dry mouth, pain, taste disturbance, and fatigue. The gastrointestinal (GI) cluster involves nausea, vomiting, and dehydration. With the exception of patients 65years old or older, diagnosed with larynx cancer, or with stage III cancer, the two clusters were generalizable to different subgroups defined by age, gender, race, education, marital status, history of tobacco use, treatments, primary sites, disease stages, and tube feedings, as well as to the three symptom assessment time-points. CONCLUSIONS The data provides preliminary support for two stable clusters in patients with HNC. These findings may serve to inform the symptom management in clinical practice. Moreover, the findings necessitate future research to examine the generalizability of identified clusters in the late symptom phase or other treatment modalities, and to understand the underlying biological mechanism.
Collapse
|
219
|
Garden AS, Kies MS, Morrison WH, Weber RS, Frank SJ, Glisson BS, Gunn GB, Beadle BM, Ang KK, Rosenthal DI, Sturgis EM. Outcomes and patterns of care of patients with locally advanced oropharyngeal carcinoma treated in the early 21st century. Radiat Oncol 2013; 8:21. [PMID: 23360540 PMCID: PMC3576243 DOI: 10.1186/1748-717x-8-21] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/20/2013] [Indexed: 12/03/2022] Open
Abstract
Background We performed this study to assess outcomes of patients with oropharyngeal cancer treated with modern therapy approaches. Methods Demographics, treatments and outcomes of patients diagnosed with Stage 3- 4B squamous carcinoma of the oropharynx, between 2000 – 2007 were tabulated and analyzed. Results The cohort consisted of 1046 patients. The 5- year actuarial overall survival, recurrence-free survival and local-regional control rates for the entire cohort were 78%, 77% and 87% respectively. More advanced disease, increasing T-stage and smoking were associated with higher rates of local-regional recurrence and poorer survival. Conclusions Patients with locally advanced oropharyngeal cancer have a relatively high survival rate. Patients’ demographics and primary tumor volume were very influential on these favorable outcomes. In particular, patients with small primary tumors did very well even when treatment was not intensified with the addition of chemotherapy.
Collapse
|
220
|
Schwartz DL, Garden AS, Shah SJ, Chronowski G, Sejpal S, Rosenthal DI, Chen Y, Zhang Y, Zhang L, Wong PF, Garcia JA, Kian Ang K, Dong L. Adaptive radiotherapy for head and neck cancer—Dosimetric results from a prospective clinical trial. Radiother Oncol 2013; 106:80-4. [DOI: 10.1016/j.radonc.2012.10.010] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 10/10/2012] [Accepted: 10/20/2012] [Indexed: 10/27/2022]
|
221
|
Awan M, Kalpathy-Cramer J, Gunn GB, Beadle BM, Garden AS, Phan J, Holliday E, Jones WE, Maani E, Patel A, Choi J, Clyburn V, Tantiwongkosi B, Rosenthal DI, Fuller CD. Prospective assessment of an atlas-based intervention combined with real-time software feedback in contouring lymph node levels and organs-at-risk in the head and neck: Quantitative assessment of conformance to expert delineation. Pract Radiat Oncol 2012; 3:186-193. [PMID: 24674363 DOI: 10.1016/j.prro.2012.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 11/06/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE A number of studies have previously assessed the role of teaching interventions to improve organ-at-risk (OAR) delineation. We present a preliminary study demonstrating the benefit of a combined atlas and real time software-based feedback intervention to aid in contouring of OARs in the head and neck. METHODS AND MATERIALS The study consisted of a baseline evaluation, a real-time feedback intervention, atlas presentation, and a follow-up evaluation. At baseline evaluation, 8 resident observers contoured 26 OARs on a computed tomography scan without intervention or aid. They then received feedback comparing their contours both statistically and graphically to a set of atlas-based expert contours. Additionally, they received access to an atlas to contour these structures. The resident observers were then asked to contour the same 26 OARs on a separate computed tomography scan with atlas access. In addition, 6 experts (5 radiation oncologists specializing in the head and neck, and 1 neuroradiologist) contoured the 26 OARs on both scans. A simultaneous truth and performance level estimation (STAPLE) composite of the expert contours was used as a gold-standard set for analysis of OAR contouring. RESULTS Of the 8 resident observers who initially participated in the study, 7 completed both phases of the study. Dice similarity coefficients were calculated for each user-drawn structure relative to the expert STAPLE composite for each structure. Mean dice similarity coefficients across all structures increased between phase 1 and phase 2 for each resident observer, demonstrating a statistically significant improvement in overall OAR-contouring ability (P < .01). Additionally, intervention improved contouring in 16/26 delineated organs-at-risk across resident observers at a statistically significant level (P ≤ .05) including all otic structures and suprahyoid lymph node levels of the head and neck. CONCLUSIONS Our data suggest that a combined atlas and real-time feedback-based educational intervention detectably improves contouring of OARs in the head and neck.
Collapse
|
222
|
Chakravarthy AB, Catalano PJ, Mondschein JK, Rosenthal DI, Haller DG, Whittington R, Spitz FR, Wagner H, Sigurdson ER, Tschetter LK, Bayer GK, Mulcahy MF, Benson AB. Phase II Trial of Paclitaxel/Cisplatin Followed by Surgery and Adjuvant Radiation Therapy and 5-Fluorouracil/Leucovorin for Gastric Cancer (ECOG E7296). GASTROINTESTINAL CANCER RESEARCH : GCR 2012; 5:191-197. [PMID: 23293700 PMCID: PMC3533847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/17/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Randomized trials have shown an increase in survival with perioperative chemotherapy as well as with postoperative chemoradiation. It was hypothesized that combining induction chemotherapy with postoperative chemoradiation would be well tolerated and improve pathologic complete response. METHODS Patients with resectable cancers of the stomach/gastroesophageal junction were eligible. Neoadjuvant chemotherapy consisted of 3 cycles of paclitaxel and cisplatin. Adjuvant therapy consisted of 1 cycle of 5-fluorouracil (FU) and leucovorin (LV) followed by chemoradiation (45 Gy with concurrent 5-FU/LV). Chemoradiation was followed by 2 additional cycles of 5-FU/LV. Response to neoadjuvant therapy was based on pathology. RESULTS From 1999 to 2002, 38 eligible patients were enrolled; 35 completed induction chemotherapy, and 29 went on to surgery. Sixteen patients did not develop metastatic progression, 10 developed metastatic disease, and 12 were unevaluable. There were no pathologic complete responses after induction therapy. Twenty-five of 38 patients suffered grade 3-4 toxicities during induction paclitaxel/cisplatin. Six of the 7 patients who received postoperative therapy suffered grade 3-4 toxicities. Only 3 of 38 (7.9%) eligible patients completed all assigned treatment. The median overall survival was 1.6 years, and the 2-year survival was 40%. CONCLUSIONS This regimen of neoadjuvant paclitaxel/cisplatin followed by postoperative 5-FU/LV-based chemoradiation did not have a high enough response rate and proved to be too toxic for further development.
Collapse
|
223
|
Sandulache VC, Ow TJ, Daram SP, Hamilton J, Skinner H, Bell D, Rosenthal DI, Beadle BM, Ang KK, Kies MS, Johnson FM, El-Naggar AK, Myers JN. Residual nodal disease in patients with advanced-stage oropharyngeal squamous cell carcinoma treated with definitive radiation therapy and posttreatment neck dissection: Association with locoregional recurrence, distant metastasis, and decreased survival. Head Neck 2012; 35:1454-60. [DOI: 10.1002/hed.23173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
224
|
Garden AS, Dong L, Morrison WH, Stugis EM, Glisson BS, Frank SJ, Beadle BM, Gunn GB, Schwartz DL, Kies MS, Weber RS, Ang KK, Rosenthal DI. Patterns of disease recurrence following treatment of oropharyngeal cancer with intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 2012; 85:941-7. [PMID: 22975604 DOI: 10.1016/j.ijrobp.2012.08.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/02/2012] [Accepted: 08/03/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE To report mature results of a large cohort of patients diagnosed with squamous cell carcinoma of the oropharynx who were treated with intensity modulated radiation therapy (IMRT). METHODS AND MATERIALS The database of patients irradiated at The University of Texas, M.D. Anderson Cancer Center was searched for patients diagnosed with oropharyngeal cancer and treated with IMRT between 2000 and 2007. A retrospective review of outcome data was performed. RESULTS The cohort consisted of 776 patients. One hundred fifty-nine patients (21%) were current smokers, 279 (36%) former smokers, and 337 (43%) never smokers. T and N categories and American Joint Committee on Cancer group stages were distributed as follows: T1/x, 288 (37%); T2, 288 (37%); T3, 113 (15%); T4, 87 (11%); N0, 88(12%); N1/x, 140 (18%); N2a, 101 (13%); N2b, 269 (35%); N2c, 122 (16%); and N3, 56 (7%); stage I, 18(2%); stage II, 40(5%); stage III, 150(19%); and stage IV, 568(74%). Seventy-one patients (10%) presented with nodes in level IV. Median follow-up was 54 months. The 5-year overall survival, locoregional control, and overall recurrence-free survival rates were 84%, 90%, and 82%, respectively. Primary site recurrence developed in 7% of patients, and neck recurrence with primary site control in 3%. We could only identify 12 patients (2%) who had locoregional recurrence outside the high-dose target volumes. Poorer survival rates were observed in current smokers, patients with larger primary (T) tumors and lower neck disease. CONCLUSIONS Patients with oropharyngeal cancer treated with IMRT have excellent disease control. Locoregional recurrence was uncommon, and most often occurred in the high dose volumes. Parotid sparing was accomplished in nearly all patients without compromising tumor coverage.
Collapse
|
225
|
Gunn GB, Koukourakis MI, Mendoza TR, Cleeland CS, Rosenthal DI. Linguistic validation of the Greek M.D. Anderson Symptom Inventory - Head and Neck Module. FORUM OF CLINICAL ONCOLOGY 2012; 3:29-31. [PMID: 23439668 PMCID: PMC3576859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND: Our goal is to linguistically validate the Greek translation of the M.D. Anderson Symptom Inventory Index - Head and Neck Module. PATIENTS & METHODS: Following forward and backward translation of the previously validated head and neck cancer specific items of the English MDASI-HN into Greek (G-MDASI-HN), it was administered along with a cognitive debriefing to head and neck cancer patients able to read and understand Greek. Individual and group responses are presented using descriptive statistics. RESULTS: From 02/2009 through 06/2009 30 subjects with head and neck cancer completed the G-MDASI-HN followed by completion of the accompanying cognitive debriefing. Ninety-eight percent of the individual G-MDASI-HN items were completed. "Voice" item was not completed by 5 patients. Average time to complete the G-MDASI-HN was 13.3 minutes. Average ease of completion was rated at 1.21 on a 0 to 10 scale with "0" being "very easy" and "10" being "very hard". Only 10% of patients reported trouble completing any item, namely "distress" and "numbness". CONCLUSIONS: The Greek-MDASI-HN is linguistically valid and a patient-reported instrument that can be used both in outcomes research and as a clinical tool.
Collapse
|