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Mikhael M, Kansara B, Basta A, Hume E, Nguyen OT, Reblin M, Hong YR, Tabriz AA, Patel K, Magnuson JS, Turner K. Optimizing presurgical education for patients with head and neck cancer receiving laryngectomy and free flap surgery: A qualitative study. Head Neck 2024. [PMID: 38459809 DOI: 10.1002/hed.27729] [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: 09/29/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND There has been limited study of oncology professionals' perspectives on optimizing delivery of presurgical education for individuals with head and neck cancer (HNC). Therefore, we assessed oncology professionals' perspectives about presurgical education for laryngectomy and free flap surgeries, which have a significant impact on patients' quality of life. METHODS Interviews were conducted with 27 oncology professionals from an NCI-designated Comprehensive Cancer Center and a community oncology setting. RESULTS Participants identified six recommendations to improve presurgical education: (1) establishing preoperative consultations with allied health professionals; (2) educating patients and providers on the concept of team-based care; (3) optimizing education through multimodal strategies; (4) connecting patients with other HNC surgical patients; (5) preparing caregivers for their role; and (6) educating patients on insurance navigation. CONCLUSIONS Study findings demonstrate gaps in the timing, content, and mode of delivery for presurgical education and suggest strategies for further evaluation in future studies.
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Affiliation(s)
- Marian Mikhael
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Bhargav Kansara
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Ameer Basta
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Emma Hume
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Oliver T Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Maija Reblin
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Krupal Patel
- Department of Head and Neck Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jeffery Scott Magnuson
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Head and Neck Surgery, AdventHealth Orlando, Orlando, Florida, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Lassig AAD, Lindgren BR, Wilson AC, Joseph AM, Davison M, Yueh B. InCISE: Instrument for Comprehensive Incisional and Surgical Evaluation. Laryngoscope 2023; 133:2166-2173. [PMID: 36226730 PMCID: PMC10097828 DOI: 10.1002/lary.30439] [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: 06/08/2022] [Revised: 08/22/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The evaluation of healing after head and neck surgery is currently qualitative and non-standardized, limiting the quality of surgical healing assessments in clinical and research settings. We sought to develop an objective, standardized wound assessment score, and hypothesize that a reliable instrument can be developed to evaluate head and neck surgical wounds. METHODS A prospective cohort study was conducted in a tertiary-care, academic head and neck surgery practice. Patients undergoing head and neck surgery were enrolled. A digital photograph protocol was developed for evaluating healing surgical wounds. A panel of experts developed and refined a wound healing score and established reliability, reproducibility, internal consistency, and validity of the score. RESULTS InCISE: Instrument for comprehensive incisional and surgical evaluation was created. The utility of our wound healing score was assessed using classical test theory. We performed the major steps of establishing reliability in head and neck surgeons: (1) internal consistency (Cronbach's α = 0.81), (2) inter-observer reliability (intra-class correlation = 0.76), and (3) intra-rater reliability (intra-class correlation = 0.87), and content validity (through focus groups). Our composite measure was found to have strong internal consistency, inter-rater reliability, and intra-rater reliability. Preliminary work suggests criterion validity via associations with physical health related quality of life (SF-12). CONCLUSION A wound healing score for head and neck surgery, InCISE, has been developed and is reliable, reproducible, and consistent. Although content validity is present and criterion validity is suggested, work continues to establish validity in this instrument to allow for expanded clinical and research use. LEVEL OF EVIDENCE NA Laryngoscope, 133:2166-2173, 2023.
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Affiliation(s)
- Amy Anne D. Lassig
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, Hennepin Healthcare Research Institute / Hennepin County Medical Center, Minneapolis, MN USA
| | - Bruce R. Lindgren
- Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN USA
| | - Anna C. Wilson
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, Hennepin Healthcare Research Institute / Hennepin County Medical Center, Minneapolis, MN USA
| | - Anne M. Joseph
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN USA
| | - Mark Davison
- Department of Education, University of Minnesota, Minneapolis, MN USA
| | - Bevan Yueh
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
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Vermaire JA, Raaijmakers CPJ, Monninkhof EM, Leemans CR, Baatenburg de Jong RJ, Takes RP, Leeuw IMVD, Jansen F, Langendijk JA, Terhaard CHJ, Speksnijder CM. The course of swallowing problems in the first 2 years after diagnosis of head and neck cancer. Support Care Cancer 2022; 30:9527-9538. [PMID: 36040669 PMCID: PMC9633522 DOI: 10.1007/s00520-022-07322-w] [Citation(s) in RCA: 4] [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: 05/02/2022] [Accepted: 08/09/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Head and neck cancer (HNC) and its treatment often negatively impact swallowing function. The aim was to investigate the course of patient-reported swallowing problems from diagnosis to 3, 6, 12, and 24 months after treatment, in relation to demographic, clinical, and lifestyle factors. METHODS Data were used of the Netherlands Quality of Life and Biomedical Cohort Study in head and neck cancer research (NET-QUBIC). The primary outcome measures were the subscales of the Swallowing Quality of Life Questionnaire (SWAL-QOL). Linear mixed-effects models (LMM) were conducted to investigate changes over time and associations with patient, clinical, and lifestyle parameters as assessed at baseline. RESULTS Data were available of 603 patients. There was a significant change over time on all subscales. Before treatment, 53% of patients reported swallowing problems. This number increased to 70% at M3 and decreased to 59% at M6, 50% at M12, and 48% at M24. Swallowing problems (i.e., longer eating duration) were more pronounced in the case of female, current smoking, weight loss prior to treatment, and stage III or IV tumor, and were more prevalent at 3 to 6 months after treatment. Especially patients with an oropharynx and oral cavity tumor, and patients receiving (C)RT following surgery or CRT only showed a longer eating duration after treatment, which did not return to baseline levels. CONCLUSION Half of the patients with HNC report swallowing problems before treatment. Eating duration was associated with sex, smoking, weight loss, tumor site and stage, and treatment modality, and was more pronounced 3 to 6 months after treatment.
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Affiliation(s)
- Jorine A Vermaire
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis P J Raaijmakers
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Evelyn M Monninkhof
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC Cancer Center, Rotterdam, the Netherlands
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Chris H J Terhaard
- Department of Radiation Oncology, Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Caroline M Speksnijder
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, G05.122, P.O. Box 85.500, 3508 GA, Utrecht, the Netherlands.
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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Yildiz E, Grasl S, Denk-Linnert DM, Altorjai G, Herrmann H, Grasl MC, Erovic BM, Janik S. Long-Term Swallowing Outcome and Dysphagia in Advanced Staged Head and Neck Squamous Cell Carcinomas after Radiotherapy. J Clin Med 2022; 11:jcm11102688. [PMID: 35628813 PMCID: PMC9143144 DOI: 10.3390/jcm11102688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the impact of radiotherapy (RT) on dysphagia and long-term swallowing outcome in patients with stage III and IV head and neck squamous cell carcinomas (HNSCCs). Material and Methods: Between 2005 and 2008, 189 patients with HNSCCs underwent primary or adjuvant RT in a curative setting. Long-term swallowing outcome was evaluated in 50 patients. Among them, 26 were further eligible for prospective analysis of long-term swallowing and dysphagia outcome. Medical charts were retrospectively reviewed regarding pre- and post-treatment dysphagia (3 months after last irradiation setting) as well as persisting long-term dysphagia (2019−2021). Results: Pre-treatment dysphagia was observed in 24 (48%) of 50 patients, particularly in oropharyngeal or hypopharyngeal stage III−IV tumors (OR 9.3; p = 0.003). Conversely, 46 patients (92%) complained about post-treatment dysphagic symptoms, which were more commonly seen in patients with positive neck nodes (OR 10.5; p = 0.037). The post-treatment dysphagia rate dropped from 92% to 24% (p < 0.001) during surveillance, which was significantly linked to xerostomia (OR 5.77; p = 0.019), dysgeusia (OR 9.9; p = 0.036) and free flap reconstruction (OR 6.1; p = 0.022). Conclusion: Pretreatment dysphagia is common in advanced stage HNSCCs and almost all patients complain about dysphagia at the end of RT. Importantly, applied RT protocols did not affect long-term dysphagia, which improves significantly in the majority of patients over time. Meeting Information: Preliminary results have been presented at the 65th Annual Meeting of the Austrian Society of Otorhinolaryngology, 22−26 September 2021, Austria.
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Affiliation(s)
- Erdem Yildiz
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.G.); (M.C.G.)
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.G.); (M.C.G.)
| | - Doris-Maria Denk-Linnert
- Department of Otorhinolaryngology, Division of Phoniatrics and Speech Language Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Gabriela Altorjai
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria; (G.A.); (H.H.)
| | - Harald Herrmann
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria; (G.A.); (H.H.)
| | - Matthaeus C. Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.G.); (M.C.G.)
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria;
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (E.Y.); (S.G.); (M.C.G.)
- Correspondence:
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Clinicopathological characterization of children with dysphagia, family impact and health-related quality of life of their caregivers. An Pediatr (Barc) 2022; 96:431-440. [DOI: 10.1016/j.anpede.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
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Molnár K, Hietanen S, Liisanantti J, Koivunen P, Lahtinen S. Quality of life after free flap reconstruction for the cancer of the head and neck: Comparison between five-year survivors and non-survivors. Oral Oncol 2022; 128:105855. [DOI: 10.1016/j.oraloncology.2022.105855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 11/12/2022]
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Umezawa H, Umezawa M, Hokazono Y, Matsutani T, Ogawa R. Relationship between pharyngeal or esophageal reconstruction and esophageal pressure after swallowing. Cancer Rep (Hoboken) 2022; 6:e1619. [PMID: 35384372 PMCID: PMC9875660 DOI: 10.1002/cnr2.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 01/23/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-resolution manometry, which measures esophageal luminal pressure changes after swallowing, could shed more light on food-transport dynamics after pharyngeal/esophageal reconstruction. This prospective cohort study assessed the influence of two head-and-neck and esophageal tumor-resection and reconstruction approaches on esophageal pressure. METHODS The cohort consisted of 17 patients who underwent esophageal/pharyngeal resection/reconstruction for cancer and then participated in postoperative high-resolution manometry. Five healthy controls also underwent manometry for comparison. RESULTS Partial pharyngectomy with patch grafts associated with smooth and continuous esophageal/pharyngeal movement. By contrast, surgery that removed the thoracic esophagus led to complete loss of peristalsis and poor food transport. CONCLUSIONS High-resolution manometry effectively characterized the changes in food-transport dynamics caused by pharyngeal/esophageal resection/reconstruction. These findings suggest that continuous and smooth movement of the pharynx and esophagus is important for swallowing and high resolution manometry could be useful in patients after pharyngeal/esophageal resection/reconstruction.
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Affiliation(s)
- Hiroki Umezawa
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
| | - Mariko Umezawa
- Department of GastroenterologyNippon Medical SchoolTokyoJapan
| | - Yu Hokazono
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
| | | | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
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Ortiz Pérez P, Valero Arredondo I, Torcuato Rubio E, Rosa López A, García-Herrera Taillifer P, Navas-López VM. [Clinicopathological characterization of children with dysphagia, family impact and health-related quality of life of their caregivers]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00219-8. [PMID: 34257061 DOI: 10.1016/j.anpedi.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/04/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Oropharyngeal dysphagia (DOF) without proper evaluation can be underdiagnosed in certain groups of the pediatric population. Meeting the needs of these patients can lead to an overload of their caregivers. OBJECTIVES To describe the epidemiological and clinical characteristics of the patients evaluated after starting a monographic DOF clinic (C-DOF) and study whether there are changes at the nutritional level, as well as the burden and impact that caregivers find on quality of life related to health (HRQOL). MATERIAL AND METHODS Descriptive observational study of patients evaluated in a C-DOF from its start-up. To evaluate HRQOL, an ad hoc survey adapted from the Swallowing Quality of Life Questionnaire of the adult population was designed. RESULTS 103 patients were evaluated, 85.4% presenting some neurological disease. A videofluoroscopic study was performed in 51 patients (49.5%), reporting combined alterations in both the oral and pharyngeal phases in 64.7% of them. There was a directly proportional correlation between the severity of the DOF and the presence of aspirations, as well as with the patient's motor impairment. Regarding the anthropometric evaluation, there was a trend toward improvement in weight z-score (+0.14 SD), height (+0.17 SD) and BMI (+0.16 SD). Out of 46.2% of the caregivers reported that the DOF problem interfered negatively in the basic activities of daily life. The increase in HRQOL, after the evaluation in the monographic DOF clinic, was statistically significant overall. CONCLUSIONS The monographic DOF clinic provided specialized care, impacting positively at the nutritional status of patients, as well as perceived changes in HRQOL, with a probable impact on caregivers.
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Affiliation(s)
- Pilar Ortiz Pérez
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España.
| | - Inés Valero Arredondo
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España
| | - Encarnación Torcuato Rubio
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España
| | - Andrés Rosa López
- Sección de Radiología Pediátrica, Hospital Regional Universitario de Málaga, Málaga, España
| | | | - Víctor Manuel Navas-López
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España
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Clinical Importance and Risk Factors for Postoperative Late-Onset Pneumonia After Major Oral Cancer Surgery With Microvascular Reconstruction. Ann Plast Surg 2021; 84:S7-S10. [PMID: 31800550 DOI: 10.1097/sap.0000000000002170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pulmonary complications are common among patients who have undergone major oral cancer surgery with microvascular reconstruction. Current literatures focused on early-onset pneumonia in the postoperative acute stage. In contrast, we are aiming to identify the clinical importance and the risk factors associated with late-onset pneumonia in oral cancer patients after acute stage. METHODS In total, 195 patients were included from May 2014 to December 2016 and followed up for up to 1 year after surgery. Their medical histories were reviewed to identify the risk factors of late-onset pneumonia and outcome. Primary outcome was late-onset pneumonia. Other outcome measures included early-onset pneumonia, tumor recurrence, and death within 1 year after surgery. RESULTS Patients with late-onset pneumonia have demonstrated a significantly higher rate of tumor recurrence (P < 0.001) and death within 1 year (P < 0.001). Independent risk factors of late-onset pneumonia identified were age (P = 0.031), previous radiotherapy (P = 0.017), postoperative radiotherapy (P = 0.002), flap size (P = 0.001), flap type other than osteocutaneous fibula flap (P = 0.009), and tumor recurrence (P < 0.001). CONCLUSIONS Late-onset pneumonia can act as a warning sign for oral cancer patients who have received microsurgical reconstruction, for its high correlation with tumor recurrence and mortality rate.
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Course of Self-Reported Dysphagia, Voice Impairment and Pain in Head and Neck Cancer Survivors. BIOLOGY 2021; 10:biology10020144. [PMID: 33670412 PMCID: PMC7918686 DOI: 10.3390/biology10020144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Head and neck cancer (HNC)-specific symptoms have a substantial impact on health-related quality of life. The aim of this study was to determine whether self-reported dysphagia, voice problems and pain of HNC patients changed over time and whether specific clinical or sociodemographic variables were associated with these symptoms. METHODS HNC patients (n = 299) in an outpatient setting answered questionnaires (Eating Assessment Tool-10; questions from the EORTC QLQ-C30 and EORTC H&N35) on dysphagia, voice problems and pain, collected with the software "OncoFunction" at three different timepoints (t1-t3) after diagnosis. The mean score changes from t1 to t3 were expressed in terms of effect sizes d. The impact of sociodemographic and clinical factors on the course of the variables was tested with multivariate analyses of variance. RESULTS Dysphagia, voice impairment and pain in HNC survivors significantly improved over a period of approximately 14 months after diagnosis. Tumor site, stage, treatment modality, occupational state and ECOG state were significantly correlated with self-reported functional outcome. The pain level of the HNC patients was rather low. CONCLUSIONS Patients suffer from functional impairments after HNC treatment, but an improvement in self-reported symptoms could be demonstrated within this time period.
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FLOX (5-fluorouracil + leucovorin + oxaliplatin) chemotherapy for colorectal cancer leads to long-term orofacial neurotoxicity: a STROBE-guided longitudinal prospective study. Int J Clin Oncol 2020; 25:2066-2074. [PMID: 32761281 DOI: 10.1007/s10147-020-01757-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Colorectal carcinoma (CRC) is widely treated by chemotherapy based on an intensely neurotoxic drug: oxaliplatin (OXL). We objective to evaluate prospectively the orofacial neurotoxicity during FLOX (fluorouracil + leucovorin + OXL) chemotherapy. METHODS So, 46 patients with CRC were prospectively evaluated during FLOX chemotherapy by 3 cycles (C) of 6 weeks (W) each. We weekly applied the orofacial section of the Acute and Chronic Neuropathy Questionnaire of Common Toxicity Criteria for Adverse Events of the National Cancer Institute of the United States of America (Oxaliplatin-specific neurotoxicity scale). Patients were asked the following concerning the severity (scores 0-5) of orofacial symptoms: jaw pain, eyelids drooping, throat discomfort, ear pain, tingling in mouth, difficulty with speech, burning or discomfort of the eyes, loss of any vision, feeling shock/pain down back and problems breathing. We summed the scores (0-50) and evaluated the clinicopathological data. Friedman/Dunn, Chi square and multinomial regression logistic tests were used (SPSS 20.0, p < 0.05). RESULTS There was a significant increase in sum of orofacial neurotoxicity from baseline to C1.W3, C2.W1 and C3.W5 (p < 0.001) due increase in scores of jaw pain (p < 0.001), eyelids drooping (p = 0.034), throat discomfort (p < 0.001), ear pain (p = 0.034), tingling in mouth (p = 0.015), burning/discomfort of your eyes (p < 0.001), loss of any vision (p < 0.001), feeling shock/pain down back (p < 0.001), problems with breathing (p = 0.045), but not difficulty with speech (p = 0.087). Women (p = 0.021) and young patients (p = 0.027) had significant higher prevalence of orofacial neurotoxicity. CONCLUSIONS FLOX-related orofacial neurotoxicity begins acutely and remains long term with increased incidence in women and younger patients.
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Causes of nutrition deficit during immediate postoperative period after free flap surgery for cancer of the head and neck. Eur Arch Otorhinolaryngol 2020; 278:1171-1178. [PMID: 32666293 PMCID: PMC7954733 DOI: 10.1007/s00405-020-06206-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/08/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the present of study was to examine nutrition deficit during the immediate postoperative in-hospital period following free flap surgery for cancer of the head and neck (HNC). Underfeeding and malnutrition are known to be associated with impaired short- and long-time recovery after major surgery. METHODS This single-center retrospective cohort study included 218 HNC patients who underwent free flap surgery in Oulu University Hospital, Finland between the years 2008 and 2018. Nutrition delivery methods, the adequacy of nutrition and complication rates were evaluated during the first 10 postoperative days. RESULTS A total of 131 (60.1%) patients reached nutritional adequacy of 60% of calculated individual demand during the follow-up period. According to multivariate analysis, nutrition inadequacy was associated with higher ideal body weight (OR 1.11 [1.04-1.20]), whereas adequate nutrition was associated with higher number of days with oral food intake (OR 0.79 [0.67-0.93]). CONCLUSION Inadequate nutrition is common after HNC free flap surgery. The present results suggest that more adequate nutrition delivery might be obtained by the early initiation of oral food intake and close monitoring of nutrition support.
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李 建, 宋 培, 杨 东, 胡 恺, 陈 默, 许 操, 孙 悦. [Effect of double-leaf perforator free flap posterolateral calf peroneal artery on reconstruction of oropharyngeal anatomy after ablation of advanced oropharyngeal carcinoma]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:814-821. [PMID: 32895207 PMCID: PMC7321275 DOI: 10.12122/j.issn.1673-4254.2020.06.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the effect of using free double- leaf perforator flap posterolateral calf peroneal artery in anatomical reconstruction of the oropharyngeal structure after ablation of advanced oropharyngeal carcinoma. METHODS Twenty-six patients with oropharyngeal defects after ablation of oropharyngeal malignancies were recruited, including 12 with carcinoma in the tongue base, 5 in the latenral pharyngeal wall and 9 in the soft palate. Between July, 2016 and July, 2018, the patients underwent surgeries for reconstruction of the oropharyngeal defects using flaps. The areas of tissue defects repaired by double-leaf perforator flaps ranged from 40.5 to 72.5 cm2. Reconstruction was performed for oropharyngeal defects in the soft palate, pterygopalate, parapharyngeal, pterygo- mandibular, and tongue base tissues. The patients' outcomes including mouth opening, functions of deglutition, linguistic function, restoration of palatopharyngeal anatomical structure and postoperative survival were evaluated, and their quality of life was assessed using FACT-H&N scale (Chinese Edition). RESULTS All the 26 patients with transplantation of the free flaps survived. Six months after the operation, the oropharyngeal function and anatomical structure of the patients were basically restored. The questionnaire survey showed that the patients' physical, social/family, emotional and functional conditions, the total score of the core scale, items scores for the head and neck, and the total score of the scale all improved significantly after the operation compared with those before the operation (P < 0.05). CONCLUSIONS The free peroneal artery bilobate perforator flap in the posterolateral crus, which seldom has anatomical variations of the blood vessels, allows flexible design and contains rich tissue volume to facilitate defect repair with different approaches and ranges. The application of this flap, which is an ideal perforator flap for reconstruction of the oropharyngeal structure and function, can improve the quality of life of patients following operations for advanced oropharyngeal cancer.
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Affiliation(s)
- 建成 李
- 蚌埠医学院第一附属医院 口腔颌面外科,安徽 蚌埠 233004Department of Stomatology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 培军 宋
- 蚌埠医学院第一附属医院整形烧伤科,安徽 蚌埠 233004Department of Plastic and Burn Surgery, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 东昆 杨
- 蚌埠医学院第一附属医院 口腔颌面外科,安徽 蚌埠 233004Department of Stomatology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 恺 胡
- 蚌埠医学院第一附属医院 口腔颌面外科,安徽 蚌埠 233004Department of Stomatology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 默 陈
- 蚌埠医学院第一附属医院 口腔颌面外科,安徽 蚌埠 233004Department of Stomatology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 操 许
- 蚌埠医学院第一附属医院 口腔颌面外科,安徽 蚌埠 233004Department of Stomatology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
| | - 悦 孙
- 蚌埠医学院第一附属医院 口腔颌面外科,安徽 蚌埠 233004Department of Stomatology, First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
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14
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Zhou H, Xian W, Zhang Y, Yang Y, Fang W, Liu J, Shen J, Zhang Z, Hong S, Huang Y, Zhang L. Suicide among cancer patients: adolescents and young adult (AYA) versus all-age patients. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:658. [PMID: 31930059 DOI: 10.21037/atm.2019.10.51] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Many researchers have studied suicide risk factors of patients with one specific cancer. But there is no comprehensive study to compare suicide issues between adolescents and young adult (AYA) group and all-age groups in a pan-cancer view. Methods Patients diagnosed with 20 solid malignancies were identified from SEER database. Multivariable logistic regression was operated to find out risk factors of suicide. Results Male sex has less impact on AYA than all-age patients (OR 2.72, 95% CI: 2.23-3.31, P<0.001 vs. OR 4.64, 95% CI: 4.37-4.94, P<0.001), while white race (OR 3.28, 95% CI: 2.02-5.77, P<0.001 vs. OR 3.40, 95% CI: 3.02-3.84, P<0.001) and unmarried status (OR 1.51, 95% CI: 1.24-1.83, P<0.001 vs. OR 1.39, 95% CI: 1.33-1.46, P<0.001) have similar impact on AYA and all-age groups. Localized cancer stage may have stronger impact on AYA than all-age (OR 2.90, 95% CI: 1.83-4.84; P<0.001 vs. OR 1.76, 95% CI: 1.61-1.92; P<0.001), while surgery only influence all-age (OR 1.14, P=0.451 vs. 1.24, P<0.001). Within 5 years from cancer diagnosis, longer survival time is associated with higher suicide risk of both all-age and AYA patients. Conclusions Male sex, white race and unmarried status, earlier cancer stage and longer survival time within 5 years are similar prevalent risk factors for both AYA group patients and all-age patients. It is not necessary to pick AYA cancer patients out when considering suicide risk of cancer patients.
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Affiliation(s)
- Huaqiang Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Wei Xian
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Yaxiong Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yunpeng Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Jiaqing Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Jiayi Shen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhonghan Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Shaodong Hong
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yan Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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15
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Zebralla V, Meuret S, Wiegand S. Monitoring and Evaluation of Late Functional Outcome in Post-treatment Follow-Up in Clinical Routine Setting. Front Oncol 2019; 9:700. [PMID: 31417873 PMCID: PMC6682590 DOI: 10.3389/fonc.2019.00700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/15/2019] [Indexed: 12/12/2022] Open
Abstract
Patients treated for head and neck cancer (HNC) often suffer from severe and visible loss of function as the cancer itself and the side effects of aggressive treatments have the potential to severely affect quality of life. Therefore, the aim of follow-up is not only the early detection of potentially curable recurrences and second primary tumors but also the diagnosis and rehabilitation of functional impairments. Clear guidelines determining the frequency of follow-up visits are missing, and the impact of follow-up visits on patient's prognosis is unclear. An intensive post-treatment follow-up is needed to detect functional impairments and to initiate their treatment. The aim is an optimal rehabilitation of the patients. This article focusses on goals of aftercare treatment and describes the spectrum of long-term sequelae, and the impact of Patient Reported Outcome (PRO) instruments of which three will be introduced.
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Affiliation(s)
- Veit Zebralla
- Clinic of Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
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