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Shih CL, Chen CH, Sheu CF, Lang HC, Hsieh CL. Validating and improving the reliability of the EORTC qlq-c30 using a multidimensional Rasch model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:848-854. [PMID: 23947980 DOI: 10.1016/j.jval.2013.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 04/11/2013] [Accepted: 05/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The reliability and validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) has not been examined while taking into account the correlation between subscales. The reliability of the EORTC QLQ-C30 subscales is modest, thus limiting their utility in both clinical and research settings. The purpose of this study was to validate the factor structure of multiple-item subscales of the EORTC QLQ-C30 and to improve their reliability by means of an item response analysis by using the multidimensional partial credit model. METHODS A total of 2295 patients with complete data were used for the analysis. One- and nine-dimensional partial credit models were used to fit the data to validate the construct validity of the multiple-item subscales of the QLQ-C30. RESULTS The model comparison showed that the nine-dimensional factor structure of multiple-item subscales was satisfactory. The multidimensional partial credit model fit data of the multiple-item subscales of the QLQ-C30 reasonably well. The estimated test reliabilities of each domain obtained from the multidimensional approach were higher than those obtained from the unidimensional approach. CONCLUSIONS The constructs represented by the multiple-item subscales of the QLQ-C30 were validated. The improved reliability of the multiple-item subscales of the QLQ-C30 under the multidimensional approach can facilitate their applications in clinical and research settings.
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Affiliation(s)
- Ching-Lin Shih
- Center for Teacher Education, National Sun Yat-sen University, Kaohsiung, Taiwan
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Singer S, Danker H, Guntinas-Lichius O, Oeken J, Pabst F, Schock J, Vogel HJ, Meister EF, Wulke C, Dietz A. Quality of life before and after total laryngectomy: Results of a multicenter prospective cohort study. Head Neck 2013; 36:359-68. [DOI: 10.1002/hed.23305] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 01/23/2023] Open
Affiliation(s)
- Susanne Singer
- University Medical Centre Mainz; Institute of Medical Biostatistics; Epidemiology and Informatics (IMBEI); Mainz Germany
- University of Leipzig; Division of Psychosocial Oncology; Leipzig Germany
| | - Helge Danker
- University of Leipzig; Department of Psychosomatic Medicine and Psychotherapy; Leipzig Germany
| | | | - Jens Oeken
- Hospital Chemnitz; Department of Otorhinolaryngology; Chemnitz Germany
| | - Friedemann Pabst
- Hospital Dresden-Friedrichstadt; Department of Otorhinolaryngology; Dresden Germany
| | - Juliane Schock
- Hospital Martha-Maria; Department of Otorhinolaryngology; Halle-Dölau Germany
| | - Hans-Joachim Vogel
- Hospital Elblandkliniken; Department of Otorhinolaryngology; Riesa Germany
| | - Eberhard F. Meister
- Community Hospital St. Georg; Department of Otorhinolaryngology; Leipzig Germany
| | - Cornelia Wulke
- Community Hospital St. Georg; Department of Otorhinolaryngology; Leipzig Germany
| | - Andreas Dietz
- University of Leipzig; Department of Otorhinolaryngology; Leipzig Germany
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Bedard G, Zeng L, Zhang L, Lauzon N, Holden L, Tsao M, Danjoux C, Barnes E, Sahgal A, Poon M, Chow E. Minimal important differences in the EORTC QLQ-C30 in patients with advanced cancer. Asia Pac J Clin Oncol 2013; 10:109-17. [PMID: 23551530 DOI: 10.1111/ajco.12070] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 11/30/2022]
Abstract
AIMS Quality of life (QOL) is important in patients with advanced cancer. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 is a general QOL tool used in cancer patients. Often, with a large enough sample, statistical significance of changecan be reached, however the clinical significance is often unknown. This study aimed to determine the magnitude of change that is meaningful to advanced cancer patients in the EORTC QLQ-C30. METHODS Patients completed the EORTC QLQ-C30 at baseline and 1 month post-radiation to assess changes in their QOL. Minimal important differences (MID) were calculated through anchor and distribution-based methods for improvement and deterioration. The two anchors of overall health and overall QOL were used to determine meaningful change. RESULTS Statistically significant meaningful changes were seen in the use of both anchors. The overall health anchor produced a greater number of scales and symptoms that reached a statistically significant meaningful change. Meaningful change for improvement with these two anchors ranged from 9.1 units (cognitive functioning) to 23.5 units (pain), and for deterioration it ranged from 7.2 units (physical functioning) to 13.5 units (role functioning). Distribution-based estimates were closest to 0.5 SD. CONCLUSION Knowledge of meaningful change on the EORTC QLQ-C30 allows physicians to assess patients' changes over time, along with evaluating the impact of treatment on a patient's QOL. This knowledge gives insight into whether the treatment is effective and, ultimately, whether it should be continued. Knowledge of MID may assist in the determination of sample size for future trials.
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Affiliation(s)
- Gillian Bedard
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Singer S, Arraras JI, Chie WC, Fisher SE, Galalae R, Hammerlid E, Nicolatou-Galitis O, Schmalz C, Verdonck-de Leeuw I, Gamper E, Keszte J, Hofmeister D. Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQ-H&N35: a methodological review. Qual Life Res 2012. [PMID: 23188134 DOI: 10.1007/s11136-012-0325-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The EORTC QLQ-H&N35 (H&N35) is widely used to measure quality of life in head and neck cancer patients. The aims of this study were to obtain insight into a) the languages in which the H&N35 has been used and the psychometric properties in those languages, b) the study designs, and c) its acceptance by patients and investigators. METHODS A systematic literature review was performed searching for all original papers that had used at least one item of the H&N35. Identified papers were read and the information about methodological issues abstracted statistically analysed. RESULTS A total of 136 papers were identified. The H&N35 was administered in 19 different languages in 27 countries. The study design was cross-sectional in the majority of studies (53 %), prospective cohort studies (31 %), phase-II-trials (7 %), phase-III-trials (6 %) and case-control studies (1 %). The scales with the highest percentages of missing values were Sexuality (11.5 %) and Speech (7 %). The median Cronbach's alpha of the multi-item scales ranged from 0.61 (Senses) to 0.93 (Sexuality). Construct validity was rarely investigated. On average, 12 scales (range 0-18) of the instrument were used by the investigators. The scale most often used was swallowing (in 85 % of studies) and least often used was Weight Gain (39 %). CONCLUSION The H&N35 is widely used throughout the world, mainly in observational studies, and has demonstrated robust psychometric features in different languages. However, some methodological problems reported imply that the instrument can be improved in some areas.
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Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University of Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany,
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Singer S, Arraras JI, Baumann I, Boehm A, Chie WC, Galalae R, Langendijk JA, Guntinas-Lichius O, Hammerlid E, Pinto M, Nicolatou-Galitis O, Schmalz C, Sen M, Sherman AC, Spiegel K, Verdonck-de Leeuw I, Yarom N, Zotti P, Hofmeister D. Quality of life in patients with head and neck cancer receiving targeted or multimodal therapy - Update of the EORTC QLQ-H&N35, Phase I. Head Neck 2012; 35:1331-8. [DOI: 10.1002/hed.23127] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2012] [Indexed: 11/12/2022] Open
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[Swallowing disorders after partial laryngectomy. Prevalence and predictors]. HNO 2012; 60:892-900. [PMID: 22903464 DOI: 10.1007/s00106-012-2519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Improvements in surgical techniques have led to a higher percentage of larynx preservations. These do not always include preservation of the swallowing function. This study investigates the prevalence of swallowing disorders after partial laryngectomy and their predictors. PATIENTS AND METHODS In a multicenter cross-sectional study with patients who received a partial laryngectomy (n=154) the prevalences of problems related to swallowing and eating were gathered. Additionally, medical and sociodemographic data were obtained as well as information about alcohol and tobacco consumption. RESULTS Twenty percent of the patients had problems related to swallowing and eating; more specifically, eating solid foods and eating in public. Chances of having swallowing disorders were significantly lower for patients who received laser therapy (OR=0.12; 95% CI: 0.04-0.37; p<0.01), when time since the last laryngeal surgery was longer (OR=0.89; 95% CI: 0.75-0.99; p<0.03) and when patients were non-smokers (OR=3.39; 95% CI: 1.29-8.94; p<0.02). CONCLUSION Swallowing disorders correlate with post-surgery smoking. Physicians and therapists should focus more on the negative side effects of smoking on swallowing during patient consultations.
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Singer S, Meyer A, Fuchs M, Schock J, Pabst F, Vogel HJ, Oeken J, Sandner A, Koscielny S, Hormes K, Breitenstein K, Dietz A. Motivation as a predictor of speech intelligibility after total laryngectomy. Head Neck 2012; 35:836-46. [PMID: 22733689 DOI: 10.1002/hed.23043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND It has often been argued that if patients' success with speech rehabilitation after laryngectomy is limited, it is the result of lacking motivation on their part. This project investigated the role of motivation in speech rehabilitation. METHODS In a multicenter prospective cohort study, 141 laryngectomees were interviewed at the beginning of rehabilitation and 1 year after laryngectomy. Speech intelligibility was measured with a standardized test, and patients self-assessed their own motivation shortly after the surgery. Logistic regression, adjusted for several theory-based confounding factors, was used to assess the impact of motivation on speech intelligibility. RESULTS Speech intelligibility 1 year after laryngectomy was not significantly associated with the level of motivation at the beginning of rehabilitation (odds ratio [OR], 1.3; 95% confidence interval [CI], 0.7-2.3; p = .43) after adjusting for the effect of potential confounders (implantation of a voice prosthesis, patient's cognitive abilities, frustration tolerance, physical functioning, and type of rehabilitation). CONCLUSIONS Motivation is not a strong predictor of speech intelligibility 1 year after laryngectomy.
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Affiliation(s)
- Susanne Singer
- Department of Health Psychology, University of Wuppertal, Wuppertal, Germany.
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Macfarlane TV, Wirth T, Ranasinghe S, Ah-See KW, Renny N, Hurman D. Head and neck cancer pain: systematic review of prevalence and associated factors. J Oral Maxillofac Res 2012; 3:e1. [PMID: 24422003 PMCID: PMC3886092 DOI: 10.5037/jomr.2012.3101] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 02/23/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC. MATERIAL AND METHODS The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies. RESULTS There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43% - 70%) and after (42%, 95% CI 33% - 50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour- or treatment-related. CONCLUSIONS The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer.
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Affiliation(s)
| | - Tanja Wirth
- School of Medicine and Dentistry, University of Aberdeen, AberdeenUnited Kingdom.
- University of Bremen, BremenGermany.
| | - Sriyani Ranasinghe
- School of Medicine and Dentistry, University of Aberdeen, AberdeenUnited Kingdom.
- Postgraduate Institute of Medicine, University of ColomboSri Lanka.
| | - Kim W. Ah-See
- Department of Otolaryngology, Aberdeen Royal Infirmary, AberdeenUnited Kingdom.
| | - Nick Renny
- Department of Maxillofacial Surgery, Aberdeen Royal Infirmary, AberdeenUnited Kingdom.
| | - David Hurman
- Department of Clinical Oncology, Aberdeen Royal Infirmary, AberdeenUnited Kingdom.
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Fahsl S, Keszte J, Boehm A, Vogel HJ, Völkel W, Meister EF, Oeken J, Sandner A, Koscielny S, Kluge A, Heim ME, Dietz A, Singer S. Clinical relevance of quality-of-life data in laryngectomized patients. Laryngoscope 2012; 122:1532-8. [DOI: 10.1002/lary.23263] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 01/23/2012] [Accepted: 02/01/2012] [Indexed: 11/10/2022]
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Brotherston DC, Poon I, Le T, Leung M, Kiss A, Ringash J, Balogh J, Lee J, Wright JR. Patient preferences for oropharyngeal cancer treatment de-escalation. Head Neck 2012; 35:151-9. [PMID: 22431201 DOI: 10.1002/hed.22930] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The excellent prognosis of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinomas (SCCs) against severe chemoradiotherapy (CRT) toxicities has opened discussion of deintensification trials. The purpose of this study was to describe the perspective of patients with HPV-positive and HPV-negative disease toward such studies. METHODS Fifty-one patients with oropharyngeal SCC (post-CRT) underwent semistructured interviews contrasting toxicities of radiotherapy (RT) alone and CRT. Patients were asked what potential difference in cancer survival was acceptable to prefer RT over CRT. Initially, survival rate was the same for both treatments, then the RT rate was reduced until the preference switched. Treatment experience and preference for deintensified CRT were collected. RESULTS Ninety-percent of patients initially selected RT, but 69% switched to CRT after 0% to 5% reduction in survival. Patients that rated their treatment experience as mild would accept lower survival versus severe treatment (p = .02). Eighty-one percent of patients (33 of 40) indicated they preferred reduced chemotherapy in CRT. CONCLUSION Patients accept little difference in survival between treatments to avoid toxicity.
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Affiliation(s)
- Drew C Brotherston
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Beetz I, Schilstra C, van Luijk P, Christianen MEMC, Doornaert P, Bijl HP, Chouvalova O, van den Heuvel ER, Steenbakkers RJHM, Langendijk JA. External validation of three dimensional conformal radiotherapy based NTCP models for patient-rated xerostomia and sticky saliva among patients treated with intensity modulated radiotherapy. Radiother Oncol 2011; 105:94-100. [PMID: 22169766 DOI: 10.1016/j.radonc.2011.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/11/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE The purpose of this study was to investigate the ability of predictive models for patient-rated xerostomia (XER(6M)) and sticky saliva (STIC(6M)) at 6 months after completion of primary (chemo)radiation developed in head and neck cancer patients treated with 3D-conformal radiotherapy (3D-CRT) to predict outcome in patients treated with intensity modulated radiotherapy (IMRT). METHODS AND MATERIALS Recently, we published the results of a prospective study on predictive models for patient-rated xerostomia and sticky saliva in head and neck cancer patients treated with 3D-CRT (3D-CRT based NTCP models). The 3D-CRT based model for XER(6M) consisted of three factors, including the mean parotid dose, age, and baseline xerostomia (none versus a bit). The 3D-CRT based model for STIC(6M) consisted of the mean submandibular dose, age, the mean sublingual dose, and baseline sticky saliva (none versus a bit). In the current study, a population consisting of 162 patients treated with IMRT was used to test the external validity of these 3D-CRT based models. External validity was described by the explained variation (R(2) Nagelkerke) and the Brier score. The discriminative abilities of the models were calculated using the area under the receiver operating curve (AUC) and calibration (i.e. the agreement between predicted and observed outcome) was assessed with the Hosmer-Lemeshow "goodness-of-fit" test. RESULTS Overall model performance of the 3D-CRT based predictive models for XER(6M) and STIC(6M) was significantly worse in terms of the Brier score and R(2) Nagelkerke among patients treated with IMRT. Moreover the AUC for both 3D-CRT based models in the IMRT treated patients were markedly lower. The Hosmer-Lemeshow test showed a significant disagreement for both models between predicted risk and observed outcome. CONCLUSION 3D-CRT based models for patient-rated xerostomia and sticky saliva among head and neck cancer patients treated with primary radiotherapy or chemoradiation turned out to be less valid for patients treated with IMRT. The main message from these findings is that models developed in a population treated with a specific technique cannot be generalised and extrapolated to a population treated with another technique without external validation.
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Affiliation(s)
- Ivo Beetz
- Department of Radiation Oncology University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Beetz I, Schilstra C, Burlage FR, Koken PW, Doornaert P, Bijl HP, Chouvalova O, Leemans CR, de Bock GH, Christianen MEMC, van der Laan BFAM, Vissink A, Steenbakkers RJHM, Langendijk JA. Development of NTCP models for head and neck cancer patients treated with three-dimensional conformal radiotherapy for xerostomia and sticky saliva: the role of dosimetric and clinical factors. Radiother Oncol 2011; 105:86-93. [PMID: 21632133 DOI: 10.1016/j.radonc.2011.05.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 03/28/2011] [Accepted: 05/03/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this multicentre prospective study was to investigate the significance of the radiation dose in the major and minor salivary glands, and other pre-treatment and treatment factors, with regard to the development of patient-rated xerostomia and sticky saliva among head and neck cancer (HNC) patients treated with primary (chemo-) radiotherapy ((CH)RT). METHODS AND MATERIALS The study population was composed of 167 consecutive HNC patients treated with three-dimensional conformal (3D-CRT) (CH) RT. The primary endpoint was moderate to severe xerostomia (XER6m) as assessed by the EORTC QLQ-H&N35 at 6 months after completing (CH)RT. The secondary endpoint was moderate to severe sticky saliva at 6 months (STIC6m). All organs at risk (OARs) potentially involved in salivary function were delineated on planning-CT, including the parotid, submandibular and sublingual glands and the minor glands in the soft palate, cheeks and lips. Patients with moderate to severe xerostomia or sticky saliva at baseline were excluded. The optimum number of variables for a multivariate logistic regression model was determined using a bootstrapping method. RESULTS The multivariate analysis showed the mean parotid dose, age and baseline xerostomia (none versus a bit) to be the most important predictors for XER6m. The risk of developing xerostomia increased with age and was higher when minor baseline xerostomia was present in comparison with patients without any xerostomia complaints at baseline. Model performance was good with an area under the curve (AUC) of 0.82. For STIC6m, the mean submandibular dose, age, the mean sublingual dose and baseline sticky saliva (none versus a bit) were most predictive for sticky saliva. The risk of developing STIC6m increased with age and was higher when minor baseline sticky saliva was present in comparison with patients without any sticky saliva complaints at baseline. Model performance was good with an AUC of 0.84. CONCLUSIONS Dose distributions in the minor salivary glands in patients receiving 3D-CRT have limited significance with regard to patient-rated symptoms related to salivary dysfunction. Besides the parotid and submandibular glands, only the sublingual glands were significantly associated with sticky saliva. In addition, reliable risk estimation also requires information from other factors such as age and baseline subjective scores. When these selected factors are included in predictive models, instead of only dose volume histogram parameters, model performance can be improved significantly.
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Affiliation(s)
- Ivo Beetz
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Singer S, Krauß O, Keszte J, Siegl G, Papsdorf K, Severi E, Hauss J, Briest S, Dietz A, Brähler E, Kortmann RD. Predictors of emotional distress in patients with head and neck cancer. Head Neck 2011; 34:180-7. [DOI: 10.1002/hed.21702] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/15/2010] [Accepted: 10/26/2010] [Indexed: 11/12/2022] Open
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Quality of life evolution in patients after surgical treatment of laryngeal, hypopharyngeal or oropharyngeal carcinoma. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s2173-5735(11)70019-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Weber C, Dommerich S, Pau HW, Kramp B. Limited mouth opening after primary therapy of head and neck cancer. Oral Maxillofac Surg 2010; 14:169-73. [PMID: 20358238 DOI: 10.1007/s10006-010-0220-2] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patients after surgery and radiation/chemoradiation for treatment of head and neck cancer often suffer from oral complications. These problems may be caused by surgery and radiation. Patients complain, for example, of swallowing problems and limited mouth opening (trismus). METHODS The maximal interincisal mouth opening (MIO) was measured in patients treated with surgery and radiation/chemoradiation for head and neck cancer at the Department of Otorhinolaryngology at the University of Rostock. These patients also completed a 20-item questionnaire concerning nutritional, sensual, and speech disorders and pain. RESULTS One hundred one patients (16 female and 85 male) returned the questionnaire and were included in the study. About 50% of the patients had a limited mouth opening (<36 mm); patients with oropharyngeal cancer had a significant higher risk for trismus (p = .024) than patients with other head and neck cancers, especially compared to patients with laryngeal cancer (p = .013). The questionnaire showed that especially patients with oral cancer report about problems with opening the mouth (73%), eating (65%), drinking (73%), xerostomia (92%), speech disorders (68%), and voice (62%). Patients with laryngeal cancer only reported about problems with xerostomia (62%), speech (83%), and voice (90%), similar to patients with pharyngeal cancer. CONCLUSIONS About half of the patients who underwent primary treatment for oral and oropharyngeal cancer developed trismus and reported about problems with opening the mouth, eating, drinking, dry mouth, voice, and speech. Trismus has a negative impact on quality of life and should be a focus in the postoperative management of patients with oral and oropharyngeal cancer, and, if diagnosed, special treatment should be initialized.
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Affiliation(s)
- Clemens Weber
- Department of Head and Neck Surgery, University Hospital Rostock Otto Körner, Doberaner Str. 137/139, 18057, Rostock, Germany.
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[Quality of life evolution in patients after surgical treatment of laryngeal, hypopharyngeal or oropharyngeal carcinoma]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 62:103-12. [PMID: 21112569 DOI: 10.1016/j.otorri.2010.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 09/10/2010] [Accepted: 09/16/2010] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The assessment of quality of life in patients with head and neck cancer is dependent on many variables. OBJECTIVE The aim of this study was to evaluate the differences in quality of life among patients treated with conservative or radical surgery for laryngeal, oropharyngeal or hypopharyngeal cancer, evaluated before and at 3 and 6 months after definitive therapy. MATERIAL AND METHOD Prospective study between November 2008 and June 2009 on 53 patients diagnosed and treated for head and neck carcinoma with surgery: partial (n=32) and radical (n=21). Quality of life was evaluated using the European Organization of Research and Treatment of Cancer (EORTC) general questionnaire EORTC QLQ-C30 and its specific head and neck EORTC QLQ-H&N35 before treatment, and at 3 and 6 months afterwards. RESULTS No significant differences were found in overall health. Patients experienced the greatest changes in functional scale. There were no changes in swallowing problems or feeling of disease, while evident phonation problems were present in both groups. DISCUSSION AND CONCLUSIONS The routine application of quality of life questionnaires in cancer patients improves information regarding how and to what extent patients feel that treatment and its sequelae modify it, making it possible to adapt rehabilitation and support programs to their real needs. This data helps in choosing between different options depending on the results, delivering improved care to patients.
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Beetz I, Burlage FR, Bijl HP, Hoegen-Chouvalova O, Christianen ME, Vissink A, van der Laan BF, de Bock GH, Langendijk JA. The Groningen Radiotherapy-Induced Xerostomia questionnaire: Development and validation of a new questionnaire. Radiother Oncol 2010; 97:127-31. [PMID: 20541272 DOI: 10.1016/j.radonc.2010.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 05/15/2010] [Accepted: 05/15/2010] [Indexed: 10/19/2022]
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Bauer F, Seiss M, Gräßel E, Stelzle F, Klotz M, Rosanowski F. Schluckbezogene Lebensqualität bei Mundhöhlenkarzinomen. HNO 2010; 58:692-7. [DOI: 10.1007/s00106-010-2117-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dietz A, Meyer A, Singer S. [Measuring quality of life in head and neck cancer. Current status and future needs]. HNO 2009; 57:857-65. [PMID: 19629416 DOI: 10.1007/s00106-009-1969-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This review presents the current knowledge and methods of measuring disease-related quality of life in oncology, with particular emphasis on laryngeal and hypopharyngeal cancer. In addition to the currently popular and well-established instruments, specifics of the initial interview process, collection of psychiatric comorbidities, and the role of social care and its substantial influence on disease-related quality of life are discussed. At the forefront are the results of the central German head and neck oncology social-medical studies.
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Affiliation(s)
- A Dietz
- Klinik für Hals-, Nasen-, Ohrenheilkunde und Plastische Operationen, Universitätsklinikum Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Deutschland.
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Alicikus ZA, Akman F, Ataman OU, Dag N, Orcin E, Bakis B, Kinay M. Importance of patient, tumour and treatment related factors on quality of life in head and neck cancer patients after definitive treatment. Eur Arch Otorhinolaryngol 2008; 266:1461-8. [DOI: 10.1007/s00405-008-0889-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 12/03/2008] [Indexed: 11/30/2022]
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