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Dang RR, Lin JAJ, Hung SY, Wei FC. Quality-of-Life Outcomes in Oral Cancer Patients Reconstructed With Double Free Flaps: A Preoperative and Postoperative Assessment. Ann Plast Surg 2024; 92:658-662. [PMID: 38718341 DOI: 10.1097/sap.0000000000003915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
PURPOSE This study aimed to evaluate quality of life (QOL) in patients with locally advanced oral cancer who underwent surgical resection followed by simultaneous double free flap reconstruction. METHODS Institutional database was reviewed from 2015 to 2021 and prospectively collected University of Washington Quality of Life data that were extracted for patients who met the inclusion criteria. Mean, composite, and best percentage scores were computed. Wilcoxon signed rank test was used to analyze differences between groups. RESULTS Thirteen patients completed the assessment, all of them being male with a mean follow-up of 2.2 ± 1.2 years. Most common double free flap combination was fibula osteoseptocutaneous flap and anterolateral thigh flap (n = 11). Improvement in pain ( P = 0.01) domain score with decline in speech ( P = 0.01) and taste ( P = 0.02) was noted along with an overall decline in QOL ( P = 0.001) after cancer diagnosis. A decrease in physical function was seen postoperatively. Chewing and saliva were the most cited postoperative patient-reported domain affecting QOL. CONCLUSIONS In double free flap reconstructed patients, in the postoperative phase, pain scores improved, whereas speech and taste scores declined. The overall health-related QOL declined compared with before cancer diagnosis.
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Affiliation(s)
| | - Jennifer An-Jou Lin
- From the Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shao-Yu Hung
- From the Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Zhang KK, Graziano FD, Cohen Z, Cunningham L, Ali B, Coleman-Belin J, Kim M, Haglich K, Cracchiolo JR, Matros E, Shahzad F, Nelson JA, Allen RJ. Clinical, functional, and patient-reported outcomes of radial forearm versus anterolateral thigh free tissue transfer for reconstruction of glossectomy defects. J Surg Oncol 2024; 129:681-690. [PMID: 38073188 DOI: 10.1002/jso.27560] [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] [Received: 11/22/2023] [Accepted: 11/26/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND There is a lack of literature of health-related quality of life endpoints for radial forearm (RF) versus anterolateral thigh (ALT) free flap reconstruction for glossectomy defects. Our goal was to perform a comprehensive evaluation of clinical, functional, and quality of life outcomes after glossectomy reconstruction using a RF or ALT flap. METHODS A retrospective review was performed on patients who underwent glossectomy and immediate reconstruction with RF or ALT flaps between 2016 and 2021. Outcomes of interest included readmission and reoperation rates, functional assessments, tracheostomy and gastrostomy tube status, and FACE-Q Head and Neck Cancer scores. RESULTS Seventy-eight patients consisting of 54 RF and 24 ALT free flaps were included. ALT patients had a larger median flap size (72 vs. 48 cm2 , p = 0.021) and underwent mandibulotomy (50% vs. 7.4%, p < 0.0001) and base of tongue resection (58.3% vs. 24.1%, p = 0.005) at higher rates. No significant differences were found with respect to other outcomes. CONCLUSION The RF and ALT flaps are suitable for glossectomy reconstruction, with minimal differences seen in postoperative outcomes. Our study suggests that ALT can be used in patients with base of tongue and larger defect sizes, while providing similar functional and clinical outcomes to RF reconstruction.
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Affiliation(s)
- Kevin K Zhang
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Francis D Graziano
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Zack Cohen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Louise Cunningham
- Speech Pathology, Center for Speech and Hearing, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Barkat Ali
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Janet Coleman-Belin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kathryn Haglich
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer R Cracchiolo
- Head and Neck Oncology Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Farooq Shahzad
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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König J, Kelemen K, Váncsa S, Szabó B, Varga G, Mikulás K, Borbély J, Hegyi P, Hermann P. Comparative analysis of surgical and prosthetic rehabilitation in maxillectomy: A systematic review and meta-analysis on quality-of-life scores and objective speech and masticatory measurements. J Prosthet Dent 2023:S0022-3913(23)00775-8. [PMID: 38151428 DOI: 10.1016/j.prosdent.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023]
Abstract
STATEMENT OF PROBLEM Patients with oro-antral communication, whether from trauma, disease, or congenital anomalies, have options for surgical reconstruction or prosthetic obturation, but guiding interdisciplinary protocols are lacking. PURPOSE The purpose of this systematic review and meta-analysis was to compare surgical reconstruction and prosthetic obturation, identifying correlations with baseline characteristics to determine the most effective approach for specific patients. MATERIAL AND METHODS A systematic search was conducted in 4 databases. Searching, screening, data extraction, and risk of bias assessment were performed by 2 reviewers. Eligible studies focused on patients with palatomaxillary defects from cancer-related maxilla surgeries. Traumatic or congenital defects were excluded. The study compared prosthetic restoration (either with surgical or definitive obturators) to surgical reconstruction using flaps or grafts. Patients with surgical restoration after tooth extraction were excluded. Both subjective and objective outcomes were used for comparison. RESULTS Thirteen articles were included in the qualitative synthesis and 9 in the meta-analysis. Patient scores on quality-of-life questionnaires, objective speech, and masticatory ability evaluations were compared. The number of patients who underwent surgical reconstruction was 206, whereas 260 patients received prosthetic obturators. Results showed no significant differences. In the "activity" domain of the University of Washington QoL questionnaire, however, the 1.92 (0.45, 3.40) score difference was not clinically relevant. However, the heterogeneity of trials, the transient nature of subjective evaluations, the low number of participants, and major confounding biases did not allow a solid conclusion to be drawn. CONCLUSIONS The growing number of maxillectomy patients demands firm evidence on which rehabilitation to choose and when it should be done. The result suggests that obturator devices and surgical reconstruction have similar effects on quality of life and health outcomes. A multicentric registry in which patient strata could be analyzed separately by age, adjuvant therapies, defect sizes, and remaining dentition is advocated.
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Affiliation(s)
- János König
- Assistant Lecturer, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and PhD student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Kata Kelemen
- Assistant Lecturer, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and PhD student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Scientific Methodological Expert, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Bence Szabó
- Biostatistician, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Gábor Varga
- General & Operative Vice Director, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Full Professor, Department of Oral Biology, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztina Mikulás
- Assistant Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Judit Borbély
- Associate Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Strategic Director, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; and Strategic Director, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hermann
- Director and Full Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; and Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
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Leuke Bandara D, Kanmodi KK, Salami AA, Amzat J, Jayasinghe RD. Quality of life of dental patients treated with laser surgery: A scoping review. Health Sci Rep 2023; 6:e1368. [PMID: 37351458 PMCID: PMC10283030 DOI: 10.1002/hsr2.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/23/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023] Open
Abstract
Background and Aims The use of lasers has been increasing in various surgical procedures. Its specific characteristics have conquered the scalpel used to a major extent in certain surgical procedures. This scoping review aimed to assess the empirical evidence that exists on the quality of life (QoL) of dental patients treated with laser surgery. Methods This scoping review was conducted in accordance with the Arksey and O'Malley's guidelines for scoping reviews. Four electronic databases (PubMed, SCOPUS, CINAHL Complete, and APA PsycInfo) were systematically searched through a stepwise approach, informed by the PEO (Population [P], Exposure [E], and Outcome [O]) framework, to retrieve literatures relevant to the review question. After a two-staged and Rayyan-aided screening process, only those literatures meeting the inclusion criteria were included into the review. From the included literatures, data were extracted, collated, summarized, and presented. Results The literature search retrieved 246 articles, of which only 10 articles were selected according to the inclusion criteria. Five of the studies were from the United Kingdom and three were from Italy. Study designs were either cohort (60%) or randomized controlled trials (40%). A vast variation was observed in the study populations. The used QoL instruments were mostly disease/condition-specific and oral cancer was the most reported disease in the included articles. The patients who underwent laser surgery had better QoL on the 7th day postoperatively, although it was not significant in later days. Conclusion Depending on the indication, Laser is a safe surgical approach that could enhance the clinical outcome as well as the QoL of dental patients. Laser effects were more significant in the domain of postoperative pain. Due to the limited number of studies evaluated in this review, further longitudinal studies are needed to corroborate the findings of this review.
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Affiliation(s)
| | - Kehinde K. Kanmodi
- School of Health and Life SciencesTeesside UniversityMiddlesbroughUK
- Faculty of DentistryUniversity of PuthisastraPhnom PenhCambodia
- Cephas Health Research Initiative IncIbadanNigeria
| | - Afeez A. Salami
- Department of Oral and Maxillofacial SurgeryUniversity College HospitalIbadanNigeria
| | - Jimoh Amzat
- Department of SociologyUsmanu Danfodiyo UniversitySokotoNigeria
- Department of SociologyUniversity of JohannesburgJohannesburgSouth Africa
| | - Ruwan D. Jayasinghe
- Department of Oral Medicine and PeriodontologyUniversity of PeradeniyaPeradeniyaSri Lanka
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Petrović A, Keković G, Sekulić S, Mojsilović S. Quality of life in patients surgically treated for oral carcinoma. BALKAN JOURNAL OF DENTAL MEDICINE 2023. [DOI: 10.5937/bjdm2301021p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Background/Aim: The aim of this study was to examine quality of life in patients who were surgically treated for oral carcinoma. Material and Methods: The study included patients surgically treated over a 3-year period (2014-2016). Data on patients, tumor type and localization, disease status according to the TNM classification, type of surgical intervention and time since surgery were collected from the medical records. Postsurgery functional and aesthetic results were evaluated using the adapted University of Washington Quality of Life questionnaire. Results: Forty patients were included in the study. Male patients were more prevalent (27 vs 13) (ch2=4.225p<0.05). Ratio of planocellular vs adenocarcinoma was 35 vs 5 (ch2=11.404, p=0.0007, a=0.05). Osteotomy was performed in 52.5% of patients, and surgical intervention in the soft tissue was performed in 47.5%. Patients who had recovered >1 year showed better mood (MannWhitney test, p=0.036, a=0.05), functions of speech (Mann-Whitney test p=0.008, a=0.05) and chewing (Mann-Whitney test p=0.04, a=0.05), as well as patients who had soft tissue surgery (chewing: Mann-Whitney test p=0.016, a=0.05; speech: Mann-Whitney test p=0.043, a=0.05). Patients with T1 stage tumors considered their looks less disfigured and had fewer problems in appearing in public, compared with patients with T3 and T4 stage (Dunn's test, CI -95%). Interest in sex was significantly diminished in patients older than 30 years (Kruskal-Wallis testa (p=0.013, a=0.05). Conclusions: The stage of disease, range of resection and success of reconstruction were decisive parameters for postoperative quality of life. Early detection of disease is of utmost importance for both survival and quality of life of patients with carcinoma.
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Suzuki K, Nishio N, Kimura H, Tokura T, Kishi S, Ozaki N, Fujimoto Y, Sone M. Comparison of quality of life and psychological distress in patients with tongue cancer undergoing a total/subtotal glossectomy or extended hemiglossectomy and free flap transfer: a prospective evaluation. Int J Oral Maxillofac Surg 2022; 52:621-629. [PMID: 36470693 DOI: 10.1016/j.ijom.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
The aim of this study was to assess changes in the quality of life and psychological distress of patients with tongue cancer undergoing total/subtotal glossectomy (TG) or extended hemiglossectomy (HG) and free flap transfer. Differences between the two groups were compared using the Short Form 8-Item Health Survey (SF-8) and Hospital Anxiety and Depression Scale (HADS). Of the 43 patients with tongue cancer, 24 (56%) underwent TG and 19 (44%) underwent HG. The general health and social functioning scores in the SF-8 and depression in the HADS were significantly worse in the TG group than in the HG group at 12 months after surgery, indicating that patients in the TG group may experience social isolation and psychological distress, and have difficulty in employability even 12 months after surgery. In contrast, all items of the SF-8 in the HG group were nearly equal to those in the general population. Due to the extensive psychological impact on patients with tongue cancer who are planned for an extended resection, curative surgery with free flap transfer and multidisciplinary psychiatric support are essential to improve quality of life and manage psychological distress.
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Long SM, Singh A, Tin AL, O'Hara B, Cohen MA, Lee N, Pfister DG, Hung T, Wong RJ, Vickers AJ, Estilo CL, Cracchiolo JR. Comparison of Objective Measures of Trismus and Salivation With Patient-reported Outcomes Following Treatment for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2022; 148:749-755. [PMID: 35737363 DOI: 10.1001/jamaoto.2022.1495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Xerostomia and reduced mouth opening are negatively associated with quality of life after radiation therapy (RT) for head and neck cancer. Studies comparing objective measures of function with patient-reported outcomes (PROs) have not revealed a clear association. Objective To determine how much of the variation in PROs is explained by objective measures of salivary gland and oral cavity functions (salivary flow and maximal interincisal opening). Design, Setting, and Participants This cross-sectional study at a single academic cancer center evaluated 112 patients who underwent RT for head and neck cancer between January 2016 and March 2021. Measurements of pre-RT and post-RT saliva and a complete PROs scale within 6 months of the post-RT measurement were analyzed using pairwise associations. Interventions Three independently scored PRO scales from the validated FACE-Q Head and Neck Cancer Module were evaluated: eating and drinking, eating distress, and salivation. Three objective measures were analyzed: maximal interincisal opening, stimulated salivary flow, and unstimulated salivary flow. Main Outcomes and Measures Univariable linear regression models were performed for each PRO against each objective measure, and coefficients of determination (R2) and 95% CIs were reported. Results The patient cohort comprised 86 men (77%). Median age was 61 years (IQR, 53-68 years), 89 patients (80%) were White, and 61 patients (54%) were current or former smokers. Unstimulated saliva accounted for only a small portion of variation on the salivation scale (R2 = 14.0%). The remaining associations were even smaller (R2 = 5.0%-10.0%). No upper 95% CI bound included an R2 of 30%, suggesting that objective measurements do not explain a high level of the variation in PROs. Conclusions and Relevance In this cross-sectional study, objective measurements of salivary flow and mouth opening explained only a small fraction of variation in PROs. These findings suggest that factors other than objective function, including patient adaptation, are the dominant influence on PROs in this population. Patient-reported outcomes should be integrated into head and neck cancer clinical care and research. Additional research is required to evaluate which clinicopathological factors influence PROs for salivation, eating and drinking, and eating distress.
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Affiliation(s)
- Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Annu Singh
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy L Tin
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bridget O'Hara
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, New York.,CentraState Healthcare System, Freehold Township, New Jersey
| | - Marc A Cohen
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David G Pfister
- Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tony Hung
- Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Vickers
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cherry L Estilo
- Dental Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer R Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Sharaf MY, Eskander AE. Patient Satisfaction regarding Conventional One-Piece Versus Two-Piece Magnet-Retained Obturator for Patients with Complete Edentulism: A Preliminary Crossover Clinical Trial. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2203140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
This study aimed at evaluating patients' satisfaction with conventional one-piece obturators versus two-piece magnet-retained obturators in completely edentulous patient maxillectomy cases.
Materials and Methods:
Ten completely edentulous participants with hemimaxillectomy (8 males and 2 females) were selected in a crossover study. Participants received a conventional obturator one-piece and two-piece obturators connected by magnet attachment in alternate periods (sequences A‐B and B‐A), and outcomes were assessed after 1 week, 3 months, and 6 months Evaluation was made using Obturator Functioning Scale (OFS) and Oral Health Impact Profile for edentulous people (OHIP-EDENT). One way ANOVA test and multivariate analysis of variance with a general linear model with repeated measures was used to test the impact of the group, time, and order on each of the studied scores (α=.05).
Results:
Magnet design showed a statistically significant lower score (P <.050) than the conventional design regarding the overall satisfaction score of OFS along all follow-up periods. Concerning OHIP-EDENT, the magnet design showed a statistically significant lower score (P <.050) than the conventional design regarding total functional limitations, total physical pain, and total social disability along all follow-up periods while for total psychological discomfort, total physical disability, and total handicap, no statistically significant difference was observed between both groups (P >.050).
Conclusion:
Two-pieces magnet-retained obturator could provide better satisfaction and better restoration of orofacial function than the conventional one to manage completely edentulous patients.
Clinical Trial Registration Number:
NCT05066828
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Hardingham NM, Ward EC, Clayton NA, Gallagher RA. Does the mandibular lingual release approach impact post-operative swallowing in patients with oral cavity and/or oropharyngeal squamous cell carcinomas: a scoping review. SPEECH, LANGUAGE AND HEARING 2022. [DOI: 10.1080/2050571x.2022.2064114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- N. M. Hardingham
- Speech Pathology Department, St Vincent’s Hospital, Sydney, Australia
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
| | - E. C. Ward
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
- Centre for Functioning and Health Research, Queensland Health, Buranda, Australia
| | - N. A. Clayton
- School of Health & Rehabilitation Sciences, University of Queensland, St Lucia, Australia
- Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - R. A. Gallagher
- Otolaryngology, St Vincent’s Hospital, Sydney Australia
- School of Medicine, The University of Notre Dame, Sydney, Australia
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10
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Mortensen A, Wessel I, Rogers SN, Tolver A, Jarden M. Needs assessment in patients surgically treated for head and neck cancer-a randomized controlled trial. Support Care Cancer 2022; 30:4201-4218. [PMID: 35083545 DOI: 10.1007/s00520-021-06759-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the effect and feasibility of a head and neck cancer-specific needs assessment tool integrated into nursing rehabilitation consultations early in the post-surgical period on quality of life, symptom burden, and referrals for multidisciplinary follow-up. METHODS Ninety-two surgically treated patients with head and neck cancer were enrolled in a two-arm randomized controlled trial. All participants received nursing rehabilitation consultations prior to discharge, and two weeks and two months post-operative. The intervention group had their needs assessed using Patient Concerns Inventory, while standard care used a systematic questioning approach. Primary outcome was quality of life. Secondary outcomes were symptom burden and referrals for multidisciplinary rehabilitation follow-up. RESULTS No significant differences were found in quality of life or symptom burden between groups. However, 35% more patients in the intervention group were referred for rehabilitation. The attrition rate was similar in both groups, with a dropout rate of six in each group. No patients declined using the Patient Concerns Inventory. CONCLUSION The intervention showed no improvement in QoL or symptom burden compared to standard care. However, the results suggest that important needs were identified and addressed. Especially emotional and existential needs, which were accommodated through referrals and professional advice. Nursing rehabilitation consultations using the Patient Concerns Inventory are feasible and may ensure that patient preferences and priorities are incorporated in their care. TRIAL REGISTRATION ClinicalTrials.com (NCT03443258). Date of registration: May 31st, 2018.
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Affiliation(s)
- Annelise Mortensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Simon N Rogers
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, L39 4QP and Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, Great Britain, UK
| | - Anders Tolver
- Data Science Lab, Department of Mathematical Sciences, University of Copenhagen, Universitetsparken 5, 2200, Copenhagen N, Denmark
| | - Mary Jarden
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University and Department of Hematology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
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Lane C, Myers C, Jiang D, Cooke A, Kerr P. Selected functional outcomes in advanced oral cancer: Comparison of surgery alone versus surgery with postoperative radiotherapy. Head Neck 2021; 44:710-721. [PMID: 34939707 DOI: 10.1002/hed.26968] [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: 04/11/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Study objectives were to determine whether the addition of postoperative radiation (PORT) resulted in a decline in oral function relative to surgery alone and to describe the longitudinal course of oral function following treatment of advanced oral cancer. METHODS This was a 36-month retrospectively analyzed observational cohort study of patients with stage III-IV oral cancer. Prospectively collected, oral functional outcomes were acquired pretreatment and 3, 6, 12, 24, and 36 months post-treatment. RESULTS One hundred and eighteen patients were included. Forty-three patients treated with surgery alone were compared to 75 who received surgery with PORT. Mixed model analysis demonstrated the acute effect of PORT was associated with patient-rated xerostomia (p < 0.001) and the late or persistent effect was associated with decreased clinician-rated eating in public (p = 0.008), understandability of speech (p = 0.02), and normalcy of diet (p = 0.005) compared with surgery alone. There were no differences between surgery alone and PORT groups in clinician-rated feeding tube dependence or patient-rated speech handicap. CONCLUSIONS The use of PORT was associated with a demonstrable decline in oral function in four of six outcomes measures relative to surgery alone.
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Affiliation(s)
- Ciaran Lane
- Department of Otolaryngology - Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Candace Myers
- Section of Communication Disorders, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Deping Jiang
- George & Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Cooke
- Department of Radiation Oncology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kerr
- Department of Otolaryngology - Head and Neck Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Jimenez JE, Nilsen ML, Gooding WE, Anderson JL, Khan NI, Mady LJ, Wasserman-Wincko T, Duvvuri U, Kim S, Ferris RL, Solari MG, Kubik MW, Johnson JT, Sridharan S. Surgical factors associated with patient-reported quality of life outcomes after free flap reconstruction of the oral cavity. Oral Oncol 2021; 123:105574. [PMID: 34715452 DOI: 10.1016/j.oraloncology.2021.105574] [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: 07/19/2021] [Revised: 09/17/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine which surgical factors are associated with quality-of-life (QOL) outcomes in oral cavity cancer survivors after free flap reconstruction of the oral cavity. PATIENTS AND METHODS A cross-sectional study was conducted from a multidisciplinary head and neck cancer (HNC) survivorship clinic. Oral cavity cancer survivors with at least 6-months of postoperative follow-up from ablation and free flap reconstruction were included. Primary outcome measures were validated patient-reported outcome measures (PROMs) including the Eating Assessment Tool-10 (EAT-10) measure of swallowing-specific QOL, University of Washington Quality of Life (UW-QOL) physical and social-emotional subscale scores and feeding tube dependence. RESULTS Extent of tongue resection was associated with EAT-10 and the UW-QOL Physical subscale scores. Patients with oral tongue defects reported worse scores than with composite defects in the EAT-10 and UW-QOL physical domain (p = 0.0004, 0.0025, respectively). This association no longer applies when controlling for differences in extent of tongue resection. Patients with anterior composite resections reported worse EAT-10 scores than lateral resections (p = 0.024). This association no longer applies when controlling for extent of tongue resection (p = 0.46). Gastric tube dependence demonstrates similar trends to PROMs. CONCLUSION Extent of tongue resection was strongly associated with poor QOL outcomes after free tissue reconstruction of the oral cavity and mediates the associations between other defect characteristics and QOL. These findings demonstrate the need for emphasis on expected oral tongue defects when counseling patients and highlight the need to address QOL in a multidisciplinary fashion post-operatively.
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Affiliation(s)
- Joaquin E Jimenez
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States
| | - Marci Lee Nilsen
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States; University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, United States
| | | | - Jennifer L Anderson
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States
| | - Nayel I Khan
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States
| | - Leila J Mady
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States
| | - Tamara Wasserman-Wincko
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States
| | - Umamaheswar Duvvuri
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States
| | - Seungwon Kim
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States
| | - Robert L Ferris
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States; UPMC Hillman Cancer Center, United States
| | - Mario G Solari
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States; Department of Plastic Surgery, University of Pittsburgh Medical Center, United States
| | - Mark W Kubik
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States; Department of Plastic Surgery, University of Pittsburgh Medical Center, United States
| | - Jonas T Johnson
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States
| | - Shaum Sridharan
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States; Department of Plastic Surgery, University of Pittsburgh Medical Center, United States.
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Fitzgerald CWR, Long SM, McLean AT, Cracchiolo JR. Patient-reported outcomes in human papillomavirus-related oropharyngeal cancer. J Surg Oncol 2021; 124:967-976. [PMID: 34599762 DOI: 10.1002/jso.26690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022]
Abstract
This review explores how human papillomavirus-related oropharyngeal cancer affects health-related quality of life (HR-QoL) and the role patient-reported outcomes (PROs) can play in optimizing treatment. PRO measures (PROMs) are comprehensive, subjective assessments of patients' day-to-day HR-QoL. Developed through a scientifically robust, multistage process, PROMs offer insight into patients' symptoms, function, and satisfaction with care. The use of PROMs can increase symptom awareness, stimulate discussion, and enhance shared decision-making between patients and healthcare providers.
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Affiliation(s)
- Conall W R Fitzgerald
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell/Columbia, New York, New York, USA
| | - Andrew T McLean
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer R Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Marhic A, Guerlain J, Benmoussa N, Breuskin I, Honart JF, Janot F, Moya-Plana A, Temam S, Gorphe P. Replacement of lip-split mandibulotomy by pull-through approach for T3-4 oral carcinomas. Int J Oral Maxillofac Surg 2021; 50:1123-1130. [PMID: 33414034 DOI: 10.1016/j.ijom.2020.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/06/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022]
Abstract
At the study hospital, the lip-split mandibulotomy (LSM) has progressively been replaced by a pull-through (PT) approach. This study compared the outcomes of the LSM and PT approaches in a series of 192 patients with T3-T4a oral tongue and floor of the mouth squamous cell carcinoma treated over the two last decades. No difference in margin status (P = 0.254), rate of early complications (local infections) (P = 0.867), haematoma/haemorrhage (P = 0.221), delayed wound healing (P = 0.438), re-operation (P = 0.083), or Clavien-Dindo classification (P= 0.5281) was found. The LSM approach was associated with a higher rate of late complications such as pseudarthrosis (14.5% vs 0.9%; OR 17.89, P = 0.0005) and trismus (35% vs 13.8%; OR 3.32, P = 0.025), and a trend towards a higher rate of fistulas (24.6% vs 13.1%; OR 2.16, P = 0.088). The quality of life of long-term survivors (median 132 months) was similar in the two groups, with a mean QLQC30 score of 59.7 (P = 0.099) and mean MDADI score of 57.4 (P = 0.213). The 5-year local control rate was 86.4% in the PT group and 86.2% in the LSM group (P = 0.878), while the 5-year overall survival rates were 50.0% and 48.3%, respectively (P = 0.68). In our experience, replacement of LSM by a PT approach in oral carcinoma was associated with decreased rates of late complications such as pseudarthrosis, fistula, and trismus, without any difference in oncological outcomes.
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Affiliation(s)
- A Marhic
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - J Guerlain
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - N Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - I Breuskin
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - J-F Honart
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - F Janot
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - A Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - S Temam
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France
| | - P Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris-Saclay, Villejuif, France.
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Complex Mandibular Reconstruction for Head and Neck Squamous Cell Carcinoma-The Ongoing Challenge in Reconstruction and Rehabilitation. Cancers (Basel) 2020; 12:cancers12113198. [PMID: 33143098 PMCID: PMC7693398 DOI: 10.3390/cancers12113198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/17/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022] Open
Abstract
Simple Summary Cancer therapy includes a broad range of microvascular free flaps that may restore defects and improve patients’ quality of life. This is particularly important for head and neck squamous cell carcinoma (HNSCC) and composite mandibular reconstructions, containing tissues of bone, muscle, and skin, which may be problematic due to their magnitude and sensitive location. The subscapular system offers a highly valuable donor site with the most versatility and the potential for rapid rehabilitation. Interestingly, other donor sites are more commonly used internationally. Therefore, we evaluated the use of the subscapular system free flap (SFF), which is the most commonly used free flap at our department. To our knowledge, this retrospective study represents the largest number of SFF cases reported to date in the literature. Furthermore, we examined the quality of life in a subgroup of patients, combining prospective occurrences to provide insight into overall rehabilitation from the patients’ viewpoints. Abstract Large head and neck squamous cell carcinoma (HNSCC) tumors affecting the mandible require a versatile reconstruction to maintain form, function, and quality of life. Large defect reconstruction of soft and hard tissue in the head and neck necessitates, at best, one vascular system including various tissues by large dimensions. The subscapular flap system seems to meet these standards. A retrospective study was conducted focusing on clinical data, including an analysis of the quality of life with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires, (QLQ-C30 and QLQ-H&N43). A total of 154 patients (122 males, 32 females; age range: 31–71 years, mean: 54.5 years) treated at our department from 1983 through to 2019 were included. Of the subscapular system free flaps (SFFs), 147 were based on the angular artery branch of the thoracodorsal pedicle (95.45%), and the remaining seven cases (4.55%) were lateral scapular border flaps. Mean mandible defect length was 7.3 cm. The mean skin paddle dimension was 86.8 cm2. The most common recipient artery was the thyroid superior artery (79.22%). Major postoperative complications occurred in 13 patients (8.44%). This study confirms that SFFs offer excellent soft and hard tissue quality, component independence, a large arc of rotation length, and a large gauge of pedicle, making them the gold standard for the reconstruction of large composite defects of mandibular HNSCC tumors.
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Sauder C, Kapsner-Smith M, Baylor C, Yorkston K, Futran N, Eadie T. Communicative Participation and Quality of Life in Pretreatment Oral and Oropharyngeal Head and Neck Cancer. Otolaryngol Head Neck Surg 2020; 164:616-623. [PMID: 32928035 DOI: 10.1177/0194599820950718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine how communicative participation is affected in patients with oral and oropharyngeal head and neck cancers (HNCs) pretreatment and whether communication function predicts HNC-specific quality of life (QOL) before treatment, beyond known demographic, medical, psychosocial, and swallowing predictors. STUDY DESIGN Cross-sectional study. SETTING Tertiary care academic medical center. METHODS Eighty-seven patients with primary oral (40.2%) or oropharyngeal (59.8%) HNC were recruited prior to treatment. T stage, tumor site, and p16 status were extracted from medical records. Demographic and patient-reported measures were obtained. Communicative participation was measured using the Communicative Participation Item Bank (CPIB) General short form. A hierarchical regression analysis included demographic, medical, psychosocial, and functional measures of swallowing and communication as predictors; the University of Washington Quality of Life (UW-QOL v4) composite score was the predicted variable. RESULTS Median (SD) baseline CPIB scores were 71.0 (11.83); patients with oral cancers reported worse scores. A final sequential hierarchical regression model that included all variables explained 71% of variance in QOL scores. Tumor site, T stage, and p16 status accounted for 28% of variance (P < .001). Perceived depression predicted an additional 28% of the variance (P < .001). Swallowing and communicative participation together predicted an additional 12% of variance (P = .005). Tumor site, perceived depression, swallowing, and communication measures were unique predictors in the final model. Finally, communicative participation uniquely predicted QOL, above and beyond other predictors. CONCLUSION Pretreatment communication predicted QOL and was negatively affected in some oral and oropharyngeal patients with HNC.
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Affiliation(s)
- Cara Sauder
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA
| | - Mara Kapsner-Smith
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA
| | - Carolyn Baylor
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Kathryn Yorkston
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Neal Futran
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Tanya Eadie
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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17
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Liu T, David M, Batstone M, Clark J, Low TH, Goldstein D, Hope A, Hosni A, Chua B. The utility of postoperative radiotherapy in intermediate-risk oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2020; 50:143-150. [PMID: 32616305 DOI: 10.1016/j.ijom.2020.06.006] [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: 01/02/2020] [Revised: 04/13/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
The effectiveness of postoperative radiotherapy (PORT) in improving outcomes remains debatable for oral squamous cell carcinoma (OSCC) patients with pathological intermediate-risk factors (IRFs) after surgery. A retrospective analysis was conducted on 432 intermediate-risk OSCC patients defined by histological reporting of close margin (<5mm), early nodal disease (pN1), depth of invasion/tumour thickness ≥5mm, perineural invasion, and/or lymphovascular invasion. Outcomes measured were disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). PORT was associated with an improvement in 5-year DFS on univariable analysis (80% vs 71%; P=0.044), but this did not remain significant on multivariable analysis. PORT was not associated with differences in DSS or OS. The surgical salvage rate was similar in the PORT and surgery-only groups (41% vs 47%; P=0.972). Perineural invasion was found to be an independent predictor of inferior DSS (hazard ratio (HR) 2.19), DFS (HR 1.89), and OS (HR 1.97). Significantly worse outcomes were observed for patients with ≥4 concurrent IRFs. The application of PORT was associated with lower rates of recurrence, but the benefit was less apparent on mortality. Patients with perineural invasion and multiple concurrent IRFs were found to be at greatest risk, representing a subset of intermediate-risk OSCC patients who may benefit from PORT.
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Affiliation(s)
- T Liu
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.
| | - M David
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - M Batstone
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - J Clark
- Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - T-H Low
- Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - D Goldstein
- Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - A Hope
- Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - A Hosni
- Department of Radiation Oncology, University of Toronto and Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - B Chua
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Radiation Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Meier JK, Schuderer JG, Zeman F, Klingelhöffer C, Hullmann M, Spanier G, Reichert TE, Ettl T. Health-related quality of life: a retrospective study on local vs. microvascular reconstruction in patients with oral cancer. BMC Oral Health 2019; 19:62. [PMID: 31029131 PMCID: PMC6487048 DOI: 10.1186/s12903-019-0760-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/09/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND New medicinal and surgical oncological treatment strategies not only improve overall survival rates but continually increase the importance of Health-Related Quality of Life (HRQOL). The purpose of this retrospective cross-sectional study was to analyze HRQOL of patients with oral squamous cell carcinoma after ablative surgery and to evaluate predictive factors for HRQOL outcome. METHODS The study included 88 patients with histologically confirmed oral squamous cell carcinoma of whom 42 had undergone local reconstruction (LR) and 46 microvascular reconstruction (MVR). During follow-up, all patients completed the University of Washington Quality of Life Questionnaire (UW-QOL) containing 12 targeted questions about the head and neck. Descriptive analyses were made for the tumor site, the T-stage, and adjuvant therapies. HRQOL was compared between the LR and the MVR group with parametric tests. Further analyses were impact of the tumor site, the T-status, and the time from surgery to survey on HRQOL. Statistics also included multivariate correlations and different interaction effects. RESULTS HRQOL in the LR group was 'very good' with 84.3 ± 13.7 and 'good' in the MVR group with 73.3 ± 16.5 points. The physical domains swallowing (p = 0.00), chewing (p = 0.00), speech (p = 0.01), taste (p = 0.01), and pain (p = 0.04) were significantly worse in the MVR group. An increase in the T-status had a significant negative effect on swallowing (p = 0.01), chewing (p = 0.01), speech (p = 0.03), recreation (p = 0.05), and shoulder (p = 0.01) in both groups. Regarding the tumor site and subsequent loss of HRQOL, patients with squamous cell carcinoma on the floor of the mouth had significantly worse results in the categories pain (p = 0.002), speech (p = 0.002), swallowing (p = 0.03), activity (p = 0.02), and recreation (p = 0.01) than patients with tumors in the buccal mucosa. Speech (p = 0.03) and pain (p = 0.01) had improved 1 year after surgery. CONCLUSION Patients with flap reconstruction because of oral squamous cell carcinoma showed very good overall HRQOL. Outcomes for microvascular reconstruction were good, even in the case of larger defects. The T-status is a predictor for HRQOL. Swallowing, chewing, speaking, taste, and pain were the most important issues in our cohort. Implementing HRQOL questionnaires for the assessment of quality of life could further increase the treatment quality of patients with oral cancer.
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Affiliation(s)
- J K Meier
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
| | - J G Schuderer
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - F Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Ch Klingelhöffer
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - M Hullmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - G Spanier
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - T E Reichert
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - T Ettl
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
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Zhang PP, Meng L, Shen J, Liu H, Zhang J, Xiang X, Yan YB. Free radial forearm flap and anterolateral thigh flap for reconstruction of hemiglossectomy defects: A comparison of quality of life. J Craniomaxillofac Surg 2018; 46:2157-2163. [DOI: 10.1016/j.jcms.2018.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/21/2018] [Accepted: 10/15/2018] [Indexed: 12/25/2022] Open
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21
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Becker C, Pfeiffer J, Lange K, Dahlem KKK. Health-related quality of life in patients with major salivary gland carcinoma. Eur Arch Otorhinolaryngol 2018; 275:997-1003. [PMID: 29478078 DOI: 10.1007/s00405-018-4914-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/22/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the health-related quality of life (QOL) in patients with major salivary gland carcinoma (MSGC). METHODS 45 patients with MSGC completed the University of Washington Quality of Life (UWQOL) questionnaire. Results and factors influencing quality of life were analyzed using Mann-Whitney U test. RESULTS 24 patients were male, 21 patients were female, and median age was 57 years. 33 patients presented with early stage (UICC stage I or II) cancer. All patients had surgery as initial therapy. The UWQOL domains with the worst results were 'appearance', 'activity' and 'anxiety'. Factors influencing QOL were sex, tumor stage, comorbidities, follow-up time, tumor grade, postoperative radiation therapy and facial nerve dysfunction. CONCLUSIONS Diagnosis and treatment of MSGC has influence on overall QOL. Postoperative radiation has the greatest impact on QOL. This is one of the largest study evaluating QOL in patients with salivary gland carcinoma using the UWQOL.
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Affiliation(s)
- Christoph Becker
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.
| | - Jens Pfeiffer
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - Kitty Lange
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
| | - Kilian Konrad Kenjiro Dahlem
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Centre Freiburg, Killianstrasse 5, 79106, Freiburg, Germany
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Sjamsudin E, Maulina T, Cipta A, Iskandarsyah A, Hardianto A, Nandini M, Kasim A, Yusuf HY. Assessment of oral cancer pain, anxiety, and quality of life of oral squamous cell carcinoma patients with invasive treatment procedure. Oral Maxillofac Surg 2018; 22:83-90. [PMID: 29332186 DOI: 10.1007/s10006-018-0672-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 01/03/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Depending on its stage on diagnosis, oral squamous cell carcinoma (OSCC) might cause excruciating pain and decreased quality of life. As for treatment, the treatment of OSCC might vary from chemotherapy to surgery. The objective of the current study was to assess the preoperative and postoperative oral cancer pain, anxiety, and quality of life of OSCC patients with invasive treatment procedure. METHODS The current study was conducted by interviewing 21 (10 males; 11 females) patients who had been diagnosed with stage 3 and stage 4 OSCC and about to go through surgery at the inpatient ward of Surgical Oncology Department, Hasan Sadikin Hospital, Bandung, Indonesia. A preoperative and interview was conducted by using the Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QOL)-C30, the shortened EORTC QOL Questionnaire for Oesophageal Cancer (OES)18, the visual analog scale (VAS), and the University of California San Francisco (UCSF) Oral Cancer Pain Questionnaire. All data were analyzed to evaluate the preoperative and postoperative effect. RESULTS The current study showed a significant decrease of the postoperative oral pain (p < 0.01) and anxiety level (p < 0.01), while postoperative patient' quality of life was significantly (p < 0.01) increased. CONCLUSION Despite of the invasive procedure that might cause postoperative effect, OSCC patients in the current study showed a better quality of life after cancer removal.
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Affiliation(s)
- Endang Sjamsudin
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
| | - Tantry Maulina
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia.
| | - Ahmad Cipta
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
| | - Aulia Iskandarsyah
- Clinical Psychology Department, Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
| | - Andri Hardianto
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
| | - Mantra Nandini
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
| | - Alwin Kasim
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
| | - Harmas Yazid Yusuf
- Oral Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Jl. Sekeloa Selatan no. 1, Bandung, West Java, 40132, Indonesia
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Bozec A, Demez P, Gal J, Chamorey E, Louis MY, Blanchard D, De Raucourt D, Merol JC, Brenet E, Dassonville O, Poissonnet G, Santini J, Peyrade F, Benezery K, Lesnik M, Berta E, Ransy P, Babin E. Long-term quality of life and psycho-social outcomes after oropharyngeal cancer surgery and radial forearm free-flap reconstruction: A GETTEC prospective multicentric study. Surg Oncol 2017; 27:23-30. [PMID: 29549900 DOI: 10.1016/j.suronc.2017.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/25/2017] [Accepted: 11/22/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess long-term quality of life (QoL) and psycho-social outcomes, and to determine their predictive factors after oropharyngeal cancer (OPC) surgery and radial forearm free-flap (RFFF) reconstruction. METHODS Patients who had undergone OPC surgery and RFFF reconstruction who were still alive and disease-free at least 1 year after surgery were enrolled in this prospective multicentric study. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) Core (QLQ-C30) and Head and Neck Cancer (QLQ-H&N35) QoL questionnaires, the Voice Handicap Index (VHI-10) questionnaire and the Hospital Anxiety and Depression Scale (HADS). The level of dysphagia was evaluated using the Dysphagia Handicap Index (DHI) and the Dysphagia Outcomes and Severity Scale (DOSS). Predictive factors of these clinical outcomes were determined in univariate and multivariate analysis. RESULTS A total of 58 patients were included in this study. Long-term QoL and functioning scales scores were well-preserved (all superior to 70%). Main persistent symptoms were fatigue, reduced sexuality and oral function-related disorders (swallowing, teeth, salivary and mouth-opening problems). HADS anxiety and depression scores were 7.2 and 5.4, respectively. Twenty-one (36%) patients presented an anxiodepressive disorder (HADS global score ≥ 15). Among the 21 patients who were still working before surgery, 11 (52%) had returned to work at the time of our study. The HADS global score (p < 0.001) was the main predictor of QoL, VHI-10 and DOSS scores. CONCLUSIONS Psychological distress is the main determinant of long-term QoL and is therefore of critical importance in the multidisciplinary management of OPC patients.
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Affiliation(s)
- Alexandre Bozec
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France.
| | - Pierre Demez
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Liège, Belgium
| | - Jocelyn Gal
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Emmanuel Chamorey
- Department of Statistics, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Marie-Yolande Louis
- Department of Maxillo-facial and Head and Neck Surgery, Centre François-Baclesse, Caen, France
| | - David Blanchard
- Department of Maxillo-facial and Head and Neck Surgery, Centre François-Baclesse, Caen, France
| | - Dominique De Raucourt
- Department of Maxillo-facial and Head and Neck Surgery, Centre François-Baclesse, Caen, France
| | - Jean-Claude Merol
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Reims, France
| | - Esteban Brenet
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Reims, France
| | - Olivier Dassonville
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Gilles Poissonnet
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - José Santini
- Institut Universitaire de la Face et du Cou, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Frédéric Peyrade
- Department of Medical Oncology, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Karen Benezery
- Department of Radiotherapy, Centre Antoine Lacassagne, Université Côte d'Azur, Nice, France
| | - Maria Lesnik
- Department of Otorhinolaryngology and Head and Neck Surgery, Institut Curie, Paris, France
| | - Etienne Berta
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital of Annecy, France
| | - Pierre Ransy
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Liège, Belgium
| | - Emmanuel Babin
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Caen, France
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Breeze J, Rennie A, Dawson D, Tipper J, Rehman KU, Grew N, Pigadas N. Patient-reported quality of life outcomes following treatment for oral cancer. Int J Oral Maxillofac Surg 2017; 47:296-301. [PMID: 28943022 DOI: 10.1016/j.ijom.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/28/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
Patient-reported quality of life (QoL) outcomes have the potential to assist clinicians in providing individually tailored treatment decisions. QoL assessments were collected prospectively for 168 consecutive patients treated for oral cancer between 1 January 2010 and 31 December 2014 using the University of Washington Quality of Life Questionnaire. Patients were followed up for 18 months post-treatment. Sub-group analyses were performed using paired t-tests and analysis of variance (ANOVA) to compare the effects of adjunctive chemoradiotherapy, type of bone resection, and methods of soft and hard tissue flap reconstruction. The greatest statistically significant reduction in QoL for all oral cavity sub-sites was found following the treatment of floor of mouth tumours (-18.9%, P=0.018). Laser excision for matched patient cohorts resulted in improved resultant QoL compared to other excision techniques (P=0.0002). No significant difference in QoL was found when radial forearm and anterolateral thigh flaps were matched, or when fibula and scapula flaps were matched. These findings support the use of laser excision and the avoidance of postoperative radiotherapy if curative intent and survival outcomes are maintained.
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Affiliation(s)
- J Breeze
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, UK.
| | - A Rennie
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, UK
| | - D Dawson
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, UK
| | - J Tipper
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, UK
| | - K-U Rehman
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, UK
| | - N Grew
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, UK
| | - N Pigadas
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, UK
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Gane EM, McPhail SM, Hatton AL, Panizza BJ, O’Leary SP. Predictors of health-related quality of life in patients treated with neck dissection for head and neck cancer. Eur Arch Otorhinolaryngol 2017; 274:4183-4193. [DOI: 10.1007/s00405-017-4754-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/20/2017] [Indexed: 01/29/2023]
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Mair MD, Nair S, Nikam S, Nair D, Agarwal JP, Chaturvedi P. Longitudinal and cross-sectional assessment of quality of life in surgically treated advanced (T4) cancer of the buccal mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:529-536. [PMID: 29169511 DOI: 10.1016/j.oooo.2017.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 08/05/2017] [Accepted: 09/14/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Quality of life (QOL) has become an important aspect of today's health care management. This study performed longitudinal assessment of QOL in patients with advanced cancers of the buccal mucosa (T4). We compared the QOL between patients who received adjuvant chemoradiation therapy (CTRT) and that of patients who received radiation therapy alone and assessed whether baseline QOL can predict disease recurrence. STUDY DESIGN This was a prospective study of 225 patients with T4 buccal mucosal cancer. Health-related QOL was assessed at baseline and at 3, 6, 9, and 12 months after completion of treatment by means of the European Organization for Research and Treatment of Cancer Core QOL Questionnaire and the HN35 questionnaire. RESULTS There was persistent improvement in global QOL and pain. Emotional functioning improved at 12 months. Most of the head and neck-specific symptoms deteriorated at 3 months, with subsequent improvement at 12 months except in swallowing, senses, speech, social eating, social contact, and sexuality. Patients who received adjuvant CTRT had poorer QOL. Poorer baseline global QOL (P = .049), dyspnea (P = .04), appetite loss (P = .015), and weight loss (P = .08) may predict recurrence. CONCLUSIONS Although there is an improvement in global QOL and pain, most of the head and neck-specific symptoms worsened in the immediate postoperative period. Adjuvant CTRT has a persistent effect on specific domains compared with adjuvant radiation therapy alone. Poor baseline QOL scores are associated with a higher risk of recurrence.
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Affiliation(s)
| | - Sudhir Nair
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India.
| | - Santosh Nikam
- Head and Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | - Deepa Nair
- Head and Neck Oncosurgery, Tata Memorial Hospital, Mumbai, India
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Health-Related Quality of Life following Reconstruction for Common Head and Neck Surgical Defects. Plast Reconstr Surg 2017; 138:1312-1320. [PMID: 27879602 DOI: 10.1097/prs.0000000000002766] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Improved understanding and management of health-related quality of life represents one of the greatest unmet needs for patients with head and neck malignancies. The purpose of this study was to prospectively measure health-related quality of life associated with different anatomical (head and neck) surgical resections. METHODS A prospective analysis of health-related quality of life was performed in patients undergoing surgical resection with flap reconstruction for stage II or III head and neck malignancies. Patients completed the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire-30 and the European Organization for Research and Treatment of Cancer Head and Neck Cancer Module-35 preoperatively, and at set postoperative time points. Scores were compared with a paired t test. RESULTS Seventy-five patients were analyzed. The proportion of the cohort not alive at 2 years was 53 percent. Physical, role, and social functioning scores at 3 months were significantly lower than preoperative values (p < 0.05). At 12 months postoperatively, none of the function or global quality-of-life scores differed from preoperative levels, whereas five of the symptom scales remained below baseline. At 1 year postoperatively, maxillectomy, partial glossectomy, and oral lining defects had better function and fewer symptoms than mandibulectomy, laryngectomy, and total glossectomy. From 6 to 12 months postoperatively, partial glossectomy and oral lining defects had greater global quality of life than laryngectomies (p < 0.05). CONCLUSIONS Postoperative health-related quality of life is associated with the anatomical location of the head and neck surgical resection. Preoperative teaching should be targeted for common ablative defects, with postoperative expectations adjusted appropriately. Because surgery negatively impacts health-related quality of life in the immediate postoperative period, the limited survivorship should be reviewed with patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Free tissue flaps in head and neck reconstruction: clinical application and analysis of 93 patients of a single institution. Braz J Otorhinolaryngol 2017; 84:416-425. [PMID: 28571928 PMCID: PMC9449187 DOI: 10.1016/j.bjorl.2017.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/25/2017] [Accepted: 04/15/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Reconstruction with a free flap is routine in head and neck surgery because of better functional outcomes, improved esthetics, and generally higher success rates. Objective To evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions. Methods This was a retrospective study of 93 patients undergoing reconstructions with free flaps from 2007 to 2015. Four types of free flap were performed: anterolateral thigh (76.3%), radial forearm (16.1%), fibula (4.3%) and jejunum (3.3%). Patients’ demographic data were collected, and the outcomes measured included flap survival and complications. Postoperative functional and oncological outcome were also analyzed. Results The patients included 73 men and 20 women, with a mean age of 56.1 years. The most common tumor location was the tongue. Squamous cell carcinoma represented the vast majority of the diagnosed tumors (89.2%). The most common recipient vessels were the superior thyroid artery (77.4%) and the internal jugular vein (91.4%). Nine patients required emergency surgical re-exploration and the overall flap success rate was 90.3%. Venous thrombosis was the most common cause for re-exploration. Other complications included wound infection (5.4%), wound dehiscence (1.1%), partial flap necrosis (9.7%), fistula formation (10.8%), and 1 bleeding (1.1%). The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site after 46.7 months of mean follow-up. Conclusion Microsurgical free flap is shown to be a valuable and reliable method in head and neck surgery. It can be used safely and effectively with minimal morbidity in selected patients. The reconstruction can be performed by appropriately skilled surgeons with acceptable outcomes. Success rate appears to increase as clinical experience is gained.
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Majid A, Sayeed BZ, Khan M, Lakhani M, Saleem MM, Rajani H, Ramesh P, Hashmani N, Zia M, Abid H, Majid B, Jamali M, Murtaza K, Kamal A, Hussain M. Assessment and Improvement of Quality of Life in Patients Undergoing Treatment for Head and Neck Cancer. Cureus 2017; 9:e1215. [PMID: 28589064 PMCID: PMC5453744 DOI: 10.7759/cureus.1215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: We compared the pre and post-treatment quality of life in head and neck cancer (HNC) patients and identified factors that could improve the quality of life in such patients. Methods: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) questionnaire was administered to 84 patients’ pre and post-treatment. Patients who had non-metastatic, measurable, and untreated HNCs were invited, provided that their age was below 80 years. We did not discriminate based on treatment modality, stage of cancer, or co-morbidities. Patients who were mentally incapacitated, with secondary or recurrent HNC, distant metastasis, skin cancer, congenital anomaly of the head and neck, chronic illness, or any previous or current psychiatric illness were excluded from the study. A high mean score on the functional scale and a low score on symptom scale signify a better quality of life. We used the dependent t-test to compare pre and post-treatment scores. Results: We found no statistically significant differences in any variables, except the four symptom scales of diarrhoea, constipation, nausea/vomiting, and financial difficulty. All of these variables had increased mean scores with p values of < 0.001. Also, we found no statistical significance (p = 0.250) when comparing the pre-treatment (59.4 ± 18.3) and post-treatment (61.2 ± 16.2) scores for the global health status. Conclusion: We found no improvement in the quality of life in HNC patients despite intervention. In fact, diarrhoea, constipation, nausea/vomiting, and financial difficulty of these patients worsened post-treatment.
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Affiliation(s)
| | | | - Maryam Khan
- Student, Dow Medical College, Karachi, Pakistan
| | | | | | - Hina Rajani
- Student, Dow Medical College, Karachi, Pakistan
| | | | | | - Muneeba Zia
- Student, Dow Medical College, Karachi, Pakistan
| | | | | | - Momal Jamali
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
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Tadakamadla J, Kumar S, Lalloo R, Johnson NW. Development and validation of a quality-of-life questionnaire for patients with oral potentially malignant disorders. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:338-349. [DOI: 10.1016/j.oooo.2016.10.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/05/2016] [Accepted: 10/29/2016] [Indexed: 01/02/2023]
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Aguilar ML, Sandow P, Werning JW, Brenneman L, Psoter WJ. The Head and Neck Cancer Patient Concern Inventory © : Patient Concerns' Prevalence, Dental Concerns' Impact, and Relationships of Concerns with Quality of Life Measures. J Prosthodont 2017; 26:186-195. [PMID: 28220985 DOI: 10.1111/jopr.12496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The Patient Concern Inventory© (PCI) is a clinical tool of self-reported patient concerns to be used by the clinician to structure the patient-oncologist visit. It was developed in the United Kingdom to address the issues of quality of life (QOL) in head and neck cancer (HNC) patients. The purpose of the study reported here was to determine the prevalence of PCI© items, the associations between PCI© items and QOL, and to explore the importance of oral/dental issues in the patient's well-being. METHODS The PCI© and the University of Washington (UW-QOLv4) instruments were self-administered by an HNC population in a cross-sectional study. Following an a priori sample size estimate, consecutive HNC patients attending at the University of Florida's Oral Medicine and the ENT Clinics had the study described, eligibility assessed, and if eligible, were invited to participate in the study. Participants completed the PCI© and UW-QOL. PCI© issues prevalence was determined, and for those with a ≥10% prevalence: 1) Fisher's exact test was used to test for statistical differences between treatments, and 2) multivariable regression was used to test each of the prevalent PCI© issues across four QOL measures, health in the last 7 days, overall QOL in the last 7 days, and the physical and social domain scores. RESULTS Twenty of 45 PCI© issues had a prevalence ≥10%. Of the 15 prevalent items statistically associated with a QOL measure, four issues are the clinical responsibility of the dental profession: 1) chewing/eating, 2) dental health/teeth, 3) mouth opening, and 4) salivation. An additional four (eight total, 50%) are of clinical concern for dental clinicians: 5) pain in head/neck, 6) swallowing, 7) speech/voice/being understood, and 8) taste. CONCLUSIONS Dental concerns represent almost half of all PCI© concerns observed in 10% or more of the sample patients. Prosthodontists should support our maxillofacial prosthodontics specialists in joining other oral oncologists and advocate for comprehensive, integrated dental support for HNC patients by assuring dental involvement/inclusion with the multidisciplinary oncology team and a research agenda to established best patient-centered outcomes.
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Affiliation(s)
- Maria L Aguilar
- Department of Restorative Dental Science, Division of Prosthodontics, University of Florida College of Dentistry, Health Science Center, Gainesville, FL
| | - Pamela Sandow
- Department of Oral & Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Health Science Center, Gainesville, FL
| | - John W Werning
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL
| | - Lia Brenneman
- College of Liberal Arts and Sciences, University of Florida, Gainesville, FL
| | - Walter J Psoter
- Department of Dentistry, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Breeze J, Rennie A, Morrison A, Dawson D, Tipper J, Rehman K, Grew N, Snee D, Pigadas N. Health-related quality of life after maxillectomy: obturator rehabilitation compared with flap reconstruction. Br J Oral Maxillofac Surg 2016; 54:857-862. [PMID: 27266975 DOI: 10.1016/j.bjoms.2016.05.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/22/2016] [Indexed: 11/16/2022]
Abstract
Health-related quality of life (QoL) reported by patients has the potential to improve care after ablative surgery of the midface, as existing treatment algorithms still generally revolve around outcomes assessed traditionally only by clinicians. Decisions in particular relate to reconstruction with a flap compared with rehabilitation with an obturator, the need for adjuvant treatment, and morbidity related to the size of the defect. We prospectively collected health-related QoL assessments for 39 consecutive patients treated by maxillectomy between 01 January 2010 and 31 December 2014 using the University of Washington Quality of Life Questionnaire, and who had a mean (SD) duration of follow-up of 14 (4). We made sub-group analyses using paired t tests and analysis of variance (ANOVA) to compare reconstruction with a flap with rehabilitation with obturators, size of the vertical defect, and whether adjuvant treatment with radiotherapy or chemoradiotherapy adversely affected it. Overall there was a significant decrease in health-related QoL after treatment compared with before (p<0.001), but there was no significant difference in the effects of any of the paired reconstructive and rehabilitation treatments on it. Obturators remain an important option for rehabilitation in selected patients in addition to reconstruction with a flap. We found that neither increasing the size of the vertical defect (in an attempt to ensure clear margins) nor the use of postoperative radiotherapy seemed to have any adverse effect on QoL. More patients are required before we can conclude that the potential survival benefits of such measures may outweigh any adverse effects.
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Affiliation(s)
- J Breeze
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, England WV10 0QP; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham B15 2SQ
| | - A Rennie
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, England WV10 0QP
| | - A Morrison
- Biostatistical Operations, Worldwide Clinical Trials, Isaac Newton Centre, Nottingham Science Park, Nottingham, England NG7 2RH
| | - D Dawson
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, England WV10 0QP
| | - J Tipper
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, England WV10 0QP
| | - K Rehman
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, England WV10 0QP
| | - N Grew
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, England WV10 0QP
| | - D Snee
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, England WV10 0QP
| | - N Pigadas
- Department of Oral and Maxillofacial Surgery, New Cross Hospital, Wolverhampton, England WV10 0QP
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Pusic A, Liu JC, Chen CM, Cano S, Davidge K, Klassen A, Branski R, Patel S, Kraus D, Cordeiro PG. A systematic review of patient-reported outcome measures in head and neck cancer surgery. Otolaryngol Head Neck Surg 2016; 136:525-35. [PMID: 17418246 DOI: 10.1016/j.otohns.2006.12.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 12/05/2006] [Indexed: 11/22/2022]
Abstract
Objective To identify, summarize, and evaluate patient-reported outcome questionnaires for use in head and neck cancer surgery with the view to making recommendations for future research. Data Sources A systematic review of the English-language literature, with the use of head-and-neck-surgery-specific keywords, was performed in the following databases: Medline, Embase, HAPI, CINAHL, Science/Social Sciences Citation Index, and PsycINFO from 1966 to March 2006. Data Extraction and Study Selection All English-language instruments identified as patient-reported outcome questionnaires that measure quality of life and/or satisfaction that had undergone development and validation in a head and neck cancer surgery population were included. Data Synthesis Twelve patient-reported outcome questionnaires fulfilled our inclusion criteria. Of these, four were developed from expert opinion alone or did not have a published development process and seven questionnaires lacked formal item reduction. Only three questionnaires (EORTC Head and Neck Module, University of Michigan Head and Neck Quality-of-life Questionnaire, and Head and Neck Cancer Inventory) fulfilled guidelines for instrument development and evaluation as outlined by the Medical Outcomes Trust. Conclusions Rigorous instrument development is important for creating valid, reliable, and responsive disease-specific questionnaires. As a direction for future instrument development, an increased focus on qualitative research to ensure patient input may help to better conceptualize and operationalize the variables most relevant to head and neck cancer surgery patients. In addition, the use of alternative methods of psychometric data analysis, such as Rasch, may improve the value of health measurement in clinical practice for individual patients.
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Affiliation(s)
- Andrea Pusic
- Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Hinther A, Nakoneshny SC, Dort JC, Chandarana SP, Matthews TW. Historical compliance rates for providing postoperative radiotherapy in oral cavity squamous cell carcinoma. Head Neck 2016; 38:1525-9. [DOI: 10.1002/hed.24464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ashley Hinther
- Undergraduate Medical Education, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - Steven C. Nakoneshny
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - Joseph C. Dort
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - Shamir P. Chandarana
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - T. Wayne Matthews
- Ohlson Research Initiative, Arnie Charbonneau Cancer Institute, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
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Kobayashi W, Kukobota K, Ito R, Sakaki H, Nakagawa H, Teh BG. Can Superselective Intra-Arterial Chemoradiotherapy Replace Surgery Followed by Radiation for Advanced Cancer of the Tongue and Floor of the Mouth? J Oral Maxillofac Surg 2016; 74:1248-54. [PMID: 26851311 DOI: 10.1016/j.joms.2016.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 01/02/2016] [Accepted: 01/03/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE The purpose of this study was to compare quality of life (QoL) and the survival rate after surgery with and without radiotherapy versus superselective intra-arterial chemoradiotherapy (SSIACRT) for advanced cancer of the tongue and floor of the mouth. MATERIALS AND METHODS Patients with stage III and IV squamous cell carcinoma of the tongue and floor of the mouth treated between 2000 and 2013 were included in this study. The predictor variables were surgery without radiotherapy, surgery followed by radiotherapy, and SSIACRT. The outcome variables were QoL and the survival rate. The University of Washington QoL questionnaire (UW-QOL) was used for evaluation of QoL. The Kaplan-Meier method was used to estimate the overall survival rate. The UW-QOL was analyzed by analysis of covariance, and the survival rate was analyzed statistically by the log-rank test. RESULTS Sixty-two patients were eligible for this study. Of these, 13 were treated by surgery without radiotherapy, 29 were treated by surgery plus radiotherapy, and 20 were treated by SSIACRT. The SSIACRT group had the best UW-QOL scores among the 3 groups. The 5-year Kaplan-Meier disease-specific survival rates for these groups were 92.9%, 62.9%, and 83.2%, respectively, with no significant difference (P = .20) shown. CONCLUSIONS The QoL scores of the SSIACRT group were the best among the 3 groups in most domains. The superiority of QoL and the survival rate in the SSIACRT group showed that SSIACRT should be preferred in managing advanced cancer of the tongue and floor of the mouth.
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Affiliation(s)
- Wataru Kobayashi
- Professor, Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Kosei Kukobota
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ryohei Ito
- Resident, Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotaka Sakaki
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirosi Nakagawa
- Research Associate, Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Beng Gwan Teh
- Department Head, Department of Oral and Maxillofacial Surgery, Misawa City Hospital, Misawa, Japan
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Facial lymph node involvement as a prognostic factor for patient survival in oral cavity squamous cell carcinoma. Tumour Biol 2015; 37:3489-96. [DOI: 10.1007/s13277-015-4188-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/01/2015] [Indexed: 10/23/2022] Open
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A systematic review of quality of life in head and neck cancer treated with surgery with or without adjuvant treatment. Oral Oncol 2015. [PMID: 26209066 DOI: 10.1016/j.oraloncology.2015.07.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Quality of life (QoL) is an important consideration in the management of head and neck cancers (HNC). We systematically reviewed the literature to assess the impact of curative surgical resection (+/- adjuvant therapy) of HNC on QoL. Eligible studies (participants>age 18 years, reported fully in English, and prospectively assessed QoL) were filtered using quality criteria, and classified according to the added value, using a published taxonomy. MEDLINE and EMBASE searching yielded 302 distinct reports, 49 met eligibility, and 26 met quality criteria. Among the eligible studies, achievement of certain quality criteria was poor: a priori hypothesis (8%), statistical accounting of missing data (8%), reporting of assessment interval (35%) and rationale for chosen measure (53%). The most frequent ways QoL added value were: understanding of treatment benefit and risk (100%), comparing treatments for QoL effect (92%) and advancing QoL research methodology (50%). QoL (physical/social functioning and various symptom domains) deteriorated with treatment, gradually recovering to baseline (cancer diagnosis) level. Swallowing, chewing, saliva, taste, eating disruption, and aesthetic deficits may persist. Advanced tumors, extensive surgical resection, need for flap reconstruction, neck dissection, and postoperative radiation are associated with worse QoL outcomes. Knowledge of these trends can be applied in shared decision making, identification of commonly faced QoL issues, and to develop and provide survivorship resources. Future research should focus on routinely incorporating QoL in randomized studies, reporting the result according to guidelines, and following knowledge translation principles to maximize the clinician's and patient's ability to use QoL data.
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Health-related quality of life after segmental resection of the lateral mandible: Free fibula flap versus plate reconstruction. J Craniomaxillofac Surg 2015; 43:658-62. [DOI: 10.1016/j.jcms.2015.03.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 02/02/2015] [Accepted: 03/19/2015] [Indexed: 11/23/2022] Open
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Abstract
PURPOSE OF REVIEW The public demands that 'all modes of treatment' should be offered to patients who present with head and neck cancer. Up to 40% of patients present with advanced stage disease, of whom some 10% have metastatic disease and are currently deemed incurable. This review summarizes the current role and philosophy of surgical interventions in the palliation of head and neck cancer. RECENT FINDINGS Patients who present with advanced or recurrent head and neck cancers over the past decade have been offered nonsurgical palliative treatments of radiotherapy with or without chemotherapy, with variable responses. The aims are to achieve tumour shrinkage and gain effective relief of symptoms, such as pain, breathing and swallowing. The use of surgery in the palliation of disease and its symptoms has declined significantly since the 1980s. Within the concept of multidisciplinary clinical working as the 'gold standard' for the provision of optimum care for the head and neck patient, the place for surgery should be discussed within the many options available currently. SUMMARY Patients who present with advanced, incurable or recurrent head and neck cancer should be made aware of their prognosis and the potential need and benefits of palliative care. The active involvement of patients and their carers, their desires and wishes should be the prime consideration for any interventions. Careful selection of suitable patients can achieve prolonged symptom relief safely and result in an improvement in their quality of living. The ultimate goal should incorporate not only quality of life but quality of dying.
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Devireddy SK, Senthil Murugan M, Kishore Kumar RV, Gali R, Kanubaddy SR, Sunayana M. Evaluation of Non-vascular Fibula Graft for Mandibular Reconstruction. J Maxillofac Oral Surg 2014; 14:299-307. [PMID: 26028850 DOI: 10.1007/s12663-014-0657-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 07/01/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Functional and cosmetic defects in maxillofacial region are caused by various ailments like trauma, neoplasm, developmental, infections and iatrogenic causes. Reconstruction of these defects with free flaps remains the gold standard but demerits like need for surgical expertise and equipment, prolonged duration of surgery, compliance of the patient and increased cost are associated with microvascular reconstruction. Hence reconstruction with nonvascular bone grafts can be considered when defect is nonirradiated and <9 cm and with sufficient soft tissue cover available. PURPOSE To retrospectively evaluate clinical, radiological outcome and complications encountered with mandibular reconstruction using non vascular fibula graft. PATIENTS AND METHODS This retrospective study included 7 patients who were treated in the Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Nellore, AP between 2011 and 2013 with histologically proven benign osteolytic lesions of mandible that require a segmental mandibulectomy and primary reconstruction using autogenous non-vascularised fibular graft. The clinical case records of the patients and personal patient assessment forms (Quality of Life Assessment Forms) were analysed. They were recalled every 3rd, 6th and 9th month after surgery for evaluation of clinical, radiological outcome of the graft and complications occurring at recipient and donor sites. RESULTS In all the 7 patients, the lower border continuity was maintained except in one where the graft was dislodged. Tongue movements in all the patients were unrestricted. Jaw movements were affected in cases of ramus defects with slight deviation to operated side and reduced mouth opening. Radiological observations revealed no significant changes in 3 months except for slight reduction in graft height. The radioopaque bridging with continuity of lower border of mandible was noticed in 6th month indicating the take of the graft. This was achieved in every case except in one where the graft was lost due to dislodged reconstruction plate. In 9th month the edges of the graft i.e., graft to native mandible junction showed more resorption (3 mm) especially where there is >2 mm of gap. Whereas increase in height of graft in other areas especially in graft to graft junction was seen. Significant graft resorption was seen in two cases. There were no major complications associated with the donor site. CONCLUSION Avascular fibula graft although a second choice to vascularised fibula, is a favourable option for mandible defects of 6-10 cm under optimum conditions especially in developing countries where financial and/or surgical resources are limited. An attempt for primary reconstruction with this is never futile as it prevents aesthetic deformity even in the event of failure and thus makes secondary reconstruction easy. However in order to confirm the results a prospective study with large scale of patients is necessary.
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Affiliation(s)
- Sathya Kumar Devireddy
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - M Senthil Murugan
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India ; OMFS, SRM Dental College and Hospital, Ramapuram, Chennai, India
| | - R V Kishore Kumar
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - Rajasekhar Gali
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - Sridhar Reddy Kanubaddy
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
| | - M Sunayana
- Department of Oral and Maxillofacial Surgery, Narayana Dental College and Hospital, Chintareddypalem, Nellore, 524002 A.P. India
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Crombie AK, Farah CS, Batstone MD. Health-related quality of life of patients treated with primary chemoradiotherapy for oral cavity squamous cell carcinoma: a comparison with surgery. Br J Oral Maxillofac Surg 2013; 52:111-7. [PMID: 24148700 DOI: 10.1016/j.bjoms.2013.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 09/21/2013] [Indexed: 11/29/2022]
Abstract
Our aim was to document the health-related quality of life (QoL) of patients with squamous cell carcinoma (SCC) of the oral cavity who were treated with chemoradiotherapy, and to compare it with that of patients treated with conventional surgery with or without adjuvant treatment. All patients who presented with SCC of the oral cavity treated with chemoradiotherapy alone at the Royal Brisbane & Women's Hospital between 2000 and 2011 and who were alive without disease were included. Health-related QoL was assessed by the University of Washington QoL questionnaire version 4, and the European Organisation for the Research and Treatment of Cancer (EORTC) QoL questionnaires C30 and HN35. The questionnaires were sent to all survivors. Those who responded to chemoradiotherapy were matched with patients who were treated by conventional surgery with or without adjuvant treatment by age, sex, subsite of tumour, and TNM stage. Sixteen patients completed the questionnaires (8 in each group). There was no significant difference between the 2 groups in any of the domains of any of the questionnaires. The overall outcome scores for both treatments in all 3 groups were reasonably high, which suggests that both treatments provided acceptable health-related QoL. The surgical group recorded higher scores than the chemoradiotherapy alone group in all domains of the UW-QoL except shoulder and anxiety. They recorded lower scores in all scales and items of EORTC HN35. There was no significant difference in health-related QoL between the 2 groups. Conventional surgery with or without adjuvant treatment recorded higher scores in most QoL domains including chewing, swallowing, saliva, and speech, issues most important to patients with SCC of the oral cavity.
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Affiliation(s)
- Anthony K Crombie
- Maxillofacial Unit, Royal Brisbane & Women's Hospital, Herston, Qld 4029, Australia; The University of Queensland, School of Dentistry, Brisbane, Qld 4000, Australia; The University of Queensland Centre for Clinical Research, Herston, Qld 4006, Australia.
| | - Camile S Farah
- The University of Queensland, School of Dentistry, Brisbane, Qld 4000, Australia; The University of Queensland Centre for Clinical Research, Herston, Qld 4006, Australia
| | - Martin D Batstone
- Maxillofacial Unit, Royal Brisbane & Women's Hospital, Herston, Qld 4029, Australia; The University of Queensland Centre for Clinical Research, Herston, Qld 4006, Australia
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Ch'ng S, Oates J, Gao K, Foo K, Davies S, Brunner M, Clark JR. Prospective quality of life assessment between treatment groups for oral cavity squamous cell carcinoma. Head Neck 2013; 36:834-40. [DOI: 10.1002/hed.23387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/25/2013] [Accepted: 05/15/2013] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sydney Ch'ng
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Justine Oates
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Kerwyn Foo
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Sarah Davies
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Markus Brunner
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Jonathan R. Clark
- Sydney Head and Neck Cancer Institute; Royal Prince Alfred Hospital; Sydney New South Wales Australia
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Quality of Life in Oral Cancer Patients-Effects of Tongue Resection and Sociocultural Aspects. J Craniofac Surg 2013; 24:e493-6. [DOI: 10.1097/scs.0b013e31829429aa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chigurupati R, Aloor N, Salas R, Schmidt BL. Quality of Life After Maxillectomy and Prosthetic Obturator Rehabilitation. J Oral Maxillofac Surg 2013; 71:1471-8. [DOI: 10.1016/j.joms.2013.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
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Barrios R, Montero J, González-Moles MA, Baca P, Bravo M. Levels of scientific evidence of the quality of life in patients treated for oral cancer. Med Oral Patol Oral Cir Bucal 2013; 18:e578-84. [PMID: 23722141 PMCID: PMC3731084 DOI: 10.4317/medoral.19052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/10/2013] [Indexed: 12/24/2022] Open
Abstract
Treatments used in cancer of the oral cavity have great impact on the physical, psychological and functional state of patients. There has been increasingly interest in evaluating the health-related quality of life using questionnaires among patients treated with oral cancer. Up to our knowledge no review on this theme has incorporated the level of evidence of the single identified studies. The objective of the present study is to determinate results and conclusions about the health-related quality of life of these patients, in view of scientific evidence. In general, the diversity of designs, level of evidence and questionnaires used for their assessment does not affect results, which indicate a decline in the health related quality of life after treatment. This decline is greater when the tumor is large in size, and when radiotherapy is used, though the situation is seen to improve over the span of a year. Questionnaires on health-related quality of life provide concrete information regarding the impact of cancer treatment on patients.
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Affiliation(s)
- Rocío Barrios
- School of Dentistry, University of Granada, Granada, Spain
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Checcoli E, Bianchini C, Ciorba A, Candiani M, Riberti C, Pelucchi S, Pastore A. Reconstructive Head and Neck Surgery: Oncological and Functional Results. TUMORI JOURNAL 2013; 99:493-9. [DOI: 10.1177/030089161309900409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims The aim of this retrospective study is to review the experience in performing head and neck reconstruction surgery between 1989 and 2009 at the ENT Department of the University Hospital of Ferrara, Italy, considering the oncological as well as the functional and psychological outcome. Methods and study design Thirty-three consecutive patients were enrolled. Patients underwent flap reconstruction following primary or salvage surgery for squamous cell carcinoma of the oral cavity or oropharynx. Oncological results in terms of survival rate and disease-free interval, as well as functional and psychological results were evaluated. Results The oncological results, i.e. survival rate related to cancer stage and disease-free interval, were in agreement with those of the literature. Functional assessment, swallowing function and speech intelligibility were statistically poorer in patients affected by oropharyngeal malignancies than in patients affected by oral cancer. Quality of life was compromised in terms of reduced relationships and onset of depression or irritability. Conclusions Reconstructive surgery can be considered a relatively standard procedure in the treatment of head and neck cancer. The main drawback is still related to the major impact on patients' quality of life and functional status.
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Affiliation(s)
| | | | - Andrea Ciorba
- ENT Department, University Hospital of Ferrara, Ferrara, Italy
| | - Marco Candiani
- Plastic Surgery Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Carlo Riberti
- Plastic Surgery Unit, University Hospital of Ferrara, Ferrara, Italy
| | | | - Antonio Pastore
- ENT Department, University Hospital of Ferrara, Ferrara, Italy
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Pierre CS, Dassonville O, Chamorey E, Poissonnet G, Ettaiche M, Santini J, Peyrade F, Benezery K, Sudaka A, Bozec A. Long-term quality of life and its predictive factors after oncologic surgery and microvascular reconstruction in patients with oral or oropharyngeal cancer. Eur Arch Otorhinolaryngol 2013; 271:801-7. [DOI: 10.1007/s00405-013-2592-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
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A systematic review of questionnaires to measure the impact of appearance on quality of life for head and neck cancer patients. J Plast Reconstr Aesthet Surg 2013; 66:647-59. [DOI: 10.1016/j.bjps.2013.01.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 01/07/2013] [Accepted: 01/07/2013] [Indexed: 11/23/2022]
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Comparison of quality of life in head and neck stage IV squamous cell cancer patients treated with surgery and reconstruction versus radical radiotherapy. Ann Plast Surg 2013; 73:205-9. [PMID: 23403545 DOI: 10.1097/sap.0b013e318270449e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to analyze the differences in quality of life (QOL) in head and neck stage IV squamous cell cancer patients treated with surgery and reconstruction versus radical radiotherapy.The QOL was analyzed in 2 groups of patients. All patients had the same demographic and oncologic features but were treated differently. Group 1 (n = 16) was compound with patients treated with surgery and radiotherapy, whereas group 2 (n = 14) was formed with those who received radical radiotherapy. The University of Washington questionnaire was used for this purpose.A total of 30 questionnaires were received. The total score of the questionnaires ranged from 485 to 1120. The mean values were 837.8 for group 1 and 827.85 for group 2, with no statistical significance. Significant differences were found in several domains. By using a validated questionnaire, it is possible to estimate the impact in QOL of these patients.
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