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Manduchi B, Fitch MI, Ringash JG, Howell D, Martino R. A core outcome set for patient-reported dysphagia for use in head and neck cancer clinical trials: An international multistakeholder Delphi study. Head Neck 2024; 46:831-848. [PMID: 38204219 DOI: 10.1002/hed.27626] [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: 10/11/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Measuring dysphagia-related patient-reported outcomes (PROs) in Head and Neck Cancer (HNC) patients is challenging due to dysphagia's multidimensional impact, causing inconsistency in outcome reporting. To address this issue, this study derived a consensus-based core outcome set (COS) for patient-reported dysphagia in HNC clinical trials where swallowing is a primary or secondary endpoint. METHODS A sample of HNC clinicians, researchers, patients, and caregivers participated in a 2-Round Delphi technique. A Delphi survey, containing a comprehensive list of dysphagia-related PROs, was developed. In Round 1, participants rated item importance on a 5-point scale. Items rated ≥4 by >70% advanced to Round 2, where a consensus meeting addressed items with varied opinions, and the Delphi survey with remaining items was completed. Items rated ≥4 by >70% formed the final COS. RESULTS Forty-five participants from nine countries were recruited. After Round 1, 40 items were excluded and 64 advanced to Round 2. After Round 2, a 7-outcome COS was established, comprising the domains of dysphagia symptoms, health status and quality of life. CONCLUSION This study achieved consensus among HNC stakeholders on essential dysphagia PROs for HNC clinical trials. It is advisable to include these 7-core concepts in clinical trials involving people with HNC to facilitate treatment comparisons and data synthesis.
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Affiliation(s)
- Beatrice Manduchi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jolie G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Funcionalidade de pacientes oncológicos: um estudo transversal com o core set genérico da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. CONSCIENTIAE SAÚDE 2022. [DOI: 10.5585/21.2022.21194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introdução: O câncer é considerado uma doença crônica e um dos principais problemas de saúde enfrentados pela população. Embora o tratamento possa melhorar a sobrevida dos pacientes oncológicos, os efeitos colaterais influenciam a qualidade de vida e impactam na capacidade funcional diária. Desde 2001, com a aprovação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), o entendimento da funcionalidade e o da incapacidade humana passaram a ser vistos sob nova dimensão. Objetivo: Classificar a funcionalidade de pacientes oncológicos em tratamento quimioterápico por meio do core set genérico da CIF. Método: Foi realizado um estudo transversal com 117 indivíduos em tratamento quimioterápico. Para classificar a funcionalidade foi aplicado o core set genérico da CIF, que possui sete categorias em três componentes da CIF. Resultados: Os maiores comprometimentos e deficiências relatados foram nas categorias: sensação de dor (69,2%); andar (61,5%); e funções emocionais (54,7%). Conclusão: Foi identificada uma amostra de pacientes oncológicos em tratamento quimioterápico com diferentes níveis de incapacidade funcional em todas as categorias classificadas.
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Riechelmann H, Dejaco D, Steinbichler TB, Lettenbichler-Haug A, Anegg M, Ganswindt U, Gamerith G, Riedl D. Functional Outcomes in Head and Neck Cancer Patients. Cancers (Basel) 2022; 14:cancers14092135. [PMID: 35565265 PMCID: PMC9099625 DOI: 10.3390/cancers14092135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary With increasing long-term survivorship of head and neck cancer (HNC), the functional outcomes are gaining importance. Recently, a tool for the rapid clinical assessment of the functional status in HNC-patients based on observable clinical criteria, termed “HNC-Functional InTegrity (FIT) Scales, was validated. Here, the functional outcomes of 681 newly diagnosed HNC-patients were reported using the HNC-FIT Scales. A normal/near-normal outcome in all six functional domains was observed in 61% of patients, with individual scores of 79% for food intake, 89% for breathing, 84% for speech, 89% for pain, 92% for mood, and 88% for neck and shoulder mobility. Clinically relevant impairment in at least one functional domain was observed in 30% of patients, and 9% had loss of function in at least one functional domain. Thus, clinically relevant persistent functional deficits in at least one functional domain must be expected in 40% of HNC-patients. The treatment of these functional deficits is an essential task of oncologic follow-up. Abstract With the increase in long-term survivorship of head and neck cancer (HNC), the functional outcomes are gaining importance. We reported the functional outcomes of HNC patients using the HNC-Functional InTegrity (FIT) Scales, which is a validated tool for the rapid clinical assessment of functional status based on observable clinical criteria. Patients with newly diagnosed HNC treated at the Medical University of Innsbruck between 2008 and 2020 were consecutively included, and their status in the six functional domains of food-intake, breathing, speech, pain, mood, and neck and shoulder mobility was scored by the treating physician at oncological follow-up visits on a scale from 0 (loss of function) to 4 (full function). HNC-FIT scales were available for 681 HNC patients at a median of 35 months after diagnosis. The response status was complete remission in 79.5%, 18.1% had recurrent or persistent disease, and 2.4% had a second primary HNC. Normal or near-normal scores (3 and 4) were seen in 78.6% for food intake, 88.7% for breathing, 83.7% for speech, 89% for pain, 91.8% for mood, and 87.5% for neck and shoulder mobility. A normal or near-normal outcome in all six functional domains was observed in 61% of patients. Clinically relevant impairment (score 1–2) in at least one functional domain was observed in 30%, and 9% had loss of function (score 0) in at least one functional domain. The main factors associated with poor functional outcome in a multivariable analysis were recurrence or persistent disease, poor general health (ASA III and IV), and higher T stage. Particularly, laryngeal and hypopharyngeal tumors impaired breathing and speech function, and primary radiation therapy or concomitant systemic therapy and radiotherapy worsened food intake. Clinically relevant persistent functional deficits in at least one functional domain must be expected in 40% of the patients with HNC. The treatment of these functional deficits is an essential task of oncologic follow-up.
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Affiliation(s)
- Herbert Riechelmann
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Daniel Dejaco
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
- Correspondence: ; Tel.: +43-512-504-23142
| | - Teresa Bernadette Steinbichler
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Anna Lettenbichler-Haug
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Maria Anegg
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Ute Ganswindt
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Gabriele Gamerith
- Internal Medicine V, Department of Hematology & Oncology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - David Riedl
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
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Karsten RT, Hilgers FJM, van der Molen L, van Sluis K, Smeele LE, Stuiver MM. The Timed Swallowing Proficiency for Eating and Drinking (SPEAD) Test: Development and Initial Validation of an Instrument to Objectify (Impaired) Swallowing Capacity in Head and Neck Cancer Patients. Dysphagia 2021; 36:1072-1087. [PMID: 33459852 DOI: 10.1007/s00455-020-10240-w] [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: 05/13/2020] [Accepted: 12/17/2020] [Indexed: 11/27/2022]
Abstract
Objective swallowing outcomes measure the physical swallowing function, while subjective outcomes measure swallowing perception. A test for swallowing capacity, measuring the ingestion of all consistencies is currently not available. Therefore, the Swallowing Proficiency for Eating And Drinking (SPEAD) test was developed. It entails the timed ingestion of thin liquid, thick liquid and solid. In this study, its feasibility, reliability and validity were evaluated in patients with dysphagia after treatment for head and neck cancer (HNC) and healthy participants. Thirty-eight HNC patients and forty healthy participants were enrolled in this study and performed the SPEAD test three times. Video recordings of the test were evaluated three times by one observer, and once by three additional observers, to assess test-retest, intra-rater and inter-rater reliability. Validity was assessed by calculating effect sizes for the difference between results of patients and healthy participants and by evaluating correlations with objective (e.g., videofluoroscopy and functional oral intake scale) and subjective (e.g., SWAL-QOL) swallowing outcomes. Test-retest, intra-rater and inter-rater reliability of ingestion duration was good to excellent. All hypotheses with regard to magnitude and direction of correlations were confirmed, supporting construct validity of the test. Our initial results suggest that the SPEAD test reliably measures the transport capacity of the upper digestive tract (in grams per second) and that this test can be useful to objectively evaluate and monitor the (safe) swallowing capacity in HNC patients, in both research as well as daily clinical practice.
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Affiliation(s)
- R T Karsten
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - F J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Amsterdam Center for Language and Communication/ACLC-Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - L van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Amsterdam Center for Language and Communication/ACLC-Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - K van Sluis
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - L E Smeele
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M M Stuiver
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Zebralla V, Müller J, Wald T, Boehm A, Wichmann G, Berger T, Birnbaum K, Heuermann K, Oeltze-Jafra S, Neumuth T, Singer S, Büttner M, Dietz A, Wiegand S. Obtaining Patient-Reported Outcomes Electronically With "OncoFunction" in Head and Neck Cancer Patients During Aftercare. Front Oncol 2020; 10:549915. [PMID: 33324544 PMCID: PMC7724103 DOI: 10.3389/fonc.2020.549915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/19/2020] [Indexed: 11/14/2022] Open
Abstract
The disease and treatment of patients with head and neck cancer can lead to multiple late and long-term sequelae. Especially pain, psychosocial problems, and voice issues can have a high impact on patients' health-related quality of life. The aim was to show the feasibility of implementing an electronic Patient-Reported Outcome Measure (PROM) in patients with head and neck cancer (HNC). Driven by our department's intention to assess Patient-Reported Outcomes (PRO) based on the International Classification of Functioning during tumor aftercare, the program "OncoFunction" has been implemented and continuously refined in everyday practice. The new version of "OncoFunction" was evaluated by 20 head and neck surgeons and radiation oncologists in an interview. From 7/2013 until 7/2017, 846 patients completed the PROM during 2,833 of 3,610 total visits (78.5%). The latest software version implemented newly developed add-ins and increased the already high approval ratings in the evaluation as the number of errors and the time required decreased (6 vs. 0 errors, 1.35 vs. 0.95 min; p<0.01). Notably, patients had different requests using PRO in homecare use. An additional examination shows that only 59% of HNC patients use the world wide web. Using OncoFunction for online-recording and interpretation of PROM improved data acquisition in daily HNC patients' follow-up. An accessory timeline grants access to former consultations and their visualization supported and simplified structured examinations. This provides an easy-to-use representation of the patient's functional outcome supporting comprehensive aftercare, considering all aspects of the patient's life.
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Affiliation(s)
- Veit Zebralla
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre, Leipzig, Germany
| | - Juliane Müller
- Innovation Center Computer Assisted Surgery, University of Leipzig, Leipzig, Germany
| | - Theresa Wald
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre, Leipzig, Germany
| | - Andreas Boehm
- Department of Otorhinolaryngology, Clinic St. Georg Leipzig, Leipzig, Germany
| | - Gunnar Wichmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre, Leipzig, Germany
| | - Thomas Berger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre, Leipzig, Germany
| | - Klemens Birnbaum
- Fraunhofer-Institute for Photonic Microsystems, Dresden, Germany
| | - Katharina Heuermann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre, Leipzig, Germany
| | - Steffen Oeltze-Jafra
- Innovation Center Computer Assisted Surgery, University of Leipzig, Leipzig, Germany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery, University of Leipzig, Leipzig, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Matthias Büttner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Andreas Dietz
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre, Leipzig, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre, Leipzig, Germany
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Ramsey I, Eckert M, Hutchinson AD, Marker J, Corsini N. Core outcome sets in cancer and their approaches to identifying and selecting patient-reported outcome measures: a systematic review. J Patient Rep Outcomes 2020; 4:77. [PMID: 32930891 PMCID: PMC7492323 DOI: 10.1186/s41687-020-00244-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Issues arising from a lack of outcome standardisation in health research may be addressed by the use of core outcome sets (COS), which represent agreed-upon recommendations regarding what outcomes should be measured as a minimum in studies of a health condition. This review investigated the scope, outcomes, and development methods of consensus-based COS for cancer, and their approaches and criteria for selecting instruments to assess core patient-reported outcomes (PROs). METHODS Studies that used a consensus-driven approach to develop a COS containing PROs, for use in research with cancer populations, were sought via MEDLINE, CINAHL, Embase, Cochrane Library, and grey literature. RESULTS Seventeen studies met the inclusion criteria. Most COS (82%) were specific to a cancer type (prostate, esophageal, head and neck, pancreatic, breast, ovarian, lung, or colorectal) and not specific to an intervention or treatment (76%). Conducting a systematic review was the most common approach to identifying outcomes (88%) and administering a Delphi survey was the most common approach to prioritising outcomes (71%). The included COS contained 90 PROs, of which the most common were physical function, sexual (dys) function, pain, fatigue, and emotional function. Most studies (59%) did not address how to assess the core PROs included in a set, while 7 studies (41%) recommended specific instruments. Their approaches to instrument appraisal and selection varied. CONCLUSION Efforts to standardise outcome assessment via the development of COS may be undermined by a lack of recommendations on how to measure core PROs. To optimise COS usefulness and adoption, valid and reliable instruments for the assessment of core PROs should be recommended with the aid of resources designed to facilitate this process.
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Affiliation(s)
- Imogen Ramsey
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, Australia.
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | | | - Julie Marker
- Cancer Voices South Australia, Adelaide, Australia
| | - Nadia Corsini
- Rosemary Bryant AO Research Centre, UniSA Clinical & Health Sciences, University of South Australia, Adelaide, Australia
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Beck AJCC, Passchier E, Retèl VP, Stuiver MM, van der Molen L, Klop WMC, Navran A, van Harten WH, van den Brekel MWM. Study protocol of a prospective multicenter study comparing (cost-)effectiveness of a tailored interdisciplinary head and neck rehabilitation program to usual supportive care for patients treated with concomitant chemo- or bioradiotherapy. BMC Cancer 2019; 19:655. [PMID: 31269918 PMCID: PMC6610831 DOI: 10.1186/s12885-019-5874-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients. METHODS This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands. DISCUSSION This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised. TRIAL REGISTRATION The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).
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Affiliation(s)
- Ann-Jean C. C. Beck
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
- Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen Passchier
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Valesca P. Retèl
- Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - Martijn M. Stuiver
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands
- ACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Willem M. C. Klop
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wim H. van Harten
- Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
- Rijnstate Hospital, Arnhem, the Netherlands
| | - Michiel W. M. van den Brekel
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
- Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, the Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, the Netherlands
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Bergström L, Ward EC, Finizia C. Community listeners' perceptions of voice function post-radiotherapy for laryngeal cancer. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:494-501. [PMID: 28463013 DOI: 10.1080/17549507.2017.1317360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/28/2017] [Accepted: 04/02/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Successful communication is influenced by communication partners, the community and communication environment. This study examines community members' perceptions of voice function following laryngeal cancer management compared to ratings by clinicians and patients. METHOD Sixty-six (Tis-T3) laryngeal cancer patients post-radiotherapy, 10 community members and three speech-language pathologists (clinicians) were recruited. Patients completed voice recordings and self-rated voice quality and acceptability, six months post-radiotherapy. Community members and clinicians rated patient voice recordings using (a) Voice Quality/Acceptability questionnaire, (b) Communicative Suitability Scale (voice function in different vocally demanding environments) and (c) a gender perception question. RESULT Ratings for voice quality differed significantly (p < 0.001) between community members and clinicians and approached significance (p= 0.08) between community members and patients. No significant difference for voice acceptability was noted between community members and clinicians/patients. Community members rated the irradiated voice significantly different (p ≤ 0.02) across communication environments with more vocally demanding environments being rated as "Barely Sufficient". Incorrect sex identification (gender perception) occurred with 25% of females. CONCLUSION Community communication partners identify functional voice impairments post-radiotherapy, particularly across more vocally demanding environments and for female speakers. Implications for voice rehabilitation including appropriate patient selection is highlighted.
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Affiliation(s)
- Liza Bergström
- a Department of Otorhinolaryngology , The Sahlgrenska Academy at the University of Gothenburg , Sweden
- b School of Health & Rehabilitation Sciences , The University of Queensland , Australia ; and
- c Centre for Functioning and Health Research (CFAHR), Queensland Health , Australia
| | - Elizabeth C Ward
- b School of Health & Rehabilitation Sciences , The University of Queensland , Australia ; and
- c Centre for Functioning and Health Research (CFAHR), Queensland Health , Australia
| | - Caterina Finizia
- a Department of Otorhinolaryngology , The Sahlgrenska Academy at the University of Gothenburg , Sweden
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Abstract
Rehabilitation for cancer patients aims at reducing the impact of disabling and limiting conditions resulting from cancer and its treatment in order to enable patients to regain social integration and participation. Given current trends in cancer incidence and survival along with progress in medical treatment, cancer rehabilitation is becoming increasingly important in contemporary health care. Although not without limitations, the International Classification of Functioning, Disability and Health (ICF) provides a valuable perspective for cancer rehabilitation in understanding impairments in functioning and activity as the result of an interaction between a health condition and contextual factors. The structure of cancer rehabilitation varies across countries as a function of their healthcare systems and social security legislations, although there is a broad consensus with respect to its principal goals. Cancer rehabilitation requires a careful assessment of the individual patient's rehabilitation needs and a multidisciplinary team of health professionals. A variety of rehabilitation interventions exist, including psycho-oncological and psycho-educational approaches. Research on the effectiveness of cancer rehabilitation provides evidence of improvements in relevant outcome parameters, but faces some methodological challenges as well.
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Affiliation(s)
- Joachim Weis
- Universitätsklinikum Freiburg Medizinische Fakultät, Klinik Für Onkologische Rehabilitation UKF Reha GGmbH, Albert-Ludwigs-Universität Freiburg, Breisacher Str. 117, Freiburg, 79106, Deutschland, Germany.
| | - Jürgen M Giesler
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 49, Freiburg, 79106, Deutschland, Germany
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10
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Engelbarts M, Schuster V, Kisser U, Sabariego C, Stier-Jarmer M, Coenen M, Ernst BP, Strieth S, Harréus U, Becker S. The "Comprehensive ICF Core Set for Head and Neck Cancer": a Delphi consensus survey among German speaking speech and language therapists. Eur Arch Otorhinolaryngol 2017; 274:2589-2599. [PMID: 28236010 DOI: 10.1007/s00405-017-4494-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/02/2017] [Indexed: 11/26/2022]
Abstract
The "Comprehensive ICF Core Set for Head and Neck Cancer" (ICF-HNC) is an application of the "International Classification of Functioning, Disability and Health" (ICF), representing the characteristic spectrum of issues in patients with head and neck cancer (HNC). Our primary aim was to evaluate which categories of the ICF-HNC are dealt with by speech and language therapists (SLTs) in Germany, Austria, and Switzerland. The secondary aim was to identify outcome measures used by SLTs to measure the categories of the ICF-HNC in clinical practice. SLTs experienced in the treatment of HNC patients evaluated the categories of the ICF-HNC in a three-round Delphi survey. They were asked whether the listed categories represented issues treated by SLTs in HNC patients, and what outcome measures were used to assess them. Altogether, 31 SLTs completed the survey. 47 of 108 previously selected categories of the ICF-HNC achieved the cut-off value. Out of these, 40.4% were derived from the component "Body Functions", 36.2% from "Body Structures", 12.8% from "Environmental Factors", and 10.6% from "Activities and Participation". Altogether, 82 of the mentioned outcome measures were considered as reasonable from the perspective of SLTs. Of these, only 37 achieved more than 50% approval. This study emphasises the importance of "Body Structures" and "Body Functions" for SLTs in Germany and Switzerland in treating patients with HNC. Moreover, the results highlighted the need to agree on evidence-based outcome measures in speech and language therapy.
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Affiliation(s)
- Matthias Engelbarts
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Vanessa Schuster
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Ulrich Kisser
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Carla Sabariego
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
- ICF Research Branch, a Cooperation Partner Within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Munich, Germany
| | - Marita Stier-Jarmer
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
- ICF Research Branch, a Cooperation Partner Within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Munich, Germany
| | - Michaela Coenen
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
- ICF Research Branch, a Cooperation Partner Within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Munich, Germany
| | - Benjamin Philipp Ernst
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sebastian Strieth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Ulrich Harréus
- Department of Otorhinolaryngology, Head and Neck Surgery, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstr. 40, 40217, Düsseldorf, Germany
| | - Sven Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
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The development of an ICF-based clinical guideline and screening tool for the standardized assessment and evaluation of functioning after head and neck cancer treatment. Eur Arch Otorhinolaryngol 2016; 274:1035-1043. [PMID: 27695934 DOI: 10.1007/s00405-016-4317-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/22/2016] [Indexed: 11/12/2022]
Abstract
The assessment and evaluation of functioning and quality of life after tumor treatment in head and neck cancer (HNC) are considered as essential aspects of clinical routine and studies. A huge number of instruments are available that have been designed to evaluate functioning and quality of life after HNC treatment. The diversity of these instruments in terms of content, response options and administration hinders the comparability of available studies and the performance of meta-analyses. The objective of this paper is to inform about the development of a screening tool for the standardized assessment and evaluation of functioning based on the International Classification of Functioning, Disability and Health (ICF) Core Set for HNC. We followed a multi-step approach including (1) preparatory studies to identify and preselect suitable instruments for the assessment of functioning, (2) a decision-making process to agree on an ICF-based clinical guideline including instruments assessing functioning and (3) the development of a computer-based standardized screening tool to assess and evaluate functioning based on this guideline in clinical routine. Twenty-one experts participated in a consensus meeting and decided on instruments to be included in an ICF-based clinical guideline and screening tool for the assessment and evaluation of functioning in HNC patients in cancer treatment. The chosen instruments cover all aspects of the ICF Core Set for HNC addressing therapy control, pain, food intake/swallowing, voice/speech/breathing, other somatic complaints and psychosocial aspects. The screening tool contains patient-reported outcome measures and a clinician's checklist. It has to be further tested in clinical practice.
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Khan F, Amatya B, Ng L, Drummond K, Galea M. Multidisciplinary rehabilitation after primary brain tumour treatment. Cochrane Database Syst Rev 2015; 2015:CD009509. [PMID: 26298178 PMCID: PMC6481476 DOI: 10.1002/14651858.cd009509.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Brain tumours can cause significant disability, which may be amenable to multidisciplinary rehabilitation. However, the evidence base for this is unclear. This review is an update of a previously published review in the Cochrane Database of Systematic Reviews [2013, Issue 1, Art. No. CD009509] on 'Multidisciplinary rehabilitation after primary brain tumour treatment'. OBJECTIVES To assess the effectiveness of multidisciplinary rehabilitation in people after primary brain tumour treatment, especially the types of approaches that are effective (settings, intensity). SEARCH METHODS For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library up to Issue 12 of 12, 2014), MEDLINE (1950 to January week 2, 2015), EMBASE (1980 to January week 2, 2015), PEDro (1985 to January week 2 2015), and LILACS (1982 to January week 2, 2015). We checked the bibliographies of papers we identified and contacted the authors and known experts in the field to seek published and unpublished trials. SELECTION CRITERIA Controlled clinical trials (randomised and non-randomised clinical trials) that compared multidisciplinary rehabilitation in primary brain tumour with either routinely available local services or lower levels of intervention, or studies that compared multidisciplinary rehabilitation in different settings or at different levels of intensity. DATA COLLECTION AND ANALYSIS Three review authors independently assessed study quality, extracted data, and performed a 'best evidence ' synthesis based on methodological quality. MAIN RESULTS We did not identify any studies for inclusion in the previous version of this review. For this update, the literature search identified one low-quality controlled clinical trial involving 106 participants. The findings from this study suggest 'low-level' evidence to support high-intensity ambulatory (outpatient) multidisciplinary rehabilitation in reducing short- and long-term motor disability (continence, mobility and locomotion, cognition), when compared with standard outpatient care. We found improvement in some domains of disability (continence, communication) and psychosocial gains were maintained at six months follow-up. We found no evidence for improvement in overall participation (quality of life and societal relationship). No adverse events were reported as a result of multidisciplinary rehabilitation. We found no evidence for improvement in quality of life or cost-effectiveness of rehabilitation. It was also not possible to suggest best 'dose' of therapy. AUTHORS' CONCLUSIONS Since the last version of this review, one new study has been identified for inclusion. The best evidence to date comes from this CCT, which provides low quality evidence that higher intensity ambulatory (outpatient) multidisciplinary rehabilitation reduces short- and long-term disability in people with brain tumour compared with standard outpatient care. Our conclusions are tentative at best, given gaps in current research in this area. Although the strength of evidence has increased with the identification of a new controlled clinical trial in this updated review, further research is needed into appropriate and robust study designs; outcome measurement; caregiver needs; evaluation of optimal settings; type, intensity, duration of therapy; and cost-effectiveness of multidisciplinary rehabilitation in the brain tumour population.
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Affiliation(s)
- Fary Khan
- Monash UniversityDisability Inclusive Unit, Nossal Institute of Global Health & School of Public Health and Preventative MedicineThe Alfred Centre99 Commercial RoadMelbourneVictoriaAustralia3004
- The Royal Melbourne HospitalDepartment of Rehabilitation MedicineMelbourneAustralia
- University of MelbourneDepartment of MedicineMelbourneAustralia
| | - Bhasker Amatya
- Royal Melbourne Hospital, Royal Park CampusDepartment of Rehabilitation MedicinePoplar RoadParkvilleMelbourneVictoriaAustralia3052
| | - Louisa Ng
- The Royal Melbourne HospitalDepartment of Rehabilitation MedicineMelbourneAustralia
| | - Kate Drummond
- Royal Melbourne Hospital, Royal Park CampusDepartment of NeuroscienceGrattan StreetParkvilleVictoriaAustralia3052
| | - Mary Galea
- Royal Melbourne Hospital, Royal Park CampusDepartment of Rehabilitation MedicinePoplar RoadParkvilleMelbourneVictoriaAustralia3052
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Abstract
In the USA, increasing attention is being paid to adopting a value-based framework for measuring and ultimately improving health care delivery. Value is defined as the benefit achieved relative to costs. The numerator of the value equation includes quality of care and outcomes achieved. The denominator includes costs, both financial costs and harms of treatment. Herein, we describe these elements of value as they pertain to head and neck cancer. A particular focus is to identify areas of the value equation where physicians have some control. We examine quality in each of three dimensions: structure, process, and outcomes. We also adopt Porter's three-tiered hierarchy of outcomes model, with specific outcomes relevant to patients with head and neck and thyroid cancer. Finally, we review issues related to costs and harms. We believe these findings can serve as a framework for further efforts to drive value-based delivery of head and neck cancer care.
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Affiliation(s)
- Benjamin R Roman
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,
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Bölte S, de Schipper E, Holtmann M, Karande S, de Vries PJ, Selb M, Tannock R. Development of ICF Core Sets to standardize assessment of functioning and impairment in ADHD: the path ahead. Eur Child Adolesc Psychiatry 2014; 23:1139-48. [PMID: 24337412 PMCID: PMC4246121 DOI: 10.1007/s00787-013-0496-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/09/2013] [Indexed: 11/06/2022]
Abstract
In the study of health and quality of life in attention deficit/hyperactivity disorder (ADHD), it is of paramount importance to include assessment of functioning. The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive, universally accepted framework for the description of functioning in relation to health conditions. In this paper, the authors outline the process to develop ICF Core Sets for ADHD. ICF Core Sets are subgroups of ICF categories selected to capture the aspects of functioning that are most likely to be affected in specific disorders. The ICF categories that will be included in the ICF Core Sets for ADHD will be determined at an ICF Core Set Consensus Conference, wherein evidence from four preliminary studies (a systematic review, an expert survey, a patient and caregiver qualitative study, and a clinical cross-sectional study) will be integrated. Comprehensive and Brief ICF Core Sets for ADHD will be developed with the goal of providing useful standards for research and clinical practice, and to generate a common language for the description of functioning in ADHD in different areas of life and across the lifespan.
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Affiliation(s)
- Sven Bölte
- Neuropsychiatric Unit, Department of Women’s and Children’s Health, Center of Neurodevelopmental Disorders (KIND), Stockholm, Sweden
- Division of Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden
| | - Elles de Schipper
- Neuropsychiatric Unit, Department of Women’s and Children’s Health, Center of Neurodevelopmental Disorders (KIND), Stockholm, Sweden
| | - Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Ruhr University Bochum, Hamm, Germany
| | - Sunil Karande
- Learning Disability Clinic, Department of Pediatrics, Seth G.S. Medical College & K.E.M. Hospital, Mumbai, India
| | - Petrus J. de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Melissa Selb
- ICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Nottwil, Switzerland
- Swiss Paraplegic Research (SPF), Nottwil, Switzerland
| | - Rosemary Tannock
- Neurosciences and Mental Health Research Program, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Eadie TL, Lamvik K, Baylor CR, Yorkston KM, Kim J, Amtmann D. Communicative participation and quality of life in head and neck cancer. Ann Otol Rhinol Laryngol 2014; 123:257-64. [PMID: 24671481 DOI: 10.1177/0003489414525020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to determine how a new self-report outcome measure of communicative participation, the Communicative Participation Item Bank (CPIB), related to disease- and discipline-specific quality of life (QOL) outcomes in a head and neck cancer (HNC) population. METHODS One hundred ninety-five individuals treated for HNC completed the CPIB, the University of Washington Quality of Life questionnaire (UW-QOL), and the Voice Handicap Index-10 (VHI-10). RESULTS Results revealed moderate QOL scores across the UW-QOL (mean scores: global QOL = 66; physical subscale = 70; social-emotional subscale = 73) and VHI-10 (mean = 16). Correlations between the CPIB and the UW-QOL scores were statistically significant (P < .001) but relatively weak (r = .37-.38). As hypothesized, a stronger correlation was found between the CPIB and the VHI-10 (r = -0.79; P < .001). CONCLUSION Clinicians may consider adopting the CPIB to complement existing tools in assessing communication outcomes after HNC.
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Affiliation(s)
- Tanya L Eadie
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA
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16
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Abstract
Rehabilitation for cancer patients aims at reducing the impact of disabling and limiting conditions resulting from cancer and its treatment in order to enable patients to regain social integration and participation. Given current trends in cancer incidence and survival along with progress in medical treatment, cancer rehabilitation is becoming increasingly important in contemporary healthcare. Although not without limitations, the International Classification of Functioning, Disability, and Health (ICF) provides a valuable perspective for cancer rehabilitation in understanding impairments in functioning and activity as the result of an interaction between a health condition and contextual factors. The structure of cancer rehabilitation varies across countries as a function of their health care systems and social security legislations, although there is a broad consensus with respect to its principal goals. Cancer rehabilitation requires a careful assessment of the individual patient's rehabilitation needs and a multidisciplinary team of health professionals. A variety of rehabilitation interventions exist, including psycho-oncological and psycho-educational approaches. Research on the effectiveness of cancer rehabilitation provides evidence of improvements in relevant outcome parameters, but faces some methodological challenges as well.
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17
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Waters AM, Tudur Smith C, Young B, Jones TM. The CONSENSUS study: protocol for a mixed methods study to establish which outcomes should be included in a core outcome set for oropharyngeal cancer. Trials 2014; 15:168. [PMID: 24885068 PMCID: PMC4023496 DOI: 10.1186/1745-6215-15-168] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/17/2014] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of oropharyngeal cancer is increasing in the developed world. This has led to a large rise in research activity and clinical trials in this area, yet there is no consensus on which outcomes should be measured. As a result, the outcomes measured often differ between trials of comparable interventions, making the combination or comparison of results between trials impossible. Outcomes may also be ‘cherry-picked’, such that favourable results are reported, and less favourable results withheld. The development of a minimum outcome reporting standard, known as a core outcome set, goes some way to addressing these problems. Core outcome sets are ideally developed using a patient-centred approach so that the outcomes measured are relevant to patients and clinical practice. Core outcome sets drive up the quality and relevance of research by ensuring that the right outcomes are consistently measured and reported in trials in specific areas of health or healthcare. Methods/Design This is a mixed methods study involving three phases to develop a core outcome set for oropharyngeal cancer clinical trials. Firstly, a systematic review will establish which outcomes are measured in published oropharyngeal cancer randomised controlled trials (RCTs). Secondly, qualitative interviews with patients and carers in the UK and the USA will aim to establish which outcomes are important to these stakeholders. Data from these first two stages will be used to develop a comprehensive list of outcomes to be considered for inclusion in the core outcome set. In the third stage, patients and clinicians will participate in an iterative consensus exercise known as a Delphi study to refine the contents of the core outcome set. This protocol lays out the methodology to be implemented in the CONSENSUS study. Discussion A core outcome set defines a minimum outcome reporting standard for clinical trials in a particular area of health or healthcare. Its consistent implementation in oropharyngeal cancer clinical trials will improve the quality and relevance of research. Trials and registration This study is registered at the National Institute for Health Research (NIHR) Clinical Research Network (CRN) portfolio, ID 13823 (17 January 2013).
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Affiliation(s)
- Aoife Mi Waters
- Department of Biostatistics, University of Liverpool, 1st Floor Duncan Building, Daulby Street, Liverpool L69 3GA, UK.
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18
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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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Tschiesner U, Sabariego C, Linseisen E, Becker S, Stier-Jarmer M, Cieza A, Harreus U. Priorities of head and neck cancer patients: a patient survey based on the brief ICF core set for HNC. Eur Arch Otorhinolaryngol 2013; 270:3133-42. [PMID: 23543319 DOI: 10.1007/s00405-013-2446-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 03/12/2013] [Indexed: 11/25/2022]
Abstract
The International Classification of Functioning, Disability and Health Core Set for Head and Neck Cancer (ICF-HNC) covers the typical spectrum of problems in functioning experienced by patients with head and neck cancer (HNC). The major goal of the present work was to evaluate patients' priorities using the brief ICF-HNC as a starting point. A priorities assessment checklist consisting of 15 statements was created based on the 14 validated categories of the brief ICF-HNC. In a cross-sectional study, patients were requested to select up to 5 items that were especially important to them. The checklist was sent by mail to 465 patients at different time points of cancer follow-up and handed out to 56 patients with recent HNC diagnosis. Altogether 300 (64.51 %) patients returned the checklist. The top priority of our sample was "I want to survive the cancer", followed by "I want that all the expenses for cancer treatment, cancer care and any additional follow-up treatments be covered by my health insurance or by the welfare system", "I want to be able to continue performing all daily life tasks well", "I want to have trusting relationships with my doctors, nurses and therapists" and "I want to be able to speak clearly". Although survival was, as expected, the top priority for patients enrolled in the study, we show that the weight given to survival and further symptoms or daily life activities meaningfully changes when the biopsychosocial perspective proposed in the ICF is adopted.
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Affiliation(s)
- Uta Tschiesner
- Department of Otorhinolaryngology, Ludwig-Maximilians-University, Marchioninistr 15, 81377, Munich, Germany
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20
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Nam HS, Kim KD, Shin HI. ICF Based Comprehensive Evaluation for Post-Acute Spinal Cord Injury. Ann Rehabil Med 2013; 36:804-14. [PMID: 23342313 PMCID: PMC3546183 DOI: 10.5535/arm.2012.36.6.804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 08/01/2012] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the feasibility of the ICF for initial comprehensive evaluation of early post-acute spinal cord injury. Method A comprehensive evaluation of 62 early post-acute spinal cord injury (SCI) patients was conducted by rehabilitation team members, such as physicians, physical therapists, occupational therapists, nutritionists, medical social-workers, and nurses. They recorded each of their evaluation according to the ICF first level classification. The contents of the comprehensive evaluation were linked to the ICF second level categories, retrospectively. The linked codes were analyzed descriptively and were also compared with the brief ICF core set for early post-acute SCI. Results In the evaluation of early post-acute SCI patients based on the ICF first level categories, 19 items from the body functions domain, such as muscle power functions (b730) and urination functions (b620), 15 items from the body structures domain, including spinal cord and related structures (s120), 11 items from the activities and participation domain, such as transferring oneself (d420) and walking (d450), and 9 items from the environmental factors domain, e.g., health professionals (e355), were linked to the ICF second level categories. In total, 82.4% of all contents were linked to the brief ICF core set. Prognosis insight, a personal factor not linkable to an ICF code, was mentioned in 29.0% of all patients. Conclusion First level ICF categories can provide a structural base for a comprehensive evaluation in early post-acute spinal cord injury. However, frequently linked items, including the brief core set, as well as personal factors should be considered via a checklist in order to prevent the omission of significant contents.
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Affiliation(s)
- Hyung Seok Nam
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul 110-744, Korea
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Hutcheson KA, Lewin JS. Functional outcomes after chemoradiotherapy of laryngeal and pharyngeal cancers. Curr Oncol Rep 2012; 14:158-65. [PMID: 22249533 DOI: 10.1007/s11912-012-0216-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Organ preservation regimens that combine chemotherapy and radiotherapy (chemoradiotherapy) are increasingly used as the primary treatment of laryngeal and pharyngeal cancers. Meta-analytic data show a survival benefit with combined modality therapy, but the functional sequelae can be significant. Dysphagia is recognized as a common and often devastating late effect of chemoradiotherapy. This review examines functional outcomes after chemoradiotherapy for laryngeal and pharyngeal cancers, with a particular emphasis on dysphagia. Topics examined include the burden of dysphagia after chemoradiation, pathophysiology of dysphagia, baseline functioning, recommendations to improve long-term function, and voice outcomes.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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van der Mei SF, Dijkers MPJM, Heerkens YF. Participation as an outcome measure in psychosocial oncology: content of cancer-specific health-related quality of life instruments. Qual Life Res 2011; 20:1617-27. [PMID: 21479851 PMCID: PMC3220821 DOI: 10.1007/s11136-011-9900-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2011] [Indexed: 11/12/2022]
Abstract
PURPOSE To examine to what extent the concept and the domains of participation as defined in the International Classification of Functioning, Disability and Health (ICF) are represented in general cancer-specific health-related quality of life (HRQOL) instruments. METHODS Using the ICF linking rules, two coders independently extracted the meaningful concepts of ten instruments and linked these to ICF codes. RESULTS The proportion of concepts that could be linked to ICF codes ranged from 68 to 95%. Although all instruments contained concepts linked to Participation (Chapters d7-d9 of the classification of 'Activities and Participation'), the instruments covered only a small part of all available ICF codes. The proportion of ICF codes in the instruments that were participation related ranged from 3 to 35%. 'Major life areas' (d8) was the most frequently used Participation Chapter, with d850 'remunerative employment' as the most used ICF code. CONCLUSIONS The number of participation-related ICF codes covered in the instruments is limited. General cancer-specific HRQOL instruments only assess social life of cancer patients to a limited degree. This study's information on the content of these instruments may guide researchers in selecting the appropriate instrument for a specific research purpose.
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Affiliation(s)
- Sijrike F van der Mei
- Department of Health Sciences, Graduate School for Health Research SHARE, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands.
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Functional outcome in patients with advanced head and neck cancer: surgery and reconstruction with free flaps versus primary radiochemotherapy. Eur Arch Otorhinolaryngol 2011; 269:629-38. [PMID: 21643935 DOI: 10.1007/s00405-011-1642-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 05/11/2011] [Indexed: 10/18/2022]
Abstract
The objective was to compare functional outcome in patients with advanced head and neck cancer (HNC) treated with (a) surgical resection and reconstruction with microvascular free flaps (MVFF) followed by radiochemotherapy versus (b) primary radiochemotherapy (RCT) on the basis of the International Classification of Functioning, Disability and Health (ICF) from WHO. This was a cross-sectional, multi-institutional study. The outcome measures included ICF Core Sets for HNC, the EORTC-QLQ, modules c30 + hn35 and the University of Washington-Quality of life Questionnaire (UW-QOL). Analyses included descriptive statistics, ranking exercises, and regression analyses in a cumulative logit model; 27 patients were treated with MVFF and 22 with RCT. Global Quality of life scores suggested a slightly better functional outcome for the surgical approach. The majority of ICF categories (81/93, 87%) did not show a difference in functional outcome between the two treatment approaches. In the remaining 12 ICF categories, n = 3 body structures were more affected in the MVFF group, while n = 3 body functions, and n = 6 activities/participations were more problematic in the RCT group. This included oral swallowing and weight maintenance functions as well as social relationships, acquiring a job, and economic self-sufficiency. In addition, nine contextual environmental factors were more relevant to the RCT group. Both treatment approaches seemed appropriate to advanced HNC from the perspective of functional outcome. The influence of treatment modalities on the social and economic lives of cancer survivors needs to be explored further. In order to guide rehabilitation according to patients' needs, the ICF offers a multidimensional view comprising body structures, body functions, and activities and participation in life.
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Rogers S, Forgie S, Lowe D, Precious L, Haran S, Tschiesner U. Development of the International Classification of Functioning, Disability and Health as a brief head and neck cancer patient questionnaire. Int J Oral Maxillofac Surg 2010; 39:975-82. [DOI: 10.1016/j.ijom.2010.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
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