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Lorenz FJ, King TS, Engle L, Beauchamp‐Perez F, Goyal N. Predictors of Quality of Life for Head and Neck Cancer Patients at an Academic Institution. OTO Open 2023; 7:e82. [PMID: 37794985 PMCID: PMC10546382 DOI: 10.1002/oto2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023] Open
Abstract
Objective Quality of life (QOL) is an important consideration in head and neck cancer (HNC) due to lasting disease and treatment-related toxicities. We performed a comprehensive review of predictors of QOL in this population, including distance to care. Study Design Retrospective cohort study from 2017 to 2022. Setting Academic medical center. Methods QOL was quantified in patients treated for HNC utilizing the University of Washington Quality of Life and 20-Item Short Form surveys completed at subsequent clinic visits. Distance to treatment center and other demographic, socioeconomic, disease-specific, and behavioral data were analyzed. Results There were 176 patients in the cohort (69% male; mean age, 64 ± 10.8 years). There was no association between miles traveled and any of the QOL subscales. Marital status was the strongest predictor of QOL, significantly associated with 7/8 QOL domains and favoring those who were married. Other significant predictors of decreased QOL included emotional/physical abuse, current tobacco use, documented religious affiliation, and treatment involving surgery plus adjuvant therapy. A significant positive trend over time existed for multiple QOL subscales. Conclusion QOL is unchanged in patients who travel greater distances for care. QOL is more closely linked to factors such as marital status, physical/emotional abuse, tobacco use, religious affiliation, treatment intensity, and time following surgery. This highlights the importance of a strong support structure and the influence of certain socioeconomic and lifestyle factors on patients, with opportunities for screening and intervention throughout their cancer care.
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Affiliation(s)
- F. Jeffrey Lorenz
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Tonya S. King
- Department of Public Health SciencesPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Linda Engle
- Department of Public Health SciencesPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Francis Beauchamp‐Perez
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Neerav Goyal
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
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Morse E, Lohia S, Dooley LM, Gupta P, Roman BR. Travel distance is associated with stage at presentation and laryngectomy rates among patients with laryngeal cancer. J Surg Oncol 2021; 124:1272-1283. [PMID: 34390494 DOI: 10.1002/jso.26643] [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] [Received: 03/14/2021] [Revised: 07/18/2021] [Accepted: 08/03/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The impact of travel distance on stage at presentation and management strategies of laryngeal squamous cell carcinoma (SCC) is unknown. We investigated this relationship. METHODS Retrospective review of patients with laryngeal SCC in the National Cancer Data Base from 2004 to 2016. Multivariate analysis determined relationships between travel distance, sociodemographic, geographic, and hospital factors. Logistic regression determined the influence of travel distance on T-stage and overall stage at presentation, and receipt of total laryngectomy. RESULTS Sixty thousand four hundred and thirty-nine patients were divided into groups based on distance to treatment: short (<12.5 miles); intermediate (12.5-49.9 miles); and long (>50 miles). Increased travel was associated with T4-stage (intermediate vs. short OR 1.11, CI 1.04-1.18, p = 0.001; long vs. short OR 1.5, CI 1.36-1.65, p < 0.001), and total laryngectomy (intermediate vs. short OR 1.40, CI 1.3-1.5, p ≤ 0.001; long vs. short OR 2.52, CI 2.28-2.79, p ≤ 0.001). In T4 disease, total laryngectomy was associated with improved survival compared to nonsurgical treatment (HR 0.75, CI 0.70-0.80, p < 0.001) regardless of travel distance. CONCLUSION Longer travel distance to care is associated with increased stage at presentation, rate of laryngectomy, and improved survival in advanced laryngeal SCC. Health policy efforts should be directed towards improving early access to diagnosis and care.
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Affiliation(s)
- Elliot Morse
- Department of Otolaryngology, Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Shivangi Lohia
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, USA
| | - Laura M Dooley
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, USA
| | - Piyush Gupta
- Department of Otolaryngology, University of Missouri, Columbia, Missouri, USA
| | - Benjamin R Roman
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Bachmann AS, Zaunbauer AC, Tolke AM, Siniatchkin M, Kluck C, Wiltfang J, Hertrampf K. Well-being and quality of life among oral cancer patients – Psychological vulnerability and coping responses upon entering initial treatment. J Craniomaxillofac Surg 2018; 46:1637-1644. [DOI: 10.1016/j.jcms.2018.05.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/26/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022] Open
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Kjaer T, Dalton SO, Andersen E, Karlsen R, Nielsen AL, Hansen MK, Frederiksen K, Johansen C. A controlled study of use of patient-reported outcomes to improve assessment of late effects after treatment for head-and-neck cancer. Radiother Oncol 2016; 119:221-8. [PMID: 27178143 DOI: 10.1016/j.radonc.2016.04.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE To test the effect of longitudinal feedback on late effects reported by survivors of head-and-neck cancer (HNC) to clinicians during regular follow-up. MATERIAL AND METHODS A total of 266 participants were sequentially assigned to either control or intervention group and filled in electronic versions of the EORTC QLQ C-30, H&N35, HADS and a study-specific list of symptoms at up to two consecutive follow-up visits. Participants' symptoms displayed according to severity were provided to the clinician for the intervention group but not for the control group. Linear mixed-effects models were used to examine the number of symptoms assessed by clinicians (primary outcome). Multivariate linear regression models examined participants' long-term symptom control and QoL (secondary outcome). RESULTS More symptoms were assessed by clinicians in the intervention group at all three visits (P<0.001, <0.001, and P=0.04). No effect was observed on most patient outcomes. When prompted by patient-reported outcomes at consultations, clinicians and patients were in better agreement about the occurrence of severe symptoms at all three visits. CONCLUSION Timely patient-reported outcomes to clinicians in routine follow-up of HNC survivors enhanced clinicians' rates of assessment of late symptoms. Giving reports of patient-reported outcome to clinicians had limited impact on participants' QoL or symptom burden.
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Affiliation(s)
- Trille Kjaer
- Danish Cancer Society Research Center, Copenhagen, Denmark.
| | | | - Elo Andersen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Denmark
| | - Randi Karlsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Merete Kjaer Hansen
- Department of Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Department of Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Chu KP, Habbous S, Kuang Q, Boyd K, Mirshams M, Liu FF, Espin-Garcia O, Xu W, Goldstein D, Waldron J, O'Sullivan B, Huang SH, Liu G. Socioeconomic status, human papillomavirus, and overall survival in head and neck squamous cell carcinomas in Toronto, Canada. Cancer Epidemiol 2015; 40:102-12. [PMID: 26706365 DOI: 10.1016/j.canep.2015.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/17/2015] [Accepted: 11/21/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite universal healthcare in some countries, lower socioeconomic status (SES) has been associated with worse cancer survival. The influence of SES on head and neck cancer (HNC) survival is of immense interest, since SES is associated with the risk and prognostic factors associated with this disease. PATIENTS AND METHODS Newly diagnosed HNC patients from 2003 to 2010 (n=2124) were identified at Toronto's Princess Margaret Cancer Centre. Principal component analysis was used to calculate a composite score using neighbourhood-level SES variables obtained from the 2006 Canada Census. Associations of SES with overall survival were evaluated in HNC subsets and by p16 status (surrogate for human papillomavirus). RESULTS SES score was higher for oral cavity (n=423) and p16-positive oropharyngeal cancer (OPC, n=404) patients compared with other disease sites. Lower SES was associated with worse survival [HR 1.14 (1.06-1.22), p=0.0002], larger tumor staging (p<0.001), current smoking (p<0.0001), heavier alcohol consumption (p<0.0001), and greater comorbidity (p<0.0002), but not with treatment regimen (p>0.20). After adjusting for age, sex, and stage, the lowest SES quintile was associated with the worst survival only for OPC patients [HR 1.66 (1.09-2.53), n=832], primarily in the p16-negative subset [HR 1.63 (0.96-2.79)]. The predictive ability of the prognostic models improved when smoking/alcohol was added to the model (c-index 0.71 vs. 0.69), but addition of SES did not (c-index 0.69). CONCLUSION SES was associated with survival, but this effect was lost after accounting for other factors (age, sex, TNM stage, smoking/alcohol). Lower SES was associated with greater smoking, alcohol consumption, comorbidity, and stage.
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Affiliation(s)
- K P Chu
- Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada
| | - S Habbous
- Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada
| | - Q Kuang
- Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada
| | - K Boyd
- Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada
| | - M Mirshams
- Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada
| | - F-F Liu
- Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - O Espin-Garcia
- Department of Biostatistics, Princess Margaret Hospital, Toronto, Canada
| | - W Xu
- Department of Biostatistics, Princess Margaret Hospital, Toronto, Canada
| | - D Goldstein
- Otolaryngology-Head and Neck Surgery, University of Toronto, Canada
| | - J Waldron
- Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - B O'Sullivan
- Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - S H Huang
- Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | - G Liu
- Medicine and Epidemiology, Dalla Lana School of Public Health, University of Toronto, Canada.
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Kjaer T, Johansen C, Andersen E, Karlsen R, Nielsen AL, Frederiksen K, Rørth M, Dalton SO. Do we reach the patients with the most problems? Baseline data from the WebCan study among survivors of head-and-neck cancer, Denmark. J Cancer Surviv 2015; 10:251-60. [DOI: 10.1007/s11764-015-0471-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 11/12/2022]
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Wissinger E, Griebsch I, Lungershausen J, Byrnes M, Travers K, Pashos CL. The humanistic burden of head and neck cancer: a systematic literature review. PHARMACOECONOMICS 2014; 32:1213-1229. [PMID: 25145800 DOI: 10.1007/s40273-014-0199-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Head and neck cancer (HNC) and its treatment can affect communication, nutrition, and physical appearance, and the global impact of this disease on patients' quality of life may be substantial. OBJECTIVE The aim of this systematic literature review was to describe the impact of HNC and its treatment on the physical, emotional, and social well-being of patients over time, by examining longitudinal studies of patient-reported outcomes (PRO) evaluating these domains. METHODS Databases (MEDLINE and Embase) were searched to identify studies published in English between January 2004 and January 2014 analyzing the humanistic aspects of HNC in adult patients. Additional relevant publications were identified through manual searches of abstracts from recent conference proceedings. RESULTS Of 1,566 studies initially identified, 130 met the inclusion criteria and were evaluated in the assessment. Investigations using a variety of PRO instruments in heterogeneous patient populations consistently reported that PRO scores decrease significantly from diagnosis through the treatment period, but generally recover to baseline in the first year post-treatment. This trend was observed for many functional domains, although some side effects, such as xerostomia, persisted well beyond 1 year. In addition, considerable evidence exists that baseline PRO scores can predict clinical endpoints such as overall and progression-free survival. CONCLUSIONS Many aspects of HNC, both disease and treatment specific, profoundly affect patients' quality of life. Improved knowledge of these effects on PRO may allow for more informed treatment decisions and can help physicians to better prepare patients for changes they may experience during therapy. Furthermore, the predictive value of baseline PRO data may enable healthcare providers to identify at-risk patients in need of more intensive intervention.
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David MC, van der Pols JC, Williams GM, Alati R, Green AC, Ware RS. Risk of attrition in a longitudinal study of skin cancer: logistic and survival models can give different results. J Clin Epidemiol 2013; 66:888-95. [DOI: 10.1016/j.jclinepi.2013.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 03/01/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
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Vangeest JB, Johnson TP. Using incentives in surveys of cancer patients: do "best practices" apply? Cancer Causes Control 2012; 23:2047-52. [PMID: 23076587 DOI: 10.1007/s10552-012-0082-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 10/05/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE Surveys of cancer patients are an important means of collecting data necessary to improve cancer prevention and control. However, health surveys generally are characterized by declining response rates, with incentives often employed to encourage participation. While successful, magnitude of effect is partially dependent upon situational characteristics of respondents, including health status. Given the health challenges experienced by cancer patients, it is unclear to what extent incentives can improve survey participation. In this study, we examine the effectiveness of monetary and non-monetary incentives in improving response to cancer patient surveys. METHODS We reviewed the available experimental literature regarding efforts to improve response rates among cancer patients/survivors via incentives. Relevant studies were identified through searches of the MEDLINE, PubMed, and PsychINFO databases from 1975 to 2012. Seed sources (e.g., Cancer Causes & Control, Cancer Epidemiology, Biomarkers & Prevention, and BMC Medical Research Methodology) were also referenced extensively in order to establish a comprehensive set of studies. RESULTS Although limited, evidence does suggest that token incentives may be less effective for improving survey participation among cancer patients, relative to other population groups. These results are contrary to well-established evidence regarding the efficacy of incentives in improving survey participation generally. Potential reasons why incentives may be less effective in this population are explored. CONCLUSIONS While more research is necessary, results suggest that survey research strategies targeting cancer patients be purposively designed in a manner that gives consideration to the distress associated with the condition, including selection of alternative strategies to improve response.
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Affiliation(s)
- Jonathan B Vangeest
- College of Public Health, Kent State University, P.O. Box 5190, Kent, OH 44242-0001, USA.
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Junn JC, Kim IA, Zahurak ML, Tan M, Fan KY, Lake ST, Zaboli D, Messing BP, Ulmer K, Harrer KB, Gold D, Ryniak KL, Zinreich ES, Tang M, Levine MA, Blanco RG, Saunders JR, Califano JA, Ha PK. Multidisciplinary service utilization pattern by advanced head and neck cancer patients: a single institution study. Int J Otolaryngol 2012; 2012:628578. [PMID: 23118755 PMCID: PMC3483826 DOI: 10.1155/2012/628578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 09/26/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose. To analyze the patterns and associations of adjunctive service visits by head and neck cancer patients receiving primary, concurrent chemoradiation therapy. Methods. Retrospective chart review of patients receiving adjunctive support during a uniform chemoradiation regimen for stages III-IV head and neck squamous cell carcinoma. Univariate and multivariate models for each outcome were obtained from simple and multivariate linear regression analyses. Results. Fifty-two consecutive patients were assessed. Female gender, single marital status, and nonprivate insurance were factors associated with an increased number of social work visits. In a multivariate analysis, female gender and marital status were related to increased social work services. Female gender and stage IV disease were significant for increased nursing visits. In a multivariate analysis for nursing visits, living greater than 20 miles between home and hospital was a negative predictive factor. Conclusion. Treatment of advanced stage head and neck cancer with concurrent chemoradiation warrants a multidisciplinary approach. Female gender, single marital status, and stage IV disease were correlated with increased utilization of social work and nursing services. Distance over 20 miles from the center was a negative factor. This information may help guide the treatment team to allocate resources for the comprehensive care of patients.
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Affiliation(s)
| | - Irene A. Kim
- Department of Otolaryngology, University of California, Los Angeles, CA, USA
| | | | - Marietta Tan
- Johns Hopkins Department of Otolaryngology, Baltimore, MD, USA
| | | | - Spencer T. Lake
- Johns Hopkins Department of Otolaryngology, Baltimore, MD, USA
| | - David Zaboli
- Department of Otolaryngology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Karen Ulmer
- Milton J. Dance Jr. Head and Neck Center, Baltimore, MD, USA
| | - Karen B. Harrer
- Milton J. Dance Jr. Head and Neck Center, Baltimore, MD, USA
| | - Dorothy Gold
- Milton J. Dance Jr. Head and Neck Center, Baltimore, MD, USA
| | - Keri L. Ryniak
- Milton J. Dance Jr. Head and Neck Center, Baltimore, MD, USA
| | | | - Mei Tang
- Department of Medical Oncology, GBMC, Baltimore, MD, USA
| | | | - Ray G. Blanco
- Johns Hopkins Head and Neck Surgery, GBMC, 1550 Orleans Street, Room 5M06, David H Koch Cancer Research Building, Baltimore, MD 21231, USA
| | - John R. Saunders
- Johns Hopkins Head and Neck Surgery, GBMC, 1550 Orleans Street, Room 5M06, David H Koch Cancer Research Building, Baltimore, MD 21231, USA
| | - Joseph A. Califano
- Johns Hopkins Department of Otolaryngology, Baltimore, MD, USA
- Johns Hopkins Head and Neck Surgery, GBMC, 1550 Orleans Street, Room 5M06, David H Koch Cancer Research Building, Baltimore, MD 21231, USA
| | - Patrick K. Ha
- Johns Hopkins Department of Otolaryngology, Baltimore, MD, USA
- Johns Hopkins Head and Neck Surgery, GBMC, 1550 Orleans Street, Room 5M06, David H Koch Cancer Research Building, Baltimore, MD 21231, USA
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