Assessment of functional outcomes in patients with head and neck cancer according to the International Classification of Functioning, Disability and Health Core Sets from the perspective of the multi-professional team: results of 4 Delphi surveys

Giving insights into an ICF training: evaluation of an in-person interactive ICF training in Germany

Introduction

The World Health Organization (WHO) adopted the International Classification of Functioning, Disability and Health (ICF) in 2001. The classification provides a framework for the standardised description of functioning and disability using health and health-related domains. The implementation of the ICF is diverse and has a wide range of applications. A thorough understanding of the ICF classification is essential for successful implementation. We developed and delivered an in-person interactive ICF training to facilitate the implementation of the ICF in Germany. The aim of this paper is to present the evaluation of this in-person interactive ICF training.

Methods

The evaluation was conducted with questionnaires assessing the organisation of the workshops and the knowledge gained during the training using Likert scaled questions. Open-ended questions were used to gather feedback on the further development of the ICF training. Data were analysed descriptively using absolute and relative frequencies. Open-ended questions were analysed qualitatively.

Results

Between 2017 and mid-2020, a team of trainers at the Chair of Public Health and Health Services Research (IBE) at LMU Munich organised 12 in-person interactive ICF trainings with a total of 191 participants. In total 151 participants filled in the questionnaires (response rate: 79.1%). The participants` professional backgrounds were primarily in the social sector (n = 76; 50.3%), clinical sector (n = 36; 23.8%), and administrative sector (n = 31; 20.5%). 42.4% of the participants strongly agreed that the content was relevant to their work, while an additional 51.0% almost agreed. According to this evaluation, 82.1% of the participants would recommend the training to others.

Discussion

A number of constructive suggestions and proposals were made for the further development of the training programme. These mainly related to the content of the training, such as the themes of children and youth and integration assistance.

Validity of functional patient-reported outcomes in head and neck oncology: A systematic review

Malignancy and treatment effects in head and neck oncology can be devastating to functional aspects of patient life such as swallowing, blinking, speech, salivation, and facial expression. Historically, the subjective nature of patient experience has resulted in difficulty with quantification and measurement of functional outcomes. Patient-Reported Outcomes (PROs) are questionnaires developed with patient input, forming the new gold standard for clinician assessment of subjective functional outcomes. The current review aims to identify and characterize the validation of PROs pertaining to four critical functional outcomes in head and neck oncology: swallowing, speech, dry mouth, and chewing. A literature search was conducted using MEDLINE, EMBASE, and the Cochrane databases for published, English language, peer-reviewed abstracts involving patients ≥ 18 years of age. Of 708 results, 705 were excluded at abstract or full text screening for not meeting inclusion criteria, exclusion of head and neck SCC patients in development, or absence of a functional domain measurement. The three reviewed studies-Xerostomia Questionnaire, Swallowing Outcomes After Laryngectomy, and Edmonton 33-exhibited strong reliability and construct and content validity, though two applied only to individual functional outcomes within specific patient populations receiving radiation or laryngectomy. While many PROs have been developed in head and neck oncology, very few properly employed extensive patient input in the development process. Further work must be committed to increasing head and neck cancer patient input in PRO development, particularly in the functional domains of speech and chewing.

Depression, anxiety, fatigue, and quality of life in a large sample of patients suffering from head and neck cancer in comparison with the general population

BACKGROUND

Treatment of head and neck cancer (HNC) often leads to visible and severe functional impairments. In addition, patients often suffer from a variety of psychosocial problems, significantly associated with a decreased quality of life. We aimed to compare depression, anxiety, fatigue and quality of life (QoL) between HNC patients and a large sample of the general population in Germany and to examine the impact of sociodemographic, behavioral and clinical factors on these symptoms.

METHODS

We assessed data of HNC patients during the aftercare consultation at the Leipzig University Medical Center with a patient reported outcome (PRO) tool named "OncoFunction". Depression, anxiety, fatigue and QoL were assessed using validated outcome measures including the PHQ-9, the GAD-2, and the EORTC QLQ-C30 questionnaire.

RESULTS

A total of 817 HNC patients were included in our study and compared to a sample of 5018 individuals of the general German population. HNC patients showed significantly higher levels of impairment in all dimensions assessed. Examination of association between depression, anxiety, fatigue and QoL and clinical as well as sociodemographic variables showed significant relationships between occupational status, ECOG-state, body mass index and time since diagnosis.

CONCLUSIONS

HNC patients suffer significantly from psychological distress. The used questionnaires are suitable for the use in daily routine practice and can be helpful to increase the detection of depression, anxiety and fatigue and therefore can improve HNC aftercare.

Rehabilitation for Cancer Patients

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.

The "Comprehensive ICF Core Set for Head and Neck Cancer": a Delphi consensus survey among German speaking speech and language therapists

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.

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

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.

Inventory of economic evaluation of head and neck oncology from the German perspective

New treatment strategies for head and neck neoplasms include induction chemotherapy and biomarker treatment. Moreover, different therapeutic modalities, especially robotic surgery, induction chemotherapy, biotherapy and altered fractionation schedules of chemo-(radio)therapy are newly combined to optimize treatment benefit and minimize treatment-associated morbidity. Often, overall survival does not change significantly between the competing treatment schedules. Therefore, the evaluation of the patient's treatment-related quality of life (QoL) and organ function becomes more and more important. Finally, the sponsor's financial resources are restricted, which makes it necessary to evaluate therapies for pricing and effectiveness. In head and neck cancer in Europe, analyses of the current situation are lacking. Selective literature research for publications on economic cost-effectiveness analyses was performed. An overview of the current situation with a special focus on Europe is provided. Cost-effectiveness values and QoL assessments should be respected in former prospective study construction to gain systematic information on this topic.

Shoulder pain, functional status, and health-related quality of life after head and neck cancer surgery

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.

Priorities of head and neck cancer patients: a patient survey based on the brief ICF core set for HNC

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.