The addition of mood and anxiety domains to the University of Washington quality of life scale

Guided placement of zygomatic implants in head and neck cancer patients: implant survival and patient outcomes at 1-3 years of follow-up

Zygomatic implants (ZI) are a valuable option for supporting an obturator prosthesis after maxillary resection. This study was performed to assess the clinical outcomes of a digitally validated guided technique for ZI placement, followed by immediate prosthetic obturation. The primary objective was to evaluate implant survival, while the secondary objective was to assess patient-reported quality of life post-rehabilitation. Twelve patients treated for head and neck cancer received a total of 36 ZI after ablative surgery. The mean duration of ZI follow-up was 30.1 months. The survival rate of ZI placed in non-irradiated patients was 100%, while it was 85% in irradiated patients. Patient-reported outcomes were evaluated using the Liverpool Oral Rehabilitation Questionnaire (LORQv3) and the University of Washington Quality of Life Questionnaire (UW-QOL v4). Most patients reported satisfactory outcomes in the oral function domain of the LORQv3 (mean score 17.7 ± 4.5; possible range 12-48, with lower scores indicating better outcomes). Regarding the UW-QOL v4, the swallowing and chewing domains had the highest scores (mean 97.5 ± 8.7 and 95.8 ± 14.4, respectively; maximum possible score of 100). In conclusion, this treatment approach improves function and quality of life after maxillary ablative surgery. However, irradiated patients showed a noticeable trend of higher implant failure, and this was influenced by tumour position and size impacting the radiation dose to the zygomatic bone.

Long-Term Functional Outcomes in Pediatric Head and Neck Cancer Patients: A Systematic Review

OBJECTIVE

The multimodal treatments for pediatric head and neck (H&N) malignancies can have significant long-term functional consequences for growing patients. This systematic review aims to analyze the current knowledge of functional outcomes for pediatric H&N cancer survivors.

DATA SOURCES

PubMed, Embase, Web of Science.

REVIEW METHODS

Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed, and 1356 papers were reviewed by 3 team members with conflict resolution by a senior member.

RESULTS

Fourteen studies were included. Nine of 14 (64%) papers reported issues with swallowing, characterized as either dysphagia, odynophagia, oropharyngeal fibrosis, esophageal stenosis, xerostomia, trismus, or general issues with the throat and mouth. Six of 14 papers noted nutritional and feeding deficiencies, and 5 of 14 additionally noted issues with speech and voice changes. Four of 14 (29%) reported hearing impairments and/or loss. A majority of papers (9/14) reported long-term functional characteristics as a secondary outcome. Three of 14 (21%) reported a quality of life (QoL) measure. Heterogeneity in methodology and reporting precluded analysis of any relationship between treatment type and functional outcomes. Recommendations include integration of objective measures of feeding support and swallowing, as well as regular measurements of function and QoL parameters during treatment to better understand the evolution of QoL and function throughout care.

CONCLUSION

Relatively few studies focus on functional outcomes following the treatment of pediatric H&N cancer. Swallowing difficulty is the most frequently reported deficit, but objective data is rarely reported. Standardization of functional outcome assessment could improve the quality of evidence for pediatric patients treated for H&N cancer.

Quality of Life Outcomes for Parotid Malignancies

BACKGROUND

This study describes patient-reported outcome measures (PROMs) and associated factors in patients who underwent surgery for malignant parotid tumors (MPT).

METHODS

This is a retrospective study of all surgically treated MPT patients in a multidisciplinary head and neck cancer (HNC) survivorship clinic (2017-2023). PROMs included University of Washington Quality of Life Questionnaire (UW-QOL), Eating Assessment Tool (EAT-10), Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Neck Disability Index (NDI), and Insomnia Severity Index. Multivariable regression analysis was used to investigate clinical predictors associated with PROMs.

RESULTS

In 62 MPT patients, the prevalence of clinically relevant dysphagia symptoms (EAT-10), elevated symptoms of depression (PHQ-8), moderate/severe symptoms of anxiety (GAD-7), moderate/severe neck pain with activities of daily living (NDI), and moderate/severe symptoms of insomnia at last follow-up was 32.3%, 15.5%, 7.1%, 17.7%, and 7.2%, respectively. Nonparametric one-sided test revealed that patients treated with adjuvant CRT had significantly worse physical QOL, social-emotional QOL, and swallowing scores than patients treated with surgery alone (p = 0.01, p = 0.02, p = 0.03, respectively); that patients treated with surgery and adjuvant RT had significantly worse physical QOL and social-emotional QOL than patients treated with surgery alone (p < 0.01, p = 0.01, respectively) and that patients treated with surgery and adjuvant CRT had significantly worse swallowing and neck pain than patients treated with surgery and adjuvant RT (p = 0.03, p = 0.05, respectively).

CONCLUSIONS

In patients with surgically treated MPT, adjuvant CRT and RT were associated with worse PROMs.

LEVEL OF EVIDENCE

4 Laryngoscope, 2024.

Validation of the "obturator functioning scale" for Chinese-speaking patients with obturator prostheses after cancer-related maxillectomy

Objective

The Obturator Functioning Scale (OFS) is a scale without formal measures of validity in any language. This study aimed to translate and adapt the OFS from English to Chinese and check its reliability and validity in Chinese-speaking patients with obturator prostheses after cancer-related maxillectomy.

Methods

The 15-item Chinese preversion of the OFS was completed by 133 patients in three tertiary stomatological hospitals. Of these, 41 completed it again one week after the first measurement. The patients also completed the Chinese version of the University of Washington quality of life scale (UW-QOL, Version 4).

Results

Item 12 ("upper lip feels numb") was deleted to achieve a better statistical fit. The 14-item Chinese version of the OFS (OFS-Ch) demonstrated high internal consistency (Cronbach's alpha = 0.908). The test-retest reliability coefficients for most items exceeded 0.90, indicating substantial reproducibility. Confirmatory factor analysis found that the scale consisted of three correlated factors: 1) eating (four items), 2) speech (five items), and 3) other problems (five items). This explained 70.2 % of the total variance using exploratory factor analysis. The scale was significantly convergent and discriminant and could validly discriminate between patients with Brown I and IId maxillary defects.

Conclusions

Our results showed that the OFS-Ch scale is a valid tool for evaluating oral dysfunction and satisfaction with appearance for patients with the obturator prosthesis and identifying those at risk of poor obturator function in clinical settings.

Factors associated with shame and stigma among head and neck cancer patients: a cross-sectional study

PURPOSE

Head and neck cancer (HNC) patients often suffer from shame and stigma due to treatment limitations or due to societal factors. The purpose of this study was to assess perceived body image, depression, physical and psychosocial function, and self-stigma, as well as to identify factors that predicted shame and stigma in patients with HNC.

METHODS

This cross-sectional study recruited 178 HNC patients from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed for patient reported outcomes using the Body Image Scale (BIS), the Hospital Anxiety and Depression Scale-Depression Subscale (HADS-Depression Subscale), the University of Washington Quality of Life Scale (UW-QOL) version 4.0, and the Shame and Stigma Scale (SSS). Data were analyzed by descriptive analysis, Pearson's product-moment correlation, and multiple regression.

RESULTS

The two top-ranked subscales of shame and stigma were: "speech and social concerns" and "regret". Shame and stigma were positively correlated with a longer time since completion of treatment, more body image concerns, and higher levels of depression. They were negatively correlated with being male and having lower physical function. Multiple regression analysis showed that female gender, a longer time since completing treatment, higher levels of body image concern, greater depression, and less physical function predicted greater shame and stigma. These factors explained 74.7% of the variance in shame and stigma.

CONCLUSION

Patients' body image concerns, depression, time since completing treatment, and physical function are associated with shame and stigma. Oncology nurses should assess and record psychological status, provide available resources, and refer appropriate HNC patients to counselling.

Patient reported outcome measures (PROMs) in zygomatic fracture surgery

Attitudes towards healthcare in the NHS and in other Western healthcare systems have been changing dramatically in recent years. There is a significant movement calling for a shift from the traditional paternalistic model, with patients as passive recipients of treatments that are supported by objective and observable evidence, towards a more holistic approach, in which patients have agency, and treatments are tailored to the individual needs of a particular patient. Whilst patient safety and clinical effectiveness remain intrinsic to the traditional measurement of successful healthcare, Patient Reported Outcome Measures (PROMs) are increasingly being advocated as an important tool to uphold patient-centric care in the NHS.The aim of this study is to complete the first evaluation of PROMs that we know of in patients receiving surgical management of zygomatic fractures, by comparing two interventions commonly used in this condition: the zygomaticomaxillary complex open reduction and internal fixation (ZMC ORIF), and the Gillies approach to zygomatic elevation. We demonstrate high levels of patient satisfaction across all domains, irrespective of surgical approach, but that mood and anxiety remain an issue after surgery.

Prevalence and persistence of depressive symptoms during the first year postdiagnosis in a large sample of patients with head and neck cancer

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.

Implications of the composite free flap harvest site on quality of life after head and neck surgery: a prospective series

Quality of life (QOL) has become a primary determinant of the treatment outcome. There is a poor evidence base regarding the QOL implications of free flap harvest from the various different osseous composite donor sites. This prospective study assessed the impact of free flap harvest on QOL and compared QOL morbidity between fibula, scapula, and iliac crest (deep circumflex iliac artery; DCIA) donor sites in head and neck reconstructive surgery. This was a single-site prospective cohort clinical research study. Fifty-nine patients were recruited between 2017 and 2021; 30 underwent fibula flap reconstructive surgery, 17 scapula flap, and 12 DCIA flap. The patients were assessed using the University of Washington Quality of Life Questionnaire version 4 (UW-QOL v4) preoperatively and again at >12 months postoperatively. The results showed no significant change in the mean global QOL score postoperatively when compared to the preoperative baseline in any of the donor site groups. However, the mean postoperative scores for the appearance domain were significantly lower than the preoperative scores in all of the donor site groups. In addition, fibula flap patients had significantly reduced physical activity and recreation QOL domain scores postoperatively when compared to the preoperative scores.

A review of the use of patient reported outcome measures (PROMS) in temporomandibular joint (TMJ) surgery

Temporomandibular joint (TMJ) surgery accounts for a significant number of patient episodes in oral and maxillofacial surgery, and treatment effectiveness is commonly assessed using measures of pain and mouth opening. Patient-reported outcome measures (PROMs) enable assessment of the patient's perspective and perception of the diseases and treatment outcomes. The purpose of this review was to assess the use of PROMs in TMJ surgery. A review of 3 databases (PubMed, OVID, Trip) was carried out to assess the use of PROMs when reporting on TMJ surgical interventions. Studies were limited to the English language, involving humans and at least one surgical intervention of the TMJ. A total of 214 articles met the inclusion and exclusion criteria, of which only 28 used 18 PROMs among them. Half of these PROMs were single-question visual analogue scales or Likert scales on quality of life and disability. The Oral Health Impact Profile and the Helkimo Clinical Dysfunction Index were the second most used (n = 3). PROMs were used most in studies on internal derangement (n = 9) and in cohort study designs (n = 26), but this was not statistically significant. In the majority of research on TMJ surgery, no PROMs are used, and when one is, there is a tendency to use weaker single-question PROMs as opposed to multi-question PROMs to assess outcomes. With the increasing importance of PROMs for assessing patients' perception of treatment outcomes, further research is needed to establish valid and reproducible PROMs for TMJ surgery.

Efficacy of personalized 3D-printed osteotomy guide in maximizing fibular utilization and minimizing graft length for reconstruction of large mandibular defect

OBJECTIVE

The study addresses the long-standing challenge of insufficient length in vascularized fibular flaps when reconstructing large mandibular defects that require dual-barrel grafts. Employing personalized 3D-printed osteotomy guides, the study aims to optimize fibular utilization and minimize the required graft length.

MATERIAL AND METHODS

Two reconstruction methods for distal bone defects were compared: a fold-down (FD) group that employed a specialized osteotomy guide for folding down a triangular bone segment, and a traditional double-barrel (DB) group. Metrics for comparison included defect and graft lengths, as well as the graft-to-defect length ratio. Postoperative quality of life was assessed using the University of Washington Quality of Life questionnaire (UW-QoL).

RESULT

Both FD and DB groups achieved successful mandibular reconstruction. Despite larger defects in the FD group (117 ± 31.35 mm vs 84 ± 35.34 mm, p = 0.028), the used fibula length was not statistically longer in the FD group. The median ratio of graft-to-defect length was also lower in the FD group (1.327 vs 1.629, p = 0.024), suggesting that FD required only 82.47% of the graft length needed in the DB approach. Quality of life scores post-surgery were comparable between the groups.

CONCLUSION

Personalized 3D-printed osteotomy guides enhance fibula graft efficacy for reconstructing larger mandibular defects, necessitating shorter graft lengths while preserving postoperative quality of life.

CLINICAL RELEVANCE

This study confirms the utility of 3D printing technology as an effective and precise tool in orthopedic surgery, particularly for complex reconstructions like large mandibular defects. It suggests a viable alternative that could potentially revolutionize current practices in bone grafting.

Quality of life following treatment with intra-arterial cisplatin with concurrent radiation and erlotinib for locally advanced head and neck cancer

OBJECTIVES

Studies that focus on the feasibility of using erlotinib plus chemoradiation to treat locally advanced head and neck cancer have given hints of improved survival outcomes compared to chemoradiation alone. However, the influence of this treatment regimen on the quality of life of the patients has not been documented. We conducted a study of this triple combination and now have documented follow-up survival data as well as long-term quality of life (QoL) measures.

METHODS

Three sets of QoL questionnaires were given to patients with a diagnosis of head and neck cancer at two time points, pre- and post-treatment, to assess differences in quality of life after receiving chemotherapy with intra-arterial (IA) cisplatin (150 mg/m2), concomitant radiation (70 Gy), and oral erlotinib (150 mg/day). Additionally, patients were followed for a total of 5 years.

RESULTS

Treatment had a detrimental effect on appearance, taste, and saliva domain scores in their QoL questionnaires. Nonetheless, fewer patients reported pain and anxiety.

SIGNIFICANCE OF RESULTS

The combination of erlotinib with chemoradiation produced similar adverse effects on the QoL scores of patients with head and neck cancer as compared to chemoradiation alone.

Assessment of quality of life in patients with surgically treated maxillofacial fractures

Background: The complex nature of maxillofacial injuries can affect the surgical treatment outcomes and general well-being of the patient. To evaluate the efficiency of the surgical treatment, assessment of the quality of life (QOL) of the patients is of vital importance. Due to the absence of an exclusive QOL assessment tool for maxillofacial fractures, we introduce the 'Twenty-point quality of life assessment in facial trauma patients in Indian population'. The aim of this study was to assess and evaluate the QOL following surgical management of maxillofacial trauma patients based on the severity of the injury. Methods: The study consisted of 182 subjects divided into two groups of 91 each (Group A: severe facial injury and Group B: mild to moderate facial injury). The Facial Injury Severity Scale (FISS) was used to determine the severity of facial fractures and injuries. The twenty-point quality of life assessment tool includes Zone 1 (Psychosocial impact) and Zone 2 (Functional and aesthetic impact), with ten domains each to assess QOL. Results: In Zone 1, the mean scores for Group A and Group B were 38.6 and 39.26, respectively. In Zone 2, Group B (44.56) had higher mean scores compared to Group A (32.92) (p< 0.001). Group B (83.8) had higher mean scores compared to Group A (71.58) when the total of both Zone 1 and Zone 2 were taken into consideration (p<0,001). In Group A, 9 out of 91 patients had a total score of 81- 100 compared to 68 in the same range in Group B. Conclusions: Proper surgical management with adequate care to the hard and soft tissues can improve the QOL by reducing postoperative psychosocial and functional complications. Aesthetic outcomes play an important role in determining the QOL. Mild/ Moderate injuries show better QOL compared to severe maxillofacial injuries.

Decisional regret, symptom burden, and quality of life following transoral robotic surgery for oropharyngeal cancer

BACKGROUND

Transoral robotic surgery (TORS) has equivalent oncologic control to radiotherapy with potential for improved quality of life (QOL) and lower patient-reported decisional regret.

METHODS

Cross-sectional study between 2016 and 2021 of TORS patients with early-stage oropharyngeal squamous cell carcinoma who completed the Decision Regret Scale (DRS), M. D. Anderson Dysphagia Inventory (MDADI), and University of Washington Quality of Life (UW-QOL). The median time from treatment to questionnaire completion was 1.8 years (IQR 1.4-3.3, range 1.0-5.6).

RESULTS

Of 65 patients, 84.6% expressed no or mild decisional regret. Regret was not associated with clinical parameters or adjuvant treatment but was correlated with MDADI (τavg = -0.23, p < 0.001) and UW-QOL (τavg = -0.27, p < 0.001). Worse MDADI was associated with older age and worse UW-QOL was associated with multi-site operation and shorter time to survey.

CONCLUSIONS

Overall, the TORS cohort expressed very limited decisional regret. DRS scores were unaffected by clinicodemographics or additional adjuvant therapies, but decision regret was correlated with worse QOL and worse swallowing.

Predictors of Quality of Life for Head and Neck Cancer Patients at an Academic Institution

Objective

Quality of life (QOL) is an important consideration in head and neck cancer (HNC) due to lasting disease and treatment-related toxicities. We performed a comprehensive review of predictors of QOL in this population, including distance to care.

Study Design

Retrospective cohort study from 2017 to 2022.

Setting

Academic medical center.

Methods

QOL was quantified in patients treated for HNC utilizing the University of Washington Quality of Life and 20-Item Short Form surveys completed at subsequent clinic visits. Distance to treatment center and other demographic, socioeconomic, disease-specific, and behavioral data were analyzed.

Results

There were 176 patients in the cohort (69% male; mean age, 64 ± 10.8 years). There was no association between miles traveled and any of the QOL subscales. Marital status was the strongest predictor of QOL, significantly associated with 7/8 QOL domains and favoring those who were married. Other significant predictors of decreased QOL included emotional/physical abuse, current tobacco use, documented religious affiliation, and treatment involving surgery plus adjuvant therapy. A significant positive trend over time existed for multiple QOL subscales.

Conclusion

QOL is unchanged in patients who travel greater distances for care. QOL is more closely linked to factors such as marital status, physical/emotional abuse, tobacco use, religious affiliation, treatment intensity, and time following surgery. This highlights the importance of a strong support structure and the influence of certain socioeconomic and lifestyle factors on patients, with opportunities for screening and intervention throughout their cancer care.

The modified vermilion border-marionette line approach: A management for buccal cancer with wider indications and higher satisfaction

OBJECTIVE

The purpose of this study is to explore the effects of modified vermilion border-marionette line (MVBML) approach on postoperative facial scar, nerves injury, and prognosis of patients with buccal squamous cell carcinoma (BSCC).

PATIENTS AND METHODS

This is a single-center, prospective cohort study that enrolled 80 patients with BSCC from June 2015 to December 2020. According to the different surgical approaches, the patients were divided into two groups: the lower lip median (LLM) approach group and the MVBML approach group.

RESULTS

The results showed that the appearance (p = 0.003), scar consciousness (p < 0.001) and satisfaction with appearance (p = 0.001) of patients in the MVBML group were significantly better than those in the LLM group, and the difference was more obvious in elderly group. Statistical analysis of postoperative nerves injury showed that the MVBML group had a lower risk of facial and mental nerves injury than the LLM group, and there was a significant statistical difference in mental nerve injury between the two groups (p < 0.001). Through Kaplan-Meier survival analysis, we found no significant difference in disease-specific survival (p = 0.47) or disease-free survival (p = 0.70) between the LLM approach group and the MVBML approach group.

CONCLUSIONS

The MVBML surgical approach is worthy of advancement for the surgical treatment of BSCC.

Functional and quality-of-life outcomes following salvage surgery for recurrent squamous cell carcinoma of the head and neck: a systematic review and meta-analysis

BACKGROUND

Recurrent head and neck squamous cell carcinomas (HNSCC) are frequently managed with salvage surgery, but the impact these operations have on function and quality-of-life (QoL) is understudied. This review aimed to provide a quantitative and qualitative assessment of the functional and QoL effects of salvage surgical procedures.

METHODS

Systematic review and meta-analysis were conducted of studies reporting QoL and function following salvage HNSCC resections.

RESULTS

The search identified 415 articles and 34 were selected for inclusion. Pooled random effects analysis revealed long-term feeding and tracheostomy tube rates of 18% and 7%. Pooled long-term feeding tube rates in open oral and oropharyngeal, transoral robotic, total and partial laryngectomy surgeries were 41%, 25%, 11% and 4%. Eight studies used validated QoL questionnaires.

CONCLUSIONS

Functional and QoL outcomes from salvage surgery are acceptable, but appear to be worse following open procedures. Prospective studies measuring changes over time are needed to assess these procedures impact on patient well-being.

The Effects of a 'New Generation' of Heat and Moisture Exchangers in Laryngectomized Patients with Previous Heat and Moisture Exchanger Experience

Objectives: To evaluate the effects of a new generation of heat and moisture exchangers (NG-HMEs) on pulmonary rehabilitation, quality of life, patient satisfaction, and usage patterns. Methods: A prospective observational study on 23 laryngectomized patients with prior HME experience from June 1, 2021 to November 30, 2021. Patients were interviewed at inclusion, after 6 weeks and after 12 weeks after the introduction of NG-HMEs. Two validated questionnaires were used to report pulmonary complaints and quality of life: the Cough and Sputum Assessment Questionnaire (CASA-Q), the European Quality of Life 5 Dimensions Index Score (EQ-5D Index Score), and the European Quality of Life 5 Dimensions Visual Analog Scale (EQ-5D-VAS). Usage patterns and patient satisfaction were reported using study-specific questionnaires. Results: The patients had an average age of 65.7 ± 6.8 years, with 87% being male, on average 33.7 ± 35.3 months after total laryngectomy (TLE). NG-HMEs were used for a mean of 21.87 ± 4.63 hours/day (P = .034). After 12 weeks of use, patients reported the following changes in the CASA-Q domains: cough symptoms (+5; P = .663), cough impact (0; P = .958), sputum symptoms (+8; P = .13), and sputum impact (+3; P = .489). The EQ-5D index score increased (+0.024; P = .917) as well as the EQ-5D VAS (+0.8; P = .27). All patients rated their experience with NG-HMEs with ≥3 out of 5. The patients who used NG-HMEs as instructed (n = 13) reported more profound changes in the CASA-Q domains: cough symptom (+11; P = .129), cough impact (+7; P = .209), sputum symptom (+11; P = .123), and sputum impact (+10; P = .102). Conclusions: Our results show that NG-HMEs could have a positive clinical impact on pulmonary rehabilitation after TLE, even in HME-experienced patients. The use of NG-HMEs does not affect the quality of life. The possible effects of NG-HMEs require further evaluation in long-term studies to fully assess their efficacy.

[Patient-reported outcomes in head and neck cancer treatment: relevance, challenges, and benefit]

Next to overall survival, quality of life is becoming more and more pivotal for cancer patients. The various domains of quality of life are complex and have different value to each patient. However, not only patients but also health care professionals, the pharmaceutical industry, and regulatory bodies ask: How can quality of life be reliably ascertained in clinical trials? For this purpose, carefully developed and validated specific questionnaires are needed: the patient-reported outcome measures (PROMs). A key challenge is to define how results based on PROMs can be used for shared decision-making. Next to clinical factors such as health and nutritional status, quality of life acts as a prognostic factor for overall survival in cancer. Thus, it is crucial to take quality of life into account in daily clinical practice.

Quality of Life in Patients With Benign Lateral Skull Base Neoplasms Following Infratemporal Fossa Approaches

Objectives: Infratemporal fossa approaches (IFAs) allow the total resection of certain lateral skull base neoplasms. To date, no studies have explored the change of patient-reported quality of life (QoL) after total resection of benign lateral skull base neoplasms through IFA. The present study aimed to give a comprehensive understanding of QoL among patients after IFA through general and disease-specific QoL questionnaires. Methods: Forty-seven patients with benign lateral skull base neoplasms were enrolled. The Short Form 36 (SF-36), World Health Organization Quality of Life-BREF (WHOQOL-BREF), and the University of Washington Head and Neck Quality of Life (UW-QOL) were chosen as tools to assess QoL before and after surgeries through IFA. Results: Patients had significantly lower scores in appearance, chewing, and speech after surgeries through IFA. However, change in health from SF-36 and physical health from WHOQOL-BREF scored higher after surgery. In multivariate linear regression analysis, age, gender, mood, speech, appearance, swallowing, and chewing contributed independently to general QoL. Conclusion: Patients were shown to benefit with regard to overall QoL after gross tumor resection from IFA, despite the impact of appearance, speech, and chewing. Function preservation and restoration are critical since their correlation with postoperative QoL.

Oral-Functioning Questionnaires in Patients with Head and Neck Cancer: A Scoping Review

Background: Oral-functioning impairment can negatively affect the quality of life (QoL) of head and neck cancer (HNC) patients after receiving radiotherapy (RT). Assessment of patient-reported oral functioning throughout treatment can improve patient care. This scoping review aims to propose a definition for oral functioning for HNC patients and to map out the available questionnaires measuring patient-reported oral functioning in RT-treated HNC patients. Methods: A literature search in relevant databases was performed. Each questionnaire was scored on the domains validity, reliability, and responsiveness. Furthermore, the items from the questionnaires were analyzed to define the common denominators for oral functioning in HNC patients. Results: Of the 6434 articles assessed, 16 met the inclusion criteria and employed 16 distinct instruments to evaluate QoL. No questionnaire covered all oral-health-related QoL items nor assessed all aspects of validity, reliability, and responsiveness. Chewing, speaking, and swallowing were the common denominators for oral functioning. Conclusions: Based on the included studies, we suggest using the VHNSS 2.0 questionnaire to assess oral functioning in HNC patients. Furthermore, we suggest to more clearly define oral functioning in HNC patients by focusing on masticatory function (chewing and grinding), mouth opening, swallowing, speaking, and salivation.

Quality of life of dental patients treated with laser surgery: A scoping review

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.

Gender differences in the laryngectomee experience

BACKGROUND

Laryngectomy is a pivotal event in patients. lives, with pervasive and far-reaching effects. Understanding gender differences in these effects may improve care of laryngectomy patients. This paper describes gender differences in the experience after laryngectomy.

AIM

To explore the similarities and differences in the laryngectomee experience based on gender.

METHODS & PROCEDURES

Four gender-matched focus groups were conducted; dialogue was audio recorded, transcribed and studied using interpretative phenomenological analysis (IPA).

OUTCOMES & RESULTS

A total of 17 laryngectomees, eight female and nine male, age range 41-80 years, participated in focus groups. Laryngectomy represented a turning point in the lives of both genders. Four themes emerged: perception of loss, adjusting to alaryngeal communication, finding a positive outlook and re-establishing the self. Themes applied to both genders, with subthemes demonstrating similarities and differences between men and women.

CONCLUSIONS & IMPLICATIONS

Men and women experienced destabilization after laryngectomy related to perceived losses and shifts in identity. Men described navigating from physical disability toward recovery of function, while women described an emotional journey concerning loss and rediscovery of meaning in their lives. Understanding the laryngectomee experience in better detail, which includes recognizing gender differences and rejecting a one-size-fits-all approach, may facilitate more effective preoperative counselling and post-operative support from providers.

WHAT THIS PAPER ADDS

What is already known on the subject Patients who undergo total laryngectomy often struggle with problems with physical, emotional, and social functioning and decreased quality of life. As the literature currently stands, the understanding of the experience of laryngectomees has primarily focused on the perspective of a singular gender. Thus, this is the first qualitative study specifically investigating differences in the laryngectomee experience between men and women. What this paper adds to existing knowledge This study finds that women and men both endorse significant mental and physical changes following laryngectomy; however, their perception of their experience differed by gender. Women endorsed alteration to meaningful life and men demonstrated distress related to loss of physical functioning; both genders described laryngectomy as a formative event that helped them rediscover joy and redefine themselves for the better. What are the potential or actual clinical implications of this work? Our findings suggest men and women have distinct mental and emotional struggles after laryngectomy despite similar physical changes. This suggests that tailoring care with consideration of these gender differences, including preoperative counselling, post-operative support and gender-matched visitors or support groups, may help beneficial in recovery after laryngectomy.

Assessment of quality of life after soft tissue resection of head and neck carcinoma and reconstruction with double-paddle peroneal artery perforator free flap

We aimed to assess the quality of life for head and neck carcinoma (HNC) patients who underwent soft tissue resection and reconstruction with double-paddle peroneal artery perforator (DPAP) free flap. The quality of life was assessed by means of the University of Washington quality of life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14) questionnaires at 12 months postoperatively. Data from 57 patients were retrospectively analysed. Out of these, 51 patients were at TNM stage III or IV. Finally, 48 patients finished and returned the two questionnaires. In the UW-QOL questionnaire, the mean (SD) higher scores were pain 76.5 (6.4), shoulder 74.3 (9.6), and activity 71.6 (6.1), whereas the lower scores were chewing 49.7 (5.2), taste 51.1 (7.7), and saliva (56.7 (7.4). In the OHIP-14 questionnaire, the higher-scoring domains were psychological discomfort (69.3 (9.6) and psychological disability 65.2 (5.8), whereas the lower-scoring domains were handicap 28.7 (4.3) and physical pain 30.4 (8.1). The DPAP free flap significantly improved appearance, activity, shoulder, mood, psychological discomfort, and handicap compared with pedicled pectoralis major myocutaneous flap reconstruction. In conclusion, DPAP free flap for reconstruction of tissue defects after soft tissue resection of HNC significantly improved the patients' QOL compared to pedicled pectoralis major myocutaneous flap reconstruction.

Affective Symptoms and Oropharyngeal Dysphagia in Head-and-Neck Cancer Patients: A Systematic Review

Oropharyngeal dysphagia (OD) is a high impact morbidity in head-and-neck cancer (HNC) patients. A wide variety of instruments are developed to screen for affective symptoms and OD. The current paper aims to systematically review and appraise the literature to obtain insight into the prevalence, strength, and causal direction of the relationship between affective symptoms and OD in HNC patients. This review was conducted in accordance with the PRISMA statement. A systematic search of the literature was performed using PubMed, PsycINFO, Cochrane, and Embase. All available publications reporting on the relationship between affective conditions and swallowing function in HNC patients were included. Conference papers, tutorials, reviews, and studies with less than 5 patients were excluded. Fifteen studies met the inclusion criteria. The level of evidence and methodological quality were assessed using the ABC-rating scale and QualSyst critical appraisal tool. Eleven studies reported a positive relationship between affective symptoms and OD. The findings of this paper highlight the importance of affective symptom screening in dysphagic HNC patients as clinically relevant affective symptoms and OD seems to be prevalent and coincident in this population. Considering the impact of affective symptoms and OD on patients' daily life, early detection and an integrated interdisciplinary approach are recommended. However, due to the heterogeneity of study designs, outcomes, and outcome measures, the generalization of study results is limited.

Post-treatment evaluation of oral health-related quality of life in head and neck cancer patients after dental implant rehabilitation

Objectives To assess oral health-related quality of life (OHRQoL) following oral rehabilitation using dental implants in patients treated for head and neck cancer (HNC).Materials and methods Service evaluation: patients who had received dental implants during their oral rehabilitation were invited to take part (n = 81). In total, 37 patients completed questionnaires and underwent a structured interview regarding OHRQoL after rehabilitation. Analysis was by descriptive statistics for questionnaire and thematic analysis of interview.Results Rehabilitation types were 17 fixed implant prostheses, 12 removable implant prostheses and 8 combination. Functional problems relating to HNC treatment had a significant effect on OHRQoL and persisted after rehabilitation. Removable implant prostheses had more problems associated than fixed. At interview, patients described: functional and emotional benefits of oral rehabilitation involving implants; ease of keeping implants clean; variations in ability of primary care dentists to maintain rehabilitation; thankfulness to have received treatment; long duration of rehabilitation; and problems encountered while undergoing rehabilitation.Conclusions HNC treatment results in functional and emotional difficulties, which has a significant impact on OHRQoL. Use of dental implants in fixed or removable oral rehabilitation can result in good OHRQoL as assessed by patients at treatment completion, although some functional difficulties often remain.

Mastication in health-related quality of life in patients treated for oral cancer: A systematic review

INTRODUCTION

Treatment for oral cancer can impair oral functions such as mastication, which may negatively affect quality of life (QoL). In this review, an overview is provided of masticatory ability in patients treated for oral cancer.

METHODS

The PubMed (MEDLINE), Embase and Cochrane databases were systematically searched for scientific literature on masticatory ability in relation to QoL in patients treated for oral cancer. Studies were included when oral cancer treatment was provided, and the University of Washington Quality of Life (UW-QoL) questionnaire was used. Risk of bias (MINORS) was independently assessed by two authors.

RESULTS

The PubMed (MEDLINE), Embase and Cochrane search yielded 575 unique records of which 111 were assessed full text, and 27 studies were included. The UW-QoL mastication scores ranged from 31.9 to 97.4. There was a wide variety in methodology, patient groups, tumour site, treatment and assessment moment, to such a degree that outcome scores are difficult to compare.

CONCLUSION

The wide variety in studies exploring health-related QoL in relation to mastication in oral cancer patients prevents the identification of possible relations between treatment, masticatory ability and QoL. Our findings underline the limitations in currently available literature and indicate the necessity for more comparable research.

Effects of personalized swallowing rehabilitation in patients with oral cancer after free flap transplantation: A cluster randomized controlled trial

OBJECTIVES

Dysphagia is a common and serious complication in patients with oral cancer after free flap transplantation (OC-FFT), which seriously affects their quality of life. Studies have found swallowing rehabilitation can improve the swallowing ability of these patients, but the studies have design deficiencies. This study's purpose was to test the effectiveness of personalized swallowing rehabilitation for this patient population.

MATERIALS AND METHODS

This is a cluster randomized, non-blind, controlled clinical trial. Participants were 68 OC-FFT patients randomly assigned to intervention (n = 34) or control (n = 34) groups. The control group received routine nursing and health education, while the intervention group received personalized swallowing rehabilitation twice a day for 10 days, based on the results of the Mann Assessment of Swallowing Ability-Oral Cancer (MASA-OC). On the 6th and 15th days and 1 month after the operation, MASA-OC scores and percentage weight loss were measured, and the removal time to nasogastric tube was also recorded. The quality of life was evaluated 1 month after the operation.

RESULTS

On day 15 and 1 month after the operation, MASA-OC scores were higher and the percentage weight loss was lower in the intervention group than the control group (P < 0.05). The removal time of the nasogastric tube was shorter (P < 0.05), and the quality of life at 1 month was better in the intervention group (P < 0.05).

CONCLUSION

Personalized swallowing rehabilitation can improve patients' swallowing after OC-FFT, promote the early removal of the nasogastric tube, and improve nutritional status and quality of life.

Quality of life in patients with cancer-related Brown IIb maxillary defect: A comparison between conventional obturation rehabilitation and submental flap reconstruction

OBJECTIVES

The purpose of this retrospective study was to compare the differences in quality of life (QOL) outcomes between the conventional obturator prostheses (COP) and the pedicled submental artery island flap (SAIF) in the reconstruction of Brown IIb maxillary defects.

MATERIALS AND METHODS

The QOL of 116 eligible patients who had a lapse ≥ 12 months after the cancer-related maxilla ablation was evaluated by the University of Washington quality of life scale (UW-QOL), Performance Status Scale for Head and Neck (PSS-HN), and Obturator Functioning Scale (OFS).

RESULTS

Patients in the SAIF group reported statistically and clinically significant higher overall QOL scores but lower chewing scores in the UW-QOL scale when compared with those in the COP group (P < 0.05). Clinically significantly higher scores were also observed in the recreation and anxiety domains in the UW-QOL scale for the SAIF group, but there was no statistical significances. The COP group reported more complaints about the nasal leakage when swallowing and the shape of the upper lip, and had a stronger willingness to avoid family or social events in the OFS (P < 0.05).

CONCLUSIONS

For patients with Brown IIb defects, SAIF reconstruction can achieve reduced nasal leakage when swallowing, improved upper-lip contour, increased social activity, and superior overall QOL than COP. The inferior chewing function in the SAIF group indicated the need for dental rehabilitation with a conventional denture or osseointegrated implants.

Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer

Head and neck squamous cell carcinoma (HNSCC) is the most common cancer involving the mucosal surfaces of the head and neck and is associated with a number of etiological factors, including cigarette smoking, alcohol and betel nut consumption and exposure to high-risk human papillomavirus. The risk of HNSCC increases with age, peaking in the seventh and eighth decade, but this varies by anatomical and histological subtype. While several advancements have been made in the treatment of head and neck cancer (HNC) in recent decades, undertaking curative treatment still subjects the majority of HNSCC patients to substantial treatment-related toxicity requiring patients to tolerate a gamut of physical, psychological, and emotional demands on their reserves. In conjunction with other patient-related factors, clinicians involved in treating patients with HNSCC may incorporate advancing chronological age into their decision-making process when determining treatment recommendations. While advancing chronological age may be associated with increased concerns regarding physical treatment tolerability, clinicians may also be concerned about heightened vulnerability in various health and wellbeing outcomes. The available literature, however, does not provide evidence of this vulnerability in patients with advancing age, and, in many instances, older patients self-report greater resilience compared to their younger counterparts. While this data is reassuring it is limited by selection bias and heterogeneity in trial and study design and the absence of a consistent definition of the elderly patient with HNSCC. This narrative review article also includes a review of the measures used to assess HRQL, psychosocial outcomes and unmet needs in elderly or older patients with HNSCC.

Health-related quality of life at 3 months following head and neck cancer treatment is a key predictor of longer-term outcome and of benefit from using the patient concerns inventory

INTRODUCTION

During clinical follow-up it can be difficult to identify those head and neck cancer (HNC) patients who are coping poorly and could benefit from additional support. Health-related quality of life (HRQOL) questionnaires and prompt lists provide a means by which patients can express their perceived outcomes and raise concerns. The first aim of this secondary analysis following a randomized trial was to explore which patient characteristics, at around 3 months following treatment completion (baseline), best predict HRQOL 12 months later. The second aim was to attempt to ascertain which patients were most likely to benefit from using prompt list.

METHODS

Cluster-controlled pragmatic trial data were analyzed. HRQOL was measured by the University of Washington Quality of life questionnaire (UW-QOLv4). The prompt list was the Patient Concerns Inventory (PCI-HN).

RESULTS

The trial involved 15 eligible consultants and a median (inter-quartile range) of 16 (13-26) primary HNC patients per consultant, with 140 PCI patients and 148 controls. Baseline HRQOL was the dominant predictor of 12-month HRQOL with other predictors related to social, financial, and lifestyle characteristics as well as clinical stage and treatment. Although formal statistical tests for interaction were non-significant the trend in analyses over a range of outcomes suggested that patients with worse baseline HRQOL could benefit more from the PCI-HN.

DISCUSSION

HRQOL early post-treatment is a key predictor of longer-term outcome. Measuring and using HRQOL and the PCI-HN are not only surrogates for predicting HRQOL at 15 months post-treatment, but also tools to help guide interventions.

A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes

Simple Summary

The delivery of higher radiation doses has been shown to increase local control, and ultimately survival, for head and neck cancer patients, but highly conformal dose distributions are necessary to minimize normal tissue toxicity. Varian’s HyperArc non-coplanar automated treatment planning and delivery technique has been shown to improve dose conformity for intracranial treatment, but its safety and efficacy for head and neck cancer treatment has yet to be verified. This study evaluates the initial results of a prospective clinical trial using HyperArc for recurrent head and neck cancer patients. We demonstrated that HyperArc can enable significant tumor dose escalation compared to conventional volumetric modulated arc therapy (VMAT) planning while minimizing the dose to organs at risk. Treatment delivery was feasible and safe, with minimal treatment-related toxicities and positive patient-reported quality of life measures.

Abstract

This study reports the initial results for the first 15 patients on a prospective phase II clinical trial exploring the safety, feasibility, and efficacy of the HyperArc technique for recurrent head and neck cancer treatment. Eligible patients were simulated and planned with both conventional VMAT and HyperArc techniques and the plan with superior dosimetry was selected for treatment. Dosimetry, delivery feasibility and safety, treatment-related toxicity, and patient-reported quality of life (QOL) were all evaluated. HyperArc was chosen over conventional VMAT for all 15 patients and enabled statistically significant increases in dose conformity (R50% reduced by 1.2 ± 2.1, p < 0.05) and mean PTV and GTV doses (by 15.7 ± 4.9 Gy, p < 0.01 and 17.1 ± 6.0 Gy, p < 0.01, respectively). The average HyperArc delivery was 2.8 min longer than conventional VMAT (p < 0.01), and the mean intrafraction motion was ≤ 0.5 ± 0.4 mm and ≤0.3 ± 0.1°. With a median follow-up of 12 months, treatment-related toxicity was minimal (only one grade 3 acute toxicity above baseline) and patient-reported QOL metrics were favorable. HyperArc enabled superior dosimetry and significant target dose escalation compared to conventional VMAT planning, and treatment delivery was feasible, safe, and well-tolerated by patients.

Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress

OBJECTIVE

The aim of this cross-sectional study was to explore the relationship between quality of life (QoL) and body image distress in patients with head and neck cancer (HNC), considering relevant psychological variables (i.e., coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress). We also aimed to explore gender differences in patients with HNC in terms of relevant psychological variables in HNC.

METHODS

Fifty-one HNC patients (37 males and 14 females) completed self-report questionnaires to assess body image distress, physical and mental QoL, and relevant psychological variables in HNC (coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress) before undergoing treatment. Pearson's correlations and four-step hierarchical regressions were performed to assess the relationship between body image distress, QoL, and the abovementioned psychological variables, while one-way analyses of variance and one-way analysis of covariance were employed to assess gender differences.

RESULTS

Physical QoL was associated with body image distress above and beyond disease duration, distress, coping strategies, pain, mental QoL, and self-esteem, while mental QoL was associated with pain above and beyond distress, coping strategies, physical QoL, self-esteem, and body image distress. Concerning gender differences, females scored higher than males on most of the explored psychological variables, except for physical QoL and intolerance of uncertainty, and showed lower mental QoL and self-esteem than males.

CONCLUSION

Body image distress and pain emerged as negatively associated with QoL, and almost all the explored psychological variables differed among genders. Psychological interventions targeting body image distress and pain should be promoted in patients with HNC to increase their QoL, while keeping gender differences in mind.

Association of Inventory to Measure and Assess imaGe Disturbance - Head and Neck Scores With Clinically Meaningful Body Image-Related Distress Among Head and Neck Cancer Survivors

Objective: The Inventory to Measure and Assess imaGe disturbance – Head and Neck (IMAGE-HN) is a validated patient-reported outcome measure of head and neck cancer-related body image-related distress (BID). However, the IMAGE-HN score corresponding to clinically relevant BID is unknown. The study objective is to determine the IMAGE-HN cutoff score that identifies head and neck cancer patients with clinically relevant BID.

Methods: We conducted a cross-sectional study at six academic medical centers. Individuals ≥18 years old with a history of head and neck cancer treated with definitive intent were included. The primary outcome measure was the IMAGE-HN. A Receiver Operating Characteristic curve analysis was performed to identify the IMAGE-HN score that maximized sensitivity and specificity relative to a Body Image Scale score of ≥10 (which indicates clinically relevant BID in a general oncology population). To confirm the validity of the IMAGE-HN cutoff score, we compared the severity of depressive [Patient Health Questionnaire-9 (PHQ-9)] and anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7)], and quality of life [University of Washington-QOL (UW-QOL)] in patients with IMAGE-HN scores above and below the cutoff.

Results: Of the 250 patients, 70.4% were male and the mean age was 62.3 years. An IMAGE-HN score of ≥22 was the optimal cutoff score relative to a Body Image Scale score of ≥10 and represents a clinically relevant level of head and neck cancer-related BID. Relative to those with an IMAGE-HN score of <22, patients with IMAGE-HN scores of ≥22 had a clinically meaningful increase in symptoms of depression (mean PHQ-9 score difference = 5.8) and anxiety (mean GAD-7 score difference = 4.1) as well as worse physical (mean UW-QOL score difference = 18.9) and social-emotional QOL (mean UW-QOL score difference = 21.5). Using an IMAGE-HN cutoff score ≥22, 28% of patients had clinically relevant BID.

Conclusion: An IMAGE-HN score of ≥22 identifies patients with clinically relevant head and neck cancer-related BID. This score may be used to detect patients who could benefit from strategies to manage their distress, select patients for studies evaluating interventions to manage head and neck cancer-related BID, and improve our understanding of the underlying epidemiology of the disorder.

Development and evaluation of the clinimetric properties of the Medication-Related Osteonecrosis of the Jaw Quality of Life Questionnaire (MRONJ-QoL)

The purpose of this study was to develop a self-administered questionnaire (MRONJ-QoL) to assess the quality of life (QoL) of patients with medication-related osteonecrosis of the jaw (MRONJ). A prospective study was performed to develop and evaluate the questionnaire. The MRONJ-QoL was formulated through a review of the literature and interviews of experts and patients. Following development, it was administered to 60 patients with a diagnosis of MRONJ. The sensibility of the questionnaire was assessed by evaluating feasibility (via interviews of patients), face validity (via interviews of patients and experts), and content validity (via evaluation of internal consistency, floor/ceiling effects, and factor analysis). Reliability was evaluated by measuring intra-rater reliability. Construct validity of the questionnaire was evaluated by both cross-sectional and longitudinal comparisons, including comparing scores of the MRONJ-QoL to disease resolution at 6 months. The final MRONJ-QoL questionnaire consisted of 14 questions, demonstrating high internal consistency (Cronbach's alpha of 0.85) and good reliability (weighted kappa score of 0.65). At the 6-month follow-up, disease resolution was found to be significantly associated with improved MRONJ-QoL scores, suggesting validity of the questionnaire (P < 0.01). Therefore, this is a sensible, reliable, and valid questionnaire for evaluating the QoL of patients with MRONJ.

Comparison Between Radial Forearm Free Flap and Pectoralis Major Myocutaneous Flap for Reconstruction in Oral Cavity Cancer Patients: Assessment of the Quality of Life

ABSTRACT

We aimed to evaluate the quality of life of Chinese patients after immediate reconstruction surgery on individuals with oral cavity cancer. In addition, we compared the differences between radial forearm free flap and pectoralis major myocutaneous flap. Using the University of Washington quality of life v4 questionnaire, 1:1 matched research was performed on patients received PMM or RFF flap. Chi-square test was used to analyze the variables. One hundred twenty four of 179 questionnaires were returned (69.3%). Age, N stage, and postoperative radiotherapy were similar for both groups. However, there were significant differences between two groups in gender, T stage, operation duration, and complication rate. Oral cavity cancer patients reconstructed with radial forearm free flap had better shoulder and speech functions but worse appearance domains. The results of our research provide important information for patients and physicians during their discussion of treatment programs for oral cavity cancers.

Optimizing brief, focused assessment of priority symptoms and concerns in recurrent and/or metastatic squamous cell carcinoma of the head and neck: Content validation of the Functional Assessment of Cancer Therapy/National Comprehensive Cancer Network Head and Neck Symptom Index-10 (FHNSI-10)

BACKGROUND AND AIMS

Patients with recurrent and/or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) experience vast disease and treatment burdens. Brief, focused instruments are needed to assess patient-reported priority symptoms and concerns as targeted outcome assessments for use in clinical research. Although the instrument was developed based on expert and patient input and is psychometrically valid, the Functional Assessment of Cancer Therapy (FACT)/National Comprehensive Cancer Network (NCCN) Head and Neck Symptom Index-10 (FHNSI-10) has yet to undergo content validation from the perspective of R/M SCCHN patients to evaluate its use as a brief symptom-focused targeted endpoint assessment for use in clinical research.

METHODS

Interviews conducted with R/M SCCHN patients explored priority symptoms and concerns, followed by cognitive debriefing of the FHNSI-10 to evaluate face validity. Transcripts were analyzed, and results were mapped to the FHNSI-10. In accordance with published recommendations, expert input from the original development and published literature was considered for content validity assessment.

RESULTS

A total of 18 patients participated in a concept elicitation interview; saturation was obtained at interview 17. Most (83%) were undergoing active treatment, male (94%), white (72%), and did not have a college degree (67%). The most commonly mentioned symptoms were lumps/swelling, pain, sore throat, difficulty swallowing, and voice changes. For all items, ≥75% reported each question was relevant to their R/M SCCHN experience and 94% reported the instrument captured their experiences with R/M SCCHN.

CONCLUSION

Results provide support for the content validity of the FHNSI-10, inasmuch as all 10 items were spontaneously reported and considered relevant to R/M SCCHN. Content validity might be enhanced by adding cough and hearing impairment items; however, the existing FHNSI-10 covers the majority of symptoms uncovered in interviews with a small sample of R/M SCCHN patients.

The Zygomatic Implant Perforated (ZIP) flap reconstructive technique for the management of low-level maxillary malignancy - clinical & patient related outcomes on 35 consecutively treated patients

BACKGROUND

The zygomatic implant perforated (ZIP) flap technique provides immediate reconstruction and rapid dental rehabilitation for low-level malignant tumors.

METHODS

Patients who underwent ZIP flap reconstruction between December 2015 and February 2021 were followed prospectively.

RESULTS

Thirty-five consecutively treated patients were studied with 16 undergoing surgery alone and 19 undergoing surgery followed by radiotherapy. The median time to fit the prosthesis was 29 days with all patients requiring adjuvant radiotherapy receiving their fixed dental prosthesis prior to its commencement. Vascularized flap (100%), zygomatic implant (98.4%), and prosthesis (97%) survival were excellent and the ZIP flap protocol was highly rated by patient-related outcome measures especially for the chewing domain.

CONCLUSIONS

The ZIP flap technique provides an excellent means of providing an autogenous oronasal seal and a foundation for immediate cortically anchored fixed dental rehabilitation.

CLINICAL SIGNIFICANCE

This technique provides rapid and robust rehabilitation for patients presenting with low-level maxillary malignancy despite the use of radiotherapy.

Comparison of physical and psychosocial function post-treatment among oral cancer patients with low-to-moderate and high nicotine dependence

PURPOSE

After suddenly stopping smoking after an initial oral cancer (OC) diagnosis, patients may restart smoking and nicotine dependence. This study sought to identify factors associated with high nicotine dependence in OC patients who restarted smoking post-treatment.

DESIGN

A cross-sectional study.

METHODS

A group of 220 OC patients who restarted smoking post-treatment were recruited from the outpatient radiation department of a single cancer center in northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed for nicotine and smoking dependence, physical activity and function, socio-emotional function, social support, and depression.

RESULTS

Among patients who restarted smoking after treatment for OC, 75.9% reported low-to-moderate dependence on smoking, while 24.1% reported high nicotine dependence. Factors associated with high nicotine dependence included higher incidence of smoking per day, greater dependence on smoking, less physical activity per week, and poorer social-emotional function. Those highly dependent on nicotine were younger, unmarried, had less education, and had begun smoking earlier than those with low-to-moderate nicotine dependence.

CONCLUSIONS

The amount of smoking per day, greater smoking behavioral dependence, less physical activity per week, and worse social-emotional function affected high nicotine dependence.

CLINICAL RELEVANCE

Smoking cessation training and counseling for OC patients may help them better control their use of tobacco after treatment.

A Tool for Rapid Assessment of Functional Outcomes in Patients with Head and Neck Cancer

Head and neck cancer (HNC) and its treatment can lead to various functional impairments. We developed and validated an instrument for rapid physician-rated assessment of basic functional outcomes in HNC patients. HNC-relevant functional domains were identified through a literature review and assigned to verbal ratings based on observable criteria. The instrument draft was subjected to systematic expert review to assess its face and content validity. Finally, the empirical validity, reliability, and responsiveness of the expert-adapted Functional Integrity in Head and Neck Cancer (HNC-FIT) scales were assessed in healthy controls and in HNC patients. A matrix of the 6 functional domains of oral food intake, respiration, speech, pain, mood, and neck and shoulder mobility was created, each with 5 verbal rating levels. Face and content validity levels of the HNC-FIT scales were judged to be adequate by 17 experts. In 37 control subjects, 24 patients with HNC before treatment, and in 60 HNC patients after treatment, the HNC-FIT ratings in the 3 groups behaved as expected and functional domains correlated closely with the outcome of corresponding scales of the EORTC-HN35-QoL questionnaire, indicating good construct and criterion validity. Interrater reliability (rICC) was ≥0.9 for all functional domains and retest reliability (rICC) was ≥0.93 for all domains except mood (rICC = 0.71). The treatment effect size (eta-square) as a measure of responsiveness was ≥0.15 (p < 0.01) for fall domains except for breathing and neck and shoulder mobility. The median HNC-FIT scale completion time was 1 min 17 s. The HNC-FIT scale is a rapid tool for physician-rated assessment of functional outcomes in HNC patients with good validity, reliability, and responsiveness.

Decision regret 3 and 6 months after treatment for head and neck cancer: An observational study of associations with clinicodemographics, anxiety, and quality of life

BACKGROUND

While quality of life (QOL), psychosocial health, and adverse treatment outcomes have been studied in head and neck cancer (HNC) patients, decision regret is an important and understudied complication that can negatively impact future health care decision making.

METHODS

Data collected using a HNC patient registry with questionnaires administered at initial consultation visits plus 3 and 6 months after treatment completion was retrospectively analyzed. A visual analog anxiety scale and the University of Washington Quality of Life were given at clinic visits. Decision regret was determined using a validated scale. Demographic and clinical variables were collected retrospectively and at baseline.

RESULTS

Patients with higher anxiety and lower self-reported QOL had higher concurrent regret at 3-month (n = 140) and at 6-month (n = 82) post-treatment. Later disease stage at presentation, nonprimary surgical treatment, and lower health literacy were associated with greater regret.

CONCLUSIONS

Decision regret was highest in HNC patients with high anxiety, low QOL, and more advanced disease.

Surgical factors associated with patient-reported quality of life outcomes after free flap reconstruction of the oral cavity

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.

Risk stratification for poor health-related quality of life following head and neck cancer through the aid of a one-page item prompt list

The aim of this work was to evaluate the usability of a single-page, patient-completed, condition-specific prompt list, the Patient Concerns Inventory (PCI-HN), to risk-stratify for poor health-related quality of life (HRQOL). Data were collected between 2008 and 2017. The main dataset comprised 310 patients first completing the PCI-HN and University of Washington Quality of Life questionnaire (UW-QOLv4) between 2012 and 2017. Another 201 patients first completing the PCI-HN between 2008 and 2011 provided a second dataset for independent validation. Subsequent completions of the PCI-HN in both groups and the distress thermometer (DT) were also used as further validation datasets. Associations between PCI-HN items selected by patients and a range of UW-QOLv4 outcomes were explored using conventional logistic regression and Chi-squared automated interaction detection (CHAID) analyses. One quarter of patients reported less than good HRQOL, range 26-29% across the four datasets. Several individual items from within the PCI-HN were predictive of adverse outcomes. The total number of items selected was also predictive. The single-sheet prompt list enables clinicians to identify patients at high risk of poor HRQOL. This simple approach has the potential to be integrated into routine clinical practice.

Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: main results of a cluster preference randomised controlled trial

PURPOSE

The patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics for one year after treatment on health-related QOL (HRQOL).

METHODS

A pragmatic cluster preference randomised control trial with 15 consultants, 8 'using' and 7 'not using' the PCI intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible.

RESULTS

Consultants saw a median (inter-quartile range) 16 (13-26) patients, with 140 PCI and 148 control patients. Of the pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) social-emotional subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (- 2.9%, 12.9%) but without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected decreased over time.

CONCLUSION

This novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.

Flexible fiber-based CO2 laser vs monopolar cautery for resection of oral cavity lesions: A single center randomized controlled trial assessing pain and quality of life following surgery

IMPORTANCE

This study reports the impact of laser surgery on quality of life in patients with oral cavity lesions.

OBJECTIVE

To compare postoperative pain and quality of life in patients treated with flexible fiberoptic CO2 laser vs electrocautery in patients with oral cavity precancerous lesions and early stage cancers.

DESIGN

Randomized controlled trial.

SETTING

Single center.

PARTICIPANTS

Patients with premalignant oral cavity lesions and early stage oral cancer.

INTERVENTION

Patients were randomized to have surgical resection using either flexible fiber carbon dioxide laser (Laser) or electrocautery (EC). The patients were then followed over a period of 28 days to assess for outcomes including pain, quality of life, performance status, return to work, and return to diet. Quality of life was measured by the University of Washington Quality of Life (UWQOL) questionnaire and the performance status score (PSS).

MAIN OUTCOME MEASURE

The primary endpoint for this study was the numerical pain rating on postoperative day (POD) 7.

RESULTS

Sixty-two patients were randomized (32 laser and 30 electrocautery). Lesions excised were carcinoma in 30(48%), dysplasia in 31(50%) and benign in 1(2%). There was no difference in the location of lesion, size of lesion, defect size, type of closure, resection time, and blood loss between Laser and EC arms. Patients who had Laser had less pain compared to EC (mean pain score on POD 7 L = 2.84 vs EC = 3.83, P = 0.11). better UW QOL scores and PSS scores, quicker return to normal diet (median days L = 26.0 vs EC = 28.5, P = 0.17) and faster return to work (median days L = 13.0 vs EC = 16.5, P = 0.14). However, these results were not statistically significant.

CONCLUSION

There was a trend for patients treated with laser to have less pain and better quality of life scores but these result were not statistically significant. Based on the actual observed difference, a large multicenter RCT with 90 patients in each arm is required to determine the clinical relevance of our results.

Construct Validity of the EuroQoL-5 Dimension and the Health Utilities Index in Head and Neck Cancer

Objective

The objective of this study was to evaluate the construct validity of 2 health utility instruments—the EuroQoL–5 Dimension (EQ-5D) and the Health Utilities Index–Mark 3 (HUI-3)—and to compare them with disease-specific measures in patients with head and neck cancer.

Study Design

Prospective cross-sectional analysis.

Setting

Princess Margaret Cancer Centre.

Methods

Patients were administered the EQ-5D, HUI-3, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its head and neck cancer module (EORTC QLQ-H&N35), and the University of Washington Quality of Life Questionnaire (UWQoL). Several a priori expected relations were examined. The correlative and discriminative properties of the various instruments were examined.

Results

A total of 209 patients completed the 4 questionnaires. A significant ceiling effect was observed among EQ-5D responses (23% reported a maximum score of 1). The EQ-5D (rho = 0.79) and HUI-3 (rho = 0.60) had a strong correlation with the social-emotional domain of the UWQoL. The EQ-5D had a moderate correlation with the physical domain of the UWQoL (rho = 0.42), whereas the HUI-3 had a weak correlation (rho = 0.29). The EQ-5D and HUI-3 were able to distinguish among levels of health severity measured on the EORTC QLQ-C30 though not the QLQ-H&N35. Comparatively, the UWQoL was able to distinguish levels of disease severity on the EORTC QLQ-C30 and QLQ-H&N35.

Conclusion

The results of this study demonstrate that disease-specific domains from head and neck quality-of-life instruments are not strongly correlated with the EQ-5D and HUI-3. Consideration should be put toward development of a disease-specific preference-based measure for health economic evaluation.

Level of evidence

4.

Which Head and Neck Cancer Patients Are Most at Risk of High Levels of Fear of Cancer Recurrence

Background: Fear of cancer recurrence (FCR) is recognized as a common concern for patients with head and neck cancer (HNC). The aim of this study is to describe in greater detail the demographic and clinical characteristics of HCN patients who indicate a high level of FCR in their review consultation.

Methods: A pragmatic cluster-controlled trial was conducted between January 2017 and December 2018 at two UK HNC centers (Leeds and Liverpool) to test the efficacy of a prompt tool called the Patient Concerns Inventory (PCI). Patients completed the PCI and the UW-QOLv4 which included a single 5 category rating of FCR. Secondary statistical analyses focused on variables associated with high FCR.

Results: Two hundred and eighty-eight trial patients were recruited in this trial. At a median of 194 days after diagnosis and 103 days after the end of treatment 8% stated (n = 24) “I get a lot of fears of recurrence and these can really preoccupy my thoughts” and 3% (n = 8) “I am fearful all the time that my cancer might return, and I struggle with this.” Thus, 11% (n = 32) responded in the worst two categories, 95% Confidence interval 7.7–15.3% for high FCR. Stepwise logistic regression resulted in female gender (p < 0.001), age (p = 0.007), and receiving financial benefits (p = 0.01) as independent predictors.

Conclusions: Around one in ten HNC patients attending routine outpatient follow-up consultations report high FCR, however for female patients under the age of 55 the rate was one in three. This group requires specialist attention and could be the focus of a multicenter intervention trial.