101
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Szturz P, Vermorken JB. Treatment of Elderly Patients with Squamous Cell Carcinoma of the Head and Neck. Front Oncol 2016; 6:199. [PMID: 27630826 PMCID: PMC5006317 DOI: 10.3389/fonc.2016.00199] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/23/2016] [Indexed: 12/27/2022] Open
Abstract
The demographics of squamous cell carcinoma of the head and neck (SCCHN) is marked by a growing number of patients aged 65 and over, which is in line with global projections for other cancer types. In developed countries, more than half of new SCCHN cases are diagnosed in older people, and in 15 years from now, the proportion is expected to rise by more than 10%. Still, a high-level evidence-based consensus to guide the clinical decision process is strikingly lacking. The available data from retrospective studies and subset analyses of prospective trials suffer from a considerable underrepresentation of senior participants. The situation is even more challenging in the recurrent and/or metastatic setting, where usually only palliative measures are employed. Nevertheless, it is becoming clear that, if treated irrespective of chronological age, fit elderly patients in a good general condition and with a low burden of comorbidities may derive a similar survival advantage as their younger counterparts. Despite that, undertreatment represents a widespread phenomenon and, together with competing non-cancer mortality, is suggested to be an important cause of the worse treatment outcomes observed in this population. Due to physiological changes in drug metabolism occurring with advancing age, the major concerns relate to chemotherapy administration. In locally advanced SCCHN, concurrent chemoradiotherapy in patients over 70 years remains a point of controversy owing to its possibly higher toxicity and questionable benefit. However, accumulating evidence suggests that it should, indeed, be considered in selected cases when biological age is taken into account. Results from a randomized trial conducted in lung cancer showed that treatment selection based on a comprehensive geriatric assessment (CGA) significantly reduced toxicity. However, a CGA is time-consuming and not necessary for all patients. To overcome this hurdle, geriatric screening tools have been introduced to decide who needs such a full evaluation. Among the various screening instruments, G8 and Flemish version of the Triage Risk Screening Tool were prospectively verified and found to have prognostic value. We, therefore, conclude that also in SCCHN, the application of elderly specific prospective trials and integration of clinical practice-oriented assessment tools and predictive models should be promoted.
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Affiliation(s)
- Petr Szturz
- Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan B. Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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102
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Nouraei S, Mace A, Middleton S, Hudovsky A, Vaz F, Moss C, Ghufoor K, Mendes R, O'Flynn P, Jallali N, Clarke P, Darzi A, Aylin P. A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics-based Outcomes Surveillance Framework. Clin Otolaryngol 2016; 42:11-28. [DOI: 10.1111/coa.12649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S.A.R. Nouraei
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
- National Institute of Health and Care Excellence (NICE) 2013 Scholar; London UK
- The Ear Institute; University College London; London UK
| | - A.D. Mace
- Department of Otolaryngology - Head & Neck Surgery; Imperial College Healthcare NHS Trust; London UK
| | | | - A. Hudovsky
- Department of Clinical Coding; Imperial College Healthcare NHS Trust; London UK
| | - F. Vaz
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
| | - C. Moss
- Department of Oral & Maxillofacial Surgery; University College Hospital NHS Foundation Trust; London UK
| | - K. Ghufoor
- Department of Otolaryngology - Head & Neck Surgery; Barts Health, Royal London Hospital; London UK
| | - R. Mendes
- Department of Clinical Oncology; University College Hospital NHS Foundation Trust; London UK
| | - P. O'Flynn
- Department of Otolaryngology - Head & Neck Surgery Surgery; University College Hospital NHS Foundation Trust; London UK
| | - N. Jallali
- Department of Plastic & Reconstructive Surgery; Imperial College Healthcare NHS Trust; London UK
| | - P.M. Clarke
- Department of Otolaryngology - Head & Neck Surgery; Imperial College Healthcare NHS Trust; London UK
| | - A. Darzi
- Academic Surgical Unit; Department of Surgery & Cancer; St Mary's Hospital; London UK
| | - P. Aylin
- Dr Foster Unit at Imperial College; Department of Primary Care and Public Health; Imperial College London; London UK
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103
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Araki D, Redman MW, Martins R, Eaton K, Baik C, Chow L, Goulart B, Lee S, Santana-Davila R, Liao J, Parvathaneni U, Laramore G, Futran N, Mendez E, Bhrany A, Rodriguez CP. Concurrent cetuximab and postoperative radiation in resected high-risk squamous cell carcinomas of the head and neck: A single-institution experience. Head Neck 2016; 38:1318-23. [DOI: 10.1002/hed.24437] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 01/02/2016] [Accepted: 01/31/2016] [Indexed: 01/10/2023] Open
Affiliation(s)
- Daisuke Araki
- Department of Medicine, Residency Program; University of Washington; Seattle Washington
| | - Mary W. Redman
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
| | - Renato Martins
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Medical Oncology; University of Washington; Seattle Washington
| | - Keith Eaton
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Medical Oncology; University of Washington; Seattle Washington
| | - Christina Baik
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Medical Oncology; University of Washington; Seattle Washington
| | - Laura Chow
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Medical Oncology; University of Washington; Seattle Washington
| | - Bernardo Goulart
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Medical Oncology; University of Washington; Seattle Washington
| | - Sylvia Lee
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Medical Oncology; University of Washington; Seattle Washington
| | - Rafael Santana-Davila
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Medical Oncology; University of Washington; Seattle Washington
| | - Jay Liao
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Radiation Oncology; University of Washington; Seattle Washington
| | - Upendra Parvathaneni
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Radiation Oncology; University of Washington; Seattle Washington
| | - George Laramore
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Radiation Oncology; University of Washington; Seattle Washington
| | - Neal Futran
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Otolaryngology - Head and Neck Surgery; University of Washington; Seattle Washington
| | - Eduardo Mendez
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Otolaryngology - Head and Neck Surgery; University of Washington; Seattle Washington
| | - Amit Bhrany
- Department of Otolaryngology - Head and Neck Surgery; University of Washington; Seattle Washington
| | - Cristina P. Rodriguez
- Clinical Research Division; Fred Hutchinson Cancer Research Center; Seattle Washington
- Department of Medicine, Division of Medical Oncology; University of Washington; Seattle Washington
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104
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Chen YP, Mao YP, Zhang WN, Chen L, Tang LL, Li WF, Liu X, Zhou GQ, Guo R, Sun Y, Kang TB, Zeng MS, Ma J. Prognostic value of wait time in nasopharyngeal carcinoma treated with intensity modulated radiotherapy: a propensity matched analysis. Oncotarget 2016; 7:14973-82. [PMID: 26942870 PMCID: PMC4924766 DOI: 10.18632/oncotarget.7789] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/29/2016] [Indexed: 01/07/2023] Open
Abstract
The aim of this study was to determine the prognostic value of wait time from histological diagnosis to primary treatmen for nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). Between October 2009 and February 2012, a total of 1672 NPC patients were retrospectively analyzed. A cutoff value of > 4 weeks was used to define prolonged wait time. Matched patients according to the wait time were identified using propensity score matching (PSM), which was also used to identify matched patients for subsequent stratified analyses. Differences in progression-free survival (PFS), overall survival (OS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRFS) were estimated using the Kaplan-Meier method and Cox proportional hazards models. In total, 407 pairs of NPC patients were selected by PSM. The 3-year PFS rate was significantly lower for patients with a prolonged wait time (> 4 weeks) than for those with an acceptable wait time (P = 0.035). Stratified analyses revealed that the negative effects of a prolonged wait time occurred primarily in patients with advanced NPC without neoadjuvant chemotherapy (NACT; PFS:P = 0.040; DMFS:P = 0.028). In multivariate analysis, a prolonged wait time was found to be an independent unfavorable prognostic factor for PFS and DMFS in advanced-staged patients without NACT. These results suggest that a prolonged time (> 4 weeks) between diagnosis and primary radical radiotherapy is a disadvantage for NPC patients, particularly those with advanced disease receiving no NACT. Thus, it is necessary to optimize resources for decreasing this wait time, although additional studies are warranted to further clarify our findings.
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Affiliation(s)
- Yu-Pei Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yan-Ping Mao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Wen-Na Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Lei Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ling-Long Tang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Wen-Fei Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Xu Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Guan-Qun Zhou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Rui Guo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ying Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Tie-Bang Kang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Mu-Sheng Zeng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Jun Ma
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
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105
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Bras L, Peters TTA, Wedman J, Plaat BEC, Witjes MJH, van Leeuwen BL, van der Laan BFAM, Halmos GB. Predictive value of the Groningen Frailty Indicator for treatment outcomes in elderly patients after head and neck, or skin cancer surgery in a retrospective cohort. Clin Otolaryngol 2016; 40:474-82. [PMID: 25754107 DOI: 10.1111/coa.12409] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Careful selection of patients eligible for extensive head and neck cancer surgery is extremely important. A reliable predictor for postoperative outcomes in the vulnerable elderly population is not yet available. The concept of frailty describes a clinical state of increased vulnerability and can be assessed using frailty tests, such as the Groningen Frailty Indicator. In the current study, the influence of Groningen Frailty Indicator-measured frailty on clinical outcome was investigated in elderly patients surgically treated for head and neck cancer. DESIGN Retrospective, explorative cohort study. SETTING Tertiary referral centre. PARTICIPANTS A total of 90 patients of 65 years and older receiving surgical treatment for head and neck cancer with different primary sites. MAIN OUTCOME MEASURES The influence of frailty (Groningen Frailty Indicator) on postoperative complications (Clavien-Dindo classification), subjective postoperative experience of both patient and surgeon and survival were analysed. RESULTS A total of 36 patients were considered as frail (40%). Postoperative complications could not be predicted by frailty status. However, the Groningen Frailty Indicator dimension 'health problems' was a significant predictor for postoperative complications (P = 0.020). Unlike age and comorbidity, frailty was associated with a poor subjective patients' experience of the postoperative recovery (P < 0.01). Although not statistically significant, survival analysis showed a worse 5-year overall survival in the frail group (33%) versus the non-frail group (74%). CONCLUSIONS Analysis of frailty could identify elderly patients who might suffer more than expected during the postoperative period after head and neck cancer surgery. In this study, frailty was not identified as a new predictor of complications after head and neck cancer surgery.
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Affiliation(s)
- L Bras
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Graduate School of Medical Sciences, Cancer Research Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T T A Peters
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Wedman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B L van Leeuwen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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106
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Dimovska EOF, Clibbon JJ, Moncrieff MDS, Heaton MJ, Figus A. Microsurgical Reconstructions for Head and Neck Cancers in Elderly Aged >80 Years: An Analysis of Surgical Outcomes and Quality of Life. Ann Surg Oncol 2015; 23:1684-92. [PMID: 26714952 DOI: 10.1245/s10434-015-5049-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The rising incidence of primary head and neck (H&N) cancers in the elderly presents a dilemma regarding the appropriateness of complex surgery in this assumed frail age group. With limited data on surgical morbidity, survival, and patient quality of life (QOL), this analysis aimed to broaden the understanding of safety and effectiveness of microsurgical treatment in very elderly H&N cancer patients. METHODS A prospective database analysis was used to evaluate surgical outcomes (morbidity, survival, and QOL) in all patients aged 80 years and older undergoing microsurgical reconstruction for cutaneous and intra-oral H&N cancers between 2004 and 2014. Outcomes were assessed for their association with surgical, tumour, and patient variables. Comorbidities were categorized by the ACE27 index and postoperative morbidity by the Clavien-Dindo scoring system. QOL was analyzed using the UW-QOLv4. RESULTS Of 720 microsurgical reconstructions, 96 patients were identified. Median survival was 25 months. The ACE27 index was the only variable significantly associated with survival with a 5-year survival of 59.2 % in the least comorbid group versus 19.7 % in the most comorbid group (p 0.015). ACE-27 showed influence on socioemotional QoL scores. Physical QOL scores were influenced by tumour and operative factors. Patients were found to value physical QOL over socioemotional. CONCLUSIONS Microsurgical reconstructions are well tolerated in the very elderly patients and should be considered predominantly based on comorbidity. Tumour stage, flap type, and cancer site should still form part of the preoperative counseling due to their implication on postoperative physical function.
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Affiliation(s)
- E O F Dimovska
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK.
| | - J J Clibbon
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - M D S Moncrieff
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - M J Heaton
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - A Figus
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Foundation Trust, Norwich, UK
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107
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Wells M, Swartzman S, Lang H, Cunningham M, Taylor L, Thomson J, Philp J, McCowan C. Predictors of quality of life in head and neck cancer survivors up to 5 years after end of treatment: a cross-sectional survey. Support Care Cancer 2015; 24:2463-72. [DOI: 10.1007/s00520-015-3045-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/29/2015] [Indexed: 11/29/2022]
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108
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Comparison of different comorbidity measures for oral cancer patients with surgical intervention: A longitudinal study from a single cancer center. Auris Nasus Larynx 2015; 43:322-9. [PMID: 26642942 DOI: 10.1016/j.anl.2015.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/09/2015] [Accepted: 10/16/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Several comorbid measures have been developed and demonstrated the predictive ability for cancer mortality. We conducted a retrospective study on oral squamous cell carcinoma (OSCC) patients to compare the Charlson comorbidity index score (CCIS) to the Elixhauser comorbidity index score (ECIS). METHODS Newly diagnosed OSCC patients (n=232) post major surgery with or without adjuvant therapy were identified from the cancer registry database between 2006 and 2011. Comorbidities present prior to the cancer diagnosis were obtained and adapted to the CCIS and ECIS. The prevalence of comorbid conditions and the influence on disease-specific survival (DSS) rate were calculated and analyzed by Cox regression model. The discriminatory ability of these two comorbid measures was evaluated by using the adjusted hazard ratio and Akaike information criterion (AIC) in a multivariate regression model. The prediction accuracy was assessed using Harrell's c-statistic. RESULTS Most of the patients (93.5%) were male with a mean age of 54 ± 11 years and 77 of them (33.1%) had at least one comorbid condition. The ECIS was associated DSS, with an additional 10% increased risk observed for mortality for each increased score (HR, 1.10; 95% confidence interval [CI], 1.03-1.18) after adjusting with pathological risk features. However, the CCIS was not an independent prognostic factor for these patients. The ECIS increased discriminatory ability but the CCIS did not improve discrimination. CONCLUSIONS Comorbid conditions significantly influenced the clinical outcomes of patient with OSCC post major surgery. A higher ECIS was associated with worse disease specific survival indicative of a valuable prognostic indicator. The ECIS may be considered in further clinical trials for a variety of cancers, including head and neck cancers.
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109
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Cardiac comorbidity in head and neck cancer patients and its influence on cancer treatment selection and mortality: a prospective cohort study. Eur Arch Otorhinolaryngol 2015; 273:2765-72. [DOI: 10.1007/s00405-015-3836-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/11/2015] [Indexed: 11/26/2022]
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110
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Biomarkers predicting chemotherapy response in head and neck squamous cell carcinoma: a review. The Journal of Laryngology & Otology 2015; 129:1046-52. [PMID: 26429303 DOI: 10.1017/s0022215115002479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Biomarkers are increasingly being used in many cancers to select patients for oncological treatment paradigms based on their inherent genetic properties. However, in head and neck cancers, there are no personalised therapies available outside the context of a clinical trial. A number of studies suggest there are intrinsic tumour properties of head and neck cancers that affect their response to chemotherapeutic agents. This paper aimed to review their evidence base. METHOD A narrative review was conducted following a search of the PubMed database. RESULTS AND CONCLUSION The review identified a number of biomarkers predicting response to chemotherapy in head and neck cancers. The paper discusses these in detail, and explores where future research could be directed in order to deliver personalised therapies for patients with head and neck cancers.
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111
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Effect of Comanagement With Internal Medicine on Hospital Stay of Patients Admitted to the Service of Otolaryngology. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2015.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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112
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Efecto de la asistencia compartida con medicina interna sobre la estancia hospitalaria de los pacientes ingresados en el Servicio de Otorrinolaringología. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 66:264-8. [DOI: 10.1016/j.otorri.2014.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/22/2014] [Accepted: 09/24/2014] [Indexed: 11/24/2022]
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113
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Wang JR, Habbous S, Espin-Garcia O, Chen D, Huang SH, Simpson C, Xu W, Liu FF, Brown DH, Gilbert RW, Gullane PJ, Irish JC, Goldstein DP, Liu G. Comorbidity and performance status as independent prognostic factors in patients with head and neck squamous cell carcinoma. Head Neck 2015; 38:736-42. [PMID: 25521753 DOI: 10.1002/hed.23947] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the individual and combined relationship of comorbidity and performance status (PS) on head and neck squamous cell carcinoma (HNSCC) survival. METHODS Six hundred patients with HNSCC were prospectively recruited. Comorbidity and PS were measured using the Charlson Comorbidity Index (CCI) and the Eastern Cooperative Oncology Group (ECOG) Scale. Outcomes were overall survival (OS) and cancer-specific survival (CSS). RESULTS A total of 48.3% of the patients had at least 1 comorbidity, and 42.3% had impaired PS at baseline. There was no correlation between CCI and ECOG (Spearman's ρ = 0.033; p = .42). In multivariate analysis, CCI score was significantly associated with OS (p = .01). ECOG was not associated with OS, but seems to act as an effect modifier in the association between comorbidity and OS. CCI and ECOG were not associated with CSS. CONCLUSION CCI and ECOG scores both provide prognostic information in predicting OS in HNSCC, but a significant association with CSS was not observed.
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Affiliation(s)
- Jennifer R Wang
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Steven Habbous
- Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Osvaldo Espin-Garcia
- Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Duoduo Chen
- Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Colleen Simpson
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dale H Brown
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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114
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Ling DC, Kabolizadeh P, Heron DE, Ohr JP, Wang H, Johnson J, Kubicek GJ. Incidence of hospitalization in patients with head and neck cancer treated with intensity-modulated radiation therapy. Head Neck 2015; 37:1750-5. [PMID: 24986324 DOI: 10.1002/hed.23821] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/30/2014] [Accepted: 06/29/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patients with primary head and neck cancer managed with radiation therapy (RT) +/- chemotherapy may experience significant treatment-related toxicities. We assessed hospitalization as a metric for severe treatment-related toxicities and evaluated patient and treatment factors for possible association. METHODS A retrospective review was performed on 147 patients with head and neck cancer treated with definitive or adjuvant intensity-modulated radiation therapy (IMRT) +/- chemotherapy. Multiple Poisson regression model was used to analyze relationships between patient or treatment factors and number of hospital stays during RT and within 8 weeks after RT. RESULTS Multivariate analysis showed preexisting diabetes or pulmonary disease, primary carcinoma of oral cavity, and prescribed radiation dose (p < .05) were associated with increased number of patient hospital stays during or shortly after RT. CONCLUSION We found that 34.7% of patients experienced a chemoradiation toxicity-related hospitalization during or shortly after treatment. Prior pulmonary disease, diabetes, and increasing prescribed radiation dose were associated with increased hospital stays.
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Affiliation(s)
- Diane C Ling
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Peyman Kabolizadeh
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James P Ohr
- Department of Medicine, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Hong Wang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonas Johnson
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gregory J Kubicek
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
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115
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Kolokythas A, Park S, Schlieve T, Pytynia K, Cox D. Squamous cell carcinoma of the oral tongue: histopathological parameters associated with outcome. Int J Oral Maxillofac Surg 2015; 44:1069-74. [PMID: 26055524 DOI: 10.1016/j.ijom.2015.01.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/05/2015] [Accepted: 01/12/2015] [Indexed: 12/26/2022]
Abstract
The purpose of this study was to investigate the applicability of the histological risk assessment model proposed by Brandwein-Gensler et al. in a cohort of oral tongue squamous cell carcinoma (OTSCC) patients treated with definitive surgery. We also examined the impact of additional histopathological features on disease acceleration. The cases of 49 OTSCC patients attending our institution between 1995 and 2009, who underwent definitive surgical resection followed by adjunct chemoradiotherapy when indicated, were reviewed retrospectively. Surgical resection specimens and complete clinical and demographic data were available for these patients; follow-up was at least 6 months. In this cohort we only identified a correlation between gender and the histopathological risk model score (P<0.001). With regard to clinical and demographic data, histopathological parameters, and disease status at last follow-up, we identified significant correlations between disease status and (1) grade of differentiation (P=0.0086), and (2) keratin score (P=0.026). We found no significant correlations between the histopathological risk assessment model and disease progression or outcomes, with the exception of gender (P<0.0001). Grade of differentiation, keratin score, and the lymphocytic host response significantly impacted disease acceleration. For OTSCC, it appears that clinical characteristics of the tumour as well as histopathological markers play an important role in the outcome. Efforts towards identifying predictive markers should be continued, especially by sub-site of the oral cavity.
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Affiliation(s)
- A Kolokythas
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA.
| | - S Park
- Department of Pathology, University of Pittsburg Medical Center, Pittsburg, PA, USA
| | - T Schlieve
- Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - K Pytynia
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Regional Care Center Katy, Houston, TX, USA
| | - D Cox
- Department of Dental Practice, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA
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Jégu J, Belot A, Borel C, Daubisse-Marliac L, Trétarre B, Ganry O, Guizard AV, Bara S, Troussard X, Bouvier V, Woronoff AS, Colonna M, Velten M. Effect of previous history of cancer on survival of patients with a second cancer of the head and neck. Oral Oncol 2015; 51:457-63. [DOI: 10.1016/j.oraloncology.2015.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 01/14/2015] [Accepted: 01/25/2015] [Indexed: 12/16/2022]
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Abstract
This article discusses risk factors, incidence trends, and prognostic considerations for head and neck cancer (HNC). The primary causes of HNC are tobacco and alcohol use, and human papillomavirus (HPV). Tobacco-related HNC incidence rates are decreasing in countries where tobacco use has declined. HPV-HNC, which occurs primarily in the oropharynx and is associated with sexual behaviors, has been increasing over the past several decades, among white men in particular. The prognosis for HNC overall has improved slightly since the 1990s, and is influenced by site, stage, and HPV status. Prognosis for HPV-HNC is significantly better than for HPV-negative disease.
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Affiliation(s)
- Eleni M Rettig
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
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118
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Yang M, Mehta HB, Bali V, Gupta P, Wang X, Johnson ML, Aparasu RR. Which risk-adjustment index performs better in predicting 30-day mortality? A systematic review and meta-analysis. J Eval Clin Pract 2015; 21:292-9. [PMID: 25659330 DOI: 10.1111/jep.12307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Individual comparisons of the performance of risk-adjustment indices have been widely conducted. Few reviews have been conducted to summarize the performance of different risk-adjustment indices. A 30-day mortality rate is widely used to evaluate the quality of care in hospitals by federal agencies like the Centers for Medicare and Medicaid Services. This study examined relative performance of risk-adjustment indices that predict 30-day mortality. METHODS Databases including Medline, PubMed and PsycINFO were searched for studies that compared risk-adjustment indices. The search protocol included comparative studies in which the performance of risk-adjustment indices were compared across any defined cohort to compare 30-day mortality, including mortality within 30 days and intensive care unit mortality, which lasts less than 30 days. Data were extracted using a structured form and abstract data included author and publication year, population studied (including location, sample size, study time period), comparison indices, outcome studied, results and conclusions from the results. A meta-analytical approach was used to summarize all the studies. Scaled ranking score was used to estimate the relative superiority of any given risk-adjustment indices. A hypergeometric test was carried out to evaluate the performance of risk-adjustment measures. RESULTS Out of 2805 studies identified, 23 studies met the eligibility criteria. Main risk-adjustment indices used for comparison included Acute Physiology and Chronic Health Evaluation, Sequential Organ Failure Assessment score, Charlson co-morbidity index, Model for End-Stage Liver Disease score and Simplified Acute Physiology Score (SAPS). Based on scaled ranking score, SAPS performed best (score 0.510) among all the risk-adjustment indices. However, based on hypergeometric test, the five measures performed equally well. CONCLUSIONS Although all the selected risk-adjustment indices perform equally well, SAPS seems better than other indices for short-term mortality based on scaled ranking score.
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Affiliation(s)
- Mo Yang
- ARIAD Pharmaceuticals, Inc, Cambridge, USA
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Validity of the age-adjusted charlson comorbidity index on clinical outcomes for patients with nasopharyngeal cancer post radiation treatment: a 5-year nationwide cohort study. PLoS One 2015; 10:e0117323. [PMID: 25617629 PMCID: PMC4305297 DOI: 10.1371/journal.pone.0117323] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/22/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To characterize the impact of comorbidity on survival outcomes for patients with nasopharyngeal carcinoma (NPC) post radiotherapy (RT). Methods A total of 4095 patients with NPC treated by RT or RT plus chemotherapy (CT) in the period from 2007 to 2011 were included through Taiwan’s National Health Insurance Research Database. Information on comorbidity present prior to the NPC diagnosis was obtained and adapted to the Charlson Comorbidity Index (CCI), Age-Adjusted Charlson Comorbidity Index (ACCI) and a revised head and neck comorbidity index (HN-CCI). The prevalence of comorbidity and the influence on survival were calculated and analyzed. Results Most of the patients (75%) were male (age 51±13 years) and 2470 of them (60%) had at least one comorbid condition. The most common comorbid condition was diabetes mellitus. According to these three different comorbidity index (CCI, ACCI and HN-CCI), higher scores were associated with worse overall survival (P< 0.001). The Receiver Operating Characteristic (ROC) curve was used to assess the discriminating ability of CCI, AACI and HN-CCI scores and it demonstrated the predictive ability for mortality with the ACCI (0.693, 95% CI 0.670–0.715) was superior to that of the CCI (0.619, 95% CI 0.593–0.644) and HN-CCI (0.545, 95%CI 0.519–0.570). Conclusion Comorbidities greatly influenced the clinical presentations, therapeutic interventions, and outcomes of patients with NPC post RT. Higher comorbidity index scores accurately was associated with worse survival. The ACCI seems to be a more appropriate prognostic indicator and should be considered in further clinical studies.
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120
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[Clinical aspects of transoral laser surgery and neck dissection for oro- and hypopharyngeal cancer in elderly patients]. HNO 2015; 62:342-9. [PMID: 24633392 DOI: 10.1007/s00106-014-2852-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The number of elderly patients with head and neck cancer is increasing. However, there are few valid data on postoperative course after head and neck cancer surgery in elderly patients. The aim of this study was to evaluate the oncological outcome of elderly patients after surgical treatment for oro- and hypopharyngeal cancer. MATERIAL AND METHODS The clinical data of 81 patients, separated into two age groups (62 < 65 years vs. 19 ≥ 65 years), were retrospectively analysed. The cohort comprised T1 and T2 oro- and hypopharyngeal cancer patients, who had undergone primary treatment with transoral laser surgery and neck dissection. Overall and disease-free survival times of the patients were analysed. Additionally, comorbidities and perioperative complications were compared between the two age groups. Median follow-up time was 5.9 years. RESULTS Comparison of different clinical and histopathological data revealed no significant differences between the age groups. The Kaplan-Meier method revealed no significant difference in disease-free survival between the age groups (p = 0.52). Age had no effect on disease-free survival in uni- or multivariate analysis (p = 0.53 vs. 0.94). Surgery-related complications were observed in 13 patients (16 %), 11 cases of which concerned the younger group of patients. CONCLUSION Transoral laser surgery and neck dissection can lead to satisfactory oncological and surgical outcomes in elderly patients with oro- and hypopharyngeal cancer.
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Guntinas-Lichius O, Wendt TG, Kornetzky N, Buentzel J, Esser D, Böger D, Müller A, Schultze-Mosgau S, Schlattmann P, Schmalenberg H. Trends in epidemiology and treatment and outcome for head and neck cancer: A population-based long-term analysis from 1996 to 2011 of the Thuringian cancer registry. Oral Oncol 2014; 50:1157-64. [DOI: 10.1016/j.oraloncology.2014.09.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/18/2014] [Accepted: 09/28/2014] [Indexed: 12/24/2022]
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Cachexia: a preventable comorbidity of cancer. A T.A.R.G.E.T. approach. Crit Rev Oncol Hematol 2014; 94:251-9. [PMID: 25468676 DOI: 10.1016/j.critrevonc.2014.10.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/17/2014] [Accepted: 10/28/2014] [Indexed: 12/31/2022] Open
Abstract
Although relevant achievements in the treatment of cancer have been obtained, some barriers still remain in the prevention and treatments of cancer comorbidities, including cachexia. Indeed, the enormous advances in the understanding of the pathogenesis of cancer cachexia have not been paralleled by effective strategies aimed at modifying the cultural approach to this devastating condition. Too little attention is still paid to the nutritional and metabolic changes occurring in cancer, despite their negative effects on patients' tolerance to antineoplastic treatments and outcome. We propose a T.A.R.G.E.T. approach as a novel strategy, encompassing active interventions and research development within the different domains influencing the onset and the progression of cancer cachexia. Moreover, based on the most recent clinical evidences, we suggest that cachexia should be considered a comorbidity of cancer.
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123
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Abstract
PURPOSE OF REVIEW The public demands that 'all modes of treatment' should be offered to patients who present with head and neck cancer. Up to 40% of patients present with advanced stage disease, of whom some 10% have metastatic disease and are currently deemed incurable. This review summarizes the current role and philosophy of surgical interventions in the palliation of head and neck cancer. RECENT FINDINGS Patients who present with advanced or recurrent head and neck cancers over the past decade have been offered nonsurgical palliative treatments of radiotherapy with or without chemotherapy, with variable responses. The aims are to achieve tumour shrinkage and gain effective relief of symptoms, such as pain, breathing and swallowing. The use of surgery in the palliation of disease and its symptoms has declined significantly since the 1980s. Within the concept of multidisciplinary clinical working as the 'gold standard' for the provision of optimum care for the head and neck patient, the place for surgery should be discussed within the many options available currently. SUMMARY Patients who present with advanced, incurable or recurrent head and neck cancer should be made aware of their prognosis and the potential need and benefits of palliative care. The active involvement of patients and their carers, their desires and wishes should be the prime consideration for any interventions. Careful selection of suitable patients can achieve prolonged symptom relief safely and result in an improvement in their quality of living. The ultimate goal should incorporate not only quality of life but quality of dying.
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Factors predict prolonged wait time and longer duration of radiotherapy in patients with nasopharyngeal carcinoma: a multilevel analysis. PLoS One 2014; 9:e109930. [PMID: 25314009 PMCID: PMC4196956 DOI: 10.1371/journal.pone.0109930] [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: 04/15/2014] [Accepted: 09/12/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Radiotherapy with or without chemotherapy is the primary treatment for patients with nasopharyngeal carcinoma (NPC). It wastes time from diagnosis to treatment. Treatment time of radiotherapy generally takes at least seven weeks. The current study aimed to evaluate factors associated with prolonged wait time and longer duration of radiotherapy in NPC patients. METHODS AND MATERIALS From Taiwan's National Health Insurance research database, we identified 3,605 NPC patients treated with radiotherapy between 2008 and 2011. Wait time was calculated from the date of diagnosis to the start of radiotherapy. The impact of each variable on wait time and duration of radiotherapy was examined by multilevel analysis using a random-intercept model. RESULTS The mean wait time and duration of radiotherapy were 1.78±3.33 and 9.72±7.27 weeks, respectively. Multilevel analysis revealed prolonged wait time in patients aged 45-65 years, those receiving radiotherapy alone, those with more comorbidities, those with low SES, and those living in eastern Taiwan. A prolonged duration of radiotherapy was associated with receipt of concurrent chemoradiotherapy, more comorbidities, and moderate SES. CONCLUSIONS Understanding the factors associated with longer wait times and duration of radiotherapy in patients with NPC may help healthcare providers better assist both these patients and potentially those with other head-and-neck cancers.
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125
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Nguyen NP, Ries T, Vock J, Vos P, Chi A, Vinh-Hung V, Thompson S, Desai A, Sroka T, Vo RA, Gelumbauskas S, Hamilton R, Karlsson U, Mignault A. Effectiveness of radiotherapy for elderly patients with non-melanoma skin cancer of the head. Geriatr Gerontol Int 2014; 15:601-5. [PMID: 25256352 DOI: 10.1111/ggi.12319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology; Howard University Hospital; Washington Washington DC USA
| | - Tiffany Ries
- Department of Radiation Oncology; University of Arizona; Tucson Arizona USA
| | - Jacqueline Vock
- Department of Radiation Oncology; Lindenhofspital; Bern Switzerland
| | - Paul Vos
- Department of Biostatistics; East Carolina University; Greenville North Carolina USA
| | - Alexander Chi
- Department of Radiation Oncology; University of West Virginia; Morgantown West Virginia USA
| | - Vincent Vinh-Hung
- Department of Radiation Oncology; University Hospitals of Martinique; Martinique France
| | | | - Anand Desai
- Department of Radiation Oncology; Akron City Hospital; Akron Ohio USA
| | - Thomas Sroka
- Department of Radiation Oncology; Darmouth College; New Lebanon New Hampshire USA
| | - Richard A Vo
- Department of Pediatrics; University of Virginia; Charlottesville Virginia USA
| | - Steve Gelumbauskas
- Department of Radiation Oncology; University of Arizona; Tucson Arizona USA
| | - Russell Hamilton
- Department of Radiation Oncology; University of Arizona; Tucson Arizona USA
| | - Ulf Karlsson
- Department of Radiation Oncology; Marshfield Clinic; Marshfield Wisconsin USA
| | - Alan Mignault
- Department of Radiation Oncology; University of Arizona; Tucson Arizona USA
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126
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Pauli N, Andréll P, Johansson M, Fagerberg-Mohlin B, Finizia C. Treating trismus: A prospective study on effect and compliance to jaw exercise therapy in head and neck cancer. Head Neck 2014; 37:1738-44. [DOI: 10.1002/hed.23818] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/10/2014] [Accepted: 06/27/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nina Pauli
- Department of Otorhinolaryngology; Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital; Gothenburg Sweden
| | - Paulin Andréll
- Department of Molecular and Clinical Medicine/Multidisciplinary Pain Centre; Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital; Gothenburg Sweden
| | - Mia Johansson
- Department of Oncology; Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital; Gothenburg Sweden
| | - Bodil Fagerberg-Mohlin
- Department of Oral and Maxillofacial Surgery; Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital; Gothenburg Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology; Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital; Gothenburg Sweden
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127
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Connor KL, Pattle S, Kerr GR, Junor E. Treatment, comorbidity and survival in stage III laryngeal cancer. Head Neck 2014; 37:698-706. [PMID: 24596316 DOI: 10.1002/hed.23653] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 03/01/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was for us to identify factors associated with survival and laryngeal function in a contemporary, population-based study of stage III laryngeal carcinoma. METHODS Patients presenting to a tertiary center with stage III laryngeal carcinoma between 1999 and 2010 were included in the study. Kaplan-Meier and Cox proportional hazards analyses were utilized. RESULTS Of 137 patients receiving either surgery ± adjuvant therapy (SURG±Adj = 24.1%), chemoradiotherapy (CRT = 32.8%), or radiotherapy alone (RT = 36.5%), 5-year cause-specific survival (5-year CSS) was 81.0% and 2-year local relapse rate was 27.5%. RT had higher recurrence (p < .01), lower 5-year CSS (90.8% vs 87.8% vs 68.9%/SURG±Adj vs CRT vs RT/p = .0026) and lower overall survival (p = .001). Adjusting for excess of severe comorbidity in the RT group, there was no difference in 5-year CSS between treatment modality. CONCLUSION SURG±Adj and CRT had similar survival. Severe comorbidity was associated with selection bias to RT and reduced 5-year CSS. Comorbidity is a key prognostic variable and should be considered in the interpretation of treatment outcomes.
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Affiliation(s)
- Katie L Connor
- Department of Oncology, The Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland
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128
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Goldenberg D, Mackley H, Koch W, Bann DV, Schaefer EW, Hollenbeak CS. Age and stage as determinants of treatment for oral cavity and oropharyngeal cancers in the elderly. Oral Oncol 2014; 50:976-82. [PMID: 25153476 DOI: 10.1016/j.oraloncology.2014.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/08/2014] [Accepted: 07/20/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND We investigate treatment selection for oral cavity and oropharyngeal (OC&OP) cancers to understand factors that influence treatment selection. METHODS We studied 7023 patients, ⩾66 years, diagnosed with a first primary OC&OP cancer using SEER-Medicare data. Multinomial logistic regression was to model treatment selection, controlling for other factors. RESULTS Most patients with OC cancer were treated with surgery alone (56.5%); most patients with OP cancer were treated with chemotherapy and radiation (28.9%). Age, stage and site were the most important predictors of treatment selection. As age increased from 70 to 81 (the interquartile range), treatment shifted toward surgery alone (OR=1.26; CI: 1.08-1.46) and no treatment (OR=1.5, 95% CI: 1.25-1.80), and away from combined surgery, radiation and treatments involving chemotherapy. CONCLUSIONS Age, stage, and site are the most important determinants of treatment selection for patients with OC&OP cancers. Increasing age and stage drive treatment toward non-surgical options and no treatment at all.
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Affiliation(s)
- David Goldenberg
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States.
| | - Heath Mackley
- Department of Radiology, The Pennsylvania State University, College of Medicine, Hershey, PA, United States
| | - Wayne Koch
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Darrin V Bann
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States
| | - Eric W Schaefer
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, United States
| | - Christopher S Hollenbeak
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, United States; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, United States
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Sinha P, Kallogjeri D, Piccirillo JF. Assessment of comorbidities in surgical oncology outcomes. J Surg Oncol 2014; 110:629-35. [DOI: 10.1002/jso.23723] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/11/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Parul Sinha
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri
| | - Jay F. Piccirillo
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri
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On the need for comprehensive assessment of impact of comorbidity in elderly patients with head and neck cancer. Eur Arch Otorhinolaryngol 2014; 271:2597-600. [PMID: 25060978 DOI: 10.1007/s00405-014-3203-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
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131
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Tadiparthi S, Enache A, Kalidindi K, O'Hara J, Paleri V. Hospital stay following complex major head and neck resection: what factors play a role? Clin Otolaryngol 2014; 39:156-63. [DOI: 10.1111/coa.12250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- S. Tadiparthi
- Department of Plastic Surgery; Newcastle upon Tyne Hospitals; Newcastle-Upon-Tyne UK
| | - A. Enache
- Department of Otolaryngology; Newcastle-Upon-Tyne Hospitals; Newcastle-Upon-Tyne UK
| | | | - J. O'Hara
- Department of Otolaryngology; City Hospitals Sunderland; Sunderland UK
| | - V. Paleri
- Department of Otolaryngology; Newcastle-Upon-Tyne Hospitals; Newcastle-Upon-Tyne UK
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Brugel L, Laurent M, Caillet P, Radenne A, Durand-Zaleski I, Martin M, Baron M, de Kermadec H, Bastuji-Garin S, Canouï-Poitrine F, Paillaud E. Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR). BMC Cancer 2014; 14:427. [PMID: 24923533 PMCID: PMC4081503 DOI: 10.1186/1471-2407-14-427] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/05/2014] [Indexed: 12/27/2022] Open
Abstract
Background Survival is poorer in elderly patients with head and neck squamous cell carcinomas [HNSCCs] than in younger patients. Possible explanations include a contribution of co-morbidities to mortality, frequent refusal of standard therapy, and the use of suboptimal treatments due to concern about toxicities. The Comprehensive Geriatric Assessment [CGA] is a multidimensional assessment of general health that can help to customise treatment and follow-up plans. The CGA has been proven effective in several health settings but has not been evaluated in randomised studies of patients with cancer. Our aim here was to assess the impact of the CGA on overall survival, function, and nutritional status of elderly patients with HNSCC. Methods/design EGeSOR is an open-label, multicentre, randomised, controlled, parallel-group trial in patients aged 70 years or older and receiving standard care for HNSCC. The intervention includes four components: the CGA conducted by a geriatrician before cancer treatment, participation of the same geriatrician in cancer treatment selection, a standardised geriatric therapeutic intervention designed by the same geriatrician; and geriatric follow-up for 24 months. The primary endpoint, assessed after 6 months, is a composite criterion including death, functional impairment [Activities of Daily Living score decrease ≥2], and weight loss ≥10%. Secondary endpoints include progression-free survival, unscheduled admissions, quality of life, treatment toxicities, costs, and completion of the planned cancer treatment. A centralised online system is used to perform 1:1 randomisation with a minimisation algorithm for centre, age, T and N stages, and tumour site [oral, oropharyngeal, hypopharyngeal, or laryngeal]. The estimated sample size is 704 patients, who are being recruited by 14 centres in 9 French cities. Discussion EGeSOR is the first randomised trial of the CGA in elderly cancer patients. We expect the CGA to have direct clinical benefits on the management of elderly patients with HNSCC. If this expectation is fulfilled, the trial may lead to modifications of the management model for elderly patients with cancer. Trial registration Trial registration:
NCT02025062
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Elena Paillaud
- AP-HP, hôpital Henri-Mondor, Département de Médecine Interne et Gériatrie, Unité d'Onco-Gériatrie, Créteil F-94010, France.
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Pauli N, Fagerberg-Mohlin B, Andréll P, Finizia C. Exercise intervention for the treatment of trismus in head and neck cancer. Acta Oncol 2014; 53:502-9. [PMID: 24175896 DOI: 10.3109/0284186x.2013.837583] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to investigate the impact of structured exercise with jaw mobilizing devices on trismus and its effect on trismus symptomatology and health-related quality of life (HRQL) in head and neck (H&N) cancer patients. MATERIAL AND METHODS Fifty patients with H&N cancer and trismus, i.e. maximum interincisal opening (MIO) ≤ 35 mm participated in a structured intervention program with jaw exercise. The patients in the intervention group underwent a 10-week exercise program with regular follow-up. A control group comprising of 50 patients with trismus and H&N cancer were matched to the intervention group according to gender, tumor location, tumor stage, comorbidity and age. HRQL and trismus-related symptoms were assessed. RESULTS The mean MIO improvement was 6.4 mm (4.8-8.0) and 0.7 (-0.3-1.7) mm in the intervention group and control group respectively, three months post-intervention commencement (p < 0.001). The intervention group demonstrated a statistically significant improvement in Role functioning, Social functioning and Global quality of life (EORTC QLQ C30) and in all Gothenburg Trismus Questionnaire (GTQ) domains, i.e. jaw-related problems (p < 0.001), eating limitation (p < 0.05) and muscular tension (p < 0.001). CONCLUSION We found that a structured jaw exercise program was effective and improved the mouth opening capacity significantly. The objective effect on trismus (MIO) was also reflected in the patient-reported outcome questionnaires where the patients who underwent the structured exercise program after cancer treatment reported improvements in HRQL and less trismus-related symptoms compared to the control group.
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Affiliation(s)
- Nina Pauli
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg University, Sweden
| | - Bodil Fagerberg-Mohlin
- Department of Oral and Maxillofacial Surgery, Faculty of Odontology, Gothenburg University, Sweden
| | - Paulin Andréll
- Department of Molecular and Clinical Medicine/Multidisciplinary Pain Centre Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg University, Sweden
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134
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Sarris EG, Harrington KJ, Saif MW, Syrigos KN. Multimodal treatment strategies for elderly patients with head and neck cancer. Cancer Treat Rev 2014; 40:465-75. [DOI: 10.1016/j.ctrv.2013.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 10/06/2013] [Accepted: 10/18/2013] [Indexed: 12/15/2022]
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135
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Rodrigues PC, Miguel MCC, Bagordakis E, Fonseca FP, de Aquino SN, Santos-Silva AR, Lopes MA, Graner E, Salo T, Kowalski LP, Coletta RD. Clinicopathological prognostic factors of oral tongue squamous cell carcinoma: a retrospective study of 202 cases. Int J Oral Maxillofac Surg 2014; 43:795-801. [PMID: 24583139 DOI: 10.1016/j.ijom.2014.01.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 12/05/2013] [Accepted: 01/29/2014] [Indexed: 01/08/2023]
Abstract
Although several histopathological parameters and grading systems have been described as predictive of the treatment response and outcome of oral squamous cell carcinoma (OSCC), none is universally accepted. A new scoring system, the histological risk model, was recently described to be a powerful predictive tool for recurrence and overall survival in OSCC. The aim of this study was to verify the predictive role of the histological risk model in a cohort of 202 patients at all stages of oral/mobile tongue squamous cell carcinoma (OTSCC). Demographic and clinical data were collected from the medical records and the tumours were evaluated using the histological risk model. Statistical analyses were performed using the χ(2) test, the Kaplan-Meier method, and the Cox regression model. The histological risk model showed no statistical correlation with demographic or clinical parameters and did not Predict the outcome of the OTSCC patients. However, multivariate regression analysis revealed a significant correlation of the clinical disease stage with the disease outcome. Despite major efforts to identify new predictive parameters and histological systems, clinical features are still the most reliable prognostic factors for patients with OTSCC.
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Affiliation(s)
- P C Rodrigues
- Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil
| | - M C C Miguel
- Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil; Department of Dentistry, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - E Bagordakis
- Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil
| | - F P Fonseca
- Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil
| | - S N de Aquino
- Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil
| | - A R Santos-Silva
- Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil
| | - M A Lopes
- Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil
| | - E Graner
- Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil
| | - T Salo
- Department of Diagnostics and Oral Medicine, Institute of Dentistry and Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland; Institute of Dentistry, University of Helsinki, Helsinki, Finland
| | - L P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - R D Coletta
- Department of Oral Diagnosis, School of Dentistry, State University of Campinas, Piracicaba, SP, Brazil.
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136
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Avery C. A perspective on the role of the pectoralis major flap in oral and maxillofacial oncology surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ors.12080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- C. Avery
- University Hospitals of Leicester; Leicester UK
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137
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Harréus U. Surgical errors and risks - the head and neck cancer patient. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc04. [PMID: 24403972 PMCID: PMC3884539 DOI: 10.3205/cto000096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery.
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Affiliation(s)
- Ulrich Harréus
- Department of Otolaryngology/Head and Neck Surgery, University Hospital Munich, Campus Grosshadern, Munich, Germany
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138
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Laryngeal cancer management in a small, rural, multidisciplinary team setting: 15-year review. The Journal of Laryngology & Otology 2013; 127:1203-7. [DOI: 10.1017/s0022215113003046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:The Cumberland Infirmary, Carlisle, serves a largely remote, rural population of 330 000. The aim of this study was to report the treatment and survival figures for patients treated for laryngeal cancer at this centre.Methods:The study included 209 consecutive patients with squamous cell carcinoma of the larynx diagnosed between 1996 and 2010 at the Cumberland Infirmary.Results:Disease-specific survival was 100 per cent for stage one, 76 per cent for stage two, 87 per cent for stage three and 46 per cent for stage four. In total, 76 patients (36 per cent) had a laryngectomy, either as primary treatment or as a salvage procedure.Conclusion:Our tumour-specific survival rate was very high, and this success may be due in part to high rates of surgical intervention. Survival data compared favourably with other centres, despite less radical radiotherapy regimes. Laryngeal cancer can be managed effectively in a small, relatively remote, multidisciplinary team setting.
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139
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Panzarella V, Pizzo G, Calvino F, Compilato D, Colella G, Campisi G. Diagnostic delay in oral squamous cell carcinoma: the role of cognitive and psychological variables. Int J Oral Sci 2013; 6:39-45. [PMID: 24287962 PMCID: PMC3967306 DOI: 10.1038/ijos.2013.88] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 06/26/2013] [Indexed: 11/09/2022] Open
Abstract
This retrospective study investigated, in two cohorts of subjects living in Southern Italy and awaiting treatment for oral squamous cell carcinoma (OSCC), the variables related to diagnostic delay ascribable to the patient, with particular reference to the cognitive and psychological ones. A total of 156 patients with OSCC (mean age: 62 years, M/F: 2.39∶1) were recruited at the Universities of Palermo and Naples. Risk factors related to patient delay included: sociodemographic, health-related, cognitive and psychological variables. The analysis was conducted by considering two different delay ranges: dichotomous (≤1 month vs. >1 month) and polytomous (<1 month, 1-3 months, >3 months) delay. Data were investigated by univariate and multivariate analyses and a P value ≤0.05 was considered statistically significant. For both delay measurements, the most relevant variables were: 'Personal experience of cancer' (dichotomous delay: P=0.05, odds ratio (OR)=0.33, 95% confidence interval (CI)=0.11-0.99; polytomous delay: P=0.006, Chi-square=10.224) and 'Unawareness' (dichotomous delay: P<0.01, OR=4.96, 95% CI=2.16-11.37; polytomous delay: P=0.087, Chi-square=4.77). Also 'Denial' (P<0.01, OR=6.84, 95% CI=2.31-20.24) and 'Knowledge of cancer' (P=0.079, Chi-square=8.359) were found to be statistically significant both for dichotomous and for polytomous categorization of delay, respectively. The findings of this study indicated that, in the investigated cohorts, the knowledge about cancer issues is strongly linked to the patient delay. Educational interventions on the Mediterranean population are necessary in order to increase the patient awareness and to emphasize his/her key role in early diagnosis of OSCC.
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Affiliation(s)
- Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Pizzo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Francesco Calvino
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Domenico Compilato
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Colella
- Department of Head/Neck Surgery, Oral Cavity and Audio/Verbal Communication, Second University of Naples, Naples, Italy
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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140
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Montero PH, Yu C, Palmer FL, Patel PD, Ganly I, Shah JP, Shaha AR, Boyle JO, Kraus DH, Singh B, Wong RJ, Morris LG, Kattan MW, Patel SG. Nomograms for preoperative prediction of prognosis in patients with oral cavity squamous cell carcinoma. Cancer 2013; 120:214-21. [DOI: 10.1002/cncr.28407] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/19/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Pablo H. Montero
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Changhong Yu
- Department of Quantitative Health Sciences; The Cleveland Clinic; Cleveland Ohio
| | - Frank L. Palmer
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Purvi D. Patel
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Ian Ganly
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Jatin P. Shah
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Ashok R. Shaha
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Jay O. Boyle
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Dennis H. Kraus
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Bhuvanesh Singh
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Richard J. Wong
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Luc G. Morris
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Michael W. Kattan
- Department of Quantitative Health Sciences; The Cleveland Clinic; Cleveland Ohio
| | - Snehal G. Patel
- Head and Neck Service, Department of Surgery; Memorial Sloan-Kettering Cancer Center; New York New York
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141
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Pauli N, Johnson J, Finizia C, Andréll P. The incidence of trismus and long-term impact on health-related quality of life in patients with head and neck cancer. Acta Oncol 2013. [PMID: 23193958 DOI: 10.3109/0284186x.2012.744466] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Trismus is a common symptom related to the treatment of head and neck (H&N) cancer. To date there are few prospective studies regarding the incidence of trismus and the patients' experience of trismus in daily life activities. The aim of the study was to assess the incidence of trismus in H&N cancer patients and the impact on health-related quality of life (HRQL), by evaluating the patients before and after oncological treatment. MATERIAL AND METHODS We used the criteria for trismus of maximum interincisal opening (MIO) ≤ 35 mm and measured the patients at several occasions before and after treatment during one year. The patients answered the HRQL questionnaires EORTC QLQ C30, EORTC QLQ H&N 35, Gothenburg Trismus Questionnaire (GTQ) and the Hospital Anxiety and Depression Scale (HADS). RESULTS The incidence of trismus was 9% pre-treatment and 28% at the one-year follow-up post-treatment. The highest incidence, 38%, was found six months post-treatment. Patients with tumours of the tonsils were most prone to develop trismus. Patients with trismus reported greater HRQL impairments with regard to the GTQ domains; mouth opening (p < 0.001), jaw-related problems (p < 0.05), eating limitations (p < 0.05) and muscular tension (p < 0.001) six months post-treatment. EORTC QLQ H&N 35 scores indicated clinically significantly more problems with dry mouth, swallowing and pain for patients with trismus, 6-12 months post-treatment. Furthermore, all patients reported pain, anxiety and depression pre- and post-treatment. CONCLUSION The incidence of trismus in patients with H&N cancer is non-negligible. Trismus severely impairs HRQL and negatively affects daily life activities in patients with H&N cancer. Further studies regarding symptomatic treatment of patients with trismus are highly warranted. The symptom-specific questionnaire GTQ is useful to identify the problems in this group of patients given it is responsive to showing change over time.
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Affiliation(s)
- Nina Pauli
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden.
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142
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Habbous S, Harland LTG, La Delfa A, Fadhel E, Xu W, Liu FF, Goldstein D, Waldron J, Huang SH, O'Sullivan B, Liu G. Comorbidity and prognosis in head and neck cancers: Differences by subsite, stage, and human papillomavirus status. Head Neck 2013; 36:802-10. [DOI: 10.1002/hed.23360] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/01/2013] [Accepted: 04/11/2013] [Indexed: 01/16/2023] Open
Affiliation(s)
- Steven Habbous
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Biostatistics; Princess Margaret Hospital; Toronto Ontario Canada
| | - Luke T. G. Harland
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
| | - Anthony La Delfa
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
| | - Ehab Fadhel
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
| | - Wei Xu
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Biostatistics; Princess Margaret Hospital; Toronto Ontario Canada
| | - Fei-Fei Liu
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Radiation Oncology; University of Toronto; Toronto Ontario Canada
| | - David Goldstein
- Department of Otolaryngology - Head and Neck Surgery; Princess Margaret Cancer Centre; University Health Network, University of Toronto; Toronto Ontario Canada
| | - John Waldron
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Radiation Oncology; University of Toronto; Toronto Ontario Canada
| | - Shao-Hui Huang
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Radiation Oncology; University of Toronto; Toronto Ontario Canada
| | - Brian O'Sullivan
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Radiation Oncology; University of Toronto; Toronto Ontario Canada
| | - Geoffrey Liu
- Department of Medicine, Medical Biophysics, and Epidemiology; Ontario Cancer Institute, Princess Margaret Hospital/University Health Network; Toronto Ontario Canada
- Department of Medical Biophysics and Epidemiology; Division of Epidemiology; Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
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143
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Ankola AA, Smith RV, Burk RD, Prystowsky MB, Sarta C, Schlecht NF. Comorbidity, human papillomavirus infection and head and neck cancer survival in an ethnically diverse population. Oral Oncol 2013; 49:911-917. [PMID: 23891528 DOI: 10.1016/j.oraloncology.2013.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/11/2013] [Accepted: 07/01/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To demonstrate the importance of comorbid conditions in head and neck squamous cell carcinoma (HNSCC), we assessed the association between comorbidity and survival in an inner-city population of HNSCC patients. PATIENTS AND METHODS Comorbid status at diagnosis was derived using medical records and the Adult Comorbidity Evaluation-27 (ACE-27) index on 288 patients with histologically confirmed HNSCC from Montefiore Medical Center in the Bronx (NY) between 2002 and 2011. The association between comorbidity, tumor human papillomavirus (HPV) status and overall and disease specific survival was assessed by Kaplan-Meier analysis and multivariable Cox regression adjusting for clinico-pathologic factors. RESULTS The study population consisted of primary oropharyngeal (36%), laryngeal (33%) and oral cavity cancer patients (31%). Overall, 19% had no comorbidity, 43% mild comorbidity, 29% moderate comorbidity, and 9% severe comorbidity. The most common comorbid conditions were hypertension, diabetes mellitus, respiratory disease, other malignancies, and illicit drug use. Survival analyses revealed that increased comorbidity at diagnosis was significantly related to poorer overall survival (p=0.016), but not to cancer survival (p=0.369) or recurrence (p=0.652). Oropharyngeal cancer patients with HPV DNA positive tumors and lower levels of comorbidity had significantly better overall survival compared to patients with HPV negative tumors (hazard ratio=0.2, 95%CI: 0.04-0.8), however there was no significant difference in overall (or disease specific) survival by HPV status among patients with higher levels of comorbidity at diagnosis (hazard ratio=0.7, 95%CI: 0.2-2.8). CONCLUSION In an inner-city predominantly minority population, comorbidity at HNSCC diagnosis is relatively common and associated with poor overall survival, but not cancer survival or recurrence. Interestingly, the relationship between HPV and improved survival appears to be specific to patients with low comorbidity at diagnosis.
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Affiliation(s)
- Ashish A Ankola
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Richard V Smith
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY 10461, United States; Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Robert D Burk
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, United States; Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY 10461, United States; Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine, Bronx, NY 10461, United States; Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Michael B Prystowsky
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Catherine Sarta
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Nicolas F Schlecht
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, United States; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, United States.
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144
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Montero-Miranda PH, Ganly I. Survivorship--competing mortalities, morbidities, and second malignancies. Otolaryngol Clin North Am 2013; 46:681-710. [PMID: 23910478 DOI: 10.1016/j.otc.2013.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mortality of head and neck cancer has declined in the United States over the past 20 years. This improvement has been linked to use of multimodality treatment of advanced disease. Despite this improvement, disease-specific survival remains low. Patients who survive head and neck cancer are exposed to morbidity and mortality secondary to the same factors as the general population. Factors related to cancer and cancer treatment predispose them to increased risk of mortality. Improvements in head and neck cancer treatment have led to a scenario where an increasing proportion of patients die from causes other than the primary cancer, called competing mortalities.
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Affiliation(s)
- Pablo H Montero-Miranda
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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145
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Peters TTA, van Dijk BAC, Roodenburg JLN, Plaat BEC, Wedman J, van der Laan BFAM, Halmos GB. Predictors of postoperative complications and survival in patients with major salivary glands malignancies: a study highlighting the influence of age. Head Neck 2013; 36:369-74. [PMID: 23765432 DOI: 10.1002/hed.23304] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to reveal prognostic factors for surgical complications and survival in young and elderly patients with malignant salivary gland tumors. METHODS Retrospective analysis of surgically treated patients with malignant major salivary gland tumors was performed. Of the 111 patients, 33 patients were 70 years or older and 78 patients were under 70. Comorbidity was recorded using the Adult Comorbidity Evaluation-27 index and complications using the Clavien-Dindo classification. RESULTS Comorbidity and complications were significantly more frequent in elderly patients (p < .05). Age, comorbidity, and length of surgery were not significant independent predictors of complications. Stage was the only independent predictive factor for postoperative complications and disease-specific survival. CONCLUSION Based on this retrospective analysis reviewing surgically treated patients, age alone should not be a reason to treat elderly patients differently, as it was not a predictor of either complications or disease-specific survival.
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Affiliation(s)
- Thomas T A Peters
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Graduate School of Medical Sciences (Groningen University Institute for Drug Exploration), University of Groningen, Groningen, The Netherlands
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146
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VanderWalde NA, Fleming M, Weiss J, Chera BS. Treatment of older patients with head and neck cancer: a review. Oncologist 2013; 18:568-78. [PMID: 23635557 DOI: 10.1634/theoncologist.2012-0427] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The incidence of head and neck cancer (HNC) in the elderly is increasing. The treatment of HNC often includes multimodality therapy that can be quite morbid. Older patients (herein, defined as ≥65 years) with HNC often have significant comorbidity and impaired functional status that may hinder their ability to receive and tolerate combined modality therapy. They have often been excluded from clinical trials that have defined standards of care. Therefore, tailoring cancer therapy for older patients with HNC can be quite challenging. In this paper, we performed a comprehensive literature review to better understand and discuss issues related to therapeutic recommendations that are particular to patients 65 years and older. Evidence suggests that older patients have similar survival outcomes compared with their younger peers; however, they may experience worse toxicity, especially with treatment intensification. Similarly, older patients may require more supportive care throughout the treatment process. Future studies incorporating geriatric tools for predictive and interventional purposes will potentially allow for improved patient selection and tolerance to intensive treatment.
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Affiliation(s)
- Noam A VanderWalde
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, USA
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147
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Halmos GB, Peters TTA, Roodenburg JLN, van Dijk BAC, van der Laan BFAM. Comorbidity, complications, and survival of sinonasal malignancies in young and elderly treated by surgery. Otolaryngol Head Neck Surg 2013; 148:860-6. [PMID: 23389240 DOI: 10.1177/0194599813477354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Sinonasal malignancies are uncommon neoplasms with several histological subtypes, most commonly treated with surgery and postoperative radiotherapy. The aim of this study was to evaluate complications and survival, focusing on differences between elderly and younger patients undergoing surgery. STUDY DESIGN Historical cohort based on medical records. SETTING Tertial referral center. SUBJECTS AND METHODS Medical charts of 103 surgically treated patients (71 patients younger than 70 years and 32 patients aged 70 years and older) in a tertiary referral center with sinonasal malignancy were retrospectively analyzed. Comorbidity was scored according to the Adult Comorbidity Evaluation 27 system. Treatment outcomes were analyzed by collecting treatment-related complications scores and survival data. RESULTS Although comorbidity was more common in elderly patients, no significant differences were recorded in complications. In multivariate analysis, length of surgery was the only predictor for complication. Furthermore, no significant differences were seen in disease-specific survival and recurrence in young and elderly patients. Young patients with malignant epithelial tumors and melanoma had worse overall survival than patients with other histological subtypes. However, in elderly patients, no significant differences were seen in survival between histological subtypes. CONCLUSION For complications, survival, and recurrence, no differences were seen between young and elderly patients. Based on this study, surgery can also be safely performed in elderly sinonasal cancer patients after careful preoperative evaluation and patient selection.
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Affiliation(s)
- Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, the Netherlands.
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Bøje CR, Dalton SO, Grønborg TK, Primdahl H, Kristensen CA, Andersen E, Johansen J, Andersen LJ, Overgaard J. The impact of comorbidity on outcome in 12 623 Danish head and neck cancer patients: a population based study from the DAHANCA database. Acta Oncol 2013; 52:285-93. [PMID: 23320773 DOI: 10.3109/0284186x.2012.742964] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is primarily caused by smoking and alcohol. Besides having a carcinogenic effect, smoking also leads to other diseases and thus contributes to a high prevalence of comorbidities among HNSCC patients. Furthermore, the world population is becoming older resulting in more elderly patients with HNSCC. The aim of this study was to investigate the prevalence and impact of comorbidity in a retrospective nationwide population-based study of all Danish HNSCC patients diagnosed from 1992 to 2008. MATERIAL AND METHODS A total of 12 623 patients diagnosed with HNSCC in the period from 1992 to 2008 were identified through the Danish Head and Neck Cancer group (DAHANCA) database. By linking to the Danish registers, information on somatic comorbidity present prior to the HNSCC diagnosis was obtained and adapted to the Charlson Comorbidity Index (CCI). The influence of comorbidity on overall survival and cancer specific death was evaluated and the type and prevalence of comorbidity described. RESULTS In total, 36% of patients had comorbidity according to CCI. Increasing age was significantly associated with increasing CCI. In multivariate analyses, the CCI score remained a strong independent prognostic factor for overall survival, the HR being 1.16 (95% CI 1.08; 1.25), 1.34 (1.22; 1.46), 1.63 (1.51; 1.80) for patients with CCI score 1, 2, and 3+, respectively. The CCI score did not influence cancer specific death. CONCLUSION Comorbidity is common among HNSCC patients and has a negative prognostic impact on overall survival. Cancer specific death was not affected by comorbidity suggesting that patients die from their comorbidities rather than their cancer. In the future, more elderly patients with comorbidity will require treatment which will demand a change in the healthcare system with a multidisciplinary approach required in order to take care of both their cancer and their comorbidities.
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149
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de Monès E, Vergez S, Barry B, Righini C, Rolland F, Raoul G, Langeard M, Chassagne JF, Badoual C, Morinière S, de Raucourt D. Initial staging for squamous cell carcinoma of the mouth, larynx and pharynx (except nasopharynx). Part 3: general assessment. 2012 SFORL recommendations. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:165-72. [PMID: 23332168 DOI: 10.1016/j.anorl.2012.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 09/13/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The French Society of Otorhinolaryngology (SFORL) set up a work group to draw up guidelines for initial staging of head and neck squamous cell carcinoma. Locoregional and remote extension assessment are dealt with in two separate reports. The present part 3 deals with the assessment of frequent associated symptoms and pathologies, requiring early treatment and the collection of data on a certain number of clinical and paraclinical parameters for therapeutic decision-making in the multidisciplinary team meeting. MATERIALS AND METHODS A multidisciplinary critical analysis of the literature was conducted. General assessment here covers screening, assessment and initial management of the following: usual risk factors (smoking, alcohol, HPV), the most frequent medical comorbidities, nutritional status, social and psychological status, dental status, pain and possible anemia. As oncologic management frequently associates surgery, radiation therapy and chemotherapy, the underlying examinations should be early, as part of initial staging. The levels of evidence for the examinations were estimated so as to grade guidelines, failing which expert consensuses were established. RESULTS The high rates of pain, malnutrition and anemia call for systematic screening and early management, especially as rapidly effective treatments exist. Assessing comorbidity and social and psychological status enables general health status to be assessed, along with possible contraindications to the usual treatments. Tracheal intubation problems may require intubation under flexible endoscopy or jet-ventilation by inter-cricothyroid catheterization from the diagnostic endoscopy stage. Assessment and adapted dental care should be conducted if radiation therapy is likely or certain. CONCLUSION Early management of symptoms and comorbidity and anticipation of subsequent treatment are intended to shorten initial staging time and to collate the data needed for therapeutic decision-making. This assessment should be performed at the same time as the locoregional and remote extension assessment, and is obviously to be adapted according to tumoral extension stage and the possible treatment options.
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Affiliation(s)
- E de Monès
- Service d'ORL et de Chirurgie Cervico-Faciale, Centre François-Xavier-Michelet, Groupe Hospitalier Pellegrin, CHU, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Østhus AA, Aarstad AKH, Olofsson J, Aarstad HJ. Comorbidity is an independent predictor of health-related quality of life in a longitudinal cohort of head and neck cancer patients. Eur Arch Otorhinolaryngol 2012; 270:1721-8. [DOI: 10.1007/s00405-012-2207-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/19/2012] [Indexed: 01/27/2023]
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