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Youn N, Sorensen J, Howland C, Gilbertson-White S. Social Determinants of Health and Cancer Pain in the US: Scoping Review. Clin Nurs Res 2024; 33:416-428. [PMID: 38375791 DOI: 10.1177/10547738241232018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Social determinants of health (SDOH) are structural factors that yield health inequities. Within the context of cancer, these inequities include screening rates and survival rates, as well as higher symptom burden during and after treatment. While pain is one of the most frequently reported symptoms, the relationship between SDOHs and cancer pain is not well understood. The purpose of this study is to describe and synthesize the published research that has evaluated the relationships between SDOH and cancer pain. A systematic search of PubMed, CINAHL, and Embase was conducted to identify studies in which cancer pain and SDOH were described. In all, 20 studies met the inclusion criteria. In total, 14 studies reported a primary aim related to SDOH and cancer pain. Demographic variables including education or income were used most frequently. Six specific measurements were utilized to measure SDOH, such as the acculturation scale, the composite measure of zip codes for poverty level and blight prevalence, or the segregation index. Among the five domains of SDOH based on Healthy People 2030, social and community was the most studied, followed by economic stability, and education access and quality. The neighborhood and built environment domain was the least studied. Despite increasing attention to SDOH, the majority of published studies use single-dimension variables derived from demographic data to evaluate the relationships between SDOH and cancer pain. Future research is needed to explore the intersectionality of SDOH domains and their impact on cancer pain. Additionally, intervention studies should be conducted to address existing disparities and to reduce the incidence and impact of cancer pain.
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Affiliation(s)
- Nayung Youn
- Univeristy of Iowa, College of Nursing, IA, USA
| | - Jamie Sorensen
- Department of Epidemiology, University of Iowa College of Public Health, IA, USA
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Ouadghiri F, Salles C, Passemard L, Lapeyre M, Mulliez A, Devoize L, Pham Dang N. After 4 years of survival, patients treated for an oral or oropharyngeal cancer have more neurosensorial disorders than chronic pain and a better quality of life. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101924. [PMID: 38802061 DOI: 10.1016/j.jormas.2024.101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE During follow-up, patients in remission after oral or oropharyngeal cancer are few to express pain, depression or anxiety, their chief complain are dry mouth and difficulties to chewing. The aim of the study is to estimate prevalence of pain, quality of life and their evolution over four years. METHODS This prospective observational study included 21 patients between June and September 2017. Clinical examination, neurosensory examination and questionnaires (using visual analogic scale DN4, PCS-CF, HADS EORTC QLQ30 and H&N 35) were performed and a second time 4 years later. RESULTS After 4 years, 17 patients could be reviewed. In 2017 as in 2021, two patients (11.8 %) experience neuropathic pain. In 2017, 14 (82.3 %) reported paresthesia or dysesthesia or hypo/anesthesia, none of them have provoked pain to a mechanical or thermal stimulus. In 2021, only 9 (53 %) still report those symptoms. Global analysis of the questionnaire QLQC30 reveals a significant increase quality of life of all 17 patients (p = 0.0003). For the two questionnaires QLQC30 and QLQ-H&N 35, dry mouth, sticky saliva, difficulties for eating and relation with food, are strong grievances which an absence of amelioration or a degradation. CONCLUSIONS Neurosensory disturbance is a frequent symptom but pain concerns only 11.8 % of patients. Quality of life increase globally, yet difficulties concerning oral cavity functions endure. IMPLICATIONS FOR CANCER SURVIVORS For remission patients, pain is an unfrequent situation unlike neurosensory disturbance. Support care improve life quality. In case of onset of pain, recurrence and osteoradionecrosis should be mentioned immediately.
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Affiliation(s)
- Fannie Ouadghiri
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, 63000, Clermont-Ferrand, France
| | - Cléa Salles
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, 63000, Clermont-Ferrand, France
| | - Léa Passemard
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, 63000, Clermont-Ferrand, France
| | - Michel Lapeyre
- Department of Radiation Oncology, Jean Perrin Cancer Center, 63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Biostatistics Unit, Clinical Research and Innovation Direction, 63000, Clermont-Ferrand, France
| | - Laurent Devoize
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Odontology, 63000, Clermont-Ferrand, France; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, 63003, Clermont-Ferrand, France
| | - Nathalie Pham Dang
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, 63000, Clermont-Ferrand, France; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, 63003, Clermont-Ferrand, France.
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Inchingolo AM, Dipalma G, Inchingolo AD, Palumbo I, Guglielmo M, Morolla R, Mancini A, Inchingolo F. Advancing Postoperative Pain Management in Oral Cancer Patients: A Systematic Review. Pharmaceuticals (Basel) 2024; 17:542. [PMID: 38675500 PMCID: PMC11054702 DOI: 10.3390/ph17040542] [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: 02/27/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
The goal of this review is to shed light on the management of orofacial discomfort after a cancer diagnosis in the head and neck region. A search was conducted on PubMed, Scopus, and Web of Science to identify studies on postoperative pain control in oral cancer. The review included open-access research, investigations into pain management, randomized clinical trials, retrospective studies, case-control studies, prospective studies, English-written studies, and full-text publications. Exclusion criteria included animal studies; in vitro studies; off-topic studies; reviews, case reports, letters, or comments; and non-English language. Three reviewers independently accessed databases and assigned a quality rating to the chosen articles. The review explores postoperative pain management in oral cancer patients; highlighting persistent opioid use; the efficacy of adjuvant drugs, such as gabapentin; and a multimodal approach. It emphasizes the need for personalized pain management, recognizing individual pain perception and tailoring interventions. Integrating pharmacological and non-pharmacological strategies is crucial for comprehensive pain management. The review also serves as a guide for future research, emphasizing the need for standardized methodologies and diverse participant populations.
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Affiliation(s)
| | - Gianna Dipalma
- Correspondence: (G.D.); (F.I.); Tel.: +39-339-698-9939 (G.D.); +39-331-211-1104 (F.I.)
| | | | | | | | | | | | - Francesco Inchingolo
- Correspondence: (G.D.); (F.I.); Tel.: +39-339-698-9939 (G.D.); +39-331-211-1104 (F.I.)
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Bolnykh I, Patterson JM, Harding S, Watson LJ, Lu L, Hurley K, Thomas SJ, Sharp L. Cancer-related pain in head and neck cancer survivors: longitudinal findings from the Head and Neck 5000 clinical cohort. J Cancer Surviv 2024:10.1007/s11764-024-01554-x. [PMID: 38421499 DOI: 10.1007/s11764-024-01554-x] [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: 11/14/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Reports suggest pain is common in head and neck cancer (HNC). However, past studies are limited by small sample sizes and design and measurement heterogeneity. Using data from the Head and Neck 5000 longitudinal cohort, we investigated pain over a year post-diagnosis. We assessed: temporal trends; compared pain across HNC treatments, stages, sites and by HPV status; and identified subgroups of patients at increased risk of pain. METHODS Sociodemographic and clinical data and patient-reported pain (measured by EORTC QLQ-C30 and QLQ-H&N35) were collected at baseline (pre-treatment), 4- and 12- months. Using mixed effects multivariable regression, we investigated time trends and identified associations between (i) clinically-important general pain and (ii) HN-specific pain and clinical, socio-economic, and demographic variables. RESULTS 2,870 patients were included. At baseline, 40.9% had clinically-important general pain, rising to 47.6% at 4-months and declining to 35.5% at 12-months. HN-specific pain followed a similar pattern (mean score (sd): baseline 26.4 (25.10); 4-months. 28.9 (26.55); 12-months, 17.2 (19.83)). Across time, general and HN-specific pain levels were increased in: younger patients, smokers, and those with depression and comorbidities at baseline, and more advanced, oral cavity and HPV negative cancers. CONCLUSIONS There is high prevalence of general pain in people living with HNC. We identified subgroups more often reporting general and HN-specific pain towards whom interventions could be targeted. IMPLICATIONS FOR CANCER SURVIVORS Greater emphasis should be placed on identifying and treating pain in HNC. Systematic pain screening could help identify those who could benefit from an early pain management plan.
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Affiliation(s)
- Iakov Bolnykh
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK
| | - Joanne M Patterson
- Liverpool Head and Neck Centre, School of Health Science, University of Liverpool, Liverpool, UK
| | - Sam Harding
- Speech and Language Therapy Research Unit, Southmead Hospital North Bristol NHS Hospital Trust, Bristol, UK
| | - Laura-Jayne Watson
- Speech & Language Therapy, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK
- NHS Forth Valley, Stirling, Scotland, UK
| | - Katrina Hurley
- Head & Neck 5000 Study, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Steve J Thomas
- Head & Neck 5000 Study, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK.
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Lopez-Garzon M, López-Fernández MD, Ruíz-Martínez AM, Galván-Banqueri P, Lozano-Lozano M, Tovar-Martín I, Postigo-Martin P, Ariza-Vega P, Artacho-Cordón F, Fernández-Lao C, Cantarero-Villanueva I, Fernández-Gualda MÁ, Arroyo-Morales M, Ruíz-Villaverde R, Galiano-Castillo N. Efficacy of photobiomodulation therapy combined with mobile health education in patients with head and neck cancer suffering from chronic xerostomia after radiotherapy: protocol for a three-arm, randomised, placebo-controlled, double-blinded study. BMJ Open 2024; 14:e078068. [PMID: 38267245 PMCID: PMC10824058 DOI: 10.1136/bmjopen-2023-078068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION The role of photobiomodulation (PBM) therapy for oral tissue damage induced by cancer treatment is currently unclear, and there is low-quality to moderate-quality evidence supporting the use of this approach for treating xerostomia and/or hyposalivation. Consequently, patients with head and neck cancer increasingly turn to basic oral hygiene to alleviate salivary gland dysfunction, and their adherence can be improved by mobile health (mHealth) education. The primary objective of this study will be to analyse the effects of different doses of PBM therapy (7.5 J/cm2 vs 3 J/cm2) plus mHealth education on quality of life (QoL), oral health, salivary secretion and salivary gland ultrasound assessment at postintervention and at the 6-month follow-up in patients with head and neck cancer after radiotherapy compared with those in control group. METHODS AND ANALYSIS A prospective, three-arm, randomised, placebo-controlled, double-blinded study will be conducted among patients with head and neck cancer suffering from chronic xerostomia. A total of 20 patients per arm will be included and randomly assigned to receive 7.5 J/cm2 of PBM, 3 J/cm2 of PBM or placebo therapy. PBM therapy will be applied during 24 sessions at 22 points extra and intraorally two times per week for 3 months, combined with a mobile application (https://www.laxer.es). The assessments will be recorded at the beginning of the study, at postintervention and at the 6-month follow-up. The primary outcomes will be QoL, oral health, salivary secretion and salivary gland ultrasound. The pain pressure threshold, functional performance, mood and sleep quality will be secondary indicators. ETHICS AND DISSEMINATION This study received ethics approval from the Andalusian Biomedical Research Ethics Portal (2402-N-21 CEIM/CEI Provincial de Granada) according to the Declaration of Helsinki for Biomedical Research. The results of this study will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT05106608.
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Affiliation(s)
- Maria Lopez-Garzon
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - María Dolores López-Fernández
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
| | - Alba Maria Ruíz-Martínez
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiation Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pilar Galván-Banqueri
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiation Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Mario Lozano-Lozano
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Isabel Tovar-Martín
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiation Oncology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Paula Postigo-Martin
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Patrocinio Ariza-Vega
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Physical Activity for HEaLth Promotion (PA-HELP), Department of Physical and Sport Education, Sports Sciences Faculty, University of Granada, Granada, Spain
| | - Francisco Artacho-Cordón
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Radiology and Physical Medicine, Medicine Faculty, University of Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Carolina Fernández-Lao
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Irene Cantarero-Villanueva
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Miguel Ángel Fernández-Gualda
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
| | - Manuel Arroyo-Morales
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
| | - Ricardo Ruíz-Villaverde
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Department of Medical Surgical Dermatology and Venereology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Noelia Galiano-Castillo
- Biomedical Group (BIO277), Department of Physical Therapy, Health Sciences Faculty, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain
- Sport and Health Research Center (IMUDs), Parque Tecnológico de la Salud, Granada, Spain
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Howren MB, Seaman A, Super GL, Christensen AJ, Pagedar NA. Examination of Predictors of Pain at 12 Months Postdiagnosis in Head and Neck Cancer Survivors. Otolaryngol Head Neck Surg 2023; 169:1506-1512. [PMID: 37403789 PMCID: PMC10766866 DOI: 10.1002/ohn.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Pain following the completion of treatment is important but has received less attention in the head and neck cancer (HNC) literature. The present study sought to examine the prevalence and predictors of pain measured 12 months postdiagnosis and its impact on HNC-specific health-related quality of life (HRQOL) in 1038 HNC survivors. STUDY DESIGN Prospective observational study. SETTING Single-institution tertiary care center. METHODS Pain was measured using a single item ranging from 0 to 10 with 0 representing no pain and 10 representing the worst pain possible. Self-reported depressive symptomatology was measured using the Beck Depression Inventory and self-reported problem alcohol use was measured by the Short Michigan Alcoholism Screening Test. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). RESULTS Hierarchical multivariable linear regression analyses indicated that in addition to pain at 3 months postdiagnosis (β = .145, t = 3.18, sr2 = .019, p = .002), both depressive symptomatology (β = .110, t = 2.49, sr2 = .011, p = .015) and problem alcohol use (β = .092, t = 2.07, sr2 = .008, p = .039) were significant predictors of pain at 12 months postdiagnosis. Subgroup analyses suggest that across all 4 HNCI domains, those in the moderate and severe pain groups at 12 months postdiagnosis failed to reach 70 which is indicative of high functioning. CONCLUSION Pain in patients with HNC is a considerable issue at 12 months postdiagnosis, deserving further attention. Behavioral factors such as depression and problem alcohol use may be associated with pain and require systematic screening over time to identify and treat issues that impact optimal long-term recovery from HNC, including disease-specific HRQOL.
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Affiliation(s)
- M. Bryant Howren
- Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University; Tallahassee, FL
- Florida Blue Center for Rural Health Research & Policy, College of Medicine, Florida State University; Tallahassee, FL
| | - Aaron Seaman
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System; Iowa City, IA
- Department of Internal Medicine, The University of Iowa; Iowa City, IA
| | - Grace L. Super
- College of Medicine, Florida State University; Tallahassee, FL
| | | | - Nitin A. Pagedar
- Department of Otolaryngology—Head and Neck Surgery, Carver College of Medicine, The University of Iowa; Iowa City, IA
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Salama V, Geng Y, Rigert J, Fuller CD, Shete S, Moreno AC. Systematic Review of Genetic Polymorphisms Associated with Acute Pain Induced by Radiotherapy for Head and Neck Cancers. Clin Transl Radiat Oncol 2023; 43:100669. [PMID: 37954025 PMCID: PMC10634655 DOI: 10.1016/j.ctro.2023.100669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/10/2023] [Accepted: 08/13/2023] [Indexed: 11/14/2023] Open
Abstract
Background/objective Pain is the most common acute symptom following radiation therapy (RT) for head and neck cancer (HNC). The multifactorial origin of RT-induced pain makes it highly challenging to manage. Multiple studies were conducted to identify genetic variants associated with cancer pain, however few of them focused on RT-induced acute pain. In this review, we summarize the potential mechanisms of acute pain after RT in HNC and identify genetic variants associated with RT-induced acute pain and relevant acute toxicities. Methods A comprehensive search of Ovid Medline, EMBASE and Web of Science databases using terms including "Variants", "Polymorphisms", "Radiotherapy", "Acute pain", "Acute toxicity" published up to February 28, 2022, was performed by two reviewers. Review articles and citations were reviewed manually. The identified SNPs associated with RT-induced acute pain and toxicities were reported, and the molecular functions of the associated genes were described based on genetic annotation using The Human Gene Database; GeneCards. Results A total of 386 articles were identified electronically and 8 more articles were included after manual search. 21 articles were finally included. 32 variants in 27 genes, of which 25% in inflammatory/immune response, 20% had function in DNA damage response and repair, 20% in cell death or cell cycle, were associated with RT-inflammatory pain and acute oral mucositis or dermatitis. 4 variants in 4 genes were associated with neuropathy and neuropathic pain. 5 variants in 4 genes were associated with RT-induced mixed types of post-RT-throat/neck pain. Conclusion Different types of pain develop after RT in HNC, including inflammatory pain; neuropathic pain; nociceptive pain; and mixed oral pain. Genetic variants involved in DNA damage response and repair, cell death, inflammation and neuropathic pathways may affect pain presentation post-RT. These variants could be used for personalized pain management in HNC patients receiving RT.
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Affiliation(s)
- Vivian Salama
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian Rigert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C. Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Salama V, Youssef S, Xu T, Wahid KA, Chen J, Rigert J, Lee A, Hutcheson KA, Gunn B, Phan J, Garden AS, Frank SJ, Morrison W, Reddy JP, Spiotto MT, Naser MA, Dede C, He R, Mohamed AS, van Dijk LV, Lin R, Roldan CJ, Rosenthal DI, Fuller CD, Moreno AC. Temporal characterization of acute pain and toxicity kinetics during radiation therapy for head and neck cancer. A retrospective study. ORAL ONCOLOGY REPORTS 2023; 7:100092. [PMID: 38638130 PMCID: PMC11025722 DOI: 10.1016/j.oor.2023.100092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Objectives Pain during Radiation Therapy (RT) for oral cavity/oropharyngeal cancer (OC/OPC) is a clinical challenge due to its multifactorial etiology and variable management. The objective of this study was to define complex pain profiles through temporal characterization of pain descriptors, physiologic state, and RT-induced toxicities for pain trajectories understanding. Materials and methods Using an electronic health record registry, 351 OC/OPC patients treated with RT from 2013 to 2021 were included. Weekly numeric scale pain scores, pain descriptors, vital signs, physician-reported toxicities, and analgesics were analyzed using linear mixed effect models and Spearman's correlation. Area under the pain curve (AUCpain) was calculated to measure pain burden over time. Results Median pain scores increased from 0 during the weekly visit (WSV)-1 to 5 during WSV-7. By WSV-7, 60% and 74% of patients reported mouth and throat pain, respectively, with a median pain score of 5. Soreness and burning pain peaked during WSV-6/7 (51%). Median AUCpain was 16% (IQR (9.3-23)), and AUCpain significantly varied based on gender, tumor site, surgery, drug use history, and pre-RT pain. A temporal increase in mucositis and dermatitis, declining mean bodyweight (-7.1%; P < 0.001) and mean arterial pressure (MAP) 6.8 mmHg; P < 0.001 were detected. Pulse rate was positively associated while weight and MAP were negatively associated with pain over time (P < 0.001). Conclusion This study provides insight on in-depth characterization and associations between dynamic pain, physiologic, and toxicity kinetics. Our findings support further needs of optimized pain control through temporal data-driven clinical decision support systems for acute pain management.
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Affiliation(s)
- Vivian Salama
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Sara Youssef
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Tianlin Xu
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jaime Chen
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jillian Rigert
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Anna Lee
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine A. Hutcheson
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Brandon Gunn
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S. Garden
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J. Frank
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - William Morrison
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Jay P. Reddy
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Michael T. Spiotto
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Mohamed A. Naser
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Cem Dede
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Abdallah S.R. Mohamed
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Lisanne V. van Dijk
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, Medical Center Groningen, University of Groningen, Groningen, NL, USA
| | - Ruitao Lin
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos J. Roldan
- Department of Pain Medicine, Division of Anesthesiology, Critical Care Medicine, and Pain Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - David I. Rosenthal
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C. Moreno
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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9
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Oral pain in the cancer patient. Curr Opin Support Palliat Care 2022; 16:174-179. [DOI: 10.1097/spc.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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10
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Long-term opioid use in patients treated with head and neck intensity-modulated radiotherapy. Support Care Cancer 2022; 30:7517-7525. [PMID: 35666302 DOI: 10.1007/s00520-022-07155-7] [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: 02/04/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Acute and chronic pain during and after radiotherapy is an important driver of poor quality of life. We aimed to identify risk factors associated with increased chronic opioid use in head and neck squamous cell cancer survivors. METHODS We performed a retrospective cohort analysis on head and neck squamous cell cancer patients treated with definitive or adjuvant intensity-modulated radiotherapy. We tracked their oncologic opioid prescription profile from initial presentation to the last follow-up date. We determined the incidences of 1- and 2-year opioid use and performed multivariate logistic regression for both outcomes. RESULTS Our analytic cohort consisted of 403 head and neck squamous cell cancer survivors. The numbers of patients requiring opioids at 3 months, 6 months, and 1 year after treatment were 316 (78%), 203 (50%), and 102 (25%), respectively. On multivariate logistic regression, positive smoking history (95% CI 1.86 [1.03, 3.43], p = 0.04), unemployment (95% CI 2.33 [1.16, 4.67], p = 0.02), prior psychiatric illness (95% CI 2.15 [1.05, 4.40], p = 0.03), and opiate use before radiotherapy (95% CI 2.75 [1.49, 5.20], p = 0.01) were independently associated with significantly greater odds of opioid use at 1 year. CONCLUSIONS Our institutional analysis has shown that a substantial amount of head and neck cancer survivors are chronically dependent on opioids following radiotherapy. We have identified a cohort at highest risk for long-term use, for whom early interventions should be targeted.
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11
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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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12
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Dal Fabbro C, Harris P, Dufresne E, Herrero Babiloni A, Mayer P, Bahig H, Filion E, Nguyen F, Ghannoum J, Schmittbuhl M, Lavigne G. Orofacial Pain and Snoring/Obstructive Sleep Apnea in Individuals with Head and Neck Cancer: A Critical Review. J Oral Facial Pain Headache 2022; 36:85-102. [PMID: 35943322 PMCID: PMC10586573 DOI: 10.11607/ofph.3176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2023]
Abstract
AIMS (1) To summarize current knowledge on the prevalence, intensity, and descriptors of orofacial pain and snoring/obstructive sleep apnea (OSA) before and after head and neck cancer (HNC) treatment; and (2) to propose future directions for research. METHODS The median prevalence for each condition was estimated from the most recent systematic reviews (SRs) and updated with new findings retrieved from the PubMed, Web of Science, Embase, and Cochrane databases up to December 2021. RESULTS The prevalence of HNC pain seems relatively stable over time, with a median of 31% before treatment in three studies to a median of 39% at 1 month to 16 years after treatment in six studies. HNC pain intensity remains mild to moderate. There was a threefold increase in temporomandibular pain prevalence after surgery (median 7.25% before to 21.3% after). The data for snoring prevalence are unreliable. The OSA/HNC prevalence seems relatively stable over time, with a median of 72% before treatment in three studies to 77% after treatment in 14 studies. CONCLUSION With the exception of temporomandibular pain, the prevalence of HNC pain and OSA seems to be stable over time. Future studies should: (1) compare the trajectory of change over time according to each treatment; (2) compare individuals with HNC to healthy subjects; (3) use a standardized and comparable method of data collection; and (4) assess tolerance to oral or breathing devices, since HNC individuals may have mucosal sensitivity or pain.
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13
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Chadwick A, Frazier A, Khan TW, Young E. Understanding the Psychological, Physiological, and Genetic Factors Affecting Precision Pain Medicine: A Narrative Review. J Pain Res 2021; 14:3145-3161. [PMID: 34675643 PMCID: PMC8517910 DOI: 10.2147/jpr.s320863] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Precision pain medicine focuses on employing methods to assess each patient individually, identify their risk profile for disproportionate pain and/or the development of chronic pain, and optimize therapeutic strategies to target specific pathological processes underlying chronic pain. This review aims to provide a concise summary of the current body of knowledge regarding psychological, physiological, and genetic determinants of chronic pain related to precision pain medicine. METHODS Following the Scale for the Assessment of Narrative Review Articles (SANRA) criteria, we employed PubMed/Medline to identify relevant articles using primary database search terms to query articles such as: precision medicine, non-modifiable factors, pain, anesthesiology, quantitative sensory testing, genetics, pain medicine, and psychological. RESULTS Precision pain medicine provides an opportunity to identify populations at risk, develop personalized treatment strategies, and reduce side effects and cost through elimination of ineffective treatment strategies. As in other complex chronic health conditions, there are two broad categories that contribute to chronic pain risk: modifiable and non-modifiable patient factors. This review focuses on three primary determinants of health, representing both modifiable and non-modifiable factors, that may contribute to a patient's profile for risk of developing pain and most effective management strategies: psychological, physiological, and genetic factors. CONCLUSION Consideration of these three domains is already being integrated into patient care in other specialties, but by understanding the role they play in development and maintenance of chronic pain, we can begin to implement both precision and personalized treatment regimens.
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Affiliation(s)
- Andrea Chadwick
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrew Frazier
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Talal W Khan
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Erin Young
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
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14
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Dugué J, Humbert M, Bendiane MK, Bouhnik AD, Babin E, Licaj I. Head and neck cancer survivors' pain in France: the VICAN study. J Cancer Surviv 2021; 16:119-131. [PMID: 33635450 DOI: 10.1007/s11764-021-01010-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Pain is an increasing concern in the growing number of head and neck cancer survivors. This study aimed to analyze the 5-year prevalence of pain in French survivors of head and neck cancer and to identify associated factors. METHODS Analyses were performed among 296 5-year cancer survivors diagnosed in 2010. Using multivariable logistic regressions, we studied the associations between pain and factors collected in the French representative national "vie après le cancer" (VICAN) survey. Eligible participants were aged from 18 to 82 years; patients' living conditions, socioeconomic characteristics, and medical data were collected. RESULTS Pain was reported by 72.6% of the participants. In the multivariable analyses, decreasing level of physical activity was the only determinant of increased overall pain (OR= 2.77, CI= 1.48-5.17). The chronic pain prevalence was 62.3%. The main risk factors found were tumor localization in the oropharynx (OR= 2.49, CI= 1.27-4.88), education (at least a high school's degree) (OR= 0.33, CI= 0.13-0.9), and decreased physical activity (OR= 2.20, CI= 1.24-3.9). CONCLUSIONS Five years after diagnosis, pain is a very frequent sequelae that has a significant impact on quality of life in head and neck cancer survivors. Reduced physical activity, a low level of education, and tumor localization in the oropharynx are factors associated with pain. IMPLICATIONS FOR CANCER SURVIVORS Pain frequency and its impact on patients' lives imply that an adaptation must be made in terms of both pain diagnosis and management and the training of healthcare professionals. CLINICAL TRIAL REGISTRATION This is not a clinical trial. ISP number: INSERM C11-63.
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Affiliation(s)
- Justin Dugué
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France.
| | - Maxime Humbert
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Marc-Karim Bendiane
- Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM) Marseille, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Anne-Déborah Bouhnik
- Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM) Marseille, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Emmanuel Babin
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Idlir Licaj
- Clinipace Biostatistics, Morrisville, NC, 27560, USA.,Clinical Research Department, Centre François Baclesse, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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15
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Starr N, Oyler DR, Schadler A, Aouad RK. Chronic opioid use after laryngeal cancer treatment. Head Neck 2020; 43:1242-1251. [PMID: 33368718 DOI: 10.1002/hed.26591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/14/2020] [Accepted: 12/17/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Survivors of head and neck cancer may be at increased risk for chronic opioid use and questions remain about risk factors. METHODS Retrospective study of patients with laryngeal cancer prescribed opioids utilizing the Truven Health Marketscan database. Patients had laryngeal cancer, underwent treatment, filled an opioid prescription, and were enrolled in this private insurance plan 1 year prior to and after treatment. RESULTS In this study, 7484 patients were included; 17.2% developed chronic opioid use, defined as consecutive opioid fills at least 90 days after treatment cessation. Early opioid use (OR = 3.607, 95% CI [3.125-4.163]), tobacco use (OR = 1.28, 95% CI [1.117-1.467]), median morphine milligram equivalent (MME; OR = 1.001, 95% CI [1.000-1.0001]), and radiation alone (OR = 1.435, 95% CI [1.199-1.717]) were predictive of chronic opioid use. CONCLUSIONS Nearly one in five patients prescribed opioids during treatment developed chronic use. Providers should discuss the risk of chronic opioid use, set expectations for opioid weaning, and consider adjunct pain regimens to develop effective pain management strategies.
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Affiliation(s)
- Nicole Starr
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Douglas R Oyler
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Aric Schadler
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Rony K Aouad
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, Kentucky, USA
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16
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Bollig CA, Kinealy BP, Gilley DR, Clark AD, Galloway TL, Zitsch RP, Jorgensen JB, Biedermann GB. Implications of Treatment Modality on Chronic Opioid Use Following Treatment for Head and Neck Cancer. Otolaryngol Head Neck Surg 2020; 164:799-806. [DOI: 10.1177/0194599820960137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective To investigate the relationship between treatment modality and chronic opioid use in a large cohort of patients with head and neck cancer. Study Design Retrospective cohort study. Setting Single academic center. Methods There were 388 patients with head and neck cancer treated between January 2011 and December 2017 who met inclusion criteria. Clinical risk factors for opioid use at 3 and 6 months were determined with univariate and multivariate analyses. Results The prevalence of opioid use was 43.0% at 3 months and 33.2% at 6 months. On multivariate analysis, primary chemoradiation (odds ratio [OR], 4.04; 95% CI, 1.91-8.55) and surgery with adjuvant chemoradiation (OR, 2.39; 95% CI, 1.09-5.26) were associated with opioid use at 3 months. Additional risk factors at that time point included pretreatment opioid use (OR, 7.63; 95% CI, 4.09-14.21) and decreasing age (OR, 1.03; 95% CI, 1.01-1.06). At 6 months, primary chemoradiation (OR, 2.40; 95% CI, 1.34-4.28), pretreatment opioid use (OR, 5.86; 95% CI, 3.30-10.38), current tobacco use (OR, 2.00; 95% CI, 1.18-3.40), and psychiatric disorder (OR, 1.79; 95% CI, 1.02-3.14) were associated with opioid use. Conclusion Of the patients who receive different treatment modalities, those receiving primary chemoradiation are independently at highest risk for chronic opioid use. Other risk factors include pretreatment opioid use, tobacco use, and a psychiatric disorder. In an effort to reduce their risk of chronic opioid use, preventative strategies should be especially directed to these patients.
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Affiliation(s)
- Craig A. Bollig
- Department of Otolaryngology–Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Brian P. Kinealy
- School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - David R. Gilley
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Andrew D. Clark
- School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Tabitha L.I. Galloway
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Robert P. Zitsch
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jeffrey B. Jorgensen
- Department of Otolaryngology–Head and Neck Surgery and Communication Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Gregory B. Biedermann
- Department of Radiation Oncology, School of Medicine, University of Missouri, Columbia, Missouri, USA
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Kriplani A, Lavery JA, Mishra A, Korenstein D, Lipitz-Snyderman AN, Boudreau DM, Moryl N, Gillespie EF, Salz T. Trends in chronic opioid therapy among survivors of head and neck cancer. Head Neck 2020; 43:223-228. [PMID: 32964530 DOI: 10.1002/hed.26478] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/22/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Survivors of head and neck cancer (HNC) have increased risk of opioid misuse. METHODS Using Surveillance, Epidemiology and End-Results-Medicare data, we matched adults ≥66 years diagnosed with HNC 2008-2015 with cancer-free controls. We computed odds ratios (OR) for receipt of chronic opioid therapy (COT, claims for ≥90 consecutive days) for HNC survivors compared to controls each year after matching through 2016. RESULTS The cohort of HNC survivors declined from 5107 in the first year after diagnosis to 604 in the sixth year after diagnosis. For 5 years, rates of COT among HNC survivors exceeded that of controls. Differences between survivors and controls declined each year (ORs: year 1, 4.36; year 2, 2.60; year 3, 2.18; year 4, 1.85; and year 5, 1.35; all P-values <.05). CONCLUSIONS Among older HNC survivors, cancer-associated opioid use in the first years after diagnosis suggests that the benefit of opioids must balance the risk of opioid misuse.
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Affiliation(s)
- Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Akriti Mishra
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Natalie Moryl
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Talya Salz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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18
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Han AY, Miller JE, Long JL, St. John MA. Time for a Paradigm Shift in Head and Neck Cancer Management During the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020; 163:447-454. [PMID: 32484380 PMCID: PMC7484111 DOI: 10.1177/0194599820931789] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/13/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has caused physicians and surgeons to consider restructuring traditional cancer management paradigms. We aim to review the current evidence regarding the diagnosis and management of head and neck cancer, with an emphasis on the role of the multidisciplinary team (MDT) during a pandemic. DATA SOURCES COVID-19 resources from PubMed, Google Scholar, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Head and Neck Society were examined. REVIEW METHODS Studies and guidelines related to the multidisciplinary management of head and neck cancer in the COVID-19 setting were reviewed. A total of 54 studies were included. Given the continuously evolving body of literature, the sources cited include the latest statements from medical and dental societies. RESULTS The unpredictable fluctuation of hospital resources and the risk of the nosocomial spread of SARS-CoV-2 have direct effects on head and neck cancer management. Using an MDT approach to help define "essential surgery" for immediately life- or function-threatening disease processes in the context of available hospital resources will help to maximize outcomes. Early enrollment in an MDT is often critical for considering nonsurgical options to protect patients and health care workers. The role of the MDT continues after cancer treatment, if delivered, and the MDT plays an essential role in surveillance and survivorship programs in these challenging times. CONCLUSION Head and neck cancer management during the COVID-19 pandemic poses a unique challenge for all specialists involved. Early MDT involvement is important to maximize patient outcomes and satisfaction in the context of public and community safety.
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Affiliation(s)
- Albert Y. Han
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), California (CA)
| | - Jessa E. Miller
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), California (CA)
| | - Jennifer L. Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), California (CA)
- Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, CA
- UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, CA
- Greater Los Angeles VA Healthcare System
| | - Maie A. St. John
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles (UCLA), California (CA)
- Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, CA
- UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, CA
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Hu ZY, Feng XQ, Fu MR, Yu R, Zhao HL. Symptom patterns, physical function and quality of life among head and neck cancer patients prior to and after surgical treatment: A prospective study. Eur J Oncol Nurs 2020; 46:101770. [PMID: 32504879 DOI: 10.1016/j.ejon.2020.101770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/22/2020] [Accepted: 05/08/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to evaluate patterns of symptoms, physical function and quality of life (QoL) among patients with head and neck cancer (HNC) prior to, 3-9 days post-surgery, and one month post-surgery. METHODS A prospective, repeated-measures design with consecutively-identified sampling was used to recruit HNC patients undergoing surgical treatment. Data collected included demographic and clinical characteristics, symptoms by M.D. Anderson Symptom Inventory-Head and Neck Module-Chinese version (MDASI-H&N-C), physical function and QoL by Function Subscales of European Cancer Research Treatment Organization Quality of Life Core Scale (EORTC QLQ C30). RESULTS 105 HNC patients suffered multiple symptoms prior to and after surgery. Pain, difficulty with voice/speech, disturbed sleep and problems with mucus (30.48%~91.43%) were the most prevalent symptoms prior to and post-surgery. Numbers of symptoms as well as specific symptoms, such as fatigue, dry mouth, problems with mucus, pain and disturbed sleep, were significantly associated with poor physical function (p < 0.05). Tracheostomy, feeding tube and age were also linked with poor physical function and poor QoL (p < 0.05). CONCLUSIONS Findings of our study underscore the importance of managing symptoms in HNC patients to ensure patients' physical function and QoL prior to and after surgical treatment. Further research should focus on developing targeted interventions for symptoms that are linked to HNC patients' poor physical function and QoL.
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Affiliation(s)
- Zi-Yi Hu
- West China Hospital/West China Medical School, Sichuan University, Department of Thyroid Surgery, Chengdu, Sichuan, 610041, China.
| | - Xian-Qiong Feng
- West China Hospital/West China Medical School, Sichuan University, Department of Nursing, Chengdu, Sichuan, 610041, China.
| | - Mei Rosemary Fu
- Barry Family & Goldman Sachs Endowed Professor, BOSTON COLLEGE William F. Connell School of Nursing, United States.
| | - Rong Yu
- West China Hospital/West China Medical School, Sichuan University, Department of Otolaryngology and Head & Neck Surgery, Chengdu, Sichuan, 610041, China.
| | - Hui-Ling Zhao
- West China Hospital/West China Medical School, Sichuan University, Department of Otolaryngology and Head & Neck Surgery, Chengdu, Sichuan, 610041, China.
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Immediate post-treatment supportive care needs of patients newly diagnosed with head and neck cancer. Support Care Cancer 2020; 28:5557-5567. [PMID: 32189100 DOI: 10.1007/s00520-020-05368-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aimed at identifying supportive care needs of patients with head and neck cancer (HNC-P) immediately post-treatment, finding early predictors of unmet needs, and contrasting how immediate post-treatment needs differed from needs in longer-term survivorship. METHODS Prospective longitudinal study of 223 consecutive adults (313 approached; 72% participation) newly diagnosed with a first occurrence of primary HNC. Patients completed the Supportive Care Needs Survey-Short Form (SCNS), the Structured Clinical Interview for DSM-IV, and other outcomes. Medical chart reviews were conducted. RESULTS A total of 68% of patients (n = 145/223) completed the SCNS. The multiple linear regression indicated that when controlled for medical variables, patients presented higher levels of unmet needs when they presented with higher level of anxiety upon HNC diagnosis (p = 0.03), higher neuroticism (p = 0.03), and more stressful life events in the year pre-diagnosis (p = 0.01). Patients immediately post-treatment had a wider variety of unmet needs compared with those in extended survivorship, with psychological unmet needs most prevalent at both time points. Immediately post-treatment, patients needed more support regarding pain (p = 0.04) and worries about treatment results (p = 0.05), whereas patients in longer-term survivorship needed more support regarding anxiety (p = 0.02), changes in sexual relationships (p = 0.04), and fear of death and dying (p = 0.001). CONCLUSION This study identifies areas needing further development to improve quality of care for HNC-P in the immediate post-treatment period, as well as early determinants of unmet needs. HNC clinics may want to routinely screen for anxiety, neuroticism, and burden from other life events, to pro-actively address needs upon treatment completion and alleviate disease burden.
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Breakthrough pain in patients with head & neck cancer. A secondary analysis of IOPS MS study. Oral Oncol 2019; 95:87-90. [DOI: 10.1016/j.oraloncology.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 12/19/2022]
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Head and neck cancer, quality of life, and determinant factors: a novel approach using decision tree analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:486-493. [DOI: 10.1016/j.oooo.2018.07.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/08/2018] [Accepted: 07/23/2018] [Indexed: 01/26/2023]
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Henry M, Alias A, Frenkiel S, Richardson K, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Chartier G, Rosberger Z. Contribution of psychiatric diagnoses to extent of opioid prescription in the first year post-head and neck cancer diagnosis: A longitudinal study. Psychooncology 2018; 28:107-115. [PMID: 30308695 DOI: 10.1002/pon.4917] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/31/2018] [Accepted: 10/06/2018] [Indexed: 11/12/2022]
Abstract
PURPOSE The purpose of this study was to determine, within the first-year post-head and neck cancer (HNC) diagnosis, the contribution of past and upon HNC psychiatric diagnoses (ie, substance use disorder, major depressive disorder, and anxiety disorder) to the extent (ie, cumulated dose) of opioid prescription. METHODS Prospective longitudinal study of 223 consecutive adults (on 313 approached; 72% participation) newly diagnosed (<2 weeks) with a first occurrence of primary HNC, including Structured Clinical Interviews for DSM-IV disorders, validated psychometric measures, and medical chart reviews. Opioid doses were translated into standardized morphine milligram equivalents (MME) using CDC guidelines. A model of variables was tested using multiple linear regression. RESULTS Fifty-five percent (123/223) of patients received opioids at some point during the first 12 months post-HNC diagnosis, 37.7% (84/223) upon HNC diagnosis (pre-treatment), 40.8% (91/223) during treatments, and 31.4% (70/223) post-treatment. The multiple linear regression indicated that an AD (P = 0.04) upon HNC diagnosis in early stage contributes to cumulated MME dose in the first year post-HNC diagnosis. CONCLUSION This study underlines how anxiety has important repercussions on the management of pain and illustrates the importance of screening for AD upon HNC diagnosis to allow for early prophylactic treatment and support.
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Affiliation(s)
- Melissa Henry
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada
| | | | - Saul Frenkiel
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada.,McGill University Health Centre, Montreal, Canada
| | - Keith Richardson
- McGill University, Montreal, Canada.,McGill University Health Centre, Montreal, Canada
| | - Michael Hier
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada
| | - Anthony Zeitouni
- McGill University, Montreal, Canada.,McGill University Health Centre, Montreal, Canada
| | - Karen Kost
- McGill University, Montreal, Canada.,McGill University Health Centre, Montreal, Canada
| | - Alex Mlynarek
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada.,McGill University Health Centre, Montreal, Canada
| | - Martin Black
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada
| | | | | | - Zeev Rosberger
- McGill University, Montreal, Canada.,Jewish General Hospital, Montreal, Canada
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24
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Cramer JD, Johnson JT, Nilsen ML. Pain in Head and Neck Cancer Survivors: Prevalence, Predictors, and Quality-of-Life Impact. Otolaryngol Head Neck Surg 2018; 159:853-858. [DOI: 10.1177/0194599818783964] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Pain is common among patients with cancer, stemming from both malignancy and side effects of treatment. The extent to which pain persists after treatment has received little attention. We examined the prevalence, predictors, and impact on quality of life (QOL) caused by pain among survivors of head and neck cancer. Study Design Cohort study. Setting Tertiary head and neck cancer survivorship clinic. Subjects and Methods We identified survivors of head and neck cancer ≥1 year after diagnosis and examined the prevalence and risk factors for development of pain. Pain and QOL were assessed with multiple QOL instruments. Ordinal regression modeling examined predictors of pain in survivors. Results We identified 175 patients at a median of 6.6 years after diagnosis. Among survivors, 45.1% reported pain, and 11.5% reported severe pain. Among patients with current pain, 46% reported low overall QOL versus only 12% of those without pain ( P < .001). On multivariable analysis after adjustment for age, sex, and stage of disease, pain was associated with trimodality treatment (odds ratio [OR], 3.55; 95% CI, 1.06-12.77). Multivariable analysis of QOL issues revealed that pain was associated with major depression (OR, 3.91; 95% CI, 1.68-9.11), anxiety (OR, 4.22; 95% CI, 2.28-7.81), poor recreation (OR, 3.31; 95% CI, 1.70-6.48), and low overall QOL (OR, 2.20; 95% CI, 1.12-4.34). Conclusions Years after head and neck cancer treatment, pain remains a significant problem and is associated with worse QOL. Future efforts should focus on preventing pain from treatment and comprehensive management.
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Affiliation(s)
- John D. Cramer
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonas T. Johnson
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marci L. Nilsen
- Department of Acute and Tertiary Care, School of Nursing, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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25
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Maximiano C, López I, Martín C, Zugazabeitia L, Martí-Ciriquián JL, Núñez MA, Contreras J, Herdman M, Traseira S, Provencio M. An exploratory, large-scale study of pain and quality of life outcomes in cancer patients with moderate or severe pain, and variables predicting improvement. PLoS One 2018; 13:e0193233. [PMID: 29614068 PMCID: PMC5882102 DOI: 10.1371/journal.pone.0193233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/07/2018] [Indexed: 12/19/2022] Open
Abstract
Background There have been few large-scale, real world studies in Spain to assess change in pain and quality of life (QOL) outcomes in cancer patients with moderate to severe pain. This study aimed to assess changes on both outcomes after 3 months of usual care and to investigate factors associated with change in QoL. Patients and methods Large, multi-centre, observational study in patients with lung, head and neck, colorectal or breast cancer experiencing a first episode of moderate to severe pain while attending one of the participating centres. QoL was assessed using the EuroQol-5D questionnaire and pain using the Brief Pain Inventory (BPI). Instruments were administered at baseline and after 3 months of follow up. Multivariate analyses were used to assess the impact of treatment factors, demographic and clinical variables, pain and other symptoms on QoL scores. Results 1711 patients were included for analysis. After 3 months of usual care, a significant improvement was observed in pain and QoL in all four cancer groups (p<0.001). Effect sizes were medium to large on the BPI and EQ-5D Index and Visual Analogue Scale (VAS). Improvements were seen on the majority of EQ-5D dimensions in all patient groups, though breast cancer patients showed the largest gains. Poorer baseline performance status (ECOG) and the presence of anxiety/depression were associated with significantly poorer QOL outcomes. Improvements in BPI pain scores were associated with improved QoL. Conclusion In the four cancer types studied, pain and QoL outcomes improved considerably after 3 months of usual care. Improvements in pain made a substantial contribution to QoL gains whilst the presence of anxiety and depression and poor baseline performance status significantly constrained improvement.
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Affiliation(s)
| | - Iker López
- Hospital Universitario Virgen del Rocío, Medical Oncology, Sevilla, Spain
| | - Cristina Martín
- Hospital de la Santa Creu i Sant Pau, Medical Oncology, Barcelona, Spain
| | | | | | | | - Jorge Contreras
- Complejo Hospitalario Regional Carlos Haya, Radiation Oncology, Málaga, Spain
| | | | - Susana Traseira
- Mundipharma Pharmaceuticals S.L., Medical Department, Madrid, Spain
| | - Mariano Provencio
- Hospital Puerta de Hierro de Majadahonda, Medical Oncology, Madrid, Spain
- * E-mail:
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26
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Smith JD, Shuman AG, Riba MB. Psychosocial Issues in Patients with Head and Neck Cancer: an Updated Review with a Focus on Clinical Interventions. Curr Psychiatry Rep 2017; 19:56. [PMID: 28726060 DOI: 10.1007/s11920-017-0811-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW There are frequent and diverse psychosocial issues that afflict patients with head and neck cancer (HNC) across the illness trajectory, prompting a focus on clinical interventions to prevent and mitigate psychosocial distress. We sought to characterize current understanding on the cause, effects, and interplay of various psychosocial factors in HNC and summarize updated, evidence-based interventions. RECENT FINDINGS The psychosocial experience of patients with HNC is characterized by a disproportionately high incidence of depression, suicide, continued substance dependence/abuse, and distress related to relationship conflict, social isolation, disfigurement, and damage to self-image. As we move towards a more thorough understanding and greater appreciation of the relationship between HNC and patient quality of life (QoL), future research focuses on implementation of effective, accessible clinical interventions to alleviate psychosocial distress in this population.
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Affiliation(s)
- Joshua D Smith
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michelle B Riba
- Department of Psychiatry, University of Michigan, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.
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27
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Huyett P, Kim S, Johnson JT, Soose RJ. Obstructive sleep apnea in the irradiated head and neck cancer patient. Laryngoscope 2017; 127:2673-2677. [DOI: 10.1002/lary.26674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/13/2017] [Accepted: 04/12/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Phillip Huyett
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Seungwon Kim
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Jonas T. Johnson
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Ryan J. Soose
- Department of Otolaryngology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
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28
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Pfeifer MP, Keeney C, Bumpous J, Schapmire TJ, Studts JL, Myers J, Head B. Impact of a telehealth intervention on quality of life and symptom distress in patients with head and neck cancer. JOURNAL OF COMMUNITY AND SUPPORTIVE ONCOLOGY 2016; 13:14-21. [PMID: 25839061 DOI: 10.12788/jcso.0101] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients undergoing treatment for head and neck cancer commonly experience signicant changes in quality of life (QoL) and levels of symptom distress. It is not known if a telehealth intervention would mitigate these changes. OBJECTIVE To evaluate the impact of a telehealth intervention on QoL and symptom burden in patients undergoing initial treatment for head and neck cancers. METHODS A randomized clinical trial comparing the impact on QoL and symptom distress of telehealth intervention and standard care was conducted with 80 patients (45 treatment, 35 control) who had been diagnosed with head or neck cancer and were receiving 1 or more treatment modalities. Treatment group participants responded daily to symptom management algorithms using a simple telehealth messaging device. QoL was evaluated by the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACTHN) and symptom burden by the Memorial Symptom Assessment Scale (MSAS). Control group participants completed assessments while they received routine care. RESULTS In the posttreatment phase, the telehealth participants had signicantly better scores than the controls for physical well-being (20.6 vs 17.0, P = .02) and trial outcome index (59.9 vs. 50.2, P = .04) on the FACT-HN, and total scores on the MSAS (0.9 vs. 1.2, P = .04). LIMITATIONS The moderate sample size of 80 patients limits the power to measure more subtle impacts of the intervention. CONCLUSIONS Using telehealth to provide support to patients with head and neck cancer during the acute phase of treatment improved some aspects of posttreatment QoL and symptom burden.
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Affiliation(s)
- Mark P Pfeifer
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Cynthia Keeney
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA. Ms Keeney is now with Big White Wall
| | - Jeffrey Bumpous
- Department of Surgery/Otolaryngology, University of Louisville, Louisville, Kentucky, USA
| | - Tara J Schapmire
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Jamie L Studts
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - John Myers
- Department of Pediatrics, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Barbara Head
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA.
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29
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Bianchini C, Malagò M, Crema L, Aimoni C, Matarazzo T, Bortolazzi S, Ciorba A, Pelucchi S, Pastore A. Post-operative pain management in head and neck cancer patients: predictive factors and efficacy of therapy. ACTA OTORHINOLARYNGOLOGICA ITALICA 2016; 36:91-6. [PMID: 27196072 PMCID: PMC4907166 DOI: 10.14639/0392-100x-499] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 06/06/2015] [Indexed: 12/03/2022]
Abstract
There is increasing interest about all aspects of pain sensation for patients undergoing head and neck surgery, and efforts have been made to better assess, monitor and reduce the occurrence of pain. The aetiology of pain is considered to be "multifactorial", as it is defined by several features such as personal experience, quality perception, location, intensity and emotional impact. The aim of this paper is: (i) to evaluate the efficacy of analgesic treatment in patients with head and neck cancer treated by surgery, and (ii) to study the variables and predictive factors that can influence the occurrence of pain. A total of 164 patients, affected by head and neck cancer and surgically treated, between December 2009 and December 2013, were included in this study. Data collected include age, gender, assessment of anaesthetic risk, tumour localisation, pathological cancer stage, TNM stage, type of surgery performed, complexity and duration of surgery, post-operative complications, postoperative days of hospital stay and pain evaluation on days 0, 1, 3 and 5 post-surgery. We studied the appropriateness of analgesic therapy in terms of incidence and prevalence of post-operative pain; we also related pain to patient characteristics, disease and surgical treatment to determine possible predictive factors. The population studied received adequate pain control through analgesic therapy immediately post-surgery and in the following days. No associations between gender, age and post-operative pain were found, whereas pathological cancer stage, complexity of surgery and tumour site were significantly associated with the risk of post-operative pain. Adequate pain control is essential in oncological patients, and particularly in head and neck cancer patients as the prevalence of pain in this localisation is reported to be higher than in other anatomical sites. Improved comprehension of the biological and psychological factors that characterise pain perception will help to enhance its control in the future.
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Affiliation(s)
| | | | - L Crema
- ENT and Audiology Department
| | | | - T Matarazzo
- Anaesthesiology Department, "S. Anna" University Hospital of Ferrara, Italy
| | - S Bortolazzi
- Anaesthesiology Department, "S. Anna" University Hospital of Ferrara, Italy
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30
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Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy. Pain 2016; 156:967-979. [PMID: 25719616 DOI: 10.1097/j.pain.0000000000000142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pain is a common symptom in patients with head and neck cancer (HNC) that is associated with significant decrements in physical and psychological functioning. Only 4 studies have evaluated for changes in and predictors of different pain characteristics in these patients. In this longitudinal study of patients with HNC, changes in pain intensity (i.e., average pain, worst pain), pain interference with function, and pain relief were evaluated from the initiation of radiotherapy and through the following 6 months. Hierarchical linear modeling was used to evaluate for changes over time in these 4 pain characteristics, as well as to identify predictors of interindividual variability in each characteristic. Overall, pain intensity and interference with function scores were in the mild-to-moderate range, while pain relief scores were in the moderate range. The occurrence of pain, as well as scores for each pain characteristic, increased from the initiation to the completion of radiotherapy, followed by a gradual decrease to near pretreatment levels at 6 months. However, interindividual variability existed in patients' ratings of each pain characteristic. Predictors of more severe pain characteristic scores were more comorbidities, worse physical functioning, not having surgery before radiotherapy, difficulty swallowing, mouth sores, sleep disturbance, fatigue, more energy, and less social support. Patients with more depressive symptoms had better pain relief. Although some of the predictors cannot be modified (e.g., rrence of surgery), other predictors (e.g., symptoms) can be treated. Therefore, information about these predictors may result in decreased pain in patients with HNC.
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Abstract
There is a systematic relationship between fatigue, sleep, and decreased quality of life in cancer patients, with notably poor sleep quality among many head and neck cancer patients during and after treatment. An often overlooked cause of sleep disturbance in this patient population is obstructive sleep apnea (OSA). This review explores the current literature on the prevalence and clinical correlates of OSA, management outcomes, and data on cytokine-mediated fatigue in OSA. OSA appears to be prevalent in head and neck cancer patients, both at baseline and after treatment, especially with multimodality therapy including radiation therapy. Predictors of developing OSA include larger tumor size and hypopharynx or larynx primary site. There is evidence that the level of fatigue seen in these patients is not necessarily correlated with the severity of their OSA. Current research highlights the role of proinflammatory cytokines, which can also be synergistically activated by radiation therapy, as mediators of fatigue. Primary management of OSA consists of continuous positive airway pressure. Although continuous positive airway pressure has been shown to improve clinical symptoms, compliance with its use remains a problem and will be an area of future research.
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32
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Dalton JA, Higgins MK, Miller AH, Keefe FJ, Khuri FR. Pain Intensity and Pain Interference in Patients With Lung Cancer: A Pilot Study of Biopsychosocial Predictors. Am J Clin Oncol 2015; 38:457-64. [PMID: 24064756 PMCID: PMC3962526 DOI: 10.1097/coc.0b013e3182a79009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To explore biopsychosocial factors (beliefs, depression, catastrophizing cytokines) in individuals newly diagnosed with lung cancer and no pain to determine their relationship at diagnosis and across time and to determine whether these factors contribute to pain intensity or pain interference with function at pain onset. MATERIALS AND METHODS A longitudinal, exploratory, pilot study was implemented in a private medical center and a VA medical center in the southeast. Twelve subjects not experiencing pain related to cancer of the lung or its treatment were recruited. A Karnofsky status of 40% and hemoglobin of 8 g were required. Five questionnaires were completed and 10 mL of blood was drawn at baseline; 4 questionnaires and blood draws were repeated monthly for 5 months. One baseline questionnaire and a pain assessment were added at final. Demographic, clinical, and questionnaire data were summarized; standardized scale scores were calculated. RESULTS Biopsychosocial scores that were low at baseline increased from T1-T4 but decreased slightly T5-T6. Individuals with higher pain intensity and higher pain interference at final had higher psychosocial scores at baseline than individuals with lower pain intensity and lower pain interference at final. CONCLUSIONS Unrelated to disease stage, metastasis, or treatment, unique levels of biopsychosocial factors are observed in patients newly diagnosed with lung cancer who report higher levels of pain intensity and higher levels of pain interference at the time pain occurs. Replication studies are needed to validate this response pattern and determine the value of repeated individual assessments.
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Affiliation(s)
- Jo Ann Dalton
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, Georgia 30322-4207
| | - Melinda K. Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, Georgia 30322-4207
| | - Andrew H. Miller
- Deparatment of Psychiatry, School of Medicine, Emory University, Winship Cancer Institute 1365-B Clifton Road, Atlanta, Georgia 30322
| | - Francis J. Keefe
- Department of Psychiatry, Division of Behavioral Medicine, P.O. Box 3159, Duke University Medical Center, Durham, North Carolina 27710
| | - Fadlo R. Khuri
- Chair, Department of Hematology and Medical Oncology and Deputy Director, Winship Cancer Institute, School of Medicine, Emory University, 1365-C Clifton Road, Atlanta, Georgia 30322
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Pattison N, Brown MR, Gubbay A, Peacock J, Ross JR, Chapman S, Sauzet O, Williams J. Towards a pain free hospital: an in-depth qualitative analysis of the pain experiences of head and neck cancer patients undergoing radiotherapy. Br J Pain 2015; 10:29-37. [PMID: 27551409 DOI: 10.1177/2049463715599995] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Treatment for head and neck cancer can frequently be a painful experience with implications for patients in terms of quality of life, nutrition and ultimately treatment outcomes. Pain may arise for a number of reasons in this patient group including the influence of localised tissue damage from radiotherapy, the effects of chemotherapeutic agents as well as the disease process itself. Early identification of cancer pain, through screening and early analgesic and pain management are thought to be the most appropriate approaches to the problem. AIM To explore in-depth, patients' views of the experience of pain related to radiotherapy for head and neck cancer, within the context of a randomised controlled trial (RCT) of pain screening and intervention. SAMPLE A purposive sample of head and neck cancer patients undergoing radiotherapy who were participating in a separate RCT of a proactive pain screening intervention. METHODS A qualitative design using one-off, face-to-face, in-depth interviews. Data were inductively analysed for themes using thematic analysis. Data were collected from September 2012 to January 2013. FINDINGS Eight participants were interviewed. Several issues around pain management arose and the influence of various factors became apparent. Four dominant themes emerged: facets of radiotherapy pain in head and neck cancer, facilitators and barriers to pain management, pain services and finally interdisciplinary working. CONCLUSION The specific issues faced by head and neck cancer patients undergoing radiotherapy highlight the need for pain relieving interventions delivered by pain specialists, in tandem with the development of robust self-management strategies. An integrated approach to care is optimal, comprising pain screening at each outpatient encounter, and review by specialists as necessary.
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Affiliation(s)
| | - Matthew Rd Brown
- Pain Management Team, The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | | | - Janet Peacock
- Division of Health & Social Care Research, King's College London, London, UK
| | - Joy R Ross
- The Royal Marsden and Royal Brompton Palliative Care Service, The Royal Marsden NHS Foundation Trust, London, UK
| | - Suzanne Chapman
- Pain Management Team, The Royal Marsden Hospital, London, UK
| | - Odile Sauzet
- Epidemiology & International Public Health, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | - John Williams
- Pain Management Team, The Royal Marsden Hospital, London, UK
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Barber B, Dergousoff J, Nesbitt M, Mitchell N, Harris J, O'Connell D, Côté D, Biron V, Seikaly H. Depression as a predictor of postoperative functional performance status (PFPS) and treatment adherence in head and neck cancer patients: a prospective study. J Otolaryngol Head Neck Surg 2015; 44:38. [PMID: 26385356 PMCID: PMC4574730 DOI: 10.1186/s40463-015-0092-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
Background Head and neck cancer (HNC) is a debilitating disease due in part to its effects on function, including speech, swallowing, and cosmesis. Previous studies regarding depression in HNC have focused on demographic predictors, incidence, and quality of life studies. There is, however, a paucity of studies that objectively address depressive symptoms in HNC patients and the resultant effects on post-treatment functional performance status. The aim of this study was to assess the relationship between preoperative depressive symptoms (PDS) and postoperative functional performance status (PFPS), in addition to other predictors of rehabilitation and survival. Methods A prospective cohort study was undertaken at the University of Alberta, including all new adult HNC patients undergoing surgery as primary therapy for HNC from May 2013 to January 2014. Baseline depressive symptoms were measured on the Quick Inventory of Depressive Symptoms (QIDS) questionnaire 2 weeks preoperatively and PFPS was assessed 12 months postoperatively on the Functional Assessment of Cancer Therapy-Head & Neck (FACT-HN) scale. Secondary outcomes included completion of adjuvant therapy, narcotic dependence, return to detrimental habits, loss of follow-up, and length of hospital stay (LOHS). Differences between the Normal-Mild and Moderate-Severe QIDS groups were assessed using Mann–Whitney and Fischer Exact statistical analyses. Results Seventy-one patients were included in the study. Mild and Moderate-Severe PDS were 35.2 % and 18.3 %, respectively. Significantly lower FACT-HN scores were noted in the Moderate-Severe group at 12 months (p = 0.03). The risk ratio (RR) for FACT-HN score < 50 % at 12 months in the Moderate-Severe group was 5.66. In addition, significantly lower completion of adjuvant treatment (p = 0.03), significantly higher incidence of narcotic dependence (p = 0.004), and significantly higher LOHS (24 days vs. 18 days; p = 0.02) was observed in the Moderate-Severe group. There was no significant difference in loss of follow-up between the 2 groups (p = 0.64). Conclusions The incidence and severity of PDS in HNC patients treated with surgery is high (53.5 %). Patients with Moderate-Severe PDS have significantly decreased PFPS, increased narcotic use, decreased completion of adjuvant therapy, and a longer LOHS. HNC patients should be monitored closely for depressive symptoms.
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Affiliation(s)
- Brittany Barber
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
| | - Jace Dergousoff
- Department of Psychiatry, University of Alberta Hospital, 1E1, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada
| | - Margaret Nesbitt
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada
| | - Nicholas Mitchell
- Department of Psychiatry, University of Alberta Hospital, 1E1, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada
| | - Jeffrey Harris
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada
| | - Daniel O'Connell
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada
| | - David Côté
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada
| | - Vincent Biron
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta Hospital, 1E4, Walter Mackenzie Centre, 8440-112 St, Edmonton, AB, T6G 2B7, Canada
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35
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Development and evaluation of an algorithm to facilitate drug prescription for inpatients with feeding tubes. Eur J Clin Pharmacol 2015; 71:489-97. [PMID: 25690983 DOI: 10.1007/s00228-015-1817-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE We aimed to develop and evaluate an algorithm to facilitate drug switching between primary and tertiary care for patients with feeding tubes. METHODS An expert consortium developed an algorithm and applied it manually to 267 preadmission drugs of 46 patients admitted to a surgical ward of a tertiary care university hospital between June 12 and December 2, 2013, and requiring a feeding tube during their inpatient stay. RESULTS The new algorithm considered the following principles: Drugs should be ideally listed on the hospital drug formulary (HDF). Additionally, drugs should include the same ingredient instead of a therapeutic equivalent. Preferred dosage forms were appropriate liquids, followed by solid drugs with liquid administration form, and solid drugs that could be crushed and/or suspended. Of all evaluated drugs, 83.5% could be switched to suitable drugs listed on the HDF and another 6.0% to drugs available on the German drug market. Additionally, for 4.1% of the drugs, the integration of individual switching rules allowed the switch from enteric-coated to immediate-release drugs. Consequently, 6.4% of the drugs could not be automatically switched and required case-to-case decision by a clinical professional (e.g., from sustained-release to immediate-release). CONCLUSIONS The predefined principles were successfully integrated in the new algorithm. Thus, the algorithm switched more than 90% of the evaluated preadmission drugs to suitable drugs for inpatients with feeding tubes. This finding suggests that the algorithm can readily be transferred to an electronic format and integrated into a clinical decision support system.
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Moderators of the response to a nurse-led psychosocial intervention to reduce depressive symptoms in head and neck cancer patients. Support Care Cancer 2015; 23:2417-26. [PMID: 25612795 PMCID: PMC4483179 DOI: 10.1007/s00520-015-2603-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/05/2015] [Indexed: 11/26/2022]
Abstract
Purpose Little is known about the variables that moderate the response to psychosocial interventions to decrease depressive symptoms in cancer patients. The purpose of this study was to determine whether variables associated with depressive symptoms in cancer patients in general moderate the response to a nurse-led psychosocial intervention in patients with head and neck cancer. Methods This study is a secondary analysis of a randomized controlled trial evaluating the effect of the nurse counseling and after intervention (NUCAI) on depressive symptoms 12 months after cancer treatment in patients with head and neck cancer. Of 205 patients, 103 received the NUCAI and 102 care as usual. Twenty-one variables were selected for analysis and a linear regression analyses including interaction terms was performed for each variable separately. Significant moderators were post hoc probed. Results Four moderators were found: marital status, global quality of life, emotional functioning, and social functioning. Patients who were married/living together or had low scores for global quality of life, and emotional or social functioning at baseline benefited more from the NUCAI than patients who were single or with high scores for global quality of life and emotional or social functioning. Conclusions Marital status, global quality of life, and emotional and social functioning of head and neck cancer patients should be evaluated to determine whether they might benefit from a psychosocial intervention to combat depressive symptoms. Further research is necessary to replicate results and to contribute to the knowledge needed to make screening and personalized patient care possible.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide the reader with an up-to-date overview on the biopsychosocial model in cancer pain. RECENT FINDINGS This review contains articles published from 2012 to 2014, which advance our understanding of biopsychosocial factors related to the cancer pain experience and psychosocial treatment for cancer pain. Greater depression, anxiety, and distress, and lower quality of life are related to greater pain intensity in cancer patients. Recent publications have expanded on this research by examining how psychosocial factors relate to the development of chronic pain conditions after cancer treatment. Recent publications have also advanced our understanding of psychosocial interventions for cancer pain and symptom management. In the last few years, several reviews have emerged, which have found modest effect sizes for psychosocial interventions in cancer pain management. SUMMARY The biopsychosocial model is a helpful way to comprehensively approach the conceptualization and treatment of pain in cancer patients at all stages of the disease process. We currently have an established base of research on the importance of biopsychosocial model in cancer pain. Our ability to treat patients with cancer pain effectively will improve as we gain a better understanding of which treatments work for which patients.
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Wissinger E, Griebsch I, Lungershausen J, Byrnes M, Travers K, Pashos CL. The humanistic burden of head and neck cancer: a systematic literature review. PHARMACOECONOMICS 2014; 32:1213-1229. [PMID: 25145800 DOI: 10.1007/s40273-014-0199-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Head and neck cancer (HNC) and its treatment can affect communication, nutrition, and physical appearance, and the global impact of this disease on patients' quality of life may be substantial. OBJECTIVE The aim of this systematic literature review was to describe the impact of HNC and its treatment on the physical, emotional, and social well-being of patients over time, by examining longitudinal studies of patient-reported outcomes (PRO) evaluating these domains. METHODS Databases (MEDLINE and Embase) were searched to identify studies published in English between January 2004 and January 2014 analyzing the humanistic aspects of HNC in adult patients. Additional relevant publications were identified through manual searches of abstracts from recent conference proceedings. RESULTS Of 1,566 studies initially identified, 130 met the inclusion criteria and were evaluated in the assessment. Investigations using a variety of PRO instruments in heterogeneous patient populations consistently reported that PRO scores decrease significantly from diagnosis through the treatment period, but generally recover to baseline in the first year post-treatment. This trend was observed for many functional domains, although some side effects, such as xerostomia, persisted well beyond 1 year. In addition, considerable evidence exists that baseline PRO scores can predict clinical endpoints such as overall and progression-free survival. CONCLUSIONS Many aspects of HNC, both disease and treatment specific, profoundly affect patients' quality of life. Improved knowledge of these effects on PRO may allow for more informed treatment decisions and can help physicians to better prepare patients for changes they may experience during therapy. Furthermore, the predictive value of baseline PRO data may enable healthcare providers to identify at-risk patients in need of more intensive intervention.
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Moubayed SP, Sampalis JS, Ayad T, Guertin L, Bissada E, Gologan OE, Soulières D, Lambert L, Filion E, Nguyen-Tan PF, Christopoulos A. Predicting depression and quality of life among long-term head and neck cancer survivors. Otolaryngol Head Neck Surg 2014; 152:91-7. [PMID: 25395572 DOI: 10.1177/0194599814557772] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study is to identify clinical factors that are predictive of depression and quality of life (QOL) among long-term survivors of head and neck squamous cell carcinoma and to develop predictive scores using these factors. STUDY DESIGN Cohort study SETTING Tertiary referral center. SUBJECTS AND METHODS A total of 209 posttreatment (median follow-up, 38.7 months) head and neck cancer patients were prospectively evaluated using the Hospital Anxiety Depression Scale (HADS), the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30, and the EORTC Quality of Life Questionnaire Head and Neck 35, and pretreatment patient-related, tumor-related, and treatment-related predictors were identified using chart review. Bivariate (χ(2) and t test) and multivariate (linear regression) analyses were used to construct predictive models. RESULTS Significant pretreatment predictors of depression were identified on multivariate analysis as smoking at diagnosis, >14 alcoholic drinks per week, T3 or T4 status, and >3 medications (P < .001). Two or more of these factors yielded an 82.3% sensitivity in detecting significant depressive symptoms (defined as a HADS cutoff score of 5). Significant predictors of fatigue, global health/QOL, social contact, speech, pain, swallowing, and xerostomia were also identified. CONCLUSION Pretreatment predictors of long-term depression and QOL have been defined using multivariate models, and an easily applicable predictive score of long-term depression is proposed. Potential eventual clinical applications include prophylactic intervention in at-risk patients.
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Affiliation(s)
- Sami P Moubayed
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada Division of Surgical Research, Department of Surgery, McGill University, Montreal, Canada
| | - John S Sampalis
- Division of Surgical Research, Department of Surgery, McGill University, Montreal, Canada
| | - Tareck Ayad
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Louis Guertin
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Eric Bissada
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Olguta E Gologan
- Department of Pathology, Université de Montréal Hospital Center, Montreal, Canada
| | - Denis Soulières
- Medical Oncology Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Louise Lambert
- Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada
| | - Edith Filion
- Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada
| | - Phuc Felix Nguyen-Tan
- Department of Radiation Oncology, Université de Montréal Hospital Center, Montreal, Canada
| | - Apostolos Christopoulos
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
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Abstract
Outcomes research is defined as clinical and population-based research that investigates the results of healthcare practices or interventions through the filter of the benefit to the patient and other stakeholders. Outcomes research is an increasingly important field or research, because of the pressing need for evidence-based information that can be used to make better informed health and healthcare decisions, and define desired health care practices in the current era of healthcare reform. This article will review the head and neck cancer (HNCA) outcomes literature published in the past year, with a focus on studies evaluating treatment and survival, short-term and long-term complications, and quality of life (QOL).
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Affiliation(s)
- Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, and the Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, 601 N. Caroline Street Suite 6260, Baltimore, MD, 21287, USA,
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Espitalier F, Testelin S, Blanchard D, Binczak M, Bollet M, Calmels P, Couturaud C, Dreyer C, Navez M, Perrichon C, Morinière S, Albert S. Management of somatic pain induced by treatment of head and neck cancer: Postoperative pain. Guidelines of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:249-52. [PMID: 25106697 DOI: 10.1016/j.anorl.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To present the guidelines of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL) concerning the management of somatic pain induced by the treatment of head and neck cancer, and in particular the management of early and late post-surgical pain. METHODS A multidisciplinary work group conducted a review of the scientific literature on the study topic. An editorial group subsequently read the resulting guidelines before validation. RESULTS It is recommended to prevent onset of pain caused by malpositioning on the operating table, as well as pain related to postoperative care. During surgery, it is recommended to spare nerve and muscle structures as far as possible to limit painful sequelae. Management of early postoperative pain upon tumor resection and flap harvesting sites requires patient-controlled analgesia by morphine pump. Physical therapy is recommended after flap harvesting to minimize painful sequelae. CONCLUSION Preventive and curative measures should be undertaken for appropriate management of post-surgical pain in the treatment of head and neck cancers.
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Affiliation(s)
- F Espitalier
- Service d'ORL et de chirurgie cervico-faciale, hôpital Hôtel-Dieu, CHU, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France.
| | - S Testelin
- Service de chirurgie maxillo-faciale, CHU, place Victor-Pauchet, 80054 Amiens cedex, France
| | - D Blanchard
- Service d'ORL et de chirurgie cervico-faciale, centre François-Baclesse - centre de lutte contre le cancer Basse-Normandie, 3, avenue Général-Harris, BP 5026, 14076 Caen cedex 05, France
| | - M Binczak
- Service d'anesthésie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - M Bollet
- Oncologie-radiothérapie, centre de radiothérapie Hartmann, 4, rue Kléber, 92300 Levallois-Perret, France
| | - P Calmels
- Service de médecine physique et de réadaptation, hôpital de Bellevue, CHU, 42055 Saint-Étienne cedex, France
| | - C Couturaud
- Service de chirurgie maxillo-faciale, CHU Nord, place Victor-Pauchet, 80054 Amiens cedex, France
| | - C Dreyer
- Service de cancérologie, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - M Navez
- Département d'anesthésie-réanimation, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France
| | - C Perrichon
- Service d'ORL et de chirurgie cervico-faciale, CHU Bretonneau, 2, boulevard Tonnellé, 37000 Tours, France
| | - S Morinière
- Service d'ORL et de chirurgie cervico-faciale, hôpital Bretonneau, CHU, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - S Albert
- Service d'ORL et de chirurgie cervico-faciale, groupe hospitalier Bichat - Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
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Abstract
PURPOSE OF REVIEW Persistent postsurgical pain (PPP) is an important cause of pain morbidity following surgery for almost any cause, but there is a greater evidence base for pain after cancer surgery. Historically, both patients and practitioners have struggled to recognize and accept this growing problem. This review will seek to highlight the awareness of this increasing epidemic and will discuss evidence base for diagnosis, risk factors and current strategies for prevention and treatment, especially after cancer surgery. RECENT FINDINGS Given the potential size of the problems of PPP, there is a relative paucity of recent data, especially as regards effective treatments. The review will synthesize current and existing evidence to give a balanced up-to-date view. There is a clear need for more high-quality randomized trials. SUMMARY An estimated 40,000 patients in the UK will develop PPP, of whom at least 5-10% will have severe pain. Lack of clear definition and lack of awareness have been barriers to diagnosis and access to treatment. Several risk factors associated with PPP have been identified and reduction of these factors may prevent its development. At present, there are large gaps in the evidence base and more large controlled trials are warranted.
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Oliveira KG, von Zeidler SV, Podestá JR, Sena A, Souza ED, Lenzi J, Bissoli NS, Gouvea SA. Influence of pain severity on the quality of life in patients with head and neck cancer before antineoplastic therapy. BMC Cancer 2014; 14:39. [PMID: 24460780 PMCID: PMC3904211 DOI: 10.1186/1471-2407-14-39] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 12/20/2013] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this study was to assess the severity of pain and its impact on the quality of life (QoL) in untreated patients with head and neck squamous cell carcinoma (HNSCC). Methods A study group of 127 patients with HNSCC were interviewed before antineoplastic treatment. The severity of pain was measured using the Brief Pain Inventory (BPI) questionnaire, and the QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and the head and neck module (QLQ-H&N35). Results The mean age of the patients was 57.9 years, and there was a predominance of men (87.4%). The most frequent site of the primary tumor was the oral cavity (70.6%), and the majority of the patients had advanced cancers (stages III and IV). QoL in early stage of cancer obtained better scores. Conversely, the patients with advanced stage cancer scored significantly higher on the symptom scales regarding fatigue, pain, appetite loss and financial difficulties, indicating greater difficulties. Regard to the severity of pain, patients with moderate-severe pain revealed a significantly worse score than patients without pain. Conclusions The severity of pain is statistically related to the advanced stages of cancer and directly affects the QoL. An assessment of the quality of life and symptoms before therapy can direct attention to the most important symptoms, and appropriate interventions can then be directed toward improving QoL outcomes and the response to treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Sonia A Gouvea
- Department of Physiological Sciences, Health Sciences Center, Federal University of Espirito Santo, Vitória, Brazil.
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Wong A, Kacker A. Incidence of unplanned admissions after sinonasal surgery: a 6-year review. Int Forum Allergy Rhinol 2013; 4:143-6. [PMID: 24227313 DOI: 10.1002/alr.21250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/07/2013] [Accepted: 10/10/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND There has been an increasing transition from hospital-based surgeries to ambulatory surgery center (ASC)-based surgeries. A significant portion of ASC cases are otolaryngological procedures, with sinonasal surgery as one of the most common procedures. However, admissions into the hospital from the ASC can be difficult for the patient and the provider. This study evaluates the incidence of unplanned admissions after sinonasal surgery in a 6-year period and identifies the factors for these admissions. METHODS A retrospective study was conducted of patients who had ambulatory sinonasal surgeries from January 2007 to December 2012 at Weill Cornell Medical Center/New York Presbyterian Hospital performed by the senior author (A.K.). Electronic medical records were reviewed for age, gender, procedure/surgery performed, and admission and/or discharge information. RESULTS A total of 750 patients who underwent sinonasal surgeries from January 2007 to December 2012 were eligible for review. The study sample had a mean age of 46 years and 55.6% were male. There were a total of 24 admissions, of which 6 were unplanned (0.8%). Reasons for unplanned admissions included pain (most common, 50%), followed by epistaxis, nausea, and other. CONCLUSION The rate for unplanned admissions for sinonasal surgeries was 0.8%, which is lower than the national rate (2.65%), indicating that sinonasal surgeries are appropriate as ambulatory cases. Because the reason for unplanned admission was highest for pain, patients should be further evaluated for more effective methods of pain control postoperatively or preemptively.
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Affiliation(s)
- Anni Wong
- Department of Otorhinolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY
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Mesgarpour B, Griebler U, Glechner A, Kien C, Strobelberger M, Van Noord M, Michalek-Sauberer A. Extended-release opioids in the management of cancer pain: A systematic review of efficacy and safety. Eur J Pain 2013; 18:605-16. [DOI: 10.1002/j.1532-2149.2013.00401.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2013] [Indexed: 01/31/2023]
Affiliation(s)
- B. Mesgarpour
- Department of Clinical Pharmacology; Medical University of Vienna; Austria
- Department of Emergency Medicine; Medical University of Vienna; Austria
| | - U. Griebler
- Department for Evidence-based Medicine and Clinical Epidemiology; Danube University Krems; Austria
| | - A. Glechner
- Department for Evidence-based Medicine and Clinical Epidemiology; Danube University Krems; Austria
| | - C. Kien
- Department for Evidence-based Medicine and Clinical Epidemiology; Danube University Krems; Austria
| | - M. Strobelberger
- Department for Evidence-based Medicine and Clinical Epidemiology; Danube University Krems; Austria
| | - M.G. Van Noord
- Department for Evidence-based Medicine and Clinical Epidemiology; Danube University Krems; Austria
| | - A. Michalek-Sauberer
- Department of Special Anaesthesia and Pain Therapy; Medical University of Vienna; Austria
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