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Saravia A, Kong KA, Roy R, Barry R, Guidry C, McDaniel LS, Raven MC, Pou AM, Mays AC. Referral Patterns of Outpatient Palliative Care among the Head and Neck Cancer Population. Int Arch Otorhinolaryngol 2022; 26:e538-e547. [DOI: 10.1055/s-0041-1741436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/23/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Patients with head and neck cancer (HNC) experience unique physical and psychosocial challenges that impact their health and quality of life. Early implementation of palliative care has been shown to improve various health care outcomes.
Objective The aim of the present study was to evaluate the patterns of referral of patients with HNC to outpatient palliative care as they relate to utilization of resources and end-of-life discussions.
Methods We performed a retrospective review of 245 patients with HNC referred to outpatient palliative care services at two Louisiana tertiary care centers from June 1, 2014, to October 1, 2019. The control group consisted of those that were referred but did not follow-up. Reasons for referral were obtained, and outcome measures such as emergency department (ED) visits, hospital readmissions, and advance care planning (ACP) documentation were assessed according to predictive variables.
Results There were 177 patients in the treatment group and 68 in the control group. Patients were more likely to follow up to outpatient palliative care services if referred for pain management. Hospital system, prior inpatient palliative care, and number of outpatient visits were associated with an increased likelihood for ED visits and hospital readmissions. Those in the palliative care treatment group were also more likely to have ACP discussions.
Conclusion Early implementation of outpatient palliative care among patients with HNC can initiate ACP discussions. However, there are discrepancies in referral reasons to palliative care and continued existing barriers to its effective utilization.
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Affiliation(s)
- Ari Saravia
- Louisiana State University School of Medicine, New Orleans, Louisiana, United States
| | - Keonho Albert Kong
- Department of Otolaryngology, University of North Carolina-Chapel Hill , Chapel Hill, North Carolina USA
| | - Ryan Roy
- Louisiana State University School of Medicine, New Orleans, Louisiana, United States
| | - Rachel Barry
- Barry Ear Nose and Throat. 4212 W Congress St, Suite 1500, Lafayette, Louisiana, USA
| | - Christine Guidry
- Department of Palliative Medicine, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States
| | - Lee S. McDaniel
- Department of Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
| | - Mary C. Raven
- Department of Palliative Medicine, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, United States
| | - Anna M. Pou
- Oschner Health System, New Orleans, Louisiana, USA
| | - Ashley C. Mays
- Department of Otolaryngology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States
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2
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Snow GE, Byrne P, Stewart CM, Eisele DW, Wright SM, Akst LM. Clinical Excellence in Otolaryngology-Head and Neck Surgery: Examples from the Published Literature. Laryngoscope 2021; 131:E2153-E2158. [PMID: 33751585 DOI: 10.1002/lary.29511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/HYPOTHESIS To apply the domains of clinical excellence, as published by the Miller-Coulson Academy of Clinical Excellence, to the field of otolaryngology-head and neck surgery (OHNS) as a framework for evaluating and improving clinical excellence. METHODS A search of PubMed, Scopus, the Cochrane Library, and the National Institute for Health and Care Excellence (NICE) databases was performed and 229 publications were reviewed. RESULTS Case reports and other articles were selected that exemplify each of the distinct domains of clinical excellence within our specialty. CONCLUSIONS The Miller-Coulson Academy's domains of clinical excellence are relevant to OHNS and can provide a framework for fostering clinical excellence in otolaryngologists. The many examples of excellent care by otolaryngologists found in the published literature can inspire otolaryngologists to provide outstanding care to all patients consistently and to advance our specialty. LEVEL OF EVIDENCE N/A Laryngoscope, 131:E2153-E2158, 2021.
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Affiliation(s)
- Grace E Snow
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Patrick Byrne
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - C Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Scott M Wright
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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3
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Sooby P, Tarmal A, Townsley R. Management of catastrophic haemorrhage in palliative head and neck cancer: creation of a new protocol using simulation. BMJ Open Qual 2020; 9:bmjoq-2020-001003. [PMID: 33139295 PMCID: PMC7607599 DOI: 10.1136/bmjoq-2020-001003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/15/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022] Open
Abstract
Catastrophic haemorrhage or carotid blowout a rare but devastating consequence of head and neck cancer. In most cases, this represents a terminal event, and the patient is prescribed pre-emptive analgesia and anxiolytics. There is anecdotal evidence that due to the time taken to prepare the medications that patients do not receive these drugs prior to death. We aimed to identify the drug to patient time using simulated catastrophic haemorrhage simulations. We used the current protocol for this and also proposed a new grab-bag with preprepared anxiolytic and anagelsic medications. Each scenario was repeated 16 times. The mean time for drug administration using the current policy was 124 s compared with 48 s when the grab-bag was used (p<0.01). The new protocol also reduced the variability in the drug to patient time. We aim to implement this new protocol on the head and neck ward.
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Affiliation(s)
- Paul Sooby
- ENT, NHS Ayrshire and Arran, Ayr, UK .,ENT, Queen Elizabeth University Hospital, Glasgow, UK
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Sekiguchi Koyama M, Ueha R, Goto T, Sato T, Tachibana A, Mizumoto Y, Nito T, Yamasoba T. Aspiration Prevention Surgery under Local Anesthesia for Palliative Care in Patients with Head and Neck Cancer: A Report of Two Cases. ORL J Otorhinolaryngol Relat Spec 2020; 83:52-58. [PMID: 33075797 DOI: 10.1159/000510800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/10/2020] [Indexed: 11/19/2022]
Abstract
Aspiration prevention (AP) surgery may improve the quality of life (QOL) of patients with severe dysphagia. However, not all patients can endure this type of surgery under general anesthesia because of their poor status. Herein, we describe the cases of 2 patients with head and neck cancer (HNC) who underwent AP surgery for palliative care. Although both patients had tracheostomy due to severe dysphagia and respiratory impairment and frequently needed suction, they were successfully managed with AP surgery under local anesthesia. A tracheostoma was reshaped to be sufficiently large for an airway to be secured without a cannula. Their respiratory failure gradually improved, and suction frequency markedly decreased after surgery; thus, they could receive medical treatment at home. When patients with HNC under palliative care have a tracheal cannula and cannot vocalize, AP surgery under local anesthesia is an option to improve their QOL.
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Affiliation(s)
| | - Rumi Ueha
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan,
| | - Takao Goto
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Taku Sato
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Akane Tachibana
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Yui Mizumoto
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Takaharu Nito
- Department of Otolaryngology, Saitama Medical Center, Saitama, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
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5
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Vengaloor Thomas T, Packianathan S, Ahmed HZ, Joseph S, Bhanat E, Mundra EK, Kuruvilla TP, Vijayakumar S. Role of concurrent chemoradiotherapy and stereotactic body radiation treatment for palliation of previously untreated head and neck cancers. PRECISION RADIATION ONCOLOGY 2020. [DOI: 10.1002/pro6.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Toms Vengaloor Thomas
- Department of Radiation OncologyUniversity of Mississippi Medical Center Jackson Mississippi USA
| | - Satyaseelan Packianathan
- Department of Radiation OncologyUniversity of Mississippi Medical Center Jackson Mississippi USA
| | - Hiba Zarah Ahmed
- Department of Radiation OncologyUniversity of Mississippi Medical Center Jackson Mississippi USA
| | - Sanjay Joseph
- Department of Radiation OncologyUniversity of Mississippi Medical Center Jackson Mississippi USA
| | - Eldrin Bhanat
- Department of Radiation OncologyUniversity of Mississippi Medical Center Jackson Mississippi USA
| | - Eswar K Mundra
- Department of Radiation OncologyUniversity of Mississippi Medical Center Jackson Mississippi USA
| | | | - Srinivasan Vijayakumar
- Department of Radiation OncologyUniversity of Mississippi Medical Center Jackson Mississippi USA
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Rohde RL, Adjei Boakye E, Challapalli SD, Patel SH, Geneus CJ, Tobo BB, Simpson MC, Mohammed KA, Deshields T, Varvares MA, Osazuwa-Peters N. Prevalence and sociodemographic factors associated with depression among hospitalized patients with head and neck cancer-Results from a national study. Psychooncology 2018; 27:2809-2814. [DOI: 10.1002/pon.4893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/04/2018] [Accepted: 09/13/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - Eric Adjei Boakye
- Saint Louis University Center for Health Outcomes Research; St Louis Missouri
| | | | - Shivam H. Patel
- Saint Louis University School of Medicine; St Louis Missouri
| | - Christian J. Geneus
- Department of Biostatistics and Bioinformatics; Tulane University School of Public Health and Tropical Medicine; New Orleans Louisiana
| | - Betelihem B. Tobo
- Department of Epidemiology and Biostatistics; Saint Louis University College for Public Health and Social Justice; St Louis Missouri
| | - Matthew C. Simpson
- Department of Otolaryngology; Harvard Medical School, Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Kahee A. Mohammed
- Department of Internal Medicine; Saint Louis University School of Medicine; St Louis Missouri
| | - Teresa Deshields
- Department of Medicine; Washington University School of Medicine; St Louis Missouri
| | - Mark A. Varvares
- Department of Otolaryngology; Harvard Medical School, Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology and Biostatistics; Saint Louis University College for Public Health and Social Justice; St Louis Missouri
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St Louis Missouri
- Saint Louis University Cancer Center; St Louis Missouri
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Makler V, Litt JS, Litofsky NS. Palliative Coverage of Cranial Defect following Failed Cranial Flap for Advanced Squamous Cell Carcinoma: Case Report. J Palliat Med 2018; 21:109-113. [DOI: 10.1089/jpm.2017.0258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Vyacheslav Makler
- Division of Neurological Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jeffrey S. Litt
- Division of Acute Care Surgery, University of Missouri School of Medicine, Columbia, Missouri
| | - N. Scott Litofsky
- Division of Neurological Surgery, University of Missouri School of Medicine, Columbia, Missouri
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8
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Bishnoi R, Bennett J, Reisman DN. Palliative treatment of patients with inoperable locally advanced, recurrent or metastatic head and neck squamous cell cancer, using a low-dose and personalized chemotherapeutic regimen. Oncol Lett 2017; 13:4633-4640. [PMID: 28588721 PMCID: PMC5452905 DOI: 10.3892/ol.2017.6068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/13/2017] [Indexed: 11/29/2022] Open
Abstract
Inoperable or metastatic head and neck squamous cell cancer (HNSCC) is known to be associated with a poor patient prognosis. First line therapies include a Taxol, platinum-based antineoplastic and fluorouracil (FU) treatment regimen (TPF) or a platinum-based antineoplastic, FU and EGFR inhibitor treatment regimen (PFE). The toxicity of these regimens is one of the major limiting factors, particularly for palliative treatment. The present study is a retrospective study of 15 patients with HNSCC, where the treatment goal was palliative. Of the 15 patients, 8 received a TPF, while 7 received a PFE. A total of 129 treatment cycles were administered with a median of 9 cycles (range, 3–14). Chemotherapy began with low doses and was subsequently titrated up based on tolerance and response. Positive responses were noted with the lower doses compared with the conventional doses, and maximal doses were not required. The median dose of cisplatin, paclitaxel and 5-FU administered was 40 mg/m2, 80 mg/m2 and 360 mg/m2/day for 5 days, respectively. Cetuximab was used at a standard dose. At the initial follow-up (mean, 64 days; 3 cycles), a 100% disease control rate (DCR) and 80% overall response rate (ORR) was achieved. A positive response, 60% DCR and 60% ORR, was maintained until the late stages of the study (mean, 217 days; 9 cycles). Following termination of chemotherapy after >9 cycles, 4 patients remained disease free for ~1 year. A total of 3 patients exhibited a pathologic complete response despite radiologically exhibiting residual disease. The median progression-free survival time was 10.03 months and the overall survival time was 15.77 months. The only grade 3 hematologic toxicity noted was neutropenia in 3 (20%) patients. Grade 3 vomiting was noted in 1 (6.67%) patient and grade 3 stomatitis was noted in 1 (6.67%) patient. Due to low toxicity patients exhibited improved tolerance to this approach, particularly in terms of palliative care. Furthermore, these results are in contrast to the axiom that increased doses are more effective.
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Affiliation(s)
- Rohit Bishnoi
- Division of Hospital Medicine, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jeffery Bennett
- Department of Radiology, University of Florida, Gainesville, FL 32610, USA
| | - David N Reisman
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
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9
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Schwam ZG, Burtness B, Yarbrough WG, Mehra S, Husain Z, Judson BL. National treatment patterns in patients presenting with Stage IVC head and neck cancer: analysis of the National Cancer Database. Cancer Med 2015; 4:1828-35. [PMID: 26471244 PMCID: PMC5123708 DOI: 10.1002/cam4.546] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/31/2015] [Accepted: 09/02/2015] [Indexed: 01/17/2023] Open
Abstract
Head and neck cancer patients presenting with distant metastases are generally considered incurable. Treatment patterns and survival by primary disease site and therapy have not been described. Retrospective cohort analysis of 2525 patients in the National Cancer Database (2003–2006). Kaplan–Meier and Cox proportional hazards analyses were performed. Combined locoregional and systemic therapy was the most common treatment regimen (39.2%), followed by no treatment (23.9%), locoregional (19.0%), and systemic treatment (17.8%). Multivariate analysis demonstrated decreased survival was associated with age 65–79 years hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.14–1.80), Medicaid/uninsured status (HR 1.27, 95% CI 1.13–1.42), Medicare/other government insurance (HR 1.21, 95% 1.07–1.38), treatment at a nonacademic/research program (HR 1.17, 95% CI 1.07–1.27), and Charlson comorbidity score of 1 (HR 1.33, 95% 1.19–1.48). Compared to systemic therapy alone, receiving locoregional and systemic therapy was associated with decreased risk of death (HR 0.73, 95% CI 0.65–0.83). Only 14.6% and 0.6% of patients were recorded as receiving palliative therapy or being enrolled in a clinical trial, respectively. Significant treatment diversity exists in distantly metastatic head and neck cancer. Those who received combination locoregional and systemic therapy were more likely to have improved overall survival, but important factors in treatment selection are unknown. A small proportion of patients was found to receive either palliative therapy or was enrolled in a clinical trial, although these data likely underestimate the true proportions.
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Affiliation(s)
- Zachary G Schwam
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Barbara Burtness
- Department of Internal Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Wendell G Yarbrough
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Saral Mehra
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
| | - Zain Husain
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Benjamin L Judson
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut
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10
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Aspiration Pneumonia in the Geriatric Population. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients. Support Care Cancer 2015; 23:3249-55. [PMID: 25832897 DOI: 10.1007/s00520-015-2720-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/23/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Oral symptoms can be a sign of an underlying systemic condition and have a significant impact on quality of life, nutrition, and cost of care, while these lesions are often studied in the context of cancer treatment. However, information regarding oral symptoms in advanced cancer patients is poor. The aim of this multicenter study was to determine the prevalence and the characteristics of oral symptoms in a large population of advanced cancer patients. METHODS A consecutive sample of patients with advanced cancer for a period of 6 months was prospectively assessed for an observational study. At time of admission, the epidemiological characteristics, surgery-radiotherapy of head and neck, and oncologic treatments in the last month were recorded. The presence of mucositis, dry mouth, and dysphagia was assessed by clinical examination and patients' report and their intensity recorded. Patients were also asked whether they had limitation on nutrition of hydration due to the local condition. RESULTS Six hundred sixty-nine patients were surveyed in the period taken into consideration. The mean age was 72.1 years (SD 12.3), and 342 patients were males. The primary tumors are listed in Table 1. The prevalence of mucositis was 22.3 %. The symptom relevantly reduced the ingestion of food or fluids and was statistically associated with the Karnofsky level and head and neck cancer. The prevalence of dry mouth was 40.4 %, with a mean intensity of 5.4 (SD 2.1). Several drugs were concomitantly given, particularly opioids (78 %), corticosteroids (75.3 %), and diuretics (70.2 %). Various and nonhomogeneous treatments were given for dry mouth, that was statistically associated with current or recent chemotherapy, and hematological tumors. The prevalence of dysphagia was 15.4 % with a mean intensity of 5.34 (SD 3). Dysphagia for liquids was observed in 52.4 % of cases. A high level of limitation for oral nutrition due to dysphagia was found, and in 53.4 % of patients, alternative routes to the oral one were used. Dysphagia was statistically associated with the Karnofsky level and head and neck cancer. A strong relationship between the three oral symptoms was found. CONCLUSION In advanced cancer patients, a range of oral problems significantly may impact on the physical, social, and psychological well-being of advanced cancer patients to varying degrees. These symptoms should be carefully assessed early but become imperative in the palliative care setting when they produce relevant consequences that may be life-threatening other than limiting the daily activities, particularly eating and drinking.
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de Almeida JR, Villanueva NL, Moskowitz AJ, Miles BA, Teng MS, Sikora A, Gupta V, Posner M, Genden EM. Preferences and utilities for health states after treatment for oropharyngeal cancer: Transoral robotic surgery versus definitive (chemo)radiotherapy. Head Neck 2014; 36:923-33. [DOI: 10.1002/hed.23340] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 01/01/2013] [Accepted: 04/05/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- John R. de Almeida
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Nathaniel L. Villanueva
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Alan J. Moskowitz
- Departments of Health Evidence and Policy and Medicine; Mount Sinai Medical Center; New York New York
| | - Brett A. Miles
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Marita S. Teng
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Andrew Sikora
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Vishal Gupta
- Department of Radiation Oncology; Mount Sinai Medical Center; New York New York
| | - Marshall Posner
- Department of Medical Oncology; Mount Sinai Medical Center; New York New York
| | - Eric M. Genden
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
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13
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McLarnon C, Kulloo P, Mehanna H, Kelly C, Paleri V. Quality-of-life considerations in treatment of unresectable, recurrent head and neck cancer. Expert Rev Anticancer Ther 2014; 10:345-52. [DOI: 10.1586/era.10.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Chibly AM, Nguyen T, Limesand KH. Palliative Care for Salivary Gland Dysfunction Highlights the Need for Regenerative Therapies: A Review on Radiation and Salivary Gland Stem Cells. ACTA ACUST UNITED AC 2014; 4. [PMID: 26693098 DOI: 10.4172/2165-7386.1000180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Radiotherapy remains the major course of treatment for Head and Neck cancer patients. A common consequence of radiation treatment is dysfunction of the salivary glands, which leads to a number of oral complications including xerostomia and dysphagia, for which there is no existent cure. Here, we briefly describe the current palliative treatments available for patients undergoing these conditions, such as oral lubricants, saliva substitutes, and saliva stimulants. None of these options achieves restoration of normal quality of life due to their limited effectiveness, and in some cases, adverse side effects of their own. Other therapies under development, such as acupuncture and electrostimulation have also yielded mixed results in clinical trials. Due to the ineffectiveness of palliative care to restore quality of life, it is reasonable to aim for the development of regenerative therapies that allow restoration of function of the salivary epithelium following radiation treatment. Adult stem cells are a necessary component of wound healing, and play important roles in preserving normal function of adult tissues. Thus, the present review mainly focuses on the effects of radiation on adult stem cells in a variety of tissues, which may be at play in the response of salivary glands to radiation treatment. This is of clinical importance because progenitor cells of the salivary glands have shown partial regenerative potential in mouse transplantation assays. Therefore, understanding how these progenitor cells are affected by radiation offers potential for development of new therapies for patients with xerostomia.
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Affiliation(s)
| | - Thao Nguyen
- The University of Arizona Nutritional Sciences Graduate Program, Tucson, AZ 85721, USA
| | - Kirsten H Limesand
- The University of Arizona Nutritional Sciences Graduate Program, Tucson, AZ 85721, USA
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Yang CH, Chiu YW, Huang CT, Haung YW, Chuang HY. A comprehensive approach in hospice shared care in Taiwan: Nonelderly patients have more physical, psychosocial and spiritual suffering. Kaohsiung J Med Sci 2013; 29:444-50. [DOI: 10.1016/j.kjms.2012.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022] Open
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16
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Wiegand S, Zimmermann AP, Müller HH, Werner JA, Sesterhenn AM. Incurable recurrences in patients with oropharyngeal and hypopharyngeal carcinomas. Head Neck 2013; 36:231-4. [PMID: 23766100 DOI: 10.1002/hed.23289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Carcinomas of the oropharyngeal and hypopharynx are difficult to treat because of their aggressive tendency to metastasize and their high recurrence rate. METHODS A retrospective review of 79 patients with recurrences of oropharyngeal or hypopharyngeal carcinomas was performed. The courses of disease from recurrence diagnosis to the valuation date or death were analyzed. RESULTS The median survival for patients classified as incurable at recurrence diagnosis amounted to 8 months (95% confidence interval [CI], 5-10 months), patients initially classified as curable at the time of recurrence diagnosis survived an estimated 12 months (95% CI, 8-22 months). No significant differences regarding the survival after diagnosed recurrence could be observed depending on the tumor location or tumor stage. CONCLUSION The knowledge about the courses of disease and especially the remaining lifetime after diagnosed incurability could facilitate the planning of the remaining lifetime in order to achieve the best possible quality of life.
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Affiliation(s)
- Susanne Wiegand
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Giessen and Marburg, Marburg, Germany
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17
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Hjermstad MJ, Bergenmar M, Fisher SE, Montel S, Nicolatou-Galitis O, Raber-Durlacher J, Singer S, Verdonck-de Leeuw I, Weis J, Yarom N, Herlofson BB. The EORTC QLQ-OH17: A supplementary module to the EORTC QLQ-C30 for assessment of oral health and quality of life in cancer patients. Eur J Cancer 2012; 48:2203-11. [DOI: 10.1016/j.ejca.2012.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/02/2012] [Accepted: 04/08/2012] [Indexed: 11/16/2022]
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18
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Gold D. The Psychosocial Care Needs of Patients with HPV-Related Head and Neck Cancer. Otolaryngol Clin North Am 2012; 45:879-97. [DOI: 10.1016/j.otc.2012.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Shuman AG, Fins JJ, Prince ME. Improving end-of-life care for head and neck cancer patients. Expert Rev Anticancer Ther 2012; 12:335-43. [PMID: 22369325 DOI: 10.1586/era.12.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite improvements in the treatment of head and neck cancer, many patients still succumb to their disease. A litany of medical, psychosocial and ethical challenges arise in managing the end-of-life experiences within this patient population. In this article, we attempt to review existing data about the end-of-life experiences of this cohort, extrapolate relevant data from other cancer patients, and suggest the most promising avenues for additional research and practice improvement for terminal head and neck cancer patients. Clinical decision-making for patients dying of head and neck cancer requires proactive consideration of quality of life, functionality, symptom control and other patient-centered objectives, and frequently benefits from palliative care team involvement. Additional research aimed toward optimizing the end of life experience of head and neck cancer patients and their families is greatly needed.
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Affiliation(s)
- Andrew G Shuman
- Division of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
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Quintyne KI, Baker S, Wallis F, Shine N, Gupta R. Advanced and rapidly progressing head and neck cancer: good palliation following intralesional bleomycin. BMJ Case Rep 2011; 2011:bcr.08.2011.4599. [PMID: 22679261 DOI: 10.1136/bcr.08.2011.4599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors herein report the case of a 61-year-old man undergoing adjuvant therapy for locally advanced laryngeal cancer, who developed parastomal recurrence in his radiation field around his tracheotomy site, while he was undergoing radiation therapy, and compromised the secure placement of his tracheotomy tube and maintenance of his upper airway. MRI restaging and biopsy confirmed recurrence and progressive disease in his mediastinum. He underwent local therapy with intralesional bleomycin with good palliation, and ability to maintain the patency of his upper airway.
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Affiliation(s)
- Keith Ian Quintyne
- Department of Medical Oncology, Mid-Western Regional Hospital, Limerick, Ireland.
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Shuman AG, Yang Y, Taylor JMG, Prince ME. End-of-life care among head and neck cancer patients. Otolaryngol Head Neck Surg 2011; 144:733-9. [PMID: 21493350 DOI: 10.1177/0194599810397603] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study is designed to (1) determine the perceived quality of care received by patients with head and neck cancer at the end of their lives, in order to (2) better anticipate and improve upon the experiences of future patients. STUDY DESIGN Cross-sectional survey. SETTING Single-institution, academic tertiary care medical center. SUBJECTS AND METHODS A validated survey instrument, the Family Assessment of Treatment at the End of life (FATE), was administered to families of patients who died of head and neck cancer (n = 58). The primary outcome was the overall FATE score. Independent variables included clinical characteristics, treatments received, and the care provided at the time of death. RESULTS Overall FATE scores and the domains assessing management of symptoms and care at the time of death did not vary by disease status (logoregional vs distant metastasis) at the end of life (P = .989). The location of death in the home or in hospice (vs hospital) significantly improves scores in all 3 categories (P = .023). Involvement of a palliative care team improved the care at the time of death (P < .001), and palliative treatments (radiation and/or chemotherapy) improved scores in managing symptoms and care at the time of death (P = .011, P = .017). CONCLUSION The FATE survey is a useful measure of the end-of-life experience of head and neck cancer patients. Palliative treatments of head and neck cancer, death outside of the hospital, and palliative care team involvement all improve the end-of-life experience in this population.
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Affiliation(s)
- Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.
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Ledeboer QCP, van der Schroeff MP, Pruyn JFA, de Boer MF, Baatenburg de Jong RJ, van der Velden LA. Survival of patients with palliative head and neck cancer. Head Neck 2010; 33:1021-6. [DOI: 10.1002/hed.21572] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/18/2010] [Accepted: 07/09/2010] [Indexed: 11/07/2022] Open
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Khalilur R, Hayashi K, Shibuya H. Brachytherapy for tongue cancer in the very elderly is an alternative to external beam radiation. Br J Radiol 2010; 84:747-9. [PMID: 20682593 DOI: 10.1259/bjr/23130739] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The result of curative treatment for very elderly patients with tongue carcinoma has not been reported to date. We retrospectively reviewed the results of brachytherapy in 125 the patients aged over 75 years. METHODS The results of brachytherapy in 125 patients, 75 years old or older, with Stage I or II squamous cell carcinoma of the oral tongue were reviewed. The 125 cases consisted of 31 Stage I and 94 Stage II cases; 67 patients were under 80 years old and 58 were over 80 years old. All patients were treated using low-dose-rate brachytherapy ((198)Au/(222)Rn: 59 cases; (192)Ir: 38 cases; (226)Ra/(137)Cs: 28 cases). RESULTS None of the patients stopped treatment during the course of brachytherapy. The 3 year and 5 year control rates of the primary lesions were both 86%. Post-brachytherapy neck node metastasis was diagnosed in 43 cases and radical neck dissection was performed for 24 cases (21 of the 24 cases were under 80 years old). As a result, the 7 year disease-specific survival (DSS) rate for patients aged under 80 years old was 70% and 41% for those over 80 years old (p = 0.03). CONCLUSION The brachytherapy for elderly patients with tongue cancer was safe, and the control of the primary lesion was almost the same as in younger patients. However, modalities available to treat neck node metastasis are limited. More conservative surgical approaches combined with post-operative irradiation may be advocated for neck node metastasis for elderly patients with tongue cancer.
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Affiliation(s)
- R Khalilur
- Department of Radiology, Tokyo Medical and Dental University, 5-45, Yushima 1-chome, Bunkyo-ku, Tokyo 113-8519, Japan
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Goal processes & self-efficacy related to psychological distress in head & neck cancer patients and their partners. Eur J Oncol Nurs 2010; 14:231-7. [DOI: 10.1016/j.ejon.2010.01.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 12/28/2009] [Accepted: 01/24/2010] [Indexed: 10/19/2022]
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Becker S, Kirchberger I, Cieza A, Berghaus A, Harréus U, Reichel O, Tschiesner U. Content validation of the Comprehensive ICF Core Set for Head and Neck Cancer (HNC): the perspective of psychologists. Psychooncology 2009; 19:594-605. [DOI: 10.1002/pon.1608] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
PURPOSE OF REVIEW Nurses can play an essential role in the treatment of head and neck cancer and the care of patients and their families. The role and influence of nursing is dependent on available evidence to fulfill that role and on the sociopolitical and organizational factors that shape the context for nursing and interdisciplinary practice. RECENT FINDINGS Nurses influence treatment for head and neck cancer through symptom management and tobacco cessation to improve quality of life and patient-reported outcomes. Nurses and interdisciplinary teams in the United States and Europe report successful, novel nurse-led care models that optimize influence on management. SUMMARY Current research suggests that nurses can influence head and neck cancer treatment through emphasis on symptom management, tobacco and alcohol cessation, and on patient and family education and care coordination. Nonetheless, evidence for practice remains scant. Only continued research, employing qualitative and quantitative approaches, conducted by nurse and interdisciplinary investigator teams will advance head and neck cancer management and optimize influence of nursing within it. Novel models for nursing care that are well fit into the organizations and society in which care is delivered may further improve care and patient outcomes. Evaluation of such models is further required to document improvements.
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Psychosocial adjustment of family caregivers of head and neck cancer survivors. Support Care Cancer 2009; 18:171-8. [PMID: 19390870 DOI: 10.1007/s00520-009-0641-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 04/03/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE This study examined the psychosocial adjustment and needs of family caregivers of head and neck cancer survivors at 6-24 months posttreatment. MATERIALS AND METHODS Family caregivers of head and neck cancer survivors (N=89) completed mailed questionnaires that assessed demographic variables, mental health, quality of life, and practical and informational needs. RESULTS Thirty-eight percent of caregivers reported moderate to high distress. However, quality of life scores for the entire sample (N=89) were better than the scores reported in initial validation studies on caregivers of patients undergoing active cancer treatment. Greater time spent caregiving was associated with worse psychological well-being, but also more positive adaptation to caregiving. In addition, 39% of caregivers reported that all of their practical and informational needs were being met. CONCLUSIONS Findings suggest that research and clinical efforts are needed to address the psychosocial concerns of this population.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:132-41. [PMID: 19363348 DOI: 10.1097/moo.0b013e32832ad5ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cannon RD, Lamping E, Holmes AR, Niimi K, Baret PV, Keniya MV, Tanabe K, Niimi M, Goffeau A, Monk BC. Efflux-mediated antifungal drug resistance. Clin Microbiol Rev 2009; 22:291-321, Table of Contents. [PMID: 19366916 PMCID: PMC2668233 DOI: 10.1128/cmr.00051-08] [Citation(s) in RCA: 385] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fungi cause serious infections in the immunocompromised and debilitated, and the incidence of invasive mycoses has increased significantly over the last 3 decades. Slow diagnosis and the relatively few classes of antifungal drugs result in high attributable mortality for systemic fungal infections. Azole antifungals are commonly used for fungal infections, but azole resistance can be a problem for some patient groups. High-level, clinically significant azole resistance usually involves overexpression of plasma membrane efflux pumps belonging to the ATP-binding cassette (ABC) or the major facilitator superfamily class of transporters. The heterologous expression of efflux pumps in model systems, such Saccharomyces cerevisiae, has enabled the functional analysis of efflux pumps from a variety of fungi. Phylogenetic analysis of the ABC pleiotropic drug resistance family has provided a new view of the evolution of this important class of efflux pumps. There are several ways in which the clinical significance of efflux-mediated antifungal drug resistance can be mitigated. Alternative antifungal drugs, such as the echinocandins, that are not efflux pump substrates provide one option. Potential therapeutic approaches that could overcome azole resistance include targeting efflux pump transcriptional regulators and fungal stress response pathways, blockade of energy supply, and direct inhibition of efflux pumps.
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Affiliation(s)
- Richard D Cannon
- Department of Oral Sciences, School of Dentistry, University of Otago, P.O. Box 647, Dunedin 9054, New Zealand.
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Namjesky A. [Palliative care in patients with head and neck cancer]. Wien Med Wochenschr 2009; 158:724-8. [PMID: 19165454 DOI: 10.1007/s10354-008-0624-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 10/28/2008] [Indexed: 11/30/2022]
Abstract
Progressive cancer leads to loss of quality of life. This is particularly true for head and neck cancers as they dramatically affect the patients and in addition to this psychological burden cause a lot of physical disabilities. Patients struggle against retreat and helplessness of their environment, feel ostracized and not any longer being a human. In advanced diseases, surgery is not the first choice of treatment. Ostensible control of symptoms, care of relatives and notice of psychosocial facts are the most important therapeutic issues in these patients. They gain the greatest benefit from palliative care with good control of symptoms. This is highlighted by the following case reports.
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Affiliation(s)
- Astrid Namjesky
- Palliativstation, Landesklinikum Waldviertel, Waidhofen an der Thaya, Osterreich.
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Guntinas-Lichius O, Rühlow S, Veelken F, Klussmann JP. Quality of life during first-line palliative chemotherapy for recurrent and metastatic head and neck cancer with weekly cisplatin and docetaxel. J Cancer Res Clin Oncol 2008; 135:901-8. [DOI: 10.1007/s00432-008-0525-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 11/25/2008] [Indexed: 11/30/2022]
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Howe EG. Red Towels: Maximizing the Care of Patients Who Are Dying. THE JOURNAL OF CLINICAL ETHICS 2008. [DOI: 10.1086/jce200819201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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