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Barlow J, Sragi Z, Rodriguez N, Alsen M, Kappauf C, Ferrandino R, Chennareddy S, Kotz T, Kirke DN, Teng MS, Genden EM, Khan MN, Roof SA. Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta-analysis. Head Neck 2024; 46:1224-1233. [PMID: 38414175 DOI: 10.1002/hed.27684] [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: 09/23/2023] [Revised: 12/28/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Traditionally, patients undergoing free flap reconstruction for oral cavity defects have been given nothing by mouth for 6-14 days post-operatively due to concern for orocutaneous fistula development. METHODS Multiple databases were screened for studies assessing the rate of orocutaneous fistula formation in early (≤5 days) versus late (>5 days) feeding groups following oral cavity free flap reconstruction. Fixed- and random-effects meta-analyses were used. RESULTS One randomized controlled trial, one prospective cohort, and three retrospective cohort studies were included. The early feeding group displayed no significant increase in orocutaneous fistula formation (RD = -0.02, p = 0.06) or free flap failure (RD = -0.01, p = 0.39), with a significantly shorter hospital length of stay (mean difference [days] = -2.43, p < 0.01). CONCLUSIONS While further prospective trials are necessary, initiation of oral intake before post-operative day 5 may be appropriate in properly selected patients following oral reconstruction.
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Affiliation(s)
- Joshua Barlow
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zara Sragi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nina Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mathilda Alsen
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catharine Kappauf
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rocco Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susmita Chennareddy
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tamar Kotz
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marita S Teng
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohemmed N Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Russell J, Breik O, Borgna SC, Volker G, Pateman K, Batstone M. Implications of the composite free flap harvest site on quality of life after head and neck surgery: a prospective series. Int J Oral Maxillofac Surg 2024; 53:275-281. [PMID: 37858382 DOI: 10.1016/j.ijom.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
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.
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Affiliation(s)
- J Russell
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - O Breik
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - S C Borgna
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - G Volker
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - K Pateman
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - M Batstone
- Oral and Maxillofacial Surgery Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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3
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Gosselin LE, Villemure-Poliquin N, Audet N. Quality of Life After Head and Neck Cancer Surgery and Free Flap Reconstruction: A Systematic Review. J Otolaryngol Head Neck Surg 2024; 53:19160216241248666. [PMID: 38888940 PMCID: PMC11155320 DOI: 10.1177/19160216241248666] [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: 02/05/2024] [Accepted: 03/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Different factors can affect the quality of life of patients treated for head and neck cancer undergoing major surgical intervention. However, it remains unclear which specific factors and what possible interventions could have the greatest influence on quality of life postoperatively for patients undergoing surgical resection with free flap reconstruction. The objective of our systematic review was to identify which factors, at the time of surgical treatment, are associated with a worse postoperative quality of life for patients undergoing surgical resection with free flap reconstruction for head and neck cancer. METHODS We performed a systematic review of MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), from their inception through November 2021. We included peer reviewed studies that evaluated the impact of specific factors on quality of life for adult patients who underwent surgery with free flap reconstruction for head and neck cancer. Two reviewers independently screened citations for eligibility and extracted data. Risk of bias of each study was evaluated using the New-Castle Ottawa Scale. Vote counting and qualitative review were used to synthesize results. All relevant findings were reported. RESULTS We initially identified 1971 articles. We included 22 articles in our systematic review, totaling 1398 patients. There was a high level of variability for factors evaluated throughout studies and many studies presented small sample sizes. However, some factors were associated with worse long-term quality of life, including older age, radiotherapy, higher tumor stage, dysphagia, anxiety as well as depressive symptoms. Very few articles analyzed their data for specific tumor subsites and the impact of psychosocial factors was rarely evaluated throughout studies. CONCLUSIONS For patients with head and neck cancer requiring free flap reconstruction, some specific factors may correlate with changes in quality of life. However, these findings are based on very few and mostly underpowered studies. A better understanding of factors affecting quality of life could allow a more personalized and overall better quality of care for patients.
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Affiliation(s)
- Laura-Elisabeth Gosselin
- Department of Ophthalmology and Otorhinolaryngology—Head and Neck Surgery, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Noémie Villemure-Poliquin
- Department of Ophthalmology and Otorhinolaryngology—Head and Neck Surgery, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Nathalie Audet
- Department of Ophthalmology and Otorhinolaryngology—Head and Neck Surgery, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Department of Surgery, Service of Otorhinolaryngology—Head and Neck Surgery, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada
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Bhardwaj T. Quality of Life of Head and Neck Cancer Patients: Psychosocial Perspective using Mixed Method Approach. Indian J Palliat Care 2021; 27:291-298. [PMID: 34511799 PMCID: PMC8428896 DOI: 10.25259/ijpc_108_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives: Head and neck cancers are one of the most visible cancers permanently damaging appearances and affecting some of the very basic life functions of the patients. With advances in medical care and multidisciplinary team interventions, such changes can be managed and patient’s quality of life (QOL) be improved. Thus, it is important to understand the QOL concerns of the patients. The objective of the study was to examine QOL concerns of the patients with head and neck cancer. Materials and Methods: A sample of 100 adult cancer patients was selected from NCT of Delhi using non-probability sampling design. Data were collected through European Organization for Research and Treatment of Cancer QOL Questionnaires 30 (EORTC QLQ30) and EORTC QLQ Head and Neck specific 35 inventories which was supplemented with qualitative data obtained through semi-structured interviews. Interdependence of the variables and their impact on QOL of patients was studied using co-relational analyses. Results: Patients with head and neck cancer experienced major changes in their speech, appearances, eating pattern, daily routine, and work efficiency. Emotional functioning of the patients was poorest, followed by social functioning, role functioning, physical functioning, and cognitive functioning. Education had significant positive correlation with global QOL (0.382**, P < 0.01). Conclusion: QOL of head and neck cancer patients was poor. Emotional functioning of the patients was worst affected as patients had high emotional concerns. The study recommends psycho-educational intervention programs to help patients cope up better with the disease and improve their QOL. Patients’ support group and peer counseling would give emotional strength to the patients as few patients derived positive experience out of the disease episode.
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Affiliation(s)
- Tushti Bhardwaj
- Department of Social Work, Dr. B.R. Ambedkar College, University of Delhi, Delhi, India
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Warinner CB, Bergmark RW, Sethi R, Rettig EM. Cancer-Related Activity Limitations Among Head and Neck Cancer Survivors. Laryngoscope 2021; 132:593-599. [PMID: 34355796 DOI: 10.1002/lary.29795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/22/2021] [Accepted: 07/21/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize self-reported cancer-related activity limitations among a broad population of head and neck (HNC) survivors and identify sociodemographic factors associated with these limitations. STUDY DESIGN Cross-sectional analysis of data from the National Health Interview Survey. METHODS The study population included individuals who completed the National Health Interview Survey (NHIS) from 1997 to 2018 and self-reported a cancer diagnosis. Data regarding activity limitations, cancer history, mental health, and demographics were extracted from the NHIS. Poisson regression was used to evaluate associations between demographics and cancer-related limitations, and a descriptive analysis was performed to identify the most common types of cancer-related limitations experienced by HNC survivors. RESULTS Individuals with HNC were more than twice as likely to report having a disability caused by cancer when compared to individuals with other cancers (24% vs. 11%, P < .001). Cancer-related disability was highest among HNC survivors who were Black (adjusted prevalence ratio (aPR) = 1.57, 95% CI = 1.13-2.18), were aged 50 to 64 (aPR = 1.74, 95% CI = 1.1-2.74), had high school or lower education (aPR = 2.40, 95% CI = 1.07-5.37), and had Medicaid insurance (aPR = 2.58, 95% CI = 1.62-4.10). Among HNC patients who reported a cancer-related limitation, the most common limitations included difficulty working (78%), going out (51%), and socializing (42%). CONCLUSIONS Cancer-related activity limitations are more common among HNC survivors compared to survivors of other cancers, and disproportionately affect socioeconomically disadvantaged HNC survivors. Clinicians should be aware of the limitations experienced by HNC survivors to provide counseling and resources to help patients cope with these limitations. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Chloe B Warinner
- Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Regan W Bergmark
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.,Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts, U.S.A
| | | | - Eleni M Rettig
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A.,Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts, U.S.A
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Zebolsky AL, Ochoa E, Badran KW, Heaton C, Park A, Seth R, Knott PD. Appearance-Related Distress and Social Functioning after Head and Neck Microvascular Reconstruction. Laryngoscope 2021; 131:E2204-E2211. [PMID: 33797087 DOI: 10.1002/lary.29548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS To better understand aesthetic patient-reported outcomes and psychosocial quality of life (QOL) after head and neck microvascular reconstruction for benign or malignant tumors. STUDY DESIGN Single-center prospectively obtained in-office validated questionnaire-based study. METHODS Analysis of prospectively collected surveys at a tertiary care academic center from June 2018 to February 2021. Patients completed two FACE-Q scales: Appearance-Related Psychosocial Distress (ARPD) and Social Function (SF). Survey scores, demographics, operative course, and adjuvant therapy data underwent univariate and multivariable analyses. RESULTS One hundred and three patients completed surveys at a median of 13.5 months postoperatively (interquartile range: 5.2-30.8). Mean ARPD from 0 (no distress) to 100 (maximum distress) was 32.4 (standard error of the mean [SEM]: 2.7). Mean SF from 0 (worst functioning) to 100 (best functioning) was 55.5 (SEM: 2.7). Postoperative adjuvant radiation was associated with 13.9% higher ARPD (95% CI: 3.4-24.4, P = .019) and 10.4% lower SF (95% CI: -20.7 to -0.1, P = .047). Each appearance-related question on the ARPD scale independently predicted impaired SF (P < .001 for all questions). Upon multivariable logistic regression, osteocutaneous reconstruction, compared to soft tissue alone (P = .043), and postoperative adjuvant radiation (P = .014) were associated with higher levels of ARPD. Age, sex, relationship status, anxiety or depression history, defect location, and hospital stay were not significantly associated with ARPD or SF scores. CONCLUSIONS Aesthetic outcomes are important determinants of psychosocial QOL following head and neck microvascular reconstruction: an effect that is worsened by adjuvant radiation. Reconstructive surgeons should prioritize aesthetic outcomes, in addition to functional restoration, to optimize social functioning in patients with head and neck tumors. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2204-E2211, 2021.
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Affiliation(s)
- Aaron L Zebolsky
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Edgar Ochoa
- School of Medicine, University of California - San Francisco, San Francisco, California, U.S.A
| | - Karam W Badran
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Chase Heaton
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Andrea Park
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - Rahul Seth
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
| | - P Daniel Knott
- Division of Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head and Neck Surgery, University of California - San Francisco, San Francisco, California, U.S.A
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Meier JK, Schuderer JG, Zeman F, Klingelhöffer C, Hullmann M, Spanier G, Reichert TE, Ettl T. Health-related quality of life: a retrospective study on local vs. microvascular reconstruction in patients with oral cancer. BMC Oral Health 2019; 19:62. [PMID: 31029131 PMCID: PMC6487048 DOI: 10.1186/s12903-019-0760-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/09/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND New medicinal and surgical oncological treatment strategies not only improve overall survival rates but continually increase the importance of Health-Related Quality of Life (HRQOL). The purpose of this retrospective cross-sectional study was to analyze HRQOL of patients with oral squamous cell carcinoma after ablative surgery and to evaluate predictive factors for HRQOL outcome. METHODS The study included 88 patients with histologically confirmed oral squamous cell carcinoma of whom 42 had undergone local reconstruction (LR) and 46 microvascular reconstruction (MVR). During follow-up, all patients completed the University of Washington Quality of Life Questionnaire (UW-QOL) containing 12 targeted questions about the head and neck. Descriptive analyses were made for the tumor site, the T-stage, and adjuvant therapies. HRQOL was compared between the LR and the MVR group with parametric tests. Further analyses were impact of the tumor site, the T-status, and the time from surgery to survey on HRQOL. Statistics also included multivariate correlations and different interaction effects. RESULTS HRQOL in the LR group was 'very good' with 84.3 ± 13.7 and 'good' in the MVR group with 73.3 ± 16.5 points. The physical domains swallowing (p = 0.00), chewing (p = 0.00), speech (p = 0.01), taste (p = 0.01), and pain (p = 0.04) were significantly worse in the MVR group. An increase in the T-status had a significant negative effect on swallowing (p = 0.01), chewing (p = 0.01), speech (p = 0.03), recreation (p = 0.05), and shoulder (p = 0.01) in both groups. Regarding the tumor site and subsequent loss of HRQOL, patients with squamous cell carcinoma on the floor of the mouth had significantly worse results in the categories pain (p = 0.002), speech (p = 0.002), swallowing (p = 0.03), activity (p = 0.02), and recreation (p = 0.01) than patients with tumors in the buccal mucosa. Speech (p = 0.03) and pain (p = 0.01) had improved 1 year after surgery. CONCLUSION Patients with flap reconstruction because of oral squamous cell carcinoma showed very good overall HRQOL. Outcomes for microvascular reconstruction were good, even in the case of larger defects. The T-status is a predictor for HRQOL. Swallowing, chewing, speaking, taste, and pain were the most important issues in our cohort. Implementing HRQOL questionnaires for the assessment of quality of life could further increase the treatment quality of patients with oral cancer.
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Affiliation(s)
- J K Meier
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany.
| | - J G Schuderer
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - F Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Ch Klingelhöffer
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - M Hullmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - G Spanier
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - T E Reichert
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
| | - T Ettl
- Department of Oral and Maxillofacial Surgery, University Medical Center Regensburg, 93042, Regensburg, Germany
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Lahtinen S, Koivunen P, Ala-Kokko T, Kaarela O, Laurila P, Liisanantti JH. Swallowing-related quality of life after free flap surgery due to cancer of the head and neck. Eur Arch Otorhinolaryngol 2019; 276:821-826. [PMID: 30593593 PMCID: PMC6411665 DOI: 10.1007/s00405-018-05264-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 12/20/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Treatment of head and neck cancers (HNC) often leads to impairment in speech and swallowing functions. This study evaluated swallowing problems and the impact of complications on swallowing-related QOL after free flap surgery for HNC. METHODS Swallowing-related QOL was assessed using MDADI and SWAL questionnaires. RESULTS Of 45 assessed patients, 25 (45.5%) had at least one postoperative complication. Patients reported less than < 86 points in 8/9 SWAL-QOL domains. The SWAL-QL total score or MDADI composite scores were not related to surgical complications. Those with medical complications had lower scores in SWAL-QOL domains of mental health (82.8 (21.8) vs 65.5 (24.2), p = 0.024) and sleep (77.6 (23.0) vs 52.3 (24.3), p = 0.003). CONCLUSIONS In conclusion, swallowing related QOL is significantly impaired after 2 years of the tumor resection and free flap reconstruction for cancer of the head and neck, when using the cut-off value of 86 points in SWAL-QOL assessment tool. Surgical complications did not have an impact on swallowing-related QOL but medical complications were related to impairment in general QOL-related domains.
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Affiliation(s)
- Sanna Lahtinen
- Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, Medical Research Center, Oulu University Hospital, University of Oulu, P.O. Box 21, 90029, Oulu, Finland.
| | - Petri Koivunen
- PEDEGO Research Unit, Department of Otorhinolaryngology and Head and Neck, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tero Ala-Kokko
- Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, Medical Research Center, Oulu University Hospital, University of Oulu, P.O. Box 21, 90029, Oulu, Finland
| | - Outi Kaarela
- Research Group of Surgery, Anesthesia and Intensive Care, Department of Surgery, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Päivi Laurila
- Division of Operative Care and Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Janne H Liisanantti
- Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, Medical Research Center, Oulu University Hospital, University of Oulu, P.O. Box 21, 90029, Oulu, Finland
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9
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Quality of life after free flap surgery for cancer of the head and neck in patients with or without postoperative complications. Eur Arch Otorhinolaryngol 2018; 275:2575-2584. [DOI: 10.1007/s00405-018-5103-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 08/20/2018] [Indexed: 01/22/2023]
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10
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Lilja M, Markkanen-Leppänen M, Viitasalo S, Saarilahti K, Lindford A, Lassus P, Mäkitie A. Olfactory and gustatory functions after free flap reconstruction and radiotherapy for oral and pharyngeal cancer: a prospective follow-up study. Eur Arch Otorhinolaryngol 2018; 275:959-966. [PMID: 29380039 DOI: 10.1007/s00405-018-4883-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/13/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The senses of smell and taste can be adversely affected by both tumour- and treatment-related factors amongst head and neck cancer patients. The consequences may negatively impact nutritional status as well as quality of life in this patient population. PATIENTS AND METHODS This prospective longitudinal follow-up study is consisted of 44 patients treated for oral cavity, oropharyngeal or hypopharyngeal cancer with tumour resection and microvascular free tissue transfer reconstruction at the Helsinki University Hospital, Helsinki, Finland. Thirty-nine (89%) of them also received radiotherapy. The senses of smell (odour detection, identification and threshold test) and taste (electrogustometry) and quality of life (UW-QOL) were evaluated preoperatively, and at 6 weeks, 3 months, 6 months and 12 months, postoperatively. RESULTS There were higher scores in the odour detection values in the 6-week and 3-month tests compared with preoperative values for the tumour side. Other detection scores did not differ statistically from the preoperative values neither in the tumour nor the contralateral side. However, in the odour identification test, all posttreatment values were statistically significantly higher than pretreatment ones. In the olfactory threshold test, no statistically significant differences were found between pre- and posttreatment values. Electrogustometry values for the taste on the tumour side were statistically significantly impaired at 6 weeks (p < 0.05) and at 3 months (p < 0.01) compared with the pretreatment results. They were also impaired at 6 months and at 12 months, although the differences were not statistically significant. The quality of life was impaired after treatment in this patient series. However, the correlation between quality of life and sense of taste was found only at one time point (3 months) and only with contralateral side measurements. CONCLUSIONS We conclude that in oral and pharyngeal cancer patients the postoperative taste problems are related to the impairment on the taste sensation in the tongue but not with the sense of smell. Moreover, the impairment in the quality of life is not clearly related to the impaired sense of taste.
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Affiliation(s)
- Markus Lilja
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS,, Helsinki, Finland
| | - Mari Markkanen-Leppänen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS,, Helsinki, Finland
| | - Sanna Viitasalo
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS,, Helsinki, Finland
| | - Kauko Saarilahti
- Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Andrew Lindford
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patrik Lassus
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS,, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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11
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Holtmann H, Spalthoff S, Gellrich NC, Handschel J, Lommen J, Kübler NR, Krüskemper G, Rana M, Sander K. Determinants for further wishes for cosmetic and reconstructive interventions in 1652 patients with surgical treated carcinomas of the oral cavity. Maxillofac Plast Reconstr Surg 2017; 39:26. [PMID: 28944220 PMCID: PMC5583133 DOI: 10.1186/s40902-017-0125-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 08/01/2017] [Indexed: 11/20/2022] Open
Abstract
Background The impairment of the appearance is a major problem for patients with carcinomas of the oral cavity. These patients want to recover their preoperative facial appearance. Some do not realize that this is not always possible and hence develop a desire for further cosmetic and reconstructive surgery (CRS) which often causes psychological problems. Method The desire of patients for CRS (N = 410; 26%) has been acquired in this DÖSAK rehab study including multiple reasons such as medical, functional, aesthetic and psychosocial aspects. They relate to the parameters of diagnosis, treatment and postoperative rehabilitation. Patients without the wish for CRS (N = 1155; 74%) served as control group. For the surgeons, knowledge of the patient’s views is relevant in the wish for CRS. Nevertheless, it has hardly been investigated for patients postoperatively to complete resection of oral cancer. In this retrospective cross-sectional study, questionnaires with 147 variables were completed during control appointments. Thirty-eight departments of Oral and Maxillofacial Surgery took part, and 1652 German patients at least 6 months after complete cancer resection answered the questions. Additionally, a physician’s questionnaire (N = 1489) was available. Statistical analysis was performed with SPSS vers. 22. Results The patient’s assessment of their appearance and scarring are the most important criteria resulting in wishes for CRS. Furthermore, functional limitations such as eating/swallowing, pain of the facial muscles, numb regions in the operating field, dealing with the social environment, return to work, tumour size and location, removal and reconstruction are closely related. Conclusion The wish for CRS depends on diverse functional psychosocial and psychological parameters. Hence, it has to be issued during conversation to improve rehabilitation. A decision on the medical treatment can be of greater satisfaction if the surgeon knows the patients’ needs and is able to compare them with the medical capabilities. The informed consent between doctor and patient in regard to these findings is necessary.
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Affiliation(s)
- Henrik Holtmann
- Department for Oral and Maxillofacial Surgery, Heinrich Heine University of Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Simon Spalthoff
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Nils-Claudius Gellrich
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Street 1, 30625 Hannover, Germany
| | - Jörg Handschel
- Department for Oral and Maxillofacial Surgery, Heinrich Heine University of Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Julian Lommen
- Department for Oral and Maxillofacial Surgery, Heinrich Heine University of Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Norbert R Kübler
- Department for Oral and Maxillofacial Surgery, Heinrich Heine University of Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Gertrud Krüskemper
- Department of Medical Psychology, Ruhr University of Bochum, Universitätsstr 150, Building MA 0/145, 44780 Bochum, Germany
| | - Majeed Rana
- Department for Oral and Maxillofacial Surgery, Heinrich Heine University of Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Karoline Sander
- Department for Oral and Maxillofacial Surgery, Heinrich Heine University of Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
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Viana TSA, Silva PGDB, Pereira KMA, Mota MRL, Alves APNN, de Souza EF, Sousa FB. Prospective Evaluation of Quality of Life in Patients Undergoing Primary Surgery for Oral Cancer: Preoperative and Postoperative Analysis. Asian Pac J Cancer Prev 2017; 18:2093-2100. [PMID: 28843228 PMCID: PMC5697466 DOI: 10.22034/apjcp.2017.18.8.2093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The purpose of the present study was to compare the preoperative and postoperative health related quality of life (HRQoL) of a sample of patients undergoing primary surgery for oral cancer in 2012-13. Materials and Methods: A cross-sectional, prospective study of 54 patients in a Brazilian population was performed. HRQoL was measured preoperatively (after histopathological diagnosis) and postoperatively (2 months after surgery) using the University of Washington Quality of Life Questionnaire (UW-QOL). Clinicopathological, sociodemographic and lifestyle data were collected. Results: Surgery had a negative impact on most HRQoL domains, but pain, mood and anxiety scores were significantly improved. Most patients rated their health-related and overall postoperative HRQoL as good or very good. Conclusions: The UW-QOL was efficient at measuring HRQoL in our sample of patients with oral cancer. Surgery had a negative impact on HRQoL, especially due to sequelae affecting the stomatognathic system, yet patients classified their postoperative health-related and overall QoL as positive. Qualitative studies are necessary for confirmation of our results and further exploration.
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Affiliation(s)
- Thales Salles Angelim Viana
- Department of Oral Medicine, School of Dentistry, Federal University of Ceará (UFC), Rua Alexandre Baraúna 949, Rodolfo Teófilo, Fortaleza, Ceará, Brazil.
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Health-Related Quality of Life following Reconstruction for Common Head and Neck Surgical Defects. Plast Reconstr Surg 2017; 138:1312-1320. [PMID: 27879602 DOI: 10.1097/prs.0000000000002766] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Improved understanding and management of health-related quality of life represents one of the greatest unmet needs for patients with head and neck malignancies. The purpose of this study was to prospectively measure health-related quality of life associated with different anatomical (head and neck) surgical resections. METHODS A prospective analysis of health-related quality of life was performed in patients undergoing surgical resection with flap reconstruction for stage II or III head and neck malignancies. Patients completed the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire-30 and the European Organization for Research and Treatment of Cancer Head and Neck Cancer Module-35 preoperatively, and at set postoperative time points. Scores were compared with a paired t test. RESULTS Seventy-five patients were analyzed. The proportion of the cohort not alive at 2 years was 53 percent. Physical, role, and social functioning scores at 3 months were significantly lower than preoperative values (p < 0.05). At 12 months postoperatively, none of the function or global quality-of-life scores differed from preoperative levels, whereas five of the symptom scales remained below baseline. At 1 year postoperatively, maxillectomy, partial glossectomy, and oral lining defects had better function and fewer symptoms than mandibulectomy, laryngectomy, and total glossectomy. From 6 to 12 months postoperatively, partial glossectomy and oral lining defects had greater global quality of life than laryngectomies (p < 0.05). CONCLUSIONS Postoperative health-related quality of life is associated with the anatomical location of the head and neck surgical resection. Preoperative teaching should be targeted for common ablative defects, with postoperative expectations adjusted appropriately. Because surgery negatively impacts health-related quality of life in the immediate postoperative period, the limited survivorship should be reviewed with patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Beck-Broichsitter BE, Huck J, Küchler T, Hauke D, Hedderich J, Wiltfang J, Becker ST. Self-perception versus professional assessment of functional outcome after ablative surgery in patients with oral cancer. J Cancer Res Clin Oncol 2016; 143:305-311. [DOI: 10.1007/s00432-016-2287-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/08/2016] [Indexed: 11/12/2022]
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Zhu J, Xiao Y, Liu F, Wang J, Yang W, Xie W. Measures of health-related quality of life and socio-cultural aspects in young patients who after mandible primary reconstruction with free fibula flap. World J Surg Oncol 2013; 11:250. [PMID: 24083617 PMCID: PMC3850790 DOI: 10.1186/1477-7819-11-250] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/22/2013] [Indexed: 11/25/2022] Open
Abstract
Background The reconstruction of mandibular defects after trauma or tumor resection is one of the most challenging problems facing reconstructive surgeons. Although the primary intended outcome of surgery to treat head-and-neck malignancies is still the disease-free survival of the patient, health-related quality of life (HRQOL) is now seen as an essential secondary outcome. This study aims to evaluate HRQOL outcomes in young patients undergoing primary mandible reconstruction with free fibula flap and to collect information about their socio-cultural situation. Methods The HRQOL outcomes of 25 young patients after primary mandible reconstruction with free fibula flap for mandible malignancies were assessed using the Medical Outcomes Study-Short Form-36 (MOS SF-36) and University of Washington Quality of Life (UW-QOL) questionnaires 12 months postoperatively. Results Using the UW-QOL questionnaire, the best-scoring domain was ‘pain’, whereas ‘chewing’ and ‘anxiety’ were given the lowest scores. Using the MOS SF-36 questionnaire, the best-scoring domain was ‘physical functioning’, while ‘bodily pain’ and ‘general health’ also scored well. Conclusions Mandible reconstruction with fibula flap will significantly influence a young patient’s HRQOL. Young patients pay more attention to postoperative facial appearance; this should be considered in surgical planning. The socio-cultural data show a fairly low level of education for the majority of patients.
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Affiliation(s)
- Juanfang Zhu
- Department of Stomatolagy, the First Affiliated Hospital of Zhengzhou University, No,1 Jianshe East Road, Zhengzhou, Henan 450052, China.
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Quality of Life in Oral Cancer Patients-Effects of Tongue Resection and Sociocultural Aspects. J Craniofac Surg 2013; 24:e493-6. [DOI: 10.1097/scs.0b013e31829429aa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chen SC, Lai YH, Liao CT, Chang JTC, Lin CY, Fan KH, Huang BS. Supportive care needs in newly diagnosed oral cavity cancer patients receiving radiation therapy. Psychooncology 2012; 22:1220-8. [DOI: 10.1002/pon.3126] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 06/02/2012] [Accepted: 06/04/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Shu-Ching Chen
- Department of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
| | - Yeur-Hur Lai
- School of Nursing, College of Medicine; National Taiwan University; Taipei Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- College of Medicine; Chang Gung University; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
| | - Joseph Tung-Chien Chang
- College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Radiation Oncology, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
| | - Chien-Yu Lin
- College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Radiation Oncology, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
| | - Kang-Hsing Fan
- College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Radiation Oncology, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
| | - Bing-Shen Huang
- College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Radiation Oncology, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- Graduate Institute of Clinical Medicine; Chang Gung University; Taoyuan Taiwan
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Kim K, Amonkar MM, Högberg D, Kasteng F. Economic burden of resected squamous cell carcinoma of the head and neck in an incident cohort of patients in the UK. HEAD & NECK ONCOLOGY 2011; 3:47. [PMID: 22035422 PMCID: PMC3219567 DOI: 10.1186/1758-3284-3-47] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 10/28/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND SCCHN is the sixth most common cancer worldwide. Locally advanced SCCHN continues to be a therapeutic challenge with high rates of morbidity and mortality and a low cure rate. Despite the apparent impact of SCCHN on patients and presumably society, the economic burden of the treatment of resected SCCHN patients in the UK has not been investigated. METHODS This retrospective data analysis was based on in- and outpatient care records extracted from Hospital Episode Statistic database and linked to mortality data in the UK. SCCHN patients with resection of lip, tongue, oral cavity, pharynx or larynx were followed for at least one year (max. of 5 years) from the date of first resection. RESULTS A total of 11,403 patients (mean age 63.2 years, 69.8% males) who met study criteria were followed for an average of 31 months. 32.3% of patients died in the follow-up period and the mean time to death was 16.9 months. In the first year, mean number of days of hospitalization and number of outpatient visits was 21.6 and 4.2, respectively; mean number of reconstructive and secondary surgeries was 0.32 and 0.14 per patient, respectively; 4.7% of the patients received radiotherapy and 12.2% received chemotherapy. From the second to fifth year healthcare utilizations rates were lower. Mean cost of post-operative healthcare utilization was £23,212 over 5 years (£19,778 for the first year and £1477, £847, £653 and £455 for years 2-5). Total cost of post-operative healthcare utilisation was estimated to be £255.5 million over the 5-year follow-up. CONCLUSIONS In the UK, SCCHN patients after surgical resection needed considerable healthcare resources and incurred substantial costs. Study findings might provide a useful source for clinicians and decision makers in understanding the economic burden of managing SCCHN in the UK and also suggests a need for new therapies that could improve outcomes and reduce the disease burden.
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Affiliation(s)
- Kun Kim
- OptumInsight, Stockholm, Sweden.
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21
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Chen SC. Life experiences of Taiwanese oral cancer patients during the postoperative period. Scand J Caring Sci 2011; 26:98-103. [DOI: 10.1111/j.1471-6712.2011.00914.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Espinosa Domínguez E, Reverón Gómez MA, Pérez Méndez L, Martínez Gimeno C, Moure García E, Yanes Luque E. [Risk factors for postoperative complications in major head and neck surgery]. ACTA ACUST UNITED AC 2011; 58:218-22. [PMID: 21608277 DOI: 10.1016/s0034-9356(11)70043-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Tumor extension is the factor that usually determines the choice of radiotherapy or surgery for head and neck cancers. The choice of surgery carries with it certain specific risks that must be assessed jointly by the maxillofacial surgeon and the anesthetist so that they can agree on the best course of action to choose. We aimed to identify risk factors for complications after major head and neck surgery. PATIENTS AND METHODS Retrospective descriptive analysis of data for patients who underwent oncologic head and neck surgery with graft reconstruction. The main candidate predictors gathered from records were age, sex, ASA physical status classification, time under anesthesia, and intra- and postoperative events. The main dependent variables were records of early and delayed complications, time until extubation, and related mortality. RESULTS We identified 61 interventions in 56 patients (mean duration of surgery, 9 hours). Early complications developed in 57.4% while they were in the critical care area. Age > or =60 years was associated with longer hospital stays. Short-term mortality was higher in current smokers (P= .01). Survival was significantly higher in patients classified ASA 1 or 2 in comparison with those classified as ASA 3 or 4, in whom long-term mortality was higher (P < .05). CONCLUSIONS The incidence of postoperative complications was associated with comorbidity and risk behaviors found in this type of patient. We feel that a multidisciplinary medical team should assess the surgical and postoperative care of these patients.
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Affiliation(s)
- E Espinosa Domínguez
- 'Senrvicio de Anestesiologfa y Reanimación, Hospital Universitario Nuestra Sehora de Candelaria, Santa Cruz de Tenerife.
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Quality of life in oral cancer patients--effects of mandible resection and socio-cultural aspects. J Craniomaxillofac Surg 2011; 40:24-7. [PMID: 21514171 DOI: 10.1016/j.jcms.2011.01.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 01/19/2011] [Accepted: 01/28/2011] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The aim of this study was to assess the postoperative quality of life in oral cancer patients depending on different mandible resection types and to collect information about their socio-cultural situation. MATERIAL AND METHODS In this cross-sectional study, patients with primary oral cancer treated with different types of mandibular resection in the Clinic of Oral and Maxillofacial Surgery at the University of Kiel between 1997 and 2007 were included. Quality of life was assessed by means of the EORTC QLQ-C30 and H&N 35 questionnaires. Furthermore, a questionnaire about the socio-cultural background of the patients was applied. To be included, at least one year had to be passed after tumour resection. RESULTS 111 of 235 questionnaires were returned (47%). Significant differences in quality of life were found between patients with soft tissue resections and bone resections. There were significant worse values for continuity resections compared to only partial resections. Sixty-seven patients (60.4%) had a graduation of an elementary school as the highest school graduation, four patients (3%) had no school graduation. CONCLUSIONS The postoperative quality of life in our patients was significantly influenced by the extent of bone resection. This should be considered for surgical planning. The socio-cultural data showed a rather low education level for the majority of the patients.
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Which oral cancer patients benefit the most from microsurgical reconstruction? EUROPEAN JOURNAL OF PLASTIC SURGERY 2011. [DOI: 10.1007/s00238-010-0462-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Dwivedi RC, Kazi RA, Agrawal N, Nutting CM, Clarke PM, Kerawala CJ, Rhys-Evans PH, Harrington KJ. Evaluation of speech outcomes following treatment of oral and oropharyngeal cancers. Cancer Treat Rev 2009; 35:417-24. [DOI: 10.1016/j.ctrv.2009.04.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
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Biomechanical assessment of regenerate integrity in irradiated mandibular distraction osteogenesis. Plast Reconstr Surg 2009; 123:114S-122S. [PMID: 19182670 DOI: 10.1097/prs.0b013e318191c5d2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of mandibular distraction osteogenesis for reconstructing mandibular defects following radiation therapy depends on the quality of attenuated bone healing in the regenerate. This study investigated the regenerate properties after radiation therapy using yield and breaking load. The authors hypothesized that both would be significantly reduced in mandibular distraction osteogenesis following radiation therapy compared with mandibular distraction osteogenesis alone. METHODS Male Sprague-Dawley rats underwent left mandibular fractionated 36-Gy preoperative external beam radiation therapy and then 2 weeks of recovery (n = 7) or no radiation therapy (n = 10) before surgery. External fixators were secured and unilateral osteotomies were created behind the third molar, followed by 4 days of latency and then mandibular distraction osteogenesis: 0.3 mm every 12 hours for 8 days (5.1 mm) and 4 weeks of consolidation. Unoperated controls received no radiation therapy (n = 13). Mandibles were tension tested at 0.5 mm/second to failure, and yield and breaking load were determined. RESULTS There was a significantly lower breaking load for mandibular distraction osteogenesis following radiation therapy compared with mandibular distraction osteogenesis, alone, but there was no significant difference in yield between the groups. Both groups had significantly lower breaking load and yield when compared with unoperated controls. CONCLUSIONS The lowered breaking load in mandibular distraction osteogenesis following radiation therapy reflects the reduced biomechanical quality of the regenerate, despite evidence of radiographic union. These data show that radiographic union is not an adequate outcome measure for regenerate healing and support the need to define quantitative bone-healing metrics in mandibular distraction osteogenesis following radiation therapy before implementation in head and neck reconstruction.
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Biazevic MG, Antunes JLF, Togni J, de Andrade FP, de Carvalho MB, Wünsch-Filho V. Immediate Impact of Primary Surgery on Health-Related Quality of Life of Hospitalized Patients With Oral and Oropharyngeal Cancer. J Oral Maxillofac Surg 2008; 66:1343-50. [DOI: 10.1016/j.joms.2007.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 05/23/2007] [Accepted: 07/11/2007] [Indexed: 10/21/2022]
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Thombs BD, Notes LD, Lawrence JW, Magyar-Russell G, Bresnick MG, Fauerbach JA. From survival to socialization: a longitudinal study of body image in survivors of severe burn injury. J Psychosom Res 2008; 64:205-12. [PMID: 18222134 DOI: 10.1016/j.jpsychores.2007.09.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 08/13/2007] [Accepted: 09/14/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Little is known about the course of body image dissatisfaction following disfiguring injury or illness. The objective of this study was to test a proposed framework for understanding the trajectory of body image dissatisfaction among burn survivors and to longitudinally investigate the role of body image in overall psychosocial functioning. METHODS A sample of 79 survivors of severe burn injuries completed the Satisfaction with Appearance Scale (SWAP), the Importance of Appearance subscale of the Multidimensional Body-Self Relations Questionnaire, and the SF-36 in the hospital and at 6 and 12 months postdischarge (SWAP and SF-36). A repeated-measures analysis of covariance model was used to assess the course of body image dissatisfaction over time, and a path analysis model tested the role of body image dissatisfaction in mediating the relationship between preburn and postburn psychosocial functioning. RESULTS Female sex (P<.05), total body surface area burned (P<.01), and importance of appearance (P<.01) predicted body image dissatisfaction. From hospitalization to 12 months postdischarge, body image dissatisfaction increased for women (P<.01) and individuals with larger burns (P<.01) compared, respectively, to men and individuals with smaller burns. In the path analysis, body image dissatisfaction was the most salient predictor of psychosocial function at 12 months (beta=.53, P<.01) and mediated the relationship between preburn and 12-month psychosocial function. CONCLUSION Findings from this study suggest the importance of routine psychological screening for body image distress during hospitalization and after discharge.
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Affiliation(s)
- Brett D Thombs
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Hirota SK, Penha SS, Lehn CN, Sugaya NN, Migliari DA. Quality of life in patients submitted to surgical treatment for minor salivary gland neoplasms. Braz Oral Res 2007; 21:375-9. [PMID: 18060267 DOI: 10.1590/s1806-83242007000400016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 02/05/2007] [Indexed: 11/21/2022] Open
Abstract
This study was aimed at assessing the quality of life in patients submitted to surgical treatment for minor salivary gland neoplasms (MSGN). Twelve patients (10 women and 2 men, mean age: 49.4 years) with histopathologic diagnosis of pleomorphic adenoma (PA, 3 cases), polymorphous low-grade adenocarcinoma (PLGA, 2 cases), cystic adenoid carcinoma (CAC, 4 cases), and muco-epidermoid carcinoma (MEC, 3 cases) were evaluated. All of them were treated by surgical excision; patients with CAC received radiotherapy as well. The patients quality of life was evaluated through a self-administered questionnaire concerning their physical well-being, emotional status, normal daily activities, and family relationships. The results showed that patients with MEC--the youngest among all patients--reported a significantly greater worsening of their physical well-being and emotional status after treatment as compared with patients treated for PA (P<0.05), and also of their functional activities as compared with those treated for PA and PLGA (P<0.05). In conclusion, age of development of the neoplasm and type of disease produce more impact on patients quality of life than does the therapys degree of aggression.
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Affiliation(s)
- Sílvio Kenji Hirota
- Department of Stomatology, School of Dentistry, University of São Paulo, and Head and Neck Surgery Service, Heliópolis Hospital, Brazil.
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Markkanen-Leppänen M, Isotalo E, Mäkitie AA, Asko-Seljavaara S, Pessi T, Suominen E, Haapanen ML. Changes in articulatory proficiency following microvascular reconstruction in oral or oropharyngeal cancer. Oral Oncol 2006; 42:646-52. [PMID: 16488177 DOI: 10.1016/j.oraloncology.2005.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 11/10/2005] [Indexed: 11/22/2022]
Abstract
Articulatory proficiency of /r/ and /s/ sounds, voice quality and resonance, speech intelligibility, and intraoral sensation were examined prospectively before operation, and at four time points during a 1-year follow-up after microvascular transfer. Forty-one patients with a large oral or oropharyngeal carcinoma undergoing tumor resection and free-flap reconstruction usually combined with radiotherapy participated in the study. Articulation, voice, and resonance were investigated both live and from recorded speech samples by two trained linguistic examiners. The patients completed a self-rating of their speech intelligibility and were assessed for anterior intraoral surface sensation by means of 2-point moving discrimination. Misarticulations of /r/ and /s/ increased significantly after the therapy. Voice quality and resonance remained essentially normal. Speech intelligibility deteriorated significantly. Intraoral sensation decreased postoperatively but was not related to speech outcome. Sensate flaps did not prove to be superior in relation to speech tasks. A multidisciplinary approach is advocated in assessment of speech outcome after cancer surgery. Speech therapy is strongly recommended, even in the absence of a gross articulatory handicap.
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Affiliation(s)
- Mari Markkanen-Leppänen
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Central Hospital, Haartmaninkatu 4E, P.O. Box 220, FI-00029 HUS, Helsinki, Finland.
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