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Edwards DM, Gharzai LA, Wang W, Mayo C, Suresh K, Schipper M, Evans JR, Malloy K, Chinn SB, Prince M, Spector M, Shuman A, Stucken C, Swiecicki PL, Worden F, Jarema J, Henderson C, Kovach A, Brenner C, Shah JL, Mierzwa ML, Casper K. Follow-up for human papillomavirus-related oropharynx cancer concentrated on unequal symptom change (FOCUS): Prospective patient-reported outcome collection. Head Neck 2024. [PMID: 38680087 DOI: 10.1002/hed.27778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/12/2024] [Accepted: 04/09/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Post-treatment surveillance recommendations for oropharyngeal cancer do not vary with p16 status despite the differences in outcomes. The optimal algorithm personalizing follow-up for these patients remains undefined. Here, we evaluate the feasibility and utility of incorporating electronic patient-reported outcomes (ePROs) and circulating tumor DNA (ctDNA) into routine surveillance for patients treated for p16+ oropharynx cancer. METHODS A prospective registry was developed in which ePROs and ctDNA were incorporated into routine surveillance among patients with oropharynx cancer. ePROs were emailed monthly for 1 year and blood HPV ctDNA testing was performed every 3-6 months. The primary objective was to assess patient compliance with ePRO-based surveillance with adequate compliance defined as ≥85% of patients completing monthly ePROs. Sensitivity, specificity, and positive/negative predictive values to detect recurrence were calculated for ePROs, HPV ctDNA, or the combination. RESULTS Of 122 patients who initially expressed interest, 76 completed the electronic consent process and 44/76 (58%) were compliant with monthly surveys over 1 year; thus adequate compliance was not achieved. Technical difficulties associated with ePRO receipt through email largely limited participation. Provider feedback was significantly associated with heightened ePRO compliance. One hundred and six patients had ctDNA testing with a mean number of three tests per patient. Sensitivity to detect recurrence was 75% for the combination of ePROs and ctDNA. CONCLUSION Despite lower than anticipated compliance with ePROs, our findings show promise for incorporation of HPV ctDNA into surveillance paradigms for HPV-related oropharynx cancer with suggestions of methods to optimize ePRO formats for personalized surveillance.
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Affiliation(s)
- Donna M Edwards
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA
| | - Weilin Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Krithika Suresh
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Joseph R Evans
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly Malloy
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven B Chinn
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Spector
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Shuman
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chaz Stucken
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul L Swiecicki
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis Worden
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Jarema
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin Henderson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Amanda Kovach
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad Brenner
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer L Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
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Wang Y, Hou L, Wang M, Xiang F, Zhao X, Qian M. Autologous Fat Grafting for Functional and Aesthetic Improvement in Patients with Head and Neck Cancer: A Systematic Review. Aesthetic Plast Surg 2023; 47:2800-2812. [PMID: 37605032 DOI: 10.1007/s00266-023-03331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/15/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION The efficacy and safety of autologous fat grafting for use in oncology patients are controversial. Patients with head and neck cancer have complex anatomy and require reconstructive repair of the head and neck after comprehensive treatment. The limited additional aesthetic and functional studies on the use of autologous fat fillers in patients with head and neck cancer are unclear. This study systematically evaluates the additional function of autologous fat fillers in the head and neck and systematically reviews issues related to autologous fat grafting after comprehensive head and neck cancer treatment, including current indications, techniques, potential complications, graft survival, and patient satisfaction. METHODS A systematic literature review was performed using PubMed, The Cochrane Library, EMBASE, and Web of Science (last accessed on January 9, 2023). RESULTS A total of 249 cases of autologous fat fillers in patients with head and neck cancer were reported in 10 clinical publications. Observations were based mainly on subjective physician and patient evaluation indicators, and all studies reported the beneficial effects of autologous fat fillers on aesthetics and function after treatment for head and neck cancer. CONCLUSIONS Autologous fat fillers are effective in improving the aesthetics and function of head and neck cancer, and due to the limitations of the original study, future studies with large samples are needed to support this. PROSPERO registration number is CRD42020222870. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yu Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, Sichuan, China.
- Nursing Department, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Lili Hou
- Nursing Department, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Mingyi Wang
- Department of Oral Maxillofacial and Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Fuping Xiang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, Sichuan, China
- Nursing Department, Affiliated Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xiaomei Zhao
- Department of Oral Maxillofacial and Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Meizhen Qian
- Department of Oral Maxillofacial and Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
- National Center for Stomatology, Shanghai, 200011, China
- National Clinical Research Center for Oral Diseases, Shanghai, 200011, China
- Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
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Williamson A, Jashek-Ahmed F, Hardman J, Paleri V. Functional and quality-of-life outcomes following salvage surgery for recurrent squamous cell carcinoma of the head and neck: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:4597-4618. [PMID: 37329358 DOI: 10.1007/s00405-023-08056-z] [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: 04/25/2023] [Accepted: 06/05/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Recurrent head and neck squamous cell carcinomas (HNSCC) are frequently managed with salvage surgery, but the impact these operations have on function and quality-of-life (QoL) is understudied. This review aimed to provide a quantitative and qualitative assessment of the functional and QoL effects of salvage surgical procedures. METHODS Systematic review and meta-analysis were conducted of studies reporting QoL and function following salvage HNSCC resections. RESULTS The search identified 415 articles and 34 were selected for inclusion. Pooled random effects analysis revealed long-term feeding and tracheostomy tube rates of 18% and 7%. Pooled long-term feeding tube rates in open oral and oropharyngeal, transoral robotic, total and partial laryngectomy surgeries were 41%, 25%, 11% and 4%. Eight studies used validated QoL questionnaires. CONCLUSIONS Functional and QoL outcomes from salvage surgery are acceptable, but appear to be worse following open procedures. Prospective studies measuring changes over time are needed to assess these procedures impact on patient well-being.
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Affiliation(s)
- Andrew Williamson
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK.
- Institute for Cancer Research, London, UK.
| | - Farizeh Jashek-Ahmed
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - John Hardman
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- Institute for Cancer Research, London, UK
| | - Vinidh Paleri
- International Centre for Recurrent Head and Neck Cancer (IReC), Department of Head and Neck Surgery, The Royal Marsden Hospital, London, UK
- Institute for Cancer Research, London, UK
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Han AY, Nader ME, Lam K, Su SY. Current status of sinonasal cancer survivorship care. Head Neck 2023; 45:2458-2468. [PMID: 37449544 DOI: 10.1002/hed.27457] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/16/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
Sinonasal cancer is a heterogeneous orphan disease of diverse histologies, each with distinct clinical, oncologic, and toxicity profiles. Because of the comparative rarity of these cancers, sinonasal cancers are treated as a grouped diagnosis despite their clinical and biological heterogeneity. Multimodality treatment with a combination of surgery, chemotherapy, and/or radiotherapy is the standard-of-care for advanced-stage patients but there are few surveillance or follow-up practice guidelines or formalized survivorship care pathways. A scoping literature review was conducted via PubMed, EMBASE, and Google Scholar. A total of 112 studies were included, which were grouped along the following topics: surveillance, second primary tumors, quality of life, and symptom burden. Sinonasal cancer tends to exhibit a higher rate of local failure and occur in a delayed fashion compared to mucosal malignancies of the head and neck. Moreover, the site of failure and time-varying risk of recurrence is histology-specific. Following multimodality treatment of the skull base, patients may experience endocrine, visual, auditory, sinonasal, olfactory, and neurocognitive deficits, as well as psychosocial impairments that impact multiple physical and neuropsychological domains, resulting in diminished quality of life. Sinonasal cancer patients would benefit from tailored, histology-specific survivorship programs to address the recurrence, second primary, and functional impairments resulting from disease and treatment toxicity.
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Affiliation(s)
- Albert Y Han
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Keng Lam
- Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Huynh TTM, Aass HCD, Falk RS, Astrup GL, Helland Å, Bjøro T, Bjordal K, Dale E, Hellebust TP, Herlofson BB, Malinen E, Kiserud CE, Osnes T, Amdal CD. Associations between patient-reported late effects and systemic cytokines in long-term survivors of head and neck cancer treated with radiotherapy. J Cancer Surviv 2023; 17:1082-1093. [PMID: 36350483 PMCID: PMC9643919 DOI: 10.1007/s11764-022-01273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE Head and neck cancer (HNC) treatment may lead to late effects and impaired health-related quality of life of survivors. Knowledge on long-term late effects after radiotherapy (RT) and potential underlying biological mechanisms is lacking. We assessed the prevalence of xerostomia, dysphagia, and chronic fatigue (CF) in HNC survivors ≥ 5 years post-RT, and examined associations between pro-inflammatory cytokines and late effects. METHODS In a cross-sectional study, 263 HNC survivors treated between 2007 and 2013 were enrolled. They completed validated questionnaires assessing xerostomia and dysphagia (the EORTC QLQ-H&N35), and CF (the Fatigue Questionnaire), and underwent blood sampling and clinical examination. Pro-inflammatory cytokines were analyzed in 262 survivors and 100 healthy age- and gender-matched controls. RESULTS Median time since treatment was 8.5 years. The proportions of survivors reporting xerostomia, dysphagia, and CF were 58%, 31%, and 33%, respectively, with a preponderance of females. We found no significant associations between IL-6, IL-8, IP-10, TARC, TNF, or ENA-78 and the three late effects. The odds of having elevated levels of IL-6 and IP-10 were significantly higher in the survivors compared to the controls. CONCLUSIONS More than one-third of long-term HNC survivors experienced xerostomia, dysphagia, and CF. Persistent inflammation, with elevated systemic cytokines, was not associated with these late effects, although HNC survivors had higher levels of some cytokines than the controls. IMPLICATIONS FOR CANCER SURVIVORS This study provides new knowledge on late effects that can serve as grounds for informing patients with HNC about risk of late effects more than 5 years after RT.
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Affiliation(s)
- T T M Huynh
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway.
| | - H C D Aass
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - R S Falk
- Research Support Services, Oslo University Hospital, Oslo, Norway
| | - G L Astrup
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - Å Helland
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - T Bjøro
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - K Bjordal
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Support Services, Oslo University Hospital, Oslo, Norway
| | - E Dale
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - T P Hellebust
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - B B Herlofson
- Faculty of Dentistry, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - E Malinen
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - C E Kiserud
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - T Osnes
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - C D Amdal
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
- Research Support Services, Oslo University Hospital, Oslo, Norway
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Mathew A, Lockwood MB, Steffen A, Tirkey AJ, Pavamani SP, Patil CL, Doorenbos AZ. Symptom Cluster Experiences of Patients Operated for Oral Cancer: A Mixed Methods Study. Semin Oncol Nurs 2023; 39:151407. [PMID: 37024322 PMCID: PMC10258150 DOI: 10.1016/j.soncn.2023.151407] [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: 07/08/2022] [Revised: 02/20/2023] [Accepted: 03/01/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE This convergent mixed methods study aimed to obtain a comprehensive understanding of symptom cluster experiences in patients with oral cancer. Survey and phenomenological interviews were conducted in parallel to identify distinct patient subgroups based on symptom cluster experiences along with their predictors and explore experiences of living with symptom clusters, respectively. DATA SOURCES A convenience sample of 300 patients with oral cancer who had completed surgery provided the quantitative data, and a maximum variation purposive subsample of 20 participants, drawn from the survey sample, provided the qualitative data. Agglomerative hierarchical cluster analysis was used to identify subgroups, multivariate analyses were done to identify predictors, and thematic analysis was used for patient narratives. CONCLUSION Almost 94% of the survey participants had two or more co-occurring symptoms. The four most severe and prevalent symptoms were dysphagia, problems with teeth or gums, speech difficulty, and dry mouth. A distinct subgroup consisting of 61% of patients reported severe dysphagia and teeth problems, which was associated with age, oral cancer stage and site. Interviews revealed the causes and the context influencing the perception and response to these symptoms. Thus, the quantitative data provided information on severity and patient subgroups based on symptom cluster experiences, while the qualitative data validated these conclusions and additionally provided in-depth details and meaningful insight on perceived causes and contextual influences of their experiences. This comprehensive picture of symptom cluster experiences can aid in the development of patient-centered interventions for people with oral cancer. IMPLICATIONS FOR NURSING PRACTICE An interdisciplinary approach to targeting concurrent symptoms incorporating psychological and physical interventions is necessary. Older patients treated for Stage IV cancers and for buccal mucosa tumors are at high-risk of having severe dysphagia postoperatively, and these patients should be targeted for dysphagia interventions. The contextual factors play an important role in developing patient-centered interventions.
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Affiliation(s)
- Asha Mathew
- PhD Scholar, College of Nursing, University of Illinois Chicago, US; Professor, College of Nursing, Christian Medical College Vellore, Tamil Nadu, India
| | - Mark B Lockwood
- Assistant Professor, College of Nursing, University of Illinois Chicago, US
| | - Alana Steffen
- Research Associate Professor, College of Nursing, University of Illinois Chicago, US
| | - Amit Jiwan Tirkey
- Professor, Department of Head and Neck Surgery, Christian Medical College Vellore, Tamil Nadu, India
| | - Simon P Pavamani
- Professor, Department of Radiation Oncology, Christian Medical College Vellore, Tamil Nadu, India
| | - Crystal L Patil
- Professor, College of Nursing, University of Illinois Chicago, US
| | - Ardith Z Doorenbos
- Professor, College of Nursing, University of Illinois Chicago, US; Director of Palliative Care, University of Illinois Cancer Center, Chicago, US.
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Kuhn MA, Gillespie MB, Ishman SL, Ishii LE, Brody R, Cohen E, Dhar SI, Hutcheson K, Jefferson G, Johnson F, Rameau A, Sher D, Starmer H, Strohl M, Ulmer K, Vaitaitis V, Begum S, Batjargal M, Dhepyasuwan N. Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2023; 168:571-592. [PMID: 36965195 DOI: 10.1002/ohn.302] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/16/2023] [Accepted: 02/01/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer opportunities for quality improvement. Dysphagia in HNC was defined as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx. METHODS Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers managing dysphagia in adult HNC populations. The development group prioritized topics where there was significant practice variation and topics that would improve the quality of HNC patient care if consensus were possible. RESULTS The development group identified 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized definition for consensus; 12 statements were designated as no consensus. CONCLUSION Expert consensus was achieved for 48 statements pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to dysphagia in HNC patients.
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Affiliation(s)
- Maggie A Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stacey L Ishman
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa E Ishii
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University Medical Institute, Cockeysville, Maryland, USA
| | - Rebecca Brody
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, West Linn, Oregon, USA
| | - Ezra Cohen
- Moores Cancer Center at UC San Diego Health, La Jolla, California, USA
| | | | - Kate Hutcheson
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Center, Houston, Texas, USA
| | - Gina Jefferson
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Surgical Oncology/Microvascular Reconstruction, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Anais Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - David Sher
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Madeleine Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Karen Ulmer
- Milton J Dance, Jr Head and Neck Cancer at GBMC, Baltimore, Maryland, USA
| | - Vilija Vaitaitis
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Charleston, South Carolina, USA
| | - Sultana Begum
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Misheelt Batjargal
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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8
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Price K, Van Abel KM, Moore EJ, Patel SH, Hinni ML, Chintakuntlawar AV, Graner D, Neben-Wittich M, Garces YI, Price DL, Janus JR, Foster NR, Ginos BF, Foote RL, Ma D. Long-term Toxicity, Swallow Function, and Quality of Life on MC1273, a Phase II Study of Dose De-escalation for Adjuvant Chemoradiation in HPV-Positive Oropharyngeal Cancer (HPV-OPC). Int J Radiat Oncol Biol Phys 2022; 114:256-265. [PMID: 35675850 DOI: 10.1016/j.ijrobp.2022.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with HPV-OPC are highly curable but risk significant long-term toxicity with standard therapy. This study investigated a de-escalation strategy of decreased adjuvant radiotherapy (RT) and chemotherapy after transoral robotic surgery, and reports on long-term functional and quality of life (QOL) outcomes. METHODS Eligible patients had a p16-positive OPC and ≤10 pack-year smoking history and underwent surgery followed by treatment with either 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks with weekly docetaxel (15 mg/m2) if they had intermediate pathologic risk factors or 36 Gy in 1.8-Gy fractions twice per day over 2 weeks with the same chemotherapy if they had extranodal extension. Toxicity, swallow function, and QOL were measured longitudinally. RESULTS Seventy-nine patients (89.9% male) were treated and eligible for toxicity and functional evaluation. Dry mouth was the most common grade 1 toxicity at 1 year (55.6%), 2 years (53.3%) and 3 years (49.2%). The cumulative rates of grade 2 toxicities at 1, 2, and 3 years, were 1.4%, 6.7%, and 6.8%. There were only two grade 3 toxicities at ≥ 1 year, including a grade 3 fatigue at 2 ½ years, and a grade 3 superficial soft tissue fibrosis at 4 years. There were no grade 4-5 toxicities. No patients were PEG dependent. Swallow function improved by 12 months post-treatment. QOL improved over time by all measurement tools and most patients returned to baseline level of function and QOL. CONCLUSION De-escalated adjuvant therapy for select patients with HPV-OPC resulted in low rates of long-term toxicity, excellent swallow outcomes, and preservation of global and xerostomia-related QOL.
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Affiliation(s)
- Katharine Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
| | | | - Eric J Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Michael L Hinni
- Department of Otolaryngology, Mayo Clinic, Scottsdale, Arizona
| | | | - Darlene Graner
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel L Price
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey R Janus
- Department of Otolaryngology, Mayo Clinic, Jacksonville, Florida
| | - Nathan R Foster
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Brenda F Ginos
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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9
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Zhu Z, Sun Y, Kuang Y, Yuan X, Gu H, Zhu J, Xing W. Contemporaneous symptom networks of multidimensional symptom experiences in cancer survivors: A network analysis. Cancer Med 2022; 12:663-673. [PMID: 35651298 PMCID: PMC9844664 DOI: 10.1002/cam4.4904] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have explored the symptom networks of multidimensional symptom experiences in cancer survivors. The objectives of this study were to generate symptom networks of multidimensional symptom experiences in cancer survivors and explore the centrality indices and density in these symptom networks METHODS: Data from 1065 cancer survivors were obtained from the Shanghai CANcer Survivor (SCANS) Report. The MD Anderson Symptom Inventory was used to assess the prevalence and severity of 13 cancer-related symptoms. We constructed contemporaneous networks with all 13 symptoms after controlling for covariates. RESULTS Distress (rs = 9.18, rc = 0.06), sadness (rs = 9.05, rc = 0.06), and lack of appetite (rs = 9.04, rc = 0.06) had the largest values for strength and closeness. The density of the "less than 5 years" network was significantly different from that of the "5-10 years" and "over 10 years" networks (p < 0.001). We found that while fatigue was the most severe symptom in cancer survivorship, the centrality of fatigue was lower than that of the majority of other symptoms. CONCLUSION Our study demonstrates the need for the assessment of centrality indices and network density as an essential component of cancer care, especially for survivors with <5 years of survivorship. Future studies are warranted to develop dynamic symptom networks and trajectories of centrality indices in longitudinal data to explore causality among symptoms and markers of interventions.
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Affiliation(s)
- Zheng Zhu
- School of NursingFudan UniversityShanghaiChina,Fudan University Centre for Evidence‐based Nursing: A Joanna Briggs Institute Centre of ExcellenceFudan UniversityShanghaiChina
| | - Yanling Sun
- School of Public HealthFudan UniversityShanghaiChina
| | - Yi Kuang
- School of NursingFudan UniversityShanghaiChina
| | - Xiaoyi Yuan
- School of NursingFudan UniversityShanghaiChina
| | - Haiyan Gu
- Department of Chronic Disease Prevention and ControlXuhui District Center for Disease Control and PreventionShanghaiChina
| | - Jing Zhu
- Department of Chronic Disease Prevention and ControlXuhui District Center for Disease Control and PreventionShanghaiChina
| | - Weijie Xing
- School of NursingFudan UniversityShanghaiChina,Fudan University Centre for Evidence‐based Nursing: A Joanna Briggs Institute Centre of ExcellenceFudan UniversityShanghaiChina
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10
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Weppler S, Quon H, Schinkel C, Yarschenko A, Barbera L, Harjai N, Smith W. Patient-Reported Outcomes-Guided Adaptive Radiation Therapy for Head and Neck Cancer. Front Oncol 2021; 11:759724. [PMID: 34737963 PMCID: PMC8560706 DOI: 10.3389/fonc.2021.759724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 01/12/2023] Open
Abstract
Purpose To identify which patient-reported outcomes (PROs) may be most improved through adaptive radiation therapy (ART) with the goal of reducing toxicity incidence among head and neck cancer patients. Methods One hundred fifty-five head and neck cancer patients receiving radical VMAT (chemo)radiotherapy (66-70 Gy in 30-35 fractions) completed the MD Anderson Symptom Inventory, MD Anderson Dysphagia Inventory (MDADI), and Xerostomia Questionnaire while attending routine follow-up clinics between June-October 2019. Hierarchical clustering characterized symptom endorsement. Conventional statistical approaches indicated associations between dose and commonly reported symptoms. These associations, and the potential benefit of interfractional dose corrections, were further explored via logistic regression. Results Radiotherapy-related symptoms were commonly reported (dry mouth, difficulty swallowing/chewing). Clustering identified three patient subgroups reporting: none/mild symptoms for most items (60.6% of patients); moderate/severe symptoms affecting some aspects of general well-being (32.9%); and moderate/severe symptom reporting for most items (6.5%). Clusters of PRO items broadly consisted of acute toxicities, general well-being, and head and neck-specific symptoms (xerostomia, dysphagia). Dose-PRO relationships were strongest between delivered pharyngeal constrictor Dmean and patient-reported dysphagia, with MDADI composite scores (mean ± SD) of 25.7 ± 18.9 for patients with Dmean <50 Gy vs. 32.4 ± 17.1 with Dmean ≥50 Gy. Based on logistic regression models, during-treatment dose corrections back to planned values may confer ≥5% decrease in the absolute risk of self-reported physical dysphagia symptoms ≥1 year post-treatment in 1.2% of patients, with a ≥5% decrease in relative risk in 23.3% of patients. Conclusions Patient-reported dysphagia symptoms are strongly associated with delivered dose to the pharyngeal constrictor. Dysphagia-focused ART may provide the greatest toxicity benefit to head and neck cancer patients, and represent a potential new direction for ART, given that the existing ART literature has focused almost exclusively on xerostomia reduction.
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Affiliation(s)
- Sarah Weppler
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Harvey Quon
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Colleen Schinkel
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Adam Yarschenko
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Mechanical Engineering, University of Calgary, Calgary, AB, Canada
| | - Lisa Barbera
- Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Nabhya Harjai
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Wendy Smith
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada.,Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
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11
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Nallani R, Smith JB, Penn JP, Bur AM, Kakarala K, Shnayder Y, Villwock MR, Sykes KJ. Decision regret 3 and 6 months after treatment for head and neck cancer: An observational study of associations with clinicodemographics, anxiety, and quality of life. Head Neck 2021; 44:59-70. [PMID: 34704319 DOI: 10.1002/hed.26911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND While quality of life (QOL), psychosocial health, and adverse treatment outcomes have been studied in head and neck cancer (HNC) patients, decision regret is an important and understudied complication that can negatively impact future health care decision making. METHODS Data collected using a HNC patient registry with questionnaires administered at initial consultation visits plus 3 and 6 months after treatment completion was retrospectively analyzed. A visual analog anxiety scale and the University of Washington Quality of Life were given at clinic visits. Decision regret was determined using a validated scale. Demographic and clinical variables were collected retrospectively and at baseline. RESULTS Patients with higher anxiety and lower self-reported QOL had higher concurrent regret at 3-month (n = 140) and at 6-month (n = 82) post-treatment. Later disease stage at presentation, nonprimary surgical treatment, and lower health literacy were associated with greater regret. CONCLUSIONS Decision regret was highest in HNC patients with high anxiety, low QOL, and more advanced disease.
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Affiliation(s)
- Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joshua B Smith
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Joseph P Penn
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andres M Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mark R Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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12
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Mathew A, Tirkey AJ, Li H, Steffen A, Lockwood MB, Patil CL, Doorenbos AZ. Symptom Clusters in Head and Neck Cancer: A Systematic Review and Conceptual Model. Semin Oncol Nurs 2021; 37:151215. [PMID: 34483015 PMCID: PMC8492544 DOI: 10.1016/j.soncn.2021.151215] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The two approaches to symptom-cluster research include grouping symptoms and grouping patients. The objective of this systematic review was to examine the conceptual approaches and methodologies used in symptom-cluster research in patients with head and neck cancer. DATA SOURCES Articles were retrieved from electronic databases (CINAHL, MEDLINE via Ovid, APA PsycINFO, Scopus, Embase, and Cochrane Central Register of Controlled Trials-CENTRAL), five grey literature portals, and Google Scholar. Seventeen studies met the eligibility criteria. Eight studies grouped symptoms to identify symptom clusters, of which two used qualitative methods. The number of symptom clusters ranged from two to five, and the number of symptoms in a cluster ranged from 2 to 11. Nine studies grouped patients based on their experiences with multiple symptoms. Cluster analysis and factor analysis were most commonly used. Despite variable names and composition of symptom clusters, synthesis revealed three prominent symptom clusters: general, head and neck cancer-specific, and gastrointestinal. Being female and quality of life were significantly associated with high symptom group or cluster severity. Biological mechanisms were sparsely examined. CONCLUSION Symptom cluster research in head and neck cancer is emerging. Consensus on nomenclature of a symptom cluster will facilitate deduction of core clinically relevant symptom clusters in head and neck cancer. Further research is required on understanding patients' subjective experiences, identifying predictors and outcomes, and underlying mechanisms for symptom clusters. IMPLICATIONS FOR NURSING PRACTICE Identification of clinically relevant symptom clusters would enable targeted symptom assessment and management strategies, thus improving treatment efficiencies and patient outcomes.
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Affiliation(s)
- Asha Mathew
- College of Nursing, University of Illinois, Chicago; Christian Medical College, Vellore, India.
| | | | - Hongjin Li
- College of Nursing, University of Illinois, Chicago; Christian Medical College, Vellore, India
| | | | | | | | - Ardith Z Doorenbos
- College of Nursing, University of Illinois, Chicago; University of Illinois Cancer Center, Chicago
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13
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Lowe SM, Nobriga CV. Head and Neck Cancer in a Rural U.S. Population: Quality of Life, Coping, Health Care Literacy, and Access to Services. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1116-1133. [PMID: 33970685 DOI: 10.1044/2021_ajslp-20-00223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of this study was to explore the beliefs, access, and motivations of individuals with head and neck cancer (HNC) living in a rural community in the United States, regarding their speech and swallowing deficits. Method A convenience sample of nine patient participants with HNC and nine caregiver participants completed in-depth, semistructured interviews regarding their experiences with HNC diagnosis and treatment. The researchers utilized a thematic networks approach to analyze the qualitative data obtained. Results Primary results of the study were a set of common themes emerging from 735 units for analysis, arranged into 34 basic themes, nine organizing themes, and four global themes. The resulting networks centered around quality of life impact, coping, health literacy, and access. Direct quotes from the participants are utilized to illustrate response categories. Conclusions Individuals with HNC and their caregivers living in rural communities in the United States appear to represent a unique subset of the HNC population. While they present similarly in most areas, they display unique tendencies in the areas of psychological coping, health literacy, and access. Provision of practical, pertinent information that can be accessed by patients and caregivers alike outside the hospital is suggested to better serve this community.
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Affiliation(s)
- Shawn M Lowe
- Department of Communication Sciences and Disorders, Loma Linda University, CA
| | - Christina V Nobriga
- Department of Communication Sciences and Disorders, Loma Linda University, CA
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14
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Not Just Dyspnoea: Swallowing as a Concern for Adults with Laryngotracheal Stenosis Undergoing Airway Reconstruction. Dysphagia 2021; 37:365-374. [PMID: 33830348 PMCID: PMC8948149 DOI: 10.1007/s00455-021-10287-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/16/2021] [Indexed: 10/25/2022]
Abstract
Acquired laryngotracheal stenosis (LTS) is a rare condition causing dyspnea and stridor. Patients often require multiple surgical procedures with no guarantee of a definitive outcome. Difficulty swallowing is a recognised problem associated with LTS and the reconstructive surgeries required to manage the condition. The breathlessness patient's experience impacts on swallowing, and the vulnerable structures of the larynx are implicated during complex surgeries. This leads to dysphagia post-surgery, with some patients experiencing more chronic symptoms depending on the biomechanical impact of the surgery, or a pre-existing dysphagia. Despite this there is limited observational research about the dysphagia associated with LTS, with no exploration of the patient experience. Our aim was to investigate patient experience of living with LTS focussing on dysphagia in order to guide clinical practice. A qualitative study was completed using focus groups and semi-structured interviews with 24 patients who have had reconstructive surgery for LTS. Thematic analysis was used to identify three over-arching themes: The Physical Journey, The Emotional Journey and The Medical Journey. Key sub-themes included the importance of self-management and control, presence of symptoms, benefits of therapy, living with a life-long condition, fear and anxiety, autonomy, medicalisation of normal processes and the dichotomy between staff expertise and complacency. Swallowing was connected to all themes. The results are reviewed with consideration of the wider literature of lived experience particularly in relation to other chronic conditions and those that carry a high symptom burden such as head and neck cancer. Future clinical and research recommendations have been made. Akin to other clinical groups, adults with LTS are keen that management of their swallowing is person-centred and holistic.
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15
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Yao CMKL, Hutcheson KA. Quality of Life Implications After Transoral Robotic Surgery for Oropharyngeal Cancers. Otolaryngol Clin North Am 2020; 53:1117-1129. [PMID: 32917421 DOI: 10.1016/j.otc.2020.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Oropharyngeal cancers and their treatment can exquisitely affect a patient's quality of life and functional outcome. Transoral robotic surgery offers a minimally invasive surgical approach that mitigates injury from traditional open surgical approaches and offers a treatment more likely to have short-term side effects compared with nonsurgical treatment. Feeding tube dependence, oral intake, and swallowing questionnaires, in addition to swallowing evaluations provide a snapshot of a patient's current swallowing function. Investigation of patient-reported quality-of-life outcomes allows for understanding of their symptomatology and the comparison of different treatment strategies.
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Affiliation(s)
- Christopher M K L Yao
- Advanced Head and Neck Surgical Oncology and Microvascular Reconstruction, Department of Head and Neck Surgery, The University of Texas at MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas at MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA; Division of Radiation Oncology, The University of Texas at MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1445, Houston, TX 77030, USA.
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16
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Kristensen MB, Wessel I, Beck AM, Dieperink KB, Mikkelsen TB, Møller JJK, Zwisler AD. Effects of a Multidisciplinary Residential Nutritional Rehabilitation Program in Head and Neck Cancer Survivors-Results from the NUTRI-HAB Randomized Controlled Trial. Nutrients 2020; 12:nu12072117. [PMID: 32708864 PMCID: PMC7400860 DOI: 10.3390/nu12072117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022] Open
Abstract
Head and neck cancer survivors frequently experience nutritional challenges, and proper rehabilitation should be offered. The trial objective was to test the effect of a multidisciplinary residential nutritional rehabilitation programme addressing physical, psychological, and social aspects of eating problems after treatment. In a randomized controlled trial, 71 head and neck cancer survivors recruited through a nationwide survey were randomized to the program or a wait-list control group. Inclusion was based on self-reported interest in participation. The primary outcome was change in body weight. Secondary outcomes included physical function, quality of life, and symptoms of anxiety and depression. Differences between groups at the 3-month follow-up were tested. No significant differences were seen in body weight change, but there were overall trends towards greater improvements in physical function (hand grip strength: p = 0.042; maximal mouth opening: p = 0.072) and quality of life ("Role functioning": p = 0.041; "Speech problems": p = 0.040; "Pain": p = 0.048) in the intervention group. To conclude, a multidisciplinary residential nutritional rehabilitation program had no effect on body weight in head and neck cancer survivors with self-reported interest in participation, but it may have effect on physical function and quality of life. Further research on relevant outcomes, inclusion criteria, and the program's effect in different subgroups is needed.
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Affiliation(s)
- Marianne Boll Kristensen
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, J.B. Winsløws Vej 9A, 5000 Odense C, Denmark
- Correspondence: ; Tel.: +45-2429-6329
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark;
| | - Anne Marie Beck
- Department of Nursing and Nutrition, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark;
- Dietetics and Clinical Nutrition Research Unit, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 50, 4. 2730 Herlev, Denmark
| | - Karin B. Dieperink
- Research Unit of Oncology, Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark;
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19.3, DK-5000 Odense C, Denmark
| | - Tina Broby Mikkelsen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
| | - Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Vestergade 17, 5800 Nyborg, Denmark; (T.B.M.); (J.-J.K.M.); (A.-D.Z.)
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