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Teknos TN, Grecula J, Agrawal A, Old MO, Ozer E, Carrau R, Kang S, Rocco J, Blakaj D, Diavolitsis V, Kumar B, Kumar P, Pan Q, Palettas M, Wei L, Baiocchi R, Savvides P. A phase 1 trial of Vorinostat in combination with concurrent chemoradiation therapy in the treatment of advanced staged head and neck squamous cell carcinoma. Invest New Drugs 2018; 37:702-710. [PMID: 30569244 DOI: 10.1007/s10637-018-0696-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
Abstract
Purpose Vorinostat is a potent HDAC inhibitor that sensitizes head and neck squamous cell carcinoma (HNSCC) to cytotoxic therapy while sparing normal epithelium. The primary objective of this Phase I study was to determine the maximally tolerated dose (MTD) and safety of Vorinostat in combination with standard chemoradiation therapy treatment in HNSCC. Patients and Methods Eligible patients had pathologically confirmed Stage III, IVa, IVb HNSCC, that was unresectable or borderline resectable involving the larynx, hypopharynx, nasopharynx, and oropharynx. Vorinostat was administered at the assigned dosage level (100-400 mg, three times weekly) in a standard 3 + 3 dose escalation design. Vorinostat therapy began 1 week prior to initiation of standard, concurrent chemoradiation therapy and continued during the entire course of therapy. Results Twenty six patients met eligibility criteria and completed the entire protocol. The primary tumor sites included tonsil (12), base of tongue (9), posterior pharyngeal wall (1), larynx (4) and hypopharynx (3). Of the 26 patients, 17 were HPV-positive and 9 were HPV-negative. The MTD of Vorinostat was 300 mg administered every other day. Anemia (n = 23/26) and leukopenia (n = 20/26) were the most commonly identified toxicities. The most common Grade3/4 events included leukopenia (n = 11) and lymphopenia (n = 17). No patient had Grade IV mucositis, dermatitis or xerostomia. The median follow time was 33.8 months (range 1.6-82.9 months). Twenty four of 26 (96.2%) patients had a complete response to therapy. Conclusion Vorinostat in combination with concurrent chemoradiation therapy is a safe and highly effective treatment regimen in HNSCC. There was a high rate of complete response to therapy with toxicity rates comparable, if not favorable to existing therapies. Further investigation in Phase II and III trials is strongly recommended.
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Affiliation(s)
- Theodoros N Teknos
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA. .,Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - J Grecula
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - A Agrawal
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - M O Old
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - E Ozer
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - R Carrau
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - S Kang
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - J Rocco
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - D Blakaj
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - V Diavolitsis
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - B Kumar
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - P Kumar
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - Q Pan
- Otolaryngology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - M Palettas
- Center for Biostatistics, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - L Wei
- Center for Biostatistics, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - R Baiocchi
- Hematology-Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
| | - P Savvides
- Hematology-Medical Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), Columbus, OH, USA
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Bolt S, Baylor C, Burns M, Eadie T. "I would have told you about being forgetful, but I forgot": the experience of cognitive changes and communicative participation after head and neck cancer. Disabil Rehabil 2018; 42:931-939. [PMID: 30453786 DOI: 10.1080/09638288.2018.1514535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Survivors of head and neck cancer have reported difficulties with memory, attention, verbal fluency, and processing speed sometimes persisting years after treatment. Self-perceived cognitive function is an important predictor of communication outcomes in this population. This study explores the lived experience of cognitive changes in survivors of non-nasopharyngeal head and neck cancer and how these changes affect communication in their daily lives.Materials and methods: In the phenomenological tradition, five adult survivors of non-nasopharyngeal head and neck cancer participated in individual semi-structured interviews. The interviews were audio-recorded, transcribed, coded, and summarized into themes.Results: Two major themes emerged: (1) I would have told you about being forgetful, but I forgot; and (2) It's such a journey that much of it is uncharted. Participants described problems with memory, focus/attention, and task initiation along with slowed processing and language difficulties. These difficulties affected communication at work, socially, and at home. Participants expressed feeling unprepared for the possibility of cognitive changes, not knowing why they were happening or what to do about them.Conclusions: Results of this study have implications for counseling and treatment of individuals with head and neck cancer, as well as advocating for these patients to receive appropriate information and intervention.Implications for rehabilitationSurvivors of non-nasopharyngeal head and neck cancer described experiencing problems with memory and focus/attention along with slowed processing and language difficulties.Study participants generally felt both unprepared for the cognitive changes they experienced and, in many ways, unsupported by healthcare providers and others.Rehabilitation professionals should be aware that cognitive changes following medical treatment for head and neck cancer may affect a patient's ability to learn and follow complex treatment regimens.Rehabilitation professionals can advise and advocate for these patients to receive the appropriate referrals for assessment and treatment of their cognitive symptoms.
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Affiliation(s)
- Susan Bolt
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA
| | - Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Michael Burns
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA
| | - Tanya Eadie
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
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van der Meulen IC, May AM, Koole R, Ros WJG. A Distress Thermometer Intervention for Patients With Head and Neck Cancer
. Oncol Nurs Forum 2018; 45:E14-E32. [PMID: 29251296 DOI: 10.1188/18.onf.e14-e32] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the feasibility of an intervention using the National Comprehensive Cancer Network Distress Thermometer and Problem List with nurse-guided follow-up and the effect on depressive symptoms, health-related quality of life, and worry of cancer in patients with head and neck cancer.
. SAMPLE & SETTING 110 patients with head and neck cancer in a two-arm randomized, controlled trial in an outpatient clinic of a university hospital.
. METHODS & VARIABLES Patients were randomized to usual care (n = 57) or the intervention group (n = 53), which consisted of screening with the Distress Thermometer and Problem List plus nurse-guided follow-up lasting about 20 minutes three to four times during 12 months. Intention-to-treat analysis was performed using linear mixed models with outcomes at 6 and 12 months and baseline adjustment.
. RESULTS The intervention showed moderate compliance and acceptable session duration. Intervention participants were satisfied with nurses' care. Depressive symptoms, health-related quality of life, and worry of cancer were not significantly different in the two treatment groups. The intervention seemed feasible in clinical practice, but no effects on patient outcomes were seen.
. IMPLICATIONS FOR NURSING Patients with head and neck cancer appreciated the opportunity to discuss their problems and challenges with a nurse. Nurses supported patients with basic psychosocial care, minor interventions, and referral possibilities.
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Peach MS, Trifiletti DM, Vachani C, Arnold-Korzeniowski K, Bach C, Hampshire M, Metz JM, Hill-Kayser CE. Patient-reported outcomes in head and neck cancer: prospective multi-institutional patient-reported toxicity. PATIENT-RELATED OUTCOME MEASURES 2018; 9:245-252. [PMID: 30100773 PMCID: PMC6067627 DOI: 10.2147/prom.s153919] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose Head and neck cancer is occurring in an increasingly younger patient population, with treatment toxicity that can cause significant morbidity. Using a patient guided, Internet-based survivorship care plan program, we obtained and looked at patterns of patient-reported outcomes data from survivors seeking information after treatment for head and neck cancer. Methods The Internet-based OncoLife and LIVESTRONG Care Plan programs were employed, which design unique survivorship care plans based on patient-reported data. Care plans created for survivors of head and neck cancer were used in this evaluation. Demographics, treatment modality, and toxicity were included in this evaluation. Toxicity was further analyzed, grouped into system-based subsets. Results A total of 602 care plans were created from self-identified head and neck cancer survivors, from which patient-reported outcome data were attained. A majority of patients were Caucasian (96.2%) with median age at diagnosis of 55 years, living in suburban locations (39.9%), with ~50% receiving care within 20 miles of their residence. There was an equal distribution of education levels from high school only to graduate school. The majority of patients received care through cancer centers (96.7%), with a split between academic and non-academic centers. Ninety-three percent of patients had radiation therapy as part of their treatment modality, with 70.3% having chemotherapy and 60.1% having surgery. The most common system toxicities affected the oropharynx, followed by epithelium (skin/hair/nail), and then general global health. Specifically, the most common side effects were difficulty swallowing (61.5%) and changes in skin color/texture (49.7%). One third of patients experienced hearing/tinnitus/vertigo, xerostomia, loss of tissue flexibility, or fatigue. Conclusion The current work demonstrates the ability to obtain patient-reported outcomes of head and neck cancer survivors through an Internet-based survivorship care plan program. For this group dysphagia and dermatitis were the most commonly reported toxicities, as was expected; however, global effects of therapy, such as fatigue, were also significant and should be addressed in future survivorship planning.
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Affiliation(s)
- M Sean Peach
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | | | - Carolyn Vachani
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | | | - Christina Bach
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | - Margaret Hampshire
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
| | - James M Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA,
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Pribuisiene R, Liutkevicius V, Pribuisis K, Uloza V. Validation of the Lithuanian Version of the Speech Handicap Index. J Voice 2018; 32:385.e1-385.e6. [DOI: 10.1016/j.jvoice.2017.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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56
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Crowder SL, Douglas KG, Yanina Pepino M, Sarma KP, Arthur AE. Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review. J Cancer Surviv 2018; 12:479-494. [DOI: 10.1007/s11764-018-0687-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
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57
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Effects of a swallowing exercise education program on dysphagia-specific health-related quality of life in oral cavity cancer patients post-treatment: a randomized controlled trial. Support Care Cancer 2018; 26:2919-2928. [DOI: 10.1007/s00520-018-4148-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
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58
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Ringash J, Bernstein LJ, Devins G, Dunphy C, Giuliani M, Martino R, McEwen S. Head and Neck Cancer Survivorship: Learning the Needs, Meeting the Needs. Semin Radiat Oncol 2018; 28:64-74. [DOI: 10.1016/j.semradonc.2017.08.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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59
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Dzioba A, Aalto D, Papadopoulos-Nydam G, Seikaly H, Rieger J, Wolfaardt J, Osswald M, Harris JR, O'Connell DA, Lazarus C, Urken M, Likhterov I, Chai RL, Rauscher E, Buchbinder D, Okay D, Happonen RP, Kinnunen I, Irjala H, Soukka T, Laine J. Functional and quality of life outcomes after partial glossectomy: a multi-institutional longitudinal study of the head and neck research network. J Otolaryngol Head Neck Surg 2017; 46:56. [PMID: 28870248 PMCID: PMC5583999 DOI: 10.1186/s40463-017-0234-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/28/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND While aggressive treatment for oral cancer may optimize survival, decrements in speech and swallowing function and quality of life often result. This exploratory study investigated how patients recover their communicative function, swallowing ability, and quality of life after primary surgery [with or without adjuvant (chemo)radiation therapy] for tongue cancer over the course of the first year post-operation. METHODS Patients treated for oral cancer at three institutions (University of Alberta Hospital, Mount Sinai Beth Israel Medical Center, and Turku University Hospital) were administered patient-reported outcomes assessing speech [Speech Handicap Index (SHI)], swallowing [(M.D. Anderson Dysphagia Inventory (MDADI)] and quality of life [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC-H&N35)]. Outcome measures were completed pre-operatively and at 1-, 6-, and 12-months post-operatively. RESULTS One hundred and seventeen patients undergoing partial glossectomy with reconstruction participated in this study. Results indicated no significant differences in swallowing function (MDADI and EORTC-H&N35 subscales) between baseline and 6 months post-surgery and no significant differences in speech function (SHI subscales) between baseline and 1 year post-surgery. Most quality of life domains (EORTC-H&N35 subscales) returned to baseline levels by 1 year post-operation, while difficulties with dry mouth and sticky saliva persisted. A clear time trend of adjuvant (chemo)radiation therapy negatively affecting dry mouth scores over time was identified in this study, while negative independent effects of chemoradiation on MDADI swallowing, and EORTC-H&N35 swallowing, eating, and opening mouth subscales were found. CONCLUSIONS Assessment time influenced patient-reported speech, swallowing, and quality of life outcomes, while treatment (by time) effects were found for only swallowing and quality of life outcomes. Results of the present study will help guide clinical care and will be useful for patient counseling on expected short and long-term functional and quality of life outcomes of surgical and adjuvant treatment for oral cavity cancer.
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Affiliation(s)
- Agnieszka Dzioba
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, T6G 2G4, Canada. .,Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada.
| | - Daniel Aalto
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada.,Rehabilitation Medicine, Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada.,Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland
| | - Georgina Papadopoulos-Nydam
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada.,Rehabilitation Medicine, Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, T6G 2G4, Canada.,Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada.,Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jana Rieger
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada.,Rehabilitation Medicine, Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
| | - Johan Wolfaardt
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada.,Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - Martin Osswald
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, T6G 2G4, Canada.,Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada.,Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey R Harris
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, T6G 2G4, Canada.,Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada.,Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel A O'Connell
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, T6G 2G4, Canada.,Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB, Canada
| | - Cathy Lazarus
- Division of Head and Neck Surgery, Department of Otolaryngology, Head & Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA.,Thyroid, Head And Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Mark Urken
- Division of Head and Neck Surgery, Department of Otolaryngology, Head & Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA.,Thyroid, Head And Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Ilya Likhterov
- Division of Head and Neck Surgery, Department of Otolaryngology, Head & Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA.,Thyroid, Head And Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Raymond L Chai
- Division of Head and Neck Surgery, Department of Otolaryngology, Head & Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA.,Thyroid, Head And Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Erika Rauscher
- Thyroid, Head And Neck Cancer (THANC) Foundation, New York, NY, USA
| | - Daniel Buchbinder
- Thyroid, Head And Neck Cancer (THANC) Foundation, New York, NY, USA.,Department of Oral and Maxillofacial Surgery, Mount Sinai Beth Israel, New York, USA
| | - Devin Okay
- Thyroid, Head And Neck Cancer (THANC) Foundation, New York, NY, USA.,Department of Oral and Maxillofacial Surgery, Mount Sinai Beth Israel, New York, USA
| | - Risto-Pekka Happonen
- Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland.,Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland
| | - Ilpo Kinnunen
- Department of Oto-Rhino-Laryngology, Turku University Hospital, Turku, Finland
| | - Heikki Irjala
- Department of Oto-Rhino-Laryngology, Turku University Hospital, Turku, Finland
| | - Tero Soukka
- Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland.,Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland
| | - Juhani Laine
- Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland.,Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland
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Topf MC, Magaña LC, Salmon K, Hamilton J, Keane WM, Luginbuhl A, Curry JM, Cognetti DM, Boon M, Spiegel JR. Safety and efficacy of functional laryngectomy for end-stage dysphagia. Laryngoscope 2017; 128:597-602. [DOI: 10.1002/lary.26760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/18/2017] [Accepted: 06/01/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | - Linda C. Magaña
- Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Kelly Salmon
- Department of Otolaryngology-Head and Neck Surgery
| | | | | | | | | | | | - Maurits Boon
- Department of Otolaryngology-Head and Neck Surgery
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Goepfert RP, Lewin JS, Barrow MP, Fuller CD, Lai SY, Song J, Hobbs BP, Gunn GB, Beadle BM, Rosenthal DI, Garden AS, Kies MS, Papadimitrakopoulou VA, Schwartz DL, Hutcheson KA. Predicting two-year longitudinal MD Anderson Dysphagia Inventory outcomes after intensity modulated radiotherapy for locoregionally advanced oropharyngeal carcinoma. Laryngoscope 2016; 127:842-848. [PMID: 27440393 DOI: 10.1002/lary.26153] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/09/2016] [Accepted: 06/01/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the factors associated with longitudinal patient-reported dysphagia as measured by the MD Anderson Dysphagia Inventory (MDADI) in locoregionally advanced oropharyngeal carcinoma (OPC) survivors treated with split-field intensity modulated radiotherapy (IMRT). STUDY DESIGN Retrospective patient analysis. METHODS A retrospective analysis combined data from three single-institution clinical trials for stage III/IV head and neck carcinoma. According to trial protocols, patients had prospectively collected MDADI at baseline, 6, 12, and 24 months after treatment. OPC patients with baseline and at least one post-treatment MDADI were included. Longitudinal analysis was completed with multivariate linear mixed effects modeling. RESULTS There were 116 patients who met inclusion criteria. Mean baseline MDADI composite was 88.3, dropping to 73.8 at 6 months, and rising to 78.6 and 83.3 by 12 and 24 months, respectively (compared to baseline, all P < .0001). Tumor stage and smoking status were significant predictors of longitudinal MDADI composite scores. Patients with T1, T2, and T3 tumors had 15.9 (P = .0001), 10.9 (P = .0049), and 7.5 (P = .0615), respectively, higher mean MDADI composite than those with T4 tumors, and current smokers had a 9.4 (P = .0007) lower mean MDADI composite than never smokers. CONCLUSIONS Patients report clinically meaningful dysphagia early after split-field IMRT for locoregionally advanced OPC that remains apparent 6 months after treatment. MDADI scores recover slowly thereafter, but remain depressed at 24 months compared to baseline. Higher tumor stage and smoking status are important markers of patient-reported function through the course of treatment, suggesting these are important groups for heightened surveillance and more intensive interventions to optimize swallowing outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 127:842-848, 2017.
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Affiliation(s)
- Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Martha P Barrow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Brian P Hobbs
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Merrill S Kies
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Vali A Papadimitrakopoulou
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - David L Schwartz
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
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Articulation handicap index: an instrument for quantifying psychosocial consequences of impaired articulation. Eur Arch Otorhinolaryngol 2016; 273:4493-4500. [DOI: 10.1007/s00405-016-4143-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
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