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Howren MB, Christensen AJ, Pagedar NA. Prevalence of pain in a sample of long-term survivors of head and neck cancer. Am J Otolaryngol 2024; 45:104300. [PMID: 38640810 PMCID: PMC11168893 DOI: 10.1016/j.amjoto.2024.104300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE The experience of long-term pain in head and neck cancer (HNC) survivors is important but has received less attention in the HNC literature. The present study sought to examine the prevalence of pain from 2 to 5 years postdiagnosis and its association with HNC-specific health-related quality of life. MATERIALS & METHODS Prospective observational study at a single-institution tertiary care center. Pain was measured using a single item ranging from 0 to 10 with 0 representing no pain and 10 representing worst pain possible at 2 through 5 years postdiagnosis. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). RESULTS Pain reports were consistent across time. At 2 years postdiagnosis (N = 581), 27.6 % experienced at least some pain with 14.3 % reporting moderate or severe pain. At 3 years postdiagnosis (N = 417), 21.4 % experienced at least some pain with 14.2 % indicating moderate or severe pain. At 4 years postdiagnosis (N = 334), 26.7 % experienced at least some pain with 15.9 % reporting moderate or severe pain. At 5 years postdiagnosis (N = 399), 30.5 % experienced at least some pain with 17.5 % indicating moderate or severe pain. In general, across all four HNCI domains, those in the moderate and severe pain categories largely failed to reach 70 which is indicative of high functioning on the HNCI. CONCLUSIONS Pain is a considerable issue in long-term HNC survivors up to 5 years postdiagnosis. More research is needed to understand correlates of pain after treatment, including opportunities for screening and intervention, to improve outcomes and optimize recovery in HNC.
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Affiliation(s)
- M Bryant Howren
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, United States of America; Department of Internal Medicine, The University of Iowa, Iowa City, IA, United States of America; Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America.
| | - Alan J Christensen
- Department of Psychology, East Carolina University, Greenville, NC, United States of America
| | - Nitin A Pagedar
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America; Department of Otolaryngology, Head and Neck Surgery, The University of Iowa, Iowa City, IA, United States of America
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Howren MB, Christensen AJ, Pagedar NA. Prevalence and persistence of depressive symptoms during the first year postdiagnosis in a large sample of patients with head and neck cancer. Am J Otolaryngol 2024; 45:104257. [PMID: 38518447 PMCID: PMC11070284 DOI: 10.1016/j.amjoto.2024.104257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE The experience of persistent depressive symptomatology during the first year postdiagnosis has implications for recovery and adjustment by one year postdiagnosis. The present descriptive study sought to examine the prevalence and persistence of mild to moderate-severe depressive symptomology and associated disease-specific health-related quality of life (HRQOL) in patients with HNC. MATERIALS & METHODS This study was a prospective observational study at a single-institution tertiary cancer center. Depressive symptomatology was measured using the Beck Depression Inventory (BDI), captured at diagnosis and 3-, 6-, 9-, and 12-months postdiagnosis. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). Four subgroups were defined by BDI scores over time: persistent-moderate/severe subgroup, persistent-mild subgroup, transient subgroup, and resilient subgroup. RESULTS The distribution of patients (N = 946) was 65 (6.9 %) in the persistent-moderate/severe subgroup, 190 (20.1 %) in the persistent-mild subgroup, 186 (19.7 %) in the transient subgroup, and 505 (53.3 %) in the resilient subgroup. Across all four HNCI domains, patients in the persistent-moderate/severe subgroup failed to reach a score of 70 by 12-months postdiagnosis which is indicative of high functioning on the HNCI (aesthetics: M = 42.32, SD = 28.7; eating: M = 32.08, SD = 25.7; speech: M = 47.67, SD = 25.3; social disruption: M = 52.39, SD = 24.3). Patients in the persistent-mild subgroup failed to reach 70 in three of four domains. Patients in the resilient subgroup reached, on average, >70 on all HNCI domains. CONCLUSIONS Depression is a considerable issue during the first year postdiagnosis. Avenues for screening and intervention should be incorporated into HNC patient care per clinical practice guidelines to optimize recovery and HRQOL.
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Affiliation(s)
- M Bryant Howren
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, United States of America; Department of Internal Medicine, The University of Iowa, Iowa City, IA, United States of America; Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America.
| | - Alan J Christensen
- Department of Psychology, East Carolina University; Greenville, NC, United States of America
| | - Nitin A Pagedar
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America; Department of Otolaryngology-Head and Neck Surgery, Carver College of Medicine, The University of Iowa; Iowa City, IA, United States of America
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Cooper DJ, Travaglia I, Guller M, Talcott WJ, Ghaly M, Miles BA, Frank D, Seetharamu N, Parashar B. Clinical predictors of premature radiotherapy terminations in senior adults with oral cavity and laryngeal carcinoma. Head Neck 2024; 46:262-268. [PMID: 37950590 DOI: 10.1002/hed.27570] [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: 07/30/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The underlying factors that contribute to early radiotherapy (RT) termination are understudied, especially in the era of hypofractionated treatment regimens. In this retrospective investigation, we examined the characteristics and causes of premature RT terminations in senior adults (>70 years old) with oral cavity (OC) and laryngeal carcinomas. METHODS Hundred and eighty-eight patients treated with RT ± systemic therapy for OC and laryngeal cancer from 2017 to 2022 were identified. Premature termination was defined as completion of less than 95% of the prescribed RT. Logistic regression analysis was performed to examine factors predictive of premature termination, and survival was determined using the Kaplan-Meier method. RESULTS Twenty patients (10.6%) experienced premature RT terminations. On regression analysis, ECOG score at initiation of RT was the only covariate studied to be independently associated with premature termination (OR 2.00, 95%CI: [1.21, 3.30], p = 0.007). Three-year overall survival (49.1% vs. 77.3%) was significantly reduced in the termination cohort (p < 0.0001). CONCLUSIONS This analysis demonstrated over 1 in 10 patients had premature RT termination, which prognosticated inferior survival outcomes. Poor performance status may highlight patients at risk for premature termination and thus identify good candidates for hypofractionated protocols.
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Affiliation(s)
- Dylan J Cooper
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York, USA
| | | | - Meytal Guller
- Department of Otolaryngology - Head and Neck Surgery, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Wesley J Talcott
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Maged Ghaly
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Brett A Miles
- Department of Otolaryngology - Head and Neck Surgery, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Douglas Frank
- Department of Otolaryngology - Head and Neck Surgery, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Nagashree Seetharamu
- Division of Hematology-Oncology, Northwell Health Cancer Institute, New Hyde Park, New York, USA
| | - Bhupesh Parashar
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York, USA
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Howren MB, Seaman A, Super GL, Christensen AJ, Pagedar NA. Examination of Predictors of Pain at 12 Months Postdiagnosis in Head and Neck Cancer Survivors. Otolaryngol Head Neck Surg 2023; 169:1506-1512. [PMID: 37403789 PMCID: PMC10766866 DOI: 10.1002/ohn.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Pain following the completion of treatment is important but has received less attention in the head and neck cancer (HNC) literature. The present study sought to examine the prevalence and predictors of pain measured 12 months postdiagnosis and its impact on HNC-specific health-related quality of life (HRQOL) in 1038 HNC survivors. STUDY DESIGN Prospective observational study. SETTING Single-institution tertiary care center. METHODS Pain was measured using a single item ranging from 0 to 10 with 0 representing no pain and 10 representing the worst pain possible. Self-reported depressive symptomatology was measured using the Beck Depression Inventory and self-reported problem alcohol use was measured by the Short Michigan Alcoholism Screening Test. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). RESULTS Hierarchical multivariable linear regression analyses indicated that in addition to pain at 3 months postdiagnosis (β = .145, t = 3.18, sr2 = .019, p = .002), both depressive symptomatology (β = .110, t = 2.49, sr2 = .011, p = .015) and problem alcohol use (β = .092, t = 2.07, sr2 = .008, p = .039) were significant predictors of pain at 12 months postdiagnosis. Subgroup analyses suggest that across all 4 HNCI domains, those in the moderate and severe pain groups at 12 months postdiagnosis failed to reach 70 which is indicative of high functioning. CONCLUSION Pain in patients with HNC is a considerable issue at 12 months postdiagnosis, deserving further attention. Behavioral factors such as depression and problem alcohol use may be associated with pain and require systematic screening over time to identify and treat issues that impact optimal long-term recovery from HNC, including disease-specific HRQOL.
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Affiliation(s)
- M. Bryant Howren
- Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University; Tallahassee, FL
- Florida Blue Center for Rural Health Research & Policy, College of Medicine, Florida State University; Tallahassee, FL
| | - Aaron Seaman
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System; Iowa City, IA
- Department of Internal Medicine, The University of Iowa; Iowa City, IA
| | - Grace L. Super
- College of Medicine, Florida State University; Tallahassee, FL
| | | | - Nitin A. Pagedar
- Department of Otolaryngology—Head and Neck Surgery, Carver College of Medicine, The University of Iowa; Iowa City, IA
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Renslo B, Sawaf T, Virgen CG, Farrokhian N, Yu KM, Somani SN, Penn J, Ziegler A, Gan GN, Kakarala K, Shnayder Y, Bur AM, Sykes KJ. Assessing the Risk of Adjuvant Radiotherapy Initiation Delays With Social Support Surveys. Otolaryngol Head Neck Surg 2023; 169:928-937. [PMID: 36939526 PMCID: PMC10688033 DOI: 10.1002/ohn.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE In patients with head and neck squamous cell carcinoma (HNSCC), initiating postoperative radiotherapy (PORT) greater than 42 days after surgery is associated with a higher risk of poor survival outcomes. Social support has been shown to modulate behaviors related to care-seeking and treatment adherence. In this study, we sought to determine the relationship between social support metrics and PORT delays. STUDY DESIGN Prospective cohort study. SETTING Single tertiary medical center. METHODS Patients with HNSCC who underwent primary surgical excision requiring PORT were prospectively enrolled. Patient-perceived social support metrics were assessed using the Medical Outcomes Study Social Support Survey (MOS-SSS) at initial presurgical evaluation. Associations with PORT delays were evaluated via univariable and multivariable logistic regression analysis. RESULTS A total of 111 patients met the inclusion criteria for the study. An additional 28 patients were recommended to receive PORT but did not initiate treatment and were included for secondary analysis. All four subscales of the MOS-SSS (positive social interaction, affectionate support, tangible support, and emotional/informational support) were significantly associated with PORT initiation delays on univariable analysis. On multivariable analysis, the overall MOS-SSS score (odds ratio [OR] 2.08, 1.15-4.35, p = .028) was significantly associated with PORT initiation delays. On secondary analysis, lower tangible support was associated with a lack of PORT initiation (OR 1.63, 1.05-2.54, p = .028). CONCLUSION Social support metrics were significantly associated with PORT delays, which may help promote tighter scheduling and closer monitoring of high-risk patients.
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Affiliation(s)
- Bryan Renslo
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Tuleen Sawaf
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Celina G. Virgen
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nathan Farrokhian
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Katherine M. Yu
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shaan N. Somani
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph Penn
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrea Ziegler
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Gregory N. Gan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrés M. Bur
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J. Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Sawaf T, Virgen CG, Renslo B, Farrokhian N, Yu KM, Somani SN, Bur AM, Kakarala K, Shnayder Y, Gan GN, Graboyes EM, Sykes KJ. Association of Social-Ecological Factors With Delay in Time to Initiation of Postoperative Radiation Therapy: A Prospective Cohort Study. JAMA Otolaryngol Head Neck Surg 2023; 149:477-484. [PMID: 37079327 PMCID: PMC10119772 DOI: 10.1001/jamaoto.2023.0308] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/14/2023] [Indexed: 04/21/2023]
Abstract
Importance Timely initiation of postoperative radiation therapy (PORT) is associated with reduced recurrence rates and improved overall survival in patients with head and neck squamous cell carcinoma (HNSCC). Measurement of the association of social-ecological variables with PORT delays is lacking. Objective To assess individual and community-level factors associated with PORT delay among patients with HNSCC. Design, Setting, and Participants This prospective cohort study carried out between September 2018 and June 2022 included adults with untreated HNSCC who were enrolled in a prospective registry at a single academic tertiary medical center. Demographic information and validated self-reported measures of health literacy were obtained at baseline visits. Clinical data were recorded, and participant addresses were used to calculate the area deprivation index (ADI), a measure of community-level social vulnerability. Participants receiving primary surgery and PORT were analyzed. Univariable and multivariable regression analysis was performed to identify risk factors for PORT delays. Exposures Surgical treatment and PORT. Main Outcomes and Measures The primary outcome was PORT initiation delay (>42 days from surgery). Risk of PORT initiation delay was evaluated using individual-level (demographic, health literacy, and clinical data) and community-level information (ADI and rural-urban continuum codes). Results Of 171 patients, 104 patients (60.8%) had PORT delays. Mean (SD) age of participants was 61.0 (11.2) years, 161 were White (94.2%), and 105 were men (61.4%). Insurance was employer-based or public among 65 (38.5%) and 75 (44.4%) participants, respectively. Mean (SD) ADI (national percentile) was 60.2 (24.4), and 71 (41.8%) resided in rural communities. Tumor sites were most commonly oral cavity (123 [71.9%]), with 108 (63.5%) classified as stage 4 at presentation. On multivariable analysis, a model incorporating individual-level factors with health literacy in addition to community-level factors was most predictive of PORT delay (AOC= 0.78; R2, 0.18). Conclusions and Relevance This cohort study provides a more comprehensive assessment of predictors of PORT delays that include health literacy and community-level measures. Predictive models that incorporate multilevel measures outperform models with individual-level factors alone and may guide precise interventions to decrease PORT delay for at-risk patients with HNSCC.
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Affiliation(s)
- Tuleen Sawaf
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Celina G. Virgen
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Bryan Renslo
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Nathan Farrokhian
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Katherine M. Yu
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Shaan N. Somani
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Andrés M. Bur
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Kiran Kakarala
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Yelizaveta Shnayder
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
| | - Gregory N. Gan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City
| | - Evan M. Graboyes
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Kevin J. Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City
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