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Howren MB, Christensen AJ, Pagedar NA. Prevalence and persistence of depressive symptoms during the first year postdiagnosis in a large sample of patients with head and neck cancer. Am J Otolaryngol 2024; 45:104257. [PMID: 38518447 PMCID: PMC11070284 DOI: 10.1016/j.amjoto.2024.104257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE The experience of persistent depressive symptomatology during the first year postdiagnosis has implications for recovery and adjustment by one year postdiagnosis. The present descriptive study sought to examine the prevalence and persistence of mild to moderate-severe depressive symptomology and associated disease-specific health-related quality of life (HRQOL) in patients with HNC. MATERIALS & METHODS This study was a prospective observational study at a single-institution tertiary cancer center. Depressive symptomatology was measured using the Beck Depression Inventory (BDI), captured at diagnosis and 3-, 6-, 9-, and 12-months postdiagnosis. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). Four subgroups were defined by BDI scores over time: persistent-moderate/severe subgroup, persistent-mild subgroup, transient subgroup, and resilient subgroup. RESULTS The distribution of patients (N = 946) was 65 (6.9 %) in the persistent-moderate/severe subgroup, 190 (20.1 %) in the persistent-mild subgroup, 186 (19.7 %) in the transient subgroup, and 505 (53.3 %) in the resilient subgroup. Across all four HNCI domains, patients in the persistent-moderate/severe subgroup failed to reach a score of 70 by 12-months postdiagnosis which is indicative of high functioning on the HNCI (aesthetics: M = 42.32, SD = 28.7; eating: M = 32.08, SD = 25.7; speech: M = 47.67, SD = 25.3; social disruption: M = 52.39, SD = 24.3). Patients in the persistent-mild subgroup failed to reach 70 in three of four domains. Patients in the resilient subgroup reached, on average, >70 on all HNCI domains. CONCLUSIONS Depression is a considerable issue during the first year postdiagnosis. Avenues for screening and intervention should be incorporated into HNC patient care per clinical practice guidelines to optimize recovery and HRQOL.
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Affiliation(s)
- M Bryant Howren
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, United States of America; Department of Internal Medicine, The University of Iowa, Iowa City, IA, United States of America; Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America.
| | - Alan J Christensen
- Department of Psychology, East Carolina University; Greenville, NC, United States of America
| | - Nitin A Pagedar
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America; Department of Otolaryngology-Head and Neck Surgery, Carver College of Medicine, The University of Iowa; Iowa City, IA, United States of America
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Duffton A, Kemp O, Devlin L, Hay L, McLoone P, Paterson C. Feasibility of DW-MRI analysis of salivary glands during head and neck radiotherapy. Tech Innov Patient Support Radiat Oncol 2021; 19:46-51. [PMID: 34527819 PMCID: PMC8430428 DOI: 10.1016/j.tipsro.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION With no effective treatment for xerostomia, there remains an unmet need to reduce radiation induced toxicity. Measuring physiological changes during RT in salivary glands using DW-MRI may predict which patients are most at risk of severe toxicity. This study evaluated the feasibility of measuring apparent diffusion coefficient (ADC) in the major salivary glands and describes the observed changes in volume and ADC during RT. METHODS Scans were acquired at baseline (MR_base) and after 10 fractions (MR_rpt). Sequences included T1 post contrast fat saturated (T1PCFS) and DW-MRI (5b values, 0-1000 s/mm2). Ipsilateral and contralateral parotid (iPG/cPG), submandibular (iSMG/cSMG) and sublingual glands (iSLG/cSLG) were delineated on T1PCFS, modified on b0 and copied to the ADC map. RESULTS 31 patients with intermediate/high risk squamous cell carcinoma (SCC) of the oropharynx were evaluated. On 124 scans, SMG and SLG delineations were successful on all; parotids were fully contoured in 90.7%. Baseline mean ADC were significantly different between each gland type (p < 0.0001). IPG and cPG volume decreased during treatment by 6.7% and 11.2%. ISMG, cSMG, iSLG and cSLG volume increased by 6.9, 0.9, 60.8 and 60.3% respectively. All structures showed an increase in mean_ADC values. For each gland the increase in ADC was statistically significant p < 0.0001. A smaller mean percentage increase in ADC was observed in the group experiencing a higher grade (2 or > ) of toxicity. CONCLUSION It is feasible to measure volume and ADC of the salivary glands prior to and during RT for HNC. Early data suggests a lower rise in ADC during treatment is associated with more severe late xerostomia.
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Affiliation(s)
- Aileen Duffton
- Department of Radiotherapy, The Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, United Kingdom
| | - Olivia Kemp
- School of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, United Kingdom
| | - Lynsey Devlin
- Department of Radiotherapy, The Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, United Kingdom
| | - Lisa Hay
- Department of Radiotherapy, The Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, United Kingdom
| | - Philip McLoone
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Claire Paterson
- Department of Clinical Oncology, The Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, United Kingdom
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3
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van Nieuwenhuizen AJ, Buffart LM, Langendijk JA, Vergeer MR, Voortman J, Leemans CR, Verdonck-de Leeuw IM. Health-related quality of life and overall survival: a prospective study in patients with head and neck cancer treated with radiotherapy. Qual Life Res 2020; 30:1145-1153. [PMID: 33289866 PMCID: PMC8004520 DOI: 10.1007/s11136-020-02716-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 01/06/2023]
Abstract
Purpose We aimed to examine whether pre-treatment, post-treatment and change in health-related quality of Life (HRQoL) is associated with survival, in patients with head and neck cancer (HNC). Methods We included 948 newly diagnosed HNC patients treated with primary or adjuvant (chemo)radiotherapy with curative intent. The EORTC QLQ-C30 questionnaire was assessed pre-treatment and at 6 weeks, 6 months and 12 months post-treatment. Multivariable Cox regression analyses were performed to examine whether HRQoL at all time points and changes in HRQoL over time were associated with survival, after adjusting for demographic, clinical and lifestyle-related variables. Results Higher HRQoL scores were significantly associated with improved 5-year overall survival at all time points, except for the subscale global QoL at 6 weeks. Changes in HRQoL at 6 weeks post-treatment compared to pre-treatment were not significantly associated with survival. Changes in physical (HR: 0.88 95% CI: 0.82–0.96) and emotional functioning (HR: 0.90 95% CI: 0.85–0.96) from pre-treatment to 6 months post-treatment and changes in global QOL, and physical, emotional, and social functioning from pre-treatment to 12 months post-treatment were significantly associated with survival. Conclusion Higher HRQoL reported pre-treatment and post-treatment (6 weeks, 6 months and 12 months) are significantly associated with improved survival, as well as changes in HRQoL at 6 and 12 months compared to pre-treatment. Our results highlight the value of monitoring HRQoL and to identify those patients that report decreased or deteriorated HRQOL. This may help to further improve cancer care in a timely and efficient manner.
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Affiliation(s)
- A J van Nieuwenhuizen
- Amsterdam University Medical Centers, Department of Otolaryngology-Head and Neck Surgery, Amsterdam, The Netherlands
| | - L M Buffart
- Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam, The Netherlands.,Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J A Langendijk
- University Medical Center Groningen, Department of Radiation Oncology, University of Groningen, Groningen, The Netherlands
| | - M R Vergeer
- Amsterdam University Medical Centers, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - J Voortman
- Amsterdam University Medical Centers, Department of Medical Oncology, Amsterdam, The Netherlands
| | - C R Leemans
- Amsterdam University Medical Centers, Department of Otolaryngology-Head and Neck Surgery, Amsterdam, The Netherlands
| | - I M Verdonck-de Leeuw
- Amsterdam University Medical Centers, Department of Otolaryngology-Head and Neck Surgery, Amsterdam, The Netherlands.
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Huang VW, Imam SA, Nguyen SA. Head and neck survivorship care in the times of the SARS-CoV-2 pandemic. Head Neck 2020; 42:1664-1667. [PMID: 32358880 PMCID: PMC7267631 DOI: 10.1002/hed.26235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/24/2020] [Indexed: 12/31/2022] Open
Abstract
With the arrival of the coronavirus disease (SARS‐CoV‐2) in the United States, care practice paradigms have drastically changed. Data from China suggest that the new virus poses additional risks as case fatality of patients with cancer was higher at 5.6% compared to 2.3% of the general population. There are three proposed major strategies to address care for patients with cancer in this SARS‐CoV‐2 pandemic with postponing treatment for those with stable cancer, increasing personal protection provisions for patients with cancer, and increasing monitoring if a patient becomes infected with SARS‐CoV‐2. In this present commentary, we discuss the unique mental health challenges and burdens of patients with head and neck cancer in the times of the SARS‐CoV‐2 pandemic and approaches to mitigate these stressors through telemedicine to reduce future burdens to the patient and the health care system.
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Affiliation(s)
- Victoria W Huang
- College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sarah A Imam
- Department of Health and Human Performance, The Citadel, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Nguyen QN, Chun SG, Chow E, Komaki R, Liao Z, Zacharia R, Szeto BK, Welsh JW, Hahn SM, Fuller CD, Moon BS, Bird JE, Satcher R, Lin PP, Jeter M, O'Reilly MS, Lewis VO. Single-Fraction Stereotactic vs Conventional Multifraction Radiotherapy for Pain Relief in Patients With Predominantly Nonspine Bone Metastases: A Randomized Phase 2 Trial. JAMA Oncol 2020; 5:872-878. [PMID: 31021390 DOI: 10.1001/jamaoncol.2019.0192] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Importance Consensus is lacking as to the optimal radiotherapy dose and fractionation schedule for treating bone metastases. Objective To assess the relative efficacy of high-dose, single-fraction stereotactic body radiotherapy (SBRT) vs standard multifraction radiotherapy (MFRT) for alleviation of pain in patients with mostly nonspine bone metastases. Design, Setting, and Participants This prospective, randomized, single-institution phase 2 noninferiority trial conducted at a tertiary cancer care center enrolled 160 patients with radiologically confirmed painful bone metastases from September 19, 2014, through June 19, 2018. Patients were randomly assigned in a 1:1 ratio to receive either single-fraction SBRT (12 Gy for ≥4-cm lesions or 16 Gy for <4-cm lesions) or MFRT to 30 Gy in 10 fractions. Main Outcomes and Measures The primary end point was pain response, defined by international consensus criteria as a combination of pain score and analgesic use (daily morphine-equivalent dose). Pain failure (ie, lack of response) was defined as worsening pain score (≥2 points on a 0-to-10 scale), an increase in morphine-equivalent opioid dose of 50% or more, reirradiation, or pathologic fracture. We hypothesized that SBRT was noninferior to MFRT. Results In this phase 2 noninferiority trial of 96 men and 64 women (mean [SD] age, 62.4 [10.4] years), 81 patients received SBRT and 79 received MFRT. Among evaluable patients who received treatment per protocol, the single-fraction group had more pain responders than the MFRT group (complete response + partial response) at 2 weeks (34 of 55 [62%] vs 19 of 52 [36%]) (P = .01), 3 months (31 of 43 [72%] vs 17 of 35 [49%]) (P = .03), and 9 months (17 of 22 [77%] vs 12 of 26 [46%]) (P = .03). No differences were found in treatment-related toxic effects or quality-of-life scores after SBRT vs MFRT; local control rates at 1 and 2 years were higher in patients receiving single-fraction SBRT. Conclusions and Relevance Delivering high-dose, single-fraction SBRT seems to be an effective treatment option for patients with painful bone metastases. Among evaluable patients, SBRT had higher rates of pain response (complete response + partial response) than did MFRT and thus should be considered for patients expected to have relatively long survival. Trial Registration ClinicalTrials.gov identifier: NCT02163226.
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Affiliation(s)
- Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Stephen G Chun
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Rensi Zacharia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Bill K Szeto
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Stephen M Hahn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Bryan S Moon
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Justin E Bird
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Robert Satcher
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Patrick P Lin
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Melenda Jeter
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael S O'Reilly
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Valerae O Lewis
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston
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6
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Paterson C, Thomson M, Caldwell B, Young R, McLean A, Porteous S, Clark S, Messow C, Kean S, Grose D, Lamb C, Rizwannullah M, James A, Schipani S, Wilson C, Rulach R, Jones R. Radiotherapy-induced xerostomia: a randomised, double-blind, controlled trial of Visco-ease™ oral spray compared with placebo in patients with cancer of the head and neck. Br J Oral Maxillofac Surg 2019; 57:1119-1125. [DOI: 10.1016/j.bjoms.2019.10.300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/09/2019] [Indexed: 01/28/2023]
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Bragante KC, Groisman S, Carboni C, Baiocchi JMT, da Motta NW, Silva MF, Pinto RC, Plentz RDM, Wienandts P, Jotz GP. Efficacy of exercise therapy during radiotherapy to prevent reduction in mouth opening in patients with head and neck cancer: A randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:27-38. [PMID: 31685429 DOI: 10.1016/j.oooo.2019.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of 2 protocols of exercise therapy to avoid reduction in mouth opening (MO) in patients undergoing radiotherapy for head and neck cancer. STUDY DESIGN This was a randomized, controlled, double-blind, 3-arm, parallel-group, prevention clinical trial. Ninety patients were randomized into 3 groups to perform exercises during radiotherapy treatment: intervention group 1 (G1); intervention group 2 (G2); and control group (CG). Maximum MO was measured before (T0), immediately after (T1), and at 12 months (T2) after completion of radiotherapy treatment. Generalized estimating equations model complemented by the least significant difference test was applied to group comparisons. RESULTS There was no significant difference in MO measure between the groups at the 3 assessment time points (P = .264). The difference in MO measure from baseline to 12 months after having completed radiotherapy was -1 mm in CG (95% confidence interval [CI] -4.0 to 2.0); 1.3 mm in G1 (95% CI -1.7 to 4.3); and 0.5 mm in G2 (95% CI -3.4 to 4.4). CONCLUSIONS It was not possible to conclude that the exercise protocols performed in this study are more effective than the usual guidance to prevent reduction in MO in patients undergoing radiotherapy for head and neck cancer.
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Affiliation(s)
- Karoline Camargo Bragante
- Department of Health Science, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| | - Sandro Groisman
- Department of Health Science, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | | | - Neiro Waechter da Motta
- Department of Radiation Oncology, Hospital Santa Rita, Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, RS, Brazil
| | | | - Roselie Corcini Pinto
- Department of Radiation Oncology, Hospital Santa Rita, Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, RS, Brazil
| | - Rodrigo Della Mea Plentz
- Department of Health Science, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Patrícia Wienandts
- Department of Special Dental Care, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Geraldo Pereira Jotz
- Department of Morphological Sciences, UFRGS, Rua Sarmento Leite, Porto Alegre, RS, Brazil
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Chen MN, Ho KY, Hung YN, Su CC, Kuan CH, Tai HC, Cheng NC, Lin CC. Pre-treatment quality of life as a predictor of distant metastasis-free survival and overall survival in patients with head and neck cancer who underwent free flap reconstruction. Eur J Oncol Nurs 2019; 41:1-6. [PMID: 31358241 DOI: 10.1016/j.ejon.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE This study examined the prognostic associations of pre-treatment quality of life (QoL) with overall survival (OS) and distant metastasis-free survival (DFMS) among patients with head and neck cancer (HNC) who underwent free flap reconstruction. METHODS A cohort of 127 HNC patients who received free flap reconstruction between November 2010 and June 2014 at a hospital were recruited. Pre-treatment QoL was measured by the University of Washington Quality of Life Questionnaire, which contains six physical domains, including speech, swallowing, appearance, saliva, taste and chewing, as well as the six social-emotional domains of pain, activity, recreation, shoulder, mood, and anxiety. Cox regression analyses were performed. RESULTS Results showed that pre-treatment QoL was predictive of OS and DMFS. Of the domains, swallowing, chewing, speech, taste, saliva, pain and shoulder were demonstrated to be significant predictors of OS. Additionally, swallowing, chewing, speech, pain and activity were demonstrated making significant contributions to DMFS. CONCLUSION Our data supported that physical domains of pre-treatment QoL were predictors for OS and DFMS in HNC patients with free-flap reconstruction. Longitudinal studies are warranted to clarify the prognostic abilities of social-emotional domains. Information on pre-treatment QoL should be taken into account to individualize care plan for these patients, and hence prolong their survival.
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Affiliation(s)
- M N Chen
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - K Y Ho
- School of Nursing, The University of Hong Kong, HKSAR, China.
| | - Y N Hung
- School of Gerontology and Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - C C Su
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - C H Kuan
- Graduate Institute of Clinical Research, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - H C Tai
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - N C Cheng
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - C C Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; School of Nursing, The University of Hong Kong, HKSAR, China; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong.
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Parker V, Bennett L, Bellamy D, Britton B, Lambert S. Study Protocol: Evaluation of a DVD intervention designed to meet the informaton needs of patients with head and neck cancer and their partner, carer and families. BMC Health Serv Res 2016; 16:670. [PMID: 27876035 PMCID: PMC5118897 DOI: 10.1186/s12913-016-1875-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/26/2016] [Indexed: 11/23/2022] Open
Abstract
Background Patients who undergo surgery for cancer of the head and neck and their families face complex and difficult challenges and are at risk of anxiety and depression and inability to cope with symptom and treatment burden. Information available to support them is not flexible enough to adjust to individual need. Design/Methods A randomised clinical trial pre and post intervention design, comparing the use of a tailored DVD intervention, provided preoperatively and used throughout the post- operative period, with usual treatment. One hundred fifty-six individuals or partner couples will be randomly recruited into either the intervention or control group. A survey will be administered at three time points, preoperatively, post operatively and 3 months post-surgery. Anxiety and empowerment are the primary outcome measures. Qualitative data about use of the resource will be gathered by phone interview. Discussion This is the first study to rigorously evaluate the impact of a DVD intervention for this group of patients and their family members. The study will help to understand the impact of information usage on patient and family well- being and test a means by which to evaluate information and education resources for this and other cancer patient groups. Trial registration ACTRN12614001104640. Date registered: 17/10/2014.
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Affiliation(s)
- Vicki Parker
- Hunter New England Local Health District, New Lambton Heights, Australia. .,School of Health, University of New England, Armidale, NSW, 2351, Australia.
| | - Leearna Bennett
- Hunter New England Local Health District, New Lambton Heights, Australia
| | - Douglas Bellamy
- Hunter New England Local Health District, New Lambton Heights, Australia.,University of Newcastle, Callaghan, Australia
| | - Benjamin Britton
- Hunter New England Local Health District, New Lambton Heights, Australia.,University of Newcastle, Callaghan, Australia.,Psycho-oncology, Calvary Mater Hospital, Waratah, Australia
| | - Sylvia Lambert
- Ingram School of Nursing, McGill University, Montreal, Canada
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10
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Khan MK, Patterson J, Owen S, Rees S, Gamberini L, Paleri V. Comparing the Performance Status Scale and MD Anderson Dysphagia Inventory as swallowing outcome measures in head and neck cancer: a prospective cohort study. Clin Otolaryngol 2016; 40:321-6. [PMID: 25581425 DOI: 10.1111/coa.12369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the relationship between the two disease-specific measures currently in use to assess swallowing outcomes following treatment in patients with head and neck cancer: the Performance Status Scale (PSS) and MD Anderson Dysphagia Inventory (MDADI). DESIGN A prospective cohort study. SETTING Four head and neck cancer multidisciplinary clinics in the North of England Cancer Network. PARTICIPANTS 114 patients with cancers of the upper aerodigestive tract. MAIN OUTCOME MEASURE Measures of swallowing function administered prospectively across 4 timepoints RESULTS Spearman's correlation coefficients were used to measure the relationship between the two scales. There was statistically significant correlation between the two tools at pre-treatment (rs = 0.428, P < 0.000), 3 months post-treatment (rs = 0.454, P < 0.002), 6 months post-treatment (rs = 0.551, P < 0.000) and 12 months post-treatment (rs = 0.680, P < 0.000). CONCLUSION This is the first prospective study comparing the MDADI and PSS questionnaires at multiple time points. Our study shows that these different instruments have a good relationship in measuring swallowing function in patients with head and neck cancer in short and medium term after treatment.
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Affiliation(s)
- M K Khan
- Freeman Hospital, Newcastle upon Tyne, UK
| | | | - S Owen
- Freeman Hospital, Newcastle upon Tyne, UK
| | - S Rees
- James Cook University Hospital, Middlesbrough, UK
| | | | - V Paleri
- Freeman Hospital, Newcastle upon Tyne, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
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Abstract
BACKGROUND The prevalence of head and neck cancers is lower (3.5% of total cancers in Australia) than for a number of other cancers. Treatment for head and neck cancer is often drastic and debilitating and patient outcomes are poorer. OBJECTIVE This qualitative study explored the experiences of cancer patients who underwent surgery for head and neck cancer. METHODS In-depth face-to-face interviews were conducted with 12 patients 7 to 26 months after surgery. Interviews were thematically analyzed to produce a rich description of patients' experiences from diagnosis through surgery and beyond. RESULTS Critical aspects of patients' experiences are described through the following themes: only having half the story, shocks and aftershocks, living with the aftermath, and being supported. Participants identified difficulties arising from receiving insufficient, confusing, and often untimely information. The persistent and traumatic nature of what patients endure challenges their physical, mental, and emotional coping capacity and, in some cases, their motivation to live. CONCLUSIONS There is a need to address gaps in support and education of patients and carers. Of particular concern is the problem related to information provision and comprehension. Critical examination of current practices, together with efforts toward coordinated care tailored to individual needs, is required, along with outreach services for patients in rural areas. IMPLICATIONS FOR PRACTICE The development and evaluation of targeted resources in a variety of forms such as DVD, Internet, and pamphlets are needed. Robust assessment strategies are required to inform supportive interventions matched to stages and significant events in patients' journeys.
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Abstract
Head and neck cancer is becoming more common, and survival rates are improving. Human papillomavirus-associated oropharyngeal cancer, in particular, is increasing in incidence and is associated with an excellent prognosis. However, toxicity from disease and treatment leads to long-term impairment, disability, and handicap. Currently, more than 60% of survivors have unmet needs. As the numbers of survivors increase, current models of care will be increasingly inadequate to meet their needs. Exploration of new strategies and models of care to better address quality-of-life issues and meet the needs of survivors of head and neck cancer is urgently required.
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Affiliation(s)
- Jolie Ringash
- Jolie Ringash, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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13
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Mücke T, Koschinski J, Wolff KD, Kanatas A, Mitchell DA, Loeffelbein DJ, Deppe H, Rau A. Quality of life after different oncologic interventions in head and neck cancer patients. J Craniomaxillofac Surg 2015; 43:1895-8. [PMID: 26421469 DOI: 10.1016/j.jcms.2015.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/05/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022] Open
Abstract
Patient reported outcomes following head and neck cancer are of great importance, given the functional, psychological, and social impacts of the disease and its treatment. In addition, not only is the number of publications on health-related quality of life (HRQOL) increasing in a variety of specialties, but there is also a growing awareness of the potential role of HRQOL in practice. Therefore, we aimed to investigate the HRQOL of head and neck cancer patients following different oncologic interventions, using an internationally established test. In this cross-sectional study, we included three different groups of 32 patients each. Participants had histologically confirmed invasive oral squamous cell carcinoma (OSCC) in the anterior floor of the mouth. Group allocation was based on treatment modality, as follows: only surgery (group 1), operation and adjuvant radiotherapy (XRT) (group 2), and the additional presence of osteoradionecrosis (ORN) (group 3). All patients were questioned about their HRQOL, using the standardized University of Washington Quality of Life Questionnaire (UW-QOL). Surveys for groups 1 and 2 were conducted at least 24 months after the end of tumor-related treatment, in cases of ORN (group 3) 12 months after completion of disease-related treatment. A total of 96 patients were included into this study. The mean age was 62.79 ± 8.93 years. The patients in groups 1 and 2 revealed a reduced quality of life, of a greater magnitude after radiation therapy. Patients felt that radiotherapy was much worse than surgery; however, half of the patients stated that they would repeat radiation therapy if necessary. The subjective evaluation of the HRQOL after surgery and radiotherapy was a valuable instrument for assessing the rehabilitation of patients in the context of their function and quality of life. Radiation therapy can be considered a trigger of functional limitations and emotional distress that contributes to decreased HRQOL in patients with head and neck cancer.
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Affiliation(s)
- Thomas Mücke
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - Janett Koschinski
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - Anastasios Kanatas
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - David A Mitchell
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - Denys J Loeffelbein
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany.
| | - Herbert Deppe
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
| | - Andrea Rau
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Klinikum Rechts der Isar, München, Germany
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Pretreatment quality of life as a prognostic factor for early survival and functional outcomes in patients with head and neck cancer. Qual Life Res 2015; 25:165-74. [DOI: 10.1007/s11136-015-1063-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
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Radiotherapy-induced xerostomia, pre-clinical promise of LMS-611. Support Care Cancer 2015; 24:629-636. [DOI: 10.1007/s00520-015-2823-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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Wissinger E, Griebsch I, Lungershausen J, Byrnes M, Travers K, Pashos CL. The humanistic burden of head and neck cancer: a systematic literature review. PHARMACOECONOMICS 2014; 32:1213-1229. [PMID: 25145800 DOI: 10.1007/s40273-014-0199-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Head and neck cancer (HNC) and its treatment can affect communication, nutrition, and physical appearance, and the global impact of this disease on patients' quality of life may be substantial. OBJECTIVE The aim of this systematic literature review was to describe the impact of HNC and its treatment on the physical, emotional, and social well-being of patients over time, by examining longitudinal studies of patient-reported outcomes (PRO) evaluating these domains. METHODS Databases (MEDLINE and Embase) were searched to identify studies published in English between January 2004 and January 2014 analyzing the humanistic aspects of HNC in adult patients. Additional relevant publications were identified through manual searches of abstracts from recent conference proceedings. RESULTS Of 1,566 studies initially identified, 130 met the inclusion criteria and were evaluated in the assessment. Investigations using a variety of PRO instruments in heterogeneous patient populations consistently reported that PRO scores decrease significantly from diagnosis through the treatment period, but generally recover to baseline in the first year post-treatment. This trend was observed for many functional domains, although some side effects, such as xerostomia, persisted well beyond 1 year. In addition, considerable evidence exists that baseline PRO scores can predict clinical endpoints such as overall and progression-free survival. CONCLUSIONS Many aspects of HNC, both disease and treatment specific, profoundly affect patients' quality of life. Improved knowledge of these effects on PRO may allow for more informed treatment decisions and can help physicians to better prepare patients for changes they may experience during therapy. Furthermore, the predictive value of baseline PRO data may enable healthcare providers to identify at-risk patients in need of more intensive intervention.
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van Nieuwenhuizen AJ, Buffart LM, Brug J, Leemans CR, Verdonck-de Leeuw IM. The association between health related quality of life and survival in patients with head and neck cancer: a systematic review. Oral Oncol 2014; 51:1-11. [PMID: 25262163 DOI: 10.1016/j.oraloncology.2014.09.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/31/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study was to systematically review available evidence on the association between health-related quality of life (HRQoL) and survival in patients with head and neck cancer (HNC), adjusted for important clinical, demographic and lifestyle-related factors. A systematic literature search in four electronic bibliographic databases was conducted in January 2014. We included studies that provided data on HRQoL, survival, and the association between HRQoL and survival among HNC patients. Two researchers independently rated the quality of the included studies. A best evidence synthesis was applied to draw conclusions. Nineteen studies were included, of which twelve focused on all subscales of a HRQoL questionnaire and seven focused on selected subscales. The mean (SD) quality score was 72 (17)% and 11 (58)% studies were of high quality. According to the best evidence synthesis, we found strong evidence for a positive association between pre-treatment physical functioning and survival and between change in global QoL from pre-treatment to 6 months after treatment and survival. Due to inconsistent findings, we found insufficient evidence for an association with survival of other HRQoL domains, including role, emotional, cognitive and social functioning, mental health and well-being. Future high quality studies with a longitudinal design are needed to examine the complex association between HRQoL and survival.
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Affiliation(s)
- Annette J van Nieuwenhuizen
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes Brug
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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van Nieuwenhuizen AJ, Buffart LM, Smit JH, Brakenhoff RH, Braakhuis BJM, de Bree R, Leemans CR, Verdonck-de Leeuw IM. A comprehensive assessment protocol including patient reported outcomes, physical tests, and biological sampling in newly diagnosed patients with head and neck cancer: is it feasible? Support Care Cancer 2014; 22:3321-30. [PMID: 25110298 PMCID: PMC4218976 DOI: 10.1007/s00520-014-2359-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Large cohort studies are needed taking into account cancer-related, personal, biological, psychobehavioral, and lifestyle-related factors, to guide future research to improve treatment and supportive care. We aimed to evaluate the feasibility of a comprehensive baseline assessment of a cohort study evaluating the course of quality of life (QoL). METHODS Newly diagnosed head and neck cancer (HNC) patients were asked to participate. Assessments consisted of questionnaires (635 items), a home visit (including a psychiatric interview, physical tests, and blood and saliva collection), and tissue collection. Representativeness of the study sample was evaluated by comparing demographics, clinical factors, depression, anxiety, and QoL between responders and non-responders. Feasibility was evaluated covering the number of questions, time investment, intimacy, and physical burden. RESULTS During the inclusion period (4 months), 15 out of 26 (60 %) patients agreed to participate. Less women participated, 13 % in responders group versus 63 % in non-responders group (p = 0.008). No other differences were found between responders and non-responders. Responders completed more than 95 % of the questionnaires' items and rated the number of questions, time investment and intimacy as feasible, and the physical and psychological burden as low. It took on average 3 h to complete the questionnaires and 1.5 h for the home visit. CONCLUSIONS This study reveals that a comprehensive assessment including various questionnaires, physical measurements, and biological assessments is feasible according to patients with newly diagnosed HNC. A large prospective cohort study has started aiming to include 739 HNC patients and their informal caregivers in the Netherlands.
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Affiliation(s)
- Annette J van Nieuwenhuizen
- Department of Otolaryngology/Head and Neck Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
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McLarnon C, Kulloo P, Mehanna H, Kelly C, Paleri V. Quality-of-life considerations in treatment of unresectable, recurrent head and neck cancer. Expert Rev Anticancer Ther 2014; 10:345-52. [DOI: 10.1586/era.10.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shoulder pain, functional status, and health-related quality of life after head and neck cancer surgery. Rehabil Res Pract 2013; 2013:601768. [PMID: 24455274 PMCID: PMC3886217 DOI: 10.1155/2013/601768] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 10/22/2013] [Accepted: 12/02/2013] [Indexed: 11/18/2022] Open
Abstract
Head and neck cancer (HNC) patients experience treatment-related complications that may interfere with health-related quality of life (HRQOL). The purpose of this study was to describe the symptom experience (shoulder pain) and functional status factors that are related to global and domain-specific HRQOL at one month after HNC surgery. In this exploratory study, we examined 29 patients. The outcome variables included global HRQOL as well as physical, functional, emotional, and social well-being. Symptom experience and functional status factors were the independent variables. In the symptom experience variables, shoulder pain distress was negatively associated with physical well-being (R (2) = 0.24). Among the functional status variables, eating impairment was negatively related to global HRQOL (R (2) = 0.18) and physical well-being (R (2) = 0.21). Speaking impairment and impaired body image explained a large amount of the variance in functional well-being (R (2) = 0.45). This study provided initial results regarding symptom experience and functional status factors related to poor HRQOL in the early postoperative period for HNC patients.
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Oskam IM, Verdonck-de Leeuw IM, Aaronson NK, Witte BI, de Bree R, Doornaert P, Langendijk JA, Leemans CR. Prospective evaluation of health-related quality of life in long-term oral and oropharyngeal cancer survivors and the perceived need for supportive care. Oral Oncol 2013; 49:443-8. [PMID: 23318122 DOI: 10.1016/j.oraloncology.2012.12.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate long-term changes in health related quality of life (HRQOL) in oral/oropharyngeal cancer survivors and their need for and use of supportive care. METHODS Between 1999 and 2001, 80 advanced oral or oropharyngeal cancer patients treated with free-flap reconstruction and postoperative radiotherapy were included in a prospective study of whom 27 patients were long-term survivors (mean 9.2 years, range 8-11 years). The HRQOL of 26 patients (response rate 96%) was assessed with the EORTC QLQ-C30 and QLQ-H&N35 questionnaires at four points in time: pretreatment (baseline), and at 6 months, 12 months (short term) and 8-11 years (long-term) follow up. A study specific questionnaire was developed to evaluate the need for and use of supportive care (allied health services, peer contact, psychosocial care, and complementary care) and was completed at the period of treatment and at long-term follow up. RESULTS A number of HRQOL domains worsened significantly (p < 0.01) in the long-term: emotional functioning, social functioning, swallowing, speech, taste/smell, dry mouth, sticky saliva and coughing assessed by the mixed effects statistical model. At time of treatment, the need for supportive care was the highest for a dental hygienist (77%), a physical therapist (73%), a speech therapist (42%), a dietician (38%), and a special diet (62%). At long-term follow up, the need for supportive care was limited to a dental hygienist (46%) and a physical therapist (23%). Only small differences were observed between the perceived need for and actual use of supportive care. CONCLUSION A range of HRQOL domains in head and neck cancer survivors were deteriorated in the long-term compared to baseline and to the first year after treatment. At time of treatment and less frequently at long-term follow up, patients reported needing and using a variety of supportive care services.
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Affiliation(s)
- Inge M Oskam
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Quality of life scores as prognostic factors of overall survival in advanced head and neck cancer: Analysis of a phase III randomized trial of pemetrexed plus cisplatin versus cisplatin monotherapy. Oral Oncol 2012; 48:723-9. [DOI: 10.1016/j.oraloncology.2012.02.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 02/14/2012] [Accepted: 02/16/2012] [Indexed: 11/20/2022]
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Payakachat N, Ounpraseuth S, Suen JY. Late complications and long-term quality of life for survivors (>5 years) with history of head and neck cancer. Head Neck 2012; 35:819-25. [DOI: 10.1002/hed.23035] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2012] [Indexed: 11/12/2022] Open
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Lee R, Slevin N, Musgrove B, Swindell R, Molassiotis A. Prediction of post-treatment trismus in head and neck cancer patients. Br J Oral Maxillofac Surg 2012; 50:328-32. [DOI: 10.1016/j.bjoms.2011.06.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 06/30/2011] [Indexed: 10/17/2022]
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Reitzel LR, Nguyen N, Zafereo ME, Li G, Wei Q, Sturgis EM. Neighborhood deprivation and clinical outcomes among head and neck cancer patients. Health Place 2012; 18:861-8. [PMID: 22445028 DOI: 10.1016/j.healthplace.2012.03.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/03/2012] [Accepted: 03/04/2012] [Indexed: 11/17/2022]
Abstract
The unique effects of neighborhood-level economic deprivation on survival, recurrence, and second primary malignancy development were examined using adjusted Cox proportional hazards regression models among 1151 incident squamous cell carcinomas of the head and neck patients. Cancer site was examined as a potential moderator. Main analyses yielded null results; however, interaction analyses indicated poorer overall survival [HR=1.59 (1.00-2.53)] and greater second primary malignancy development [HR=2.99 (1.46-6.11)] among oropharyngeal cancer patients from highly deprived neighborhoods relative to less deprived neighborhoods. Results suggest a dual focus on individual and neighborhood risk factors could help improve clinical outcomes among oropharyngeal cancer patients.
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Affiliation(s)
- Lorraine R Reitzel
- Department of Health Disparities Research-Unit 1440, PO Box 301402, University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402, USA.
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Head BA, Heitz L, Keeney C, Myers J, Appana SN, Studts JL, Bumpous J, Pfeifer M. The relationship between weight loss and health-related quality of life in persons treated for head and neck cancer. Support Care Cancer 2011; 19:1511-8. [PMID: 20730547 PMCID: PMC4177674 DOI: 10.1007/s00520-010-0975-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 07/29/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE This study explores the relationship between weight loss, health-related quality of life (HRQOL), and symptom burden in patients treated for head and neck cancers. METHODS Participants completed the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) and the Memorial Symptom Assessment Scale (MSAS) pre-treatment, mid-treatment, and post-treatment. Weights were recorded prior to treatment and at the post-treatment follow-up visit, and percentage weight loss was tabulated. Relationships between weight loss, HRQOL, and symptom burden were evaluated using the nonparametric Spearman rho. A simple linear regression model was developed to examine the influence weight loss has on HRQOL in a predictive manner. RESULTS Average weight loss per patient was 12 lb with a modal value of 19. Weight loss was found to be significantly correlated with decreases in physical well-being, functional well-being, the Head and Neck specific subscale, and composite QOL scores. No significant correlations were found between weight loss and symptom burden as measured by the MSAS. Linear regression suggested that a 10% decrease in baseline weight resulted in a 19% decrease in the FACT-H&N score. CONCLUSION The strong association between weight loss and HRQOL supports the importance of efforts to prevent weight loss via patient education, aggressive monitoring, and immediate intervention to stop or reverse weight loss during treatment. New approaches to the weight loss and wasting experienced by patients should be developed and tested.
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Affiliation(s)
- Barbara A Head
- University of Louisville School of Medicine, MDR Bldg., Suite 110, 511 South Floyd St., Ste. 110, Louisville, KY 40202, USA.
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Ackerstaff AH, Rasch CRN, Balm AJM, de Boer JP, Wiggenraad R, Rietveld DHF, Gregor RT, Kröger R, Hauptmann M, Vincent A, Hilgers FJM. Five-year quality of life results of the randomized clinical phase III (RADPLAT) trial, comparing concomitant intra-arterial versus intravenous chemoradiotherapy in locally advanced head and neck cancer. Head Neck 2011; 34:974-80. [DOI: 10.1002/hed.21851] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 04/08/2011] [Accepted: 05/19/2011] [Indexed: 11/12/2022] Open
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Parvataneni R, Polley MY, Freeman T, Lamborn K, Prados M, Butowski N, Liu R, Clarke J, Page M, Rabbitt J, Fedoroff A, Clow E, Hsieh E, Kivett V, Deboer R, Chang S. Identifying the needs of brain tumor patients and their caregivers. J Neurooncol 2011; 104:737-44. [PMID: 21311950 PMCID: PMC3170122 DOI: 10.1007/s11060-011-0534-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 01/31/2011] [Indexed: 11/24/2022]
Abstract
The purpose of this study is to identify the needs of brain tumor patients and their caregivers to provide improved health services to these populations. Two different questionnaires were designed for patients and caregivers. Both questionnaires contained questions pertaining to three realms: disease symptoms/treatment, health care provider, daily living/finances. The caregivers’ questionnaires contained an additional domain on emotional needs. Each question was evaluated for the degree of importance and satisfaction. Exploratory analyses determined whether baseline characteristics affect responder importance or satisfaction. Also, areas of high agreement/disagreement in satisfaction between the participating patient-caregiver pairs were identified. Questions for which >50% of the patients and caregivers thought were “very important” but >30% were dissatisfied include: understanding the cause of brain tumors, dealing with patients’ lower energy, identifying healthful foods and activities for patients, telephone access to health care providers, information on medical insurance coverage, and support from their employer. In the emotional realm, caregivers identified 9 out of 10 items as important but need further improvement. Areas of high disagreement in satisfaction between participating patient-caregiver pairs include: getting help with household chores (P value = 0.006) and finding time for personal needs (P value < 0.001). This study provides insights into areas to improve services for brain tumor patients and their caregivers. The caregivers’ highest amount of burden is placed on their emotional needs, emphasizing the importance of providing appropriate medical and psychosocial support for caregivers to cope with emotional difficulties they face during the patients’ treatment process.
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Affiliation(s)
- Rupa Parvataneni
- Division of Neuro-Oncology in the Department of Neurosurgery, University of California, San Francisco, CA 94143, USA.
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Quality of life as predictor of survival: A prospective study on patients treated with combined surgery and radiotherapy for advanced oral and oropharyngeal cancer. Radiother Oncol 2010; 97:258-62. [DOI: 10.1016/j.radonc.2010.02.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 02/08/2010] [Accepted: 02/08/2010] [Indexed: 11/21/2022]
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Campos RJDSD, Leite ICG. Qualidade de vida e voz pós-radioterapia: repercussões para a fonoaudiologia. REVISTA CEFAC 2010. [DOI: 10.1590/s1516-18462010005000038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
TEMA: o tratamento radioterápico do câncer de cabeça e pescoço tem mostrado resultados importantes no controle da doença quando neoadjuvante ou mesmo concomitante à quimioterapia. Pesquisas apontam um aumento da sobrevida após 5 anos de tratamento do câncer de laringe, o que torna necessário e justifica os esforços realizados na reabilitação da comunicação dos pacientes, e destaca a presença do profissional de Fonoaudiologia na equipe de radioterapia. OBJETIVO: descrever as seqüelas com repercussão fonoaudiológica, tais como alterações na qualidade vocal e na qualidade de vida, associadas ao tratamento proposto para tumores de cabeça e pescoço, em especial aquelas originadas após a radioterapia. CONCLUSÃO: Várias seqüelas, agudas e crônicas, como rouquidão, odinofagia e afonia, que envolvem dificuldades na comunicação oral e/ou deglutição dos pacientes após o tratamento radioterápico em cabeça e pescoço, interfere de maneira direta na comunicação, deglutição e qualidade de vida dos pacientes. Os profissionais envolvidos no tratamento desse câncer, dentre eles o fonoaudiólogo, através do conhecimento sobre o tratamento e as fragilidades terapêuticas que comprometem a qualidade vocal e qualidade de vida desses pacientes, busca contribuir no processo de recuperação minimizando os danos causados pela doença e melhorando a condição de saúde do indivíduo.
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Eades M, Chasen M, Bhargava R. Rehabilitation: long-term physical and functional changes following treatment. Semin Oncol Nurs 2009; 25:222-30. [PMID: 19635401 DOI: 10.1016/j.soncn.2009.05.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the life altering issues that survivors of a head and neck cancer report post treatment and discuss multidimensional rehabilitation approaches. DATA SOURCES Published journal articles, literature reviews, research reports, book chapters. CONCLUSION Survivors and their family caregivers encounter many changes during the first 3 months following treatment for head and neck cancer, placing them at risk of multiple adjustment difficulties. Progressive weight loss, loss of energy, strength, muscle endurance and decreased functioning severely compromise healthy adjustment and quality of life. IMPLICATIONS FOR NURSING PRACTICE Nurses can help patients and family identify survivorship issues to be managed at home. Planning, exploring, coaching, practicing skills with survivors and their family caregivers, providing specific information, and linking them with resources can help them bridge this transition into extended survivorship.
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Affiliation(s)
- Margaret Eades
- McGill University Health Centre, Royal Victoria Hospital site, Montreal, Quebec, Canada.
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Abstract
OBJECTIVES To discuss current clinical recommendations for treatment of squamous cell carcinoma of the head and neck (SCCHN), to identify common toxicities associated with combined chemoradiotherapy or chemotherapy alone, and describe strategies for management of the most common treatment-related toxicities. DATA SOURCES Current research, published literature, National Comprehensive Cancer Network Clinical Practice Guidelines, American Society of Clinical Oncology, and Oncology Nursing Society. CONCLUSION Advances in options for systemic therapy for SCCHN have provided hope for patients with this disease. However, effective management of these patients requires a proactive and persistent multidisciplinary treatment approach, including toxicity management. IMPLICATIONS FOR NURSING PRACTICE Careful evaluation of each patient before initiating treatment with the goals of therapy reviewed by the multidisciplinary team, the patient, and the caregivers, will allow selection of the most appropriate treatment plan. The goals of therapy should provide guidance in balancing tumor response, toxicity (both acute and late effects), survival, and quality of life.
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Shortfalls in international, multidisciplinary outcome data collection following head and neck cancer: Does the ICF Core Set for HNC provide a common solution? Oral Oncol 2009; 45:849-55. [DOI: 10.1016/j.oraloncology.2009.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 04/07/2009] [Indexed: 11/18/2022]
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Perioperative assessment of psychological state and quality of life of head and neck cancer patients undergoing surgery. Int J Oral Maxillofac Surg 2009; 38:151-9. [DOI: 10.1016/j.ijom.2008.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 06/17/2008] [Accepted: 11/10/2008] [Indexed: 11/18/2022]
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Karvonen-Gutierrez CA, Ronis DL, Fowler KE, Terrell JE, Gruber SB, Duffy SA. Quality of life scores predict survival among patients with head and neck cancer. J Clin Oncol 2008; 26:2754-60. [PMID: 18509185 DOI: 10.1200/jco.2007.12.9510] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to examine whether quality of life (QOL) scores predict survival among patients with head and neck cancer, controlling for demographic, health behavior, and clinical variables. PATIENTS AND METHODS A self-administered questionnaire was given to 495 patients being treated for head and neck cancer while they were waiting to be seen for a clinic appointment. Data collected from the survey included demographics, health behaviors, and QOL as measured by Short Form-36 (SF-36) physical and mental component scores and the Head and Neck QOL scores. Clinical measures were collected by chart abstraction. Kaplan-Meier plots and univariate and multivariate Cox proportional hazards models were used to determine the association between QOL scores and survival time. RESULTS After controlling for age, time since diagnosis, marital status, education, tumor site and stage, comorbidities, and smoking, the SF-36 physical component score and three of the four Head and Neck QOL scales (pain, eating, and speech domains) were associated with survival. Controlling for the same variables, the SF-36 mental component score and the emotional domain of the Head and Neck QOL were not associated with survival. CONCLUSION QOL instruments may be valuable screening tools to identify patients who are at high risk for poor survival. Those with low QOL scores could be followed more closely, with the potential to identify recurrence earlier and perform salvage treatments, thereby possibly improving survival for this group of patients.
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Affiliation(s)
- Carrie A Karvonen-Gutierrez
- Veterans' Affairs (VA) Health Services Research and Development Center for Practice Management & Outcomes Research, VA Ann Arbor Healthcare System (11H), Ann Arbor, MI 48113-0170, USA
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Hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer: Quality of life in a prospective phase I/II trial. Radiother Oncol 2008; 87:181-7. [DOI: 10.1016/j.radonc.2007.12.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 12/18/2007] [Accepted: 12/28/2007] [Indexed: 11/19/2022]
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:175-82. [DOI: 10.1097/moo.0b013e3282fd9415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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