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Karimi Afshar M, Behniafar M, Abbaszadeh E, Parizi MT, Karimi Afshar M. Knowledge about dental care in patients with head and neck cancer among senior dental school students: a cross-sectional descriptive study. BMC MEDICAL EDUCATION 2024; 24:776. [PMID: 39030591 PMCID: PMC11264978 DOI: 10.1186/s12909-024-05728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/01/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND The dentist's central role in treating head and neck cancer patients is to care for the patient's oral cavity before, during, and after radio/chemotherapy. This research aimed to determine dental students' knowledge about head and neck cancer patients' dental care. METHODS One hundred and four fifth and sixth-year dental students participated in this cross-sectional descriptive study. The data collection tool was a questionnaire that collected demographic information (gender, year of study) and four questions consisting of attendance to courses or workshops, passing a dedicated course at the university, willing to participate in a course or workshop on the treatment of head and neck cancer patients and self-evaluating information about the treatment of head and neck cancer patients. Final part 36 questions about oral and dental care for head and neck cancer patients before, after, and during treatment. The data were analyzed with SPSS 26 statistical software and using t-tests, ANOVA, and linear regression at the 0.05 significance level. RESULTS Most of the participants were in their sixth year (48.9%). A total of 48.1% of the people reported that their information about dental treatments in patients with head and neck cancer was bad. 85% of participants agreed with the necessity of evaluating the patient's mouth and teeth before starting the treatment. The lowest percentage of correct answers was related to the ideal duration of tooth extraction and a poor prognosis before the start of cancer treatment. The regression analysis revealed a significant relationship between years of education, willingness to participate in courses, and students' knowledge evaluation and knowledge. CONCLUSION The findings showed that students' awareness of oral and dental treatment and care for patients with head and neck cancer is insufficient. It is recommended that teaching staff pay more attention to the lack of knowledge and effort to educate students by holding special courses and workshops.
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Affiliation(s)
- Marzieh Karimi Afshar
- Orthodontics, Medical Education, Orthodontics Department, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Milad Behniafar
- Kerman University of Medical Sciences, Private Practice, Kerman, Iran
| | - Elham Abbaszadeh
- Oral Medicine, Oral Disease Department, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Molook Torabi Parizi
- Oral and Maxillofacial Pathology, Medical Education, Oral and Maxillofacial Department, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehrnaz Karimi Afshar
- Prosthodontics, Medical Education, Prosthodontics Department, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
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Arranz-Martín B, Del-Castillo-Pardo-de-Vera JL, Cebrián-Carretero JL, Rouco-García D, Fernández-Oliva C, Gil-Martínez A. Quality of life, craniomandibular function, and psychosocial factors related to pain and movement in patients with head and neck cancer. Support Care Cancer 2024; 32:334. [PMID: 38722345 DOI: 10.1007/s00520-024-08518-y] [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: 11/09/2023] [Accepted: 04/21/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE To describe the characteristics of and the associations between health-related quality of life, pain, craniomandibular function, and psychosocial factors related to pain and fear of movement in patients with head and neck cancer. METHODS Seventy-eight patients diagnosed with HNC were recruited. Measurements of the maximum mouth opening range and pressure pain thresholds on the masseter muscle and the distal phalanx of the thumb were conducted, as well as a battery of self-report questionnaires were administrated, including the QoL Questionnaire (EORT QLQ-H&N35), Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), the Spanish translation of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD), and the short version of the Craniofacial Pain and Disability Inventory (CF-PDI-11). RESULTS The study sample (66.7% men, mean age 60.12 [11.95] years) experienced a moderate impact on their QoL levels (57.68 [18.25] EORT QLQ-H&N35) and high kinesiophobia values (20.49 [9.11] TSK-TMD). Pain was present in 41% of the patients, but only 3.8% reported severe pain. 26.4% had a restricted mouth opening range, and 34.62% showed significant catastrophism levels. There were strong positive correlations between EORT QLQ-H&N35 and CF-PDI-11 (r = 0.81), between NRS and CF-PDI-11 (r = 0.74), and between PCS and CF-PDI-11 (r = 0.66). CONCLUSION Patients with HNC experience negative effects in their QoL, related to their impairment in craniomandibular function. Fear of movement, pain intensity, and catastrophism are associated with poorer functionality; relationships that should be considered when attempting to improve health care.
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Affiliation(s)
- Beatriz Arranz-Martín
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Calle La Salle, 10, 28023, Madrid, Spain.
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, 28023, Madrid, Spain.
| | | | | | - David Rouco-García
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Calle La Salle, 10, 28023, Madrid, Spain
| | - Carlos Fernández-Oliva
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Calle La Salle, 10, 28023, Madrid, Spain
| | - Alfonso Gil-Martínez
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, 28023, Madrid, Spain
- Physiotherapy Unit, La Paz-Carlos III University Hospital (IdiPAZ), 28046, Madrid, Spain
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Mhatre S, Srichand R, Sethumadhavan J, Mishra PB, Patil SD, Chavan RS, Joshi M, Shetty U. Dry Mouth Dilemma: A Comprehensive Review of Xerostomia in Complete Denture Wearers. Cureus 2024; 16:e58564. [PMID: 38770459 PMCID: PMC11102879 DOI: 10.7759/cureus.58564] [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] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Xerostomia, commonly known as dry mouth, presents a significant challenge for individuals wearing complete dentures, affecting their oral health and quality of life. This review explores the relationship between saliva and complete dentures, highlighting the varied management strategies for xerostomia. Saliva plays a critical role in denture retention, lubrication, and oral environment buffering. Complete denture wearers often experience reduced salivary flow, aggravating symptoms of xerostomia. Various management approaches are discussed, including general measures such as hydration and salivary stimulation techniques which aim to boost saliva production naturally. The use of salivary substitutes provides artificial lubrication and moisture to alleviate dry mouth discomfort. Oral lubricating devices, such as sprays, gels, and lozenges, offer relief by mimicking saliva's lubricating properties, thereby improving denture stability and comfort. This review addresses the etiology of xerostomia in complete denture wearers and explores preventive measures to reduce its impact. A comprehensive approach has been discussed for the management of xerostomia which will help to improve the oral health and well-being of complete denture wearers experiencing dry mouth.
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Affiliation(s)
- Swapnali Mhatre
- Department of Prosthodontics and Crown and Bridge, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, IND
| | - Reema Srichand
- Department of Prosthodontics and Crown and Bridge, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, IND
| | - Jyotsna Sethumadhavan
- Department of Prosthodontics and Crown and Bridge, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, IND
| | - Pallavi B Mishra
- Medical School, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, IND
| | - Srushti D Patil
- Medical School, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, IND
| | - Riddhi S Chavan
- Medical School, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, IND
| | - Mridula Joshi
- Department of Prosthodontics and Crown and Bridge, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, IND
| | - Uttam Shetty
- Department of Prosthodontics and Crown and Bridge, Dental College and Hospital, Bharati Vidyapeeth (Deemed to be University), Navi Mumbai, IND
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Bolnykh I, Patterson JM, Harding S, Watson LJ, Lu L, Hurley K, Thomas SJ, Sharp L. Cancer-related pain in head and neck cancer survivors: longitudinal findings from the Head and Neck 5000 clinical cohort. J Cancer Surviv 2024:10.1007/s11764-024-01554-x. [PMID: 38421499 DOI: 10.1007/s11764-024-01554-x] [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: 11/14/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Reports suggest pain is common in head and neck cancer (HNC). However, past studies are limited by small sample sizes and design and measurement heterogeneity. Using data from the Head and Neck 5000 longitudinal cohort, we investigated pain over a year post-diagnosis. We assessed: temporal trends; compared pain across HNC treatments, stages, sites and by HPV status; and identified subgroups of patients at increased risk of pain. METHODS Sociodemographic and clinical data and patient-reported pain (measured by EORTC QLQ-C30 and QLQ-H&N35) were collected at baseline (pre-treatment), 4- and 12- months. Using mixed effects multivariable regression, we investigated time trends and identified associations between (i) clinically-important general pain and (ii) HN-specific pain and clinical, socio-economic, and demographic variables. RESULTS 2,870 patients were included. At baseline, 40.9% had clinically-important general pain, rising to 47.6% at 4-months and declining to 35.5% at 12-months. HN-specific pain followed a similar pattern (mean score (sd): baseline 26.4 (25.10); 4-months. 28.9 (26.55); 12-months, 17.2 (19.83)). Across time, general and HN-specific pain levels were increased in: younger patients, smokers, and those with depression and comorbidities at baseline, and more advanced, oral cavity and HPV negative cancers. CONCLUSIONS There is high prevalence of general pain in people living with HNC. We identified subgroups more often reporting general and HN-specific pain towards whom interventions could be targeted. IMPLICATIONS FOR CANCER SURVIVORS Greater emphasis should be placed on identifying and treating pain in HNC. Systematic pain screening could help identify those who could benefit from an early pain management plan.
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Affiliation(s)
- Iakov Bolnykh
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK
| | - Joanne M Patterson
- Liverpool Head and Neck Centre, School of Health Science, University of Liverpool, Liverpool, UK
| | - Sam Harding
- Speech and Language Therapy Research Unit, Southmead Hospital North Bristol NHS Hospital Trust, Bristol, UK
| | - Laura-Jayne Watson
- Speech & Language Therapy, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK
- NHS Forth Valley, Stirling, Scotland, UK
| | - Katrina Hurley
- Head & Neck 5000 Study, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Steve J Thomas
- Head & Neck 5000 Study, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK.
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Curtis AR, Tan SY, Boltong A, Cohen J, Kiss N. The influence of pediatric cancer treatment on taste perception and food hedonics: a systematic review. Nutr Rev 2024:nuad162. [PMID: 38204363 DOI: 10.1093/nutrit/nuad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
CONTEXT Children with cancer are at risk of poor nutritional status during treatment and into survivorship. Objectively measured taste perception and self-reported food hedonics are 2 factors that may influence food intake. OBJECTIVE This 2-armed systematic review examined whether chemotherapy and radiotherapy affect (1) taste perception and (2) hedonic experiences of children and survivors of childhood cancer. DATA SOURCE A 2-armed systematic literature search was conducted in the Medline, CINAHL, Embase, and PsychInfo database until June 2022. The effects of cancer treatment on objective taste perception or food hedonics (ie, food liking or aversion and appetite) were examined. DATA EXTRACTION Peer-reviewed articles published in English of studies that included children (aged <18 years) or survivors of childhood cancer (any age) were reviewed. Risk of bias was determined using the Evidence Analysis Library by the Academy of Nutrition and Dietetics. DATA ANALYSIS A total of 1417 articles in the taste search arm and 3862 articles in the hedonics search arm were identified. Of these, 9 and 4 articles were eligible for review, respectively. Cancer treatment had highly variable effects on taste perception during treatment and into survivorship. Learned food aversions were experienced by children receiving chemotherapy treatment and liking of meats and salty foods by children with cancer was affected. The impact of treatment on appetite varied. CONCLUSIONS Cancer treatment did not uniformly affect taste perception. Food liking may be negatively affected, and learned food aversions may develop during cancer treatment. To establish the clinical relevance of childhood cancer treatment on taste perception and food hedonics, more research is required. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no.CRD42020207127.
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Affiliation(s)
- Annie R Curtis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Sze Yen Tan
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Anna Boltong
- Cancer Australia, Surry Hills, New South Wales, Australia
- Kirby Institute, University of New South Wales (UNSW) Medicine, UNSW, Kensington, New South Wales, Australia
| | - Jennifer Cohen
- Discipline of Paediatrics and Child Health, UNSW Medicine & Health, Randwick Clinical Campus, UNSW Sydney, Sydney, New South Wales, Australia
- Canteen Australia, Sydney, New South Wales, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
- Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Aghajanzadeh S, Karlsson T, Tuomi L, Engström M, Finizia C. Facial pain, health-related quality of life and trismus-related symptoms up to 5 years post-radiotherapy for head and neck cancer. Support Care Cancer 2023; 31:699. [PMID: 37966497 PMCID: PMC10651533 DOI: 10.1007/s00520-023-08162-y] [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: 06/27/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Pain is a frequent symptom of head and neck cancer (HNC) but longitudinal studies investigating facial pain are scarce. We aimed to investigate prevalence of facial pain, its effect on health-related quality of life (HRQL) and trismus-related symptoms in a HNC cohort. METHODS Patients (n = 194) were prospectively followed post completion of radiotherapy (RT). Outcome measures included facial pain, HRQL, trismus-specific symptoms, and maximal interincisal opening (MIO). RESULTS Facial pain was reported by 50% at baseline. Corresponding figures for 3-, 12-, and 60 months post-RT were 70%, 54% and 41%. Moderate to severe pain was reported in 29-44% of patients reporting pain during the study period. Patients reporting pain scored significantly worse on more HRQL variables and trismus symptoms, as well as had significantly smaller MIO at all follow-up time points. CONCLUSIONS Facial pain was common in HNC patients pre- and post-RT and remained prevalent up to 5 years after completion of RT. Reductions in MIO were associated with more facial pain. Pain was also associated with worse HRQL.
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Affiliation(s)
- Susan Aghajanzadeh
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
- Region Västra Götaland, Department of Otorhinolaryngology- Head & Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Therese Karlsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
- Region Västra Götaland, Department of Otorhinolaryngology- Head & Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - My Engström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery Gothenburg, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
- Region Västra Götaland, Department of Otorhinolaryngology- Head & Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Tsai KY, Liao SF, Chen KL, Tang HW, Huang HY. Effect of early interventions with manual lymphatic drainage and rehabilitation exercise on morbidity and lymphedema in patients with oral cavity cancer. Medicine (Baltimore) 2022; 101:e30910. [PMID: 36281150 PMCID: PMC9592419 DOI: 10.1097/md.0000000000030910] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There are clinical and statistical inconsistencies regarding early intervention with manual lymphatic drainage (MLD). The purpose of this study was to compare the short-term effect of early interventions with rehabilitation exercise versus MLD and rehabilitation exercise in terms of pain, range of motion (ROM) and lymphedema in patients with oral cancer after surgery. METHODS A total of 39 patients who underwent surgery from December 2014 to December 2018 participated in this randomized single-blind study. There were 20 patients in the rehabilitation (R) group and 19 in the MLD (M) plus rehabilitation group. The R group received 30 minutes of rehabilitation intervention; and the M group received 30 minutes of MLD, in addition to 30 minutes of rehabilitation intervention in a work day. Clinical measures, including the visual analog pain scale (VAS), ROM of the neck and shoulder, ultrasonography and face distance for lymphedema, and the Földi and Miller lymphedema scales, were assessed before surgery, before intervention and when discharged from the hospital. RESULTS The VAS pain score, ROM of the neck, and internal and external rotation of the right shoulder were significantly improved after the interventions. Right-face distance (P = .005), and skin-to-bone distance (SBD) of the bilateral horizontal mandible and left ascending mandibular ramus were significantly improved after the interventions. Left lateral flexion of the neck (P = .038) and SBD of the right ascending mandibular ramus (P < .001) in the MLD group showed more improvement than that of the rehabilitation group. CONCLUSION Early intervention with MLD and the rehabilitation program were effective in improving ROM of the neck and controlling lymphedema in acute-phase rehabilitation. The preliminary findings suggest a potential therapeutic role for early intervention with MLD, in addition to rehabilitation exercise, in that they yielded more benefits in lymphedema control and improvement of ROM of the neck in acute care.
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Affiliation(s)
- Kuo-Yang Tsai
- Department of Oral and Maxillofacial Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Su-Fen Liao
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
- Division of Pediatric Rehabilitation, Changhua Christian Children’s Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- * Correspondence: Su-Fen Liao, Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, No.135 Nanxiao Street, Changhua, 500 Taiwan (e-mail: )
| | - Kuan-Lin Chen
- Department of Physical Medicine and Rehabilitation, Yuan Rung Medical Corporation Yuan Sheng Hospital, Yuanlin city, Changhua County, Taiwan
| | - Hao-Wei Tang
- Department of Physical Medicine and Rehabilitation, Yumin Medical Corporation Yumin Hospital, Caotun Town, Nantou County, Taiwan
| | - Hsin-Ya Huang
- Branch of Physical therapy, Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
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Yong CW, Robinson A, Hong C. Dental Evaluation Prior to Cancer Therapy. FRONTIERS IN ORAL HEALTH 2022; 3:876941. [PMID: 35510226 PMCID: PMC9058061 DOI: 10.3389/froh.2022.876941] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
A comprehensive oral examination and dental care prior to the start of cancer therapy is the standard of care in many cancer centers. This is because good oral health will likely minimize the undesirable complications such as opportunistic infections during cancer therapy. As the considerations differ between anti-neoplastic regimens, this chapter discusses the indications and rationale when planning and executing a treatment plan for patients undergoing various cancer therapies.
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Affiliation(s)
- Chee Weng Yong
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Andrew Robinson
- Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Catherine Hong
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
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Maleki S, Glewis S, Fua T, Liu C, Rischin D, Alexander M, Na L, Lingaratnam S. A randomised controlled trial of clinical pharmacy intervention versus standard care to improve medication adherence in outpatients with head and neck cancer receiving radiotherapy. Support Care Cancer 2022; 30:4243-4253. [PMID: 35091845 DOI: 10.1007/s00520-021-06779-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient understanding of medicines information and adherence to medication instructions are important variables for ensuring optimal cancer care. This randomised controlled trial (RCT) aimed to evaluate the impact of an outpatient clinical pharmacy service on medication adherence and symptom burden in cancer patients. METHODS In this single-centre RCT, 115 patients were randomised 1:1 to a pharmacist-led pharmaceutical care program (intervention, n = 59) versus standard of care (control, n = 56) within an outpatient multidisciplinary radiotherapy clinic. The primary endpoint was medication adherence as assessed by Medication Understanding and Use Self-Efficacy (MUSE) scale and Teach-Back assessment. Secondary endpoints were patient-reported symptom burden assessed by the Edmonton Symptom Assessment Scale (ESAS). Patients were assessed at baseline (weeks 1-2) and at discharge from radiotherapy (weeks 5-7). RESULTS Polypharmacy (use of five or more medications) was observed in 26% of patients at baseline compared to 97% at discharge. Patient self-efficacy and medication adherence was higher in the intervention arm compared to the control arm, with a mean MUSE score difference of 2.70 (95% CI 1.24, 4.17) after adjustment for baseline, and a higher proportion of patients with average Teach-Back score of four or more (86% vs 14%; odds ratio (OR) 46.09, 95% CI 14.49, 146.56). The mean (SD) scores for aggregate ESAS (0-100) at discharge were 26.2 (14.0) in the intervention arm and 32.0 (15.8) in the control arm demonstrating lower overall symptom burden associated with the intervention (mean score difference adjusted for baseline - 0.52; 95% CI - 1.03, - 0.01). CONCLUSION A structured outpatient clinic pharmacy service significantly improved medication adherence and reduced overall symptom burden in patients receiving radiotherapy.
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Affiliation(s)
- Sam Maleki
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
| | - Sarah Glewis
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Tsien Fua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Chen Liu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Grattan St, Parkville Victoria, 3010, Australia
| | - Marliese Alexander
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Grattan St, Parkville Victoria, 3010, Australia
| | - Lumine Na
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Senthil Lingaratnam
- Department of Pharmacy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
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Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress. Support Care Cancer 2022; 30:9127-9139. [PMID: 35997811 PMCID: PMC9633472 DOI: 10.1007/s00520-022-07334-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of this cross-sectional study was to explore the relationship between quality of life (QoL) and body image distress in patients with head and neck cancer (HNC), considering relevant psychological variables (i.e., coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress). We also aimed to explore gender differences in patients with HNC in terms of relevant psychological variables in HNC. METHODS Fifty-one HNC patients (37 males and 14 females) completed self-report questionnaires to assess body image distress, physical and mental QoL, and relevant psychological variables in HNC (coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress) before undergoing treatment. Pearson's correlations and four-step hierarchical regressions were performed to assess the relationship between body image distress, QoL, and the abovementioned psychological variables, while one-way analyses of variance and one-way analysis of covariance were employed to assess gender differences. RESULTS Physical QoL was associated with body image distress above and beyond disease duration, distress, coping strategies, pain, mental QoL, and self-esteem, while mental QoL was associated with pain above and beyond distress, coping strategies, physical QoL, self-esteem, and body image distress. Concerning gender differences, females scored higher than males on most of the explored psychological variables, except for physical QoL and intolerance of uncertainty, and showed lower mental QoL and self-esteem than males. CONCLUSION Body image distress and pain emerged as negatively associated with QoL, and almost all the explored psychological variables differed among genders. Psychological interventions targeting body image distress and pain should be promoted in patients with HNC to increase their QoL, while keeping gender differences in mind.
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Pei Y, Qi X, Chen X, Wu B. Orofacial pain among Chinese older adults in the last year of life. Gerodontology 2021; 39:384-390. [PMID: 34841577 DOI: 10.1111/ger.12608] [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: 05/02/2021] [Revised: 10/18/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the prevalence of orofacial pain and associated factors in Chinese older adults at the end of life. METHODS This cross-sectional study included 1646 participants (65 years or older) in their last year of life from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used the 6-month prevalence questions to measure two specific orofacial pain symptoms: toothache, and jaw or facial pain. Logistic regression analyses were used to examine factors, such as socioeconomic status, health behaviours and chronic diseases, that were associated with these two orofacial pain symptoms in the last year of life. RESULTS The 6-month prevalence estimates for toothache and jaw pain or facial pain for older adults in the last year of life were 14.1% and 4.5% respectively. Higher socioeconomic status was associated with lower odds of toothache and jaw pain or facial pain. Smoking was associated with high odds of toothache. Participants who brushed their teeth at least once a day were more likely to have toothache and jaw or facial pain than those who did not. Having any chronic conditions was associated with higher odds of toothache and jaw or facial pain. Older adults who had at least one tooth were more likely to have jaw or facial pain than those without any teeth. CONCLUSION A considerable proportion of Chinese older adults in their last year of life reported toothache and/or jaw pain or facial pain. These findings suggest that appropriate measures need to be taken to address the oral health needs in these vulnerable individuals, especially those of low socioeconomic status and chronic conditions.
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Affiliation(s)
- Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Xiang Qi
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Xi Chen
- Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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12
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Factors associated with unintentional weight loss among older adults in a geriatric outpatient clinic of university hospital. PLoS One 2021; 16:e0260233. [PMID: 34793549 PMCID: PMC8601429 DOI: 10.1371/journal.pone.0260233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/04/2021] [Indexed: 12/28/2022] Open
Abstract
Background Unintentional weight loss (UWL) is defined as unintentional reduction of more than 5% of baseline body weight over 6 to 12 months. UWL is a common problem in the older adults, resulting in increased rate of morbidity and mortality. With specific reference to Thailand, no information on factors associated with UWL in older adults could be traced. The aims of this research were to identify the factors associated with UWL and to assess the common causes of UWL among older adults in the geriatric outpatient clinic of university hospital. Methods A case-control study was conducted from June 1st, 2020 to December 31st, 2020. Eighty older adults aged 60 years or older were enrolled in the UWL group while the non-UWL group consisted of 160 participants. Data collection was performed by structural questionnaire including baseline characteristics, psychosocial factors, health information, lifestyle behaviors, and medications. The factors associated with UWL were analyzed by using univariate and multivariate logistic regression analysis. Causes of UWL were recorded from electronic medical records. Results The mean age of the 240 participants was 79.6 years (SD 7.4). Most patients were female (79.2%) and had fewer than 12 years of education (62.6%). The three common causes of UWL were reduced appetite (20.1%), dementia and behavioral and psychological symptoms of dementia (13.7%) and medications (11.0%). Multivariate logistic regression analysis showed that a Charlson Comorbidity Index (CCI) score of >1 (OR 2.55, 95% CI 1.37–4.73; P = 0.003), vitamin D deficiency (OR 4.01, 95% CI 1.62–9.97; P = 0.003), and hemoglobin level of <12 g/dL (OR 2.47, 95% CI 1.32–4.63; P = 0.005) were factors significantly associated with UWL. Conclusions Factors associated with UWL were CCI score >1, vitamin D deficiency, and hemoglobin level of <12 g/dl. The early detection of these associated factors, reduced appetite, dementia and polypharmacy may be important in UWL prevention in older adults.
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Glia and Orofacial Pain: Progress and Future Directions. Int J Mol Sci 2021; 22:ijms22105345. [PMID: 34069553 PMCID: PMC8160907 DOI: 10.3390/ijms22105345] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/14/2022] Open
Abstract
Orofacial pain is a universal predicament, afflicting millions of individuals worldwide. Research on the molecular mechanisms of orofacial pain has predominately focused on the role of neurons underlying nociception. However, aside from neural mechanisms, non-neuronal cells, such as Schwann cells and satellite ganglion cells in the peripheral nervous system, and microglia and astrocytes in the central nervous system, are important players in both peripheral and central processing of pain in the orofacial region. This review highlights recent molecular and cellular findings of the glia involvement and glia–neuron interactions in four common orofacial pain conditions such as headache, dental pulp injury, temporomandibular joint dysfunction/inflammation, and head and neck cancer. We will discuss the remaining questions and future directions on glial involvement in these four orofacial pain conditions.
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Dugué J, Humbert M, Bendiane MK, Bouhnik AD, Babin E, Licaj I. Head and neck cancer survivors' pain in France: the VICAN study. J Cancer Surviv 2021; 16:119-131. [PMID: 33635450 DOI: 10.1007/s11764-021-01010-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Pain is an increasing concern in the growing number of head and neck cancer survivors. This study aimed to analyze the 5-year prevalence of pain in French survivors of head and neck cancer and to identify associated factors. METHODS Analyses were performed among 296 5-year cancer survivors diagnosed in 2010. Using multivariable logistic regressions, we studied the associations between pain and factors collected in the French representative national "vie après le cancer" (VICAN) survey. Eligible participants were aged from 18 to 82 years; patients' living conditions, socioeconomic characteristics, and medical data were collected. RESULTS Pain was reported by 72.6% of the participants. In the multivariable analyses, decreasing level of physical activity was the only determinant of increased overall pain (OR= 2.77, CI= 1.48-5.17). The chronic pain prevalence was 62.3%. The main risk factors found were tumor localization in the oropharynx (OR= 2.49, CI= 1.27-4.88), education (at least a high school's degree) (OR= 0.33, CI= 0.13-0.9), and decreased physical activity (OR= 2.20, CI= 1.24-3.9). CONCLUSIONS Five years after diagnosis, pain is a very frequent sequelae that has a significant impact on quality of life in head and neck cancer survivors. Reduced physical activity, a low level of education, and tumor localization in the oropharynx are factors associated with pain. IMPLICATIONS FOR CANCER SURVIVORS Pain frequency and its impact on patients' lives imply that an adaptation must be made in terms of both pain diagnosis and management and the training of healthcare professionals. CLINICAL TRIAL REGISTRATION This is not a clinical trial. ISP number: INSERM C11-63.
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Affiliation(s)
- Justin Dugué
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France.
| | - Maxime Humbert
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Marc-Karim Bendiane
- Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM) Marseille, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Anne-Déborah Bouhnik
- Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM) Marseille, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Emmanuel Babin
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Idlir Licaj
- Clinipace Biostatistics, Morrisville, NC, 27560, USA.,Clinical Research Department, Centre François Baclesse, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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TNFα promotes oral cancer growth, pain, and Schwann cell activation. Sci Rep 2021; 11:1840. [PMID: 33469141 PMCID: PMC7815837 DOI: 10.1038/s41598-021-81500-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/07/2021] [Indexed: 12/11/2022] Open
Abstract
Oral cancer is very painful and impairs a patient's ability to eat, talk, and drink. Mediators secreted from oral cancer can excite and sensitize sensory neurons inducing pain. Cancer mediators can also activate Schwann cells, the peripheral glia that regulates neuronal function and repair. The contribution of Schwann cells to oral cancer pain is unclear. We hypothesize that the oral cancer mediator TNFα activates Schwann cells, which further promotes cancer progression and pain. We demonstrate that TNFα is overexpressed in human oral cancer tissues and correlates with increased self-reported pain in patients. Antagonizing TNFα reduces oral cancer proliferation, cytokine production, and nociception in mice with oral cancer. Oral cancer or TNFα alone increases Schwann cell activation (measured by Schwann cell proliferation, migration, and activation markers), which can be inhibited by neutralizing TNFα. Cancer- or TNFα-activated Schwann cells release pro-nociceptive mediators such as TNFα and nerve growth factor (NGF). Activated Schwann cells induce nociceptive behaviors in mice, which is alleviated by blocking TNFα. Our study suggests that TNFα promotes cancer proliferation, progression, and nociception at least partially by activating Schwann cells. Inhibiting TNFα or Schwann cell activation might serve as therapeutic approaches for the treatment of oral cancer and associated pain.
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Torabi M, Jahanian B, Afshar MK. Quality of Life in Iranian Patients with Oral and Head and Neck Cancer. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Molook Torabi
- Kerman University of Medical Sciences, Iran; Kerman University of Medical Sciences, Iran
| | | | - Maezieh Karimi Afshar
- Kerman University of Medical Sciences, Iran; Kerman University of Medical Sciences, Iran
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Schaller AKCS, Peterson A, Bäckryd E. Pain management in patients undergoing radiation therapy for head and neck cancer - a descriptive study. Scand J Pain 2020; 21:256-265. [PMID: 34387952 DOI: 10.1515/sjpain-2020-0067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/16/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Patients with head and neck cancer (HNC) experience serious pain related to tumour, surgery, chemotherapy, and radiotherapy treatment (RT). Oral mucositis, a painful complication of RT, may require opioid analgesics to control pain.This longitudinal study, during RT but also four weeks post-RT, examines the relationships between oral mucositis, pain, and opioid doses in in HNC patients. The aim was to evaluate the clinical effectiveness of an opioid treatment strategy. METHODS Sixty-three patients with HNC undergoing radiotherapy answered self-reported questionnaires on pain intensity on a 0-10 numerical rating scale (NRS) three times a week. Oral mucositis signs were evaluated using the WHO mucositis index score, ranging from 0 (normal) to 4 (severe), and pharmacological treatment with opioids was registered prospectively once a week. All data were related to given radiation dose, and all outcome measures at each time point therefore relate to the same radiation dose (i.e., not to when the patient was included in the study). RESULTS Opioids were used by 78% of the patients. Most of the patients experienced only mild pain (NRS 0-4), although the majority developed mucositis grade 2-4 according to WHO mucositis index. Function-related pain intensity and opioid doses were highest during the sixth week of RT, with 3.67 (0-9) in NRS and 84 (0-430) mg oral morphine equivalents per day (median, range). At that same time point, significant positive correlations were found between the grade of mucositis and pain intensities. Patients with mucositis grade 2-4 were investigated further; in this subgroup, we found that opioid doses did not differ between patients with mild pain and patients with moderate to severe pain. Our multivariate data analysis defined a cluster of patients characterized by the presence of mucositis, cancer site in pharynx, concomitant chemotherapy, and the absence of surgery. CONCLUSIONS In HNC patients who were followed closely by pain care personnel during and after RT, pain was often satisfactorily alleviated with a structured use of opioids, including stepwise increases of fentanyl patches and oral morphine as needed. However, some patients with oral mucositis grade 2-4 experienced severe pain. Strong opioids, i.e. the third step of the WHO pain ladder, remain the mainstay of analgesic therapy in treating moderate to severe cancer-related pain, including patients with HNC. This real-life study indicates that RT-related pain is not a fatality. A proactive stance, monitoring these patients closely and regularly, is probably crucial in order to achieve good treatment results. Further studies are needed to develop better pain treatment strategies for those patients who develop severe oral mucositis-related pain despite intensive opioid treatment.
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Affiliation(s)
- Anne K C Söderlund Schaller
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Center, Linköping University, Linköping, Sweden
| | - Anna Peterson
- Pain and Rehabilitation Center, University Hospital, Linköping, Sweden
| | - Emmanuel Bäckryd
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Center, Linköping University, Linköping, Sweden
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Bashir A, Kumar D, Dewan D, Sharma R. Quality of life of head and neck cancer patients before and after cancer-directed treatment - A longitudinal study. J Cancer Res Ther 2020; 16:500-507. [PMID: 32719257 DOI: 10.4103/jcrt.jcrt_311_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Context Head-and-neck cancer (HNC) is a major health problem worldwide and even disproportionately bigger in India. Their diagnosis and treatment create severe impact on the quality of life (QOL). We chose to study such patients because we were already reporting these cancers to the Indian Council of Medical Research as part of project titled "Pattern of care and survival studies." Aims The aim of the study is to assess and compare QOL of H and N cancer patients before and after the completion of cancer-directed treatment (CDT). Settings and Design The present study was a hospital-based study conducted in the tertiary care hospital of Jammu with longitudinal study design. Subjects and Methods All newly diagnosed HNC patients registered with the Department of Radiotherapy and ENT on inpatient or outpatient basis were included over a period of 6 months. Each patient was followed for 4-6 weeks after the completion of CDT. QOL was assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ C30) (general) and EORTC QLQ H and N-35 (specific) questionnaires. Statistical Analysis Paired t-test was calculated to compare pre- and postmean scores. Pre- and post-Cronbach alpha reliability coefficient was also calculated. Results The most frequent site was larynx followed by the oral cavity. Regarding both EORTC QLQ C-30 questionnaire and Global health status and EORTC H and N-35 specific questionnaires, the mean scores across all domains showed worsening of QoL from their baseline. The worsening was more severe in emotional function (functional scale), while physical, cognitive, and social functions were comparatively less affected. Pain, swallowing, speech, and mouth problems were most worsened. Conclusions QoL showed worsening after CDT in all domains due to acute and subacute adverse effects of chemotherapy and radiotherapy in treatment course.
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Affiliation(s)
- Abroo Bashir
- Department of Community Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Dinesh Kumar
- Department of Community Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Deepika Dewan
- Department of Community Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Rahul Sharma
- Department of Radiotherapy and Oncology, Government Medical College, Jammu, Jammu and Kashmir, India
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Maleki S, Alexander M, Liu C, Rischin D, Lingaratnam S, Fua T. Radiation oncology outpatient medication management needs and service gaps – A cross-sectional study of patients and clinicians. J Oncol Pharm Pract 2020; 26:846-852. [DOI: 10.1177/1078155219875210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients receiving radiotherapy for the treatment of cancer can have complex medication requirements related to the management of side-effects and impaired swallowing ability. This study surveyed patients and clinicians to identify service gaps and unmet medication management needs. Methods Patient and clinician surveys were developed by a multidisciplinary team based on previously validated questionnaires. The patient survey focused on medication use and adherence. The clinician survey was based around a clinical case study and focused on identifying service gaps and practice variations. This survey was disseminated to radiation oncologists, pharmacists and nurses involved with the care of head and neck or lung cancer patients in Victoria. Results A total of 93 surveys were completed including 53 patient surveys and 40 clinician surveys. Radiotherapy patients reported high medication usage with up to 53% taking five or more medications daily. When asked the same set of questions relating to medication education requirements, patients receiving polypharmacy reported greater needs (72%) than recognised by the surveyed multidisciplinary clinician group (58%). They also reported a non-adherence rate of 46%. In addition, further disparities were identified in clinician practices and their approach to clinical situations which may result in conflicting advice and confusion for patients. Conclusion While recognising deficiencies relating to the provision of medication information, oncologists, nurses and pharmacists underestimated patient needs for medication information, education and follow-up. Findings support the rationale for integration of pharmacy services within the radiotherapy clinics to support patient care and bridge service gaps relating to medication management.
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Affiliation(s)
- Sam Maleki
- Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Marliese Alexander
- Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Chen Liu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | | | - Tsien Fua
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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20
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Flöther L. [Pain therapy in palliative ENT patients]. HNO 2020; 68:503-509. [PMID: 32328667 DOI: 10.1007/s00106-020-00861-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alleviation of physical complaints through pain management and symptom control represents an essential part of a palliative treatment concept. Persistent cancer pain in palliative care leads to a significant reduction in quality of life. Evaluation of pain on the basis of a detailed pain history allows recognition of the types of pain and initiation of a corresponding effective pain therapy. The basis of cancer pain therapy in palliative patients is transdermal and oral administration of long-acting analgesics according to a fixed time schedule. Especially important is the detection and treatment of breakthrough pain. For this form of pain, sufficiently effective analgesics with a fast effect are available. Palliative otorhinologic (ENT) patients often pose a major challenge to their treating physicians, as advanced oropharyngeal tumors are often associated with dysphagia. The following article presents an overview of the possibilities of drug-based cancer pain therapy in palliative ENT patients.
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Affiliation(s)
- L Flöther
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
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Bohm N, Karlsson C, Skoogh Andersson J, Almståhl A. Variations in odontological care routines for patients undergoing treatment for head and neck cancer in county councils/regions of Sweden. Clin Exp Dent Res 2020; 6:3-15. [PMID: 32067404 PMCID: PMC7025979 DOI: 10.1002/cre2.242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/11/2019] [Accepted: 08/02/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate current odontological care routines for patients treated for head and neck cancers in the county councils/regions (C/Rs) of Sweden. METHODS An invitation to fill in a web-based questionnaire was sent to dentists/dental hygienists working in dental clinics in the 12 C/Rs, treating and responsible for the odontological care of patients undergoing treatment for cancer of the head and neck. The questionnaire started with two mandatory and one non-mandatory questions, followed by questions regarding routines before (n = 28), during (n = 23), and after (n = 9) treatment, plus two additional questions, totalling 65 questions. RESULTS Four dental hygienists and six dentists in 10 of the 12 C/Rs answered the questionnaire. Three C/Rs stated that they measure both the unstimulated and stimulated salivary secretion rate, and another C/R stated that they measure the stimulated secretion rate only. Similar recommendations were given regarding oral hygiene, salivary stimulants and substitutes, and extra fluoride. However, great variations were seen regarding recommendations for preventing and relieving oral mucositis. There were also discrepancies regarding information about the importance of avoiding smoking and alcohol. In seven C/Rs, patients visited the dental hygienist once a week during cancer treatment. CONCLUSION The results suggests that there are great variations in odontological care given to patients undergoing treatment for cancer of the head and neck region in different county councils/regions in Sweden. There is a need to develop and implement evidence-based guidelines to decrease the risk of oral complications and increase both the quality of life and the quality of care.
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Affiliation(s)
- Niklas Bohm
- Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Charlott Karlsson
- Clinic of Oral and Maxillofacial Surgery, Department of Orofacial Medicine, Institute of OdontologyJönköping UniversityJönköpingSweden
| | - Jessica Skoogh Andersson
- Department of Periodontology, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Annica Almståhl
- Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Karimi AM, Gairola M, Ahlawat P, Tandon S, Pal M, Sachdeva N, Sharief MI, Dobriyal K. Health-related quality of life assessment for head-and-neck cancer patients during and at 3 months after radiotherapy - A prospective, analytical questionnaire-based study. Natl J Maxillofac Surg 2019; 10:134-140. [PMID: 31798246 PMCID: PMC6883888 DOI: 10.4103/njms.njms_92_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/18/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Health-related quality of life (HRQoL) is a more specific area of QoL that deals with the evaluation and assessment of the impact of the disease and its treatment-related morbidities on a patient's physical, psychological, and social aspects. The aim of the present study was to assess the HRQoL of patients with head-and-neck cancer (HNCs) during and at 3 months after completion of radiotherapy (RT) by intensity-modulated RT. Materials and Methods This study was a prospective, longitudinal, observational, and self-completed questionnaire-based study that included 120 patients with HNC who underwent intensity-modulated RT. The questionnaire had adequate internal consistency. The questionnaires were given to each patient at the beginning of treatment (pretreatment), weekly visits during the course of RT (at the end of 1st, 2nd, 3rd, 4th, 5th, and 6th week), on the day of completion of RT, and then finally at 3 months after completion of RT. Thus, a total of successive nine time points were assessed. Results and Conclusions One hundred and eleven patients completed the questionnaires at all nine time points. HRQoL usually decreases during treatment and then increases to pretreatment levels by 3 months after treatment. The Quality of Life Questionnaire, Core Module and Quality of Life Questionnaire, Head and Neck Module were found to be both valid and reliable. There was a significant QoL reduction for the patients throughout treatment in relation to functions and symptoms in the treatment of HNC. However, all the functions and most of the symptoms returned to baseline at the 3-month follow-up.
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Affiliation(s)
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Manoj Pal
- Department of Medical Oncology, Millennium Cancer Center, Gurugram, Haryana, India
| | - Nishtha Sachdeva
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Muhammed Ismail Sharief
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Kiran Dobriyal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
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High Cervical Intrathecal Targeted Drug Delivery: A Case Report of Refractory Oropharyngeal Cancer Pain. Case Rep Oncol Med 2019; 2019:2098921. [PMID: 31583144 PMCID: PMC6754888 DOI: 10.1155/2019/2098921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/31/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Some patients with head and neck cancers have pain refractory to aggressive multimodal therapies. Herein, we report the use of an intrathecal targeted drug delivery (TDD) system catheter tip placed at C1 for the treatment of recalcitrant oropharyngeal cancer pain. Case Report A patient with recurrent metastatic squamous cell tongue cancer reported severe pain not controlled despite high-dose opioids and nonopioid adjuvants. It was elected to proceed with an intrathecal TDD system with the catheter tip placed at the C1 level. After pump placement, we were able to decrease her daily oral morphine equivalents (OME) from nearly 1000 mg to 300 mg over the course of two months while titrating her TDD from 0.3 mg/day to 0.7 mg/day of intrathecal hydromorphone. Unfortunately, her improvement was limited secondary to aggressive cancer-directed treatments likely contributing to device infection and explant. Conclusions In this patient, high cervical placement of an intrathecal TDD catheter was associated with a decrease in OME. While used in clinical practice on occasion, the use of high cervical TDD placement such as this implantable C1 intrathecal TDD system for cancer-associated pain is underreported in the literature. Further studies on this intervention within this challenging population are warranted.
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Söderlund Schaller A, Dragioti E, Liedberg GM, Larsson B. Are patient education and self-care advantageous for patients with head and neck cancer? A feasibility study. Nurs Open 2019; 6:1528-1541. [PMID: 31660181 PMCID: PMC6805323 DOI: 10.1002/nop2.361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/19/2019] [Accepted: 07/10/2019] [Indexed: 01/01/2023] Open
Abstract
AIM This study evaluates whether patient education and individually self-care reduces pain and improves QoL, mood and sleep during and after radiotherapy treatment for patients with head and neck cancer. DESIGN A longitudinal, two-armed feasibility study design was performed. METHODS Sixty-four participants with curative intent were included in the study. All participants answered questions about pain three times a week and completed a survey questionnaire about pain, QoL, psychological aspects and barriers towards pain management at baseline, at 4 weeks and at 10 weeks. Thirty-four of the participants attended in two education sessions on pain based on their beliefs about pain and received individualized self-care instructions based on their weekly rating of pain. RESULT This study did not find any significant group differences for the pain, QoL, mood and sleep.
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Affiliation(s)
- Anne Söderlund Schaller
- Pain and Rehabilitation Centre and Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | - Gunilla M. Liedberg
- Division of Occupational Therapy, Department of Social and Welfare StudiesFaculty of Health Sciences, Campus Norrkoping, Linköping UniversityLinköpingSweden
| | - Britt Larsson
- Pain and Rehabilitation Centre and Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
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Epstein JB, Miaskowski C. Oral Pain in the Cancer Patient. J Natl Cancer Inst Monogr 2019; 2019:5551353. [DOI: 10.1093/jncimonographs/lgz003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/07/2019] [Accepted: 04/01/2019] [Indexed: 01/02/2023] Open
Abstract
Abstract
Oral pain due to cancer and associated treatments is common. The prevalence and severity of oral cancer is high. Painful oral mucositis develops in head and neck cancer patients following surgery and associated radiation therapy and/or chemotherapy. In addition, oral pain, including pain from mucositis, occurs in patients receiving chemotherapy for cancers of the hematopoietic system and cancers at other anatomic sites. Despite pain management practices that include high-dose opioid analgesics, patients rarely obtain relief from either head and neck cancer pain or mucositis pain. Because oral pain in cancer patients is likely due to both nociceptive and neuropathic mechanisms, effective management of pain requires treatments for both processes. As knowledge of the pathophysiology of oral pain in cancer patients increases, new approaches for the prevention and management are anticipated. This article focuses on the emerging evidence that supports the molecular mechanisms and the unique oral micro-neuroanatomy that in combination produce the severe oral pain experienced by cancer patients. In addition, this article summarizes the current state of clinical management of oral mucositis pain.
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Affiliation(s)
- Joel B Epstein
- Department of Surgery, City of Hope, Duarte, CA
- Department of Surgery, Cedars-Sinai Health System, Los Angeles, CA
- Seattle Cancer Care Alliance, Seattle, WA
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA
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Drareni K, Dougkas A, Giboreau A, Laville M, Souquet PJ, Bensafi M. Relationship between food behavior and taste and smell alterations in cancer patients undergoing chemotherapy: A structured review. Semin Oncol 2019; 46:160-172. [DOI: 10.1053/j.seminoncol.2019.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022]
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Silver N, Dourado J, Hitchcock K, Fullerton A, Fredenburg K, Dziegielewski P, Danan D, Tighe P, Morris C, Amdur R, Mendenhall W, Fillingim RB. Chronic opioid use in patients undergoing treatment for oropharyngeal cancer. Laryngoscope 2019; 129:2087-2093. [DOI: 10.1002/lary.27791] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Natalie Silver
- Department of Otolaryngology–Head and Neck Surgery Gainesville Florida U.S.A
| | | | | | - Amy Fullerton
- Department of Speech Language and Hearing Sciences Gainesville Florida U.S.A
| | | | - Peter Dziegielewski
- Department of Otolaryngology–Head and Neck Surgery Gainesville Florida U.S.A
| | - Deepa Danan
- Department of Otolaryngology–Head and Neck Surgery Gainesville Florida U.S.A
| | - Patrick Tighe
- Department of Anesthesiology Gainesville Florida U.S.A
| | - Chris Morris
- Department of Radiation Oncology Gainesville Florida U.S.A
| | - Robert Amdur
- Department of Radiation Oncology Gainesville Florida U.S.A
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Oteri G, Trifirò G, Peditto M, Lo Presti L, Marcianò I, Giorgianni F, Sultana J, Marcianò A. Treatment of Medication-Related Osteonecrosis of the Jaw and its Impact on a Patient's Quality of Life: A Single-Center, 10-Year Experience from Southern Italy. Drug Saf 2018; 41:111-123. [PMID: 28766109 DOI: 10.1007/s40264-017-0582-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION No official guidelines are available for the management of medication-related osteonecrosis of the jaw (MR-ONJ). The additional benefit of surgery after pharmacological treatment is debated by both clinicians and patients. OBJECTIVE The aim of this study was to evaluate the changes in patients' MR-ONJ-related quality of life (QoL) after pharmacological treatment with or without surgery in a large cohort affected by MR-ONJ. METHODS Anonymized data on patients diagnosed with MR-ONJ were extracted from the database of the Osteonecrosis of the Jaw Treatment Center (University of Messina, Italy) in the years 2005-2015. QoL was evaluated at the moment of MR-ONJ diagnoses (T0), after pharmacological treatment with or without surgery (T1 and T2, respectively), based on scores from the European Organisation for Research and Treatment of Cancer (EORTC) QOL Module for Head and Neck Cancer (global oral health status [GOHS]) and a visual analog scale (VAS), stratified by indication for use. RESULTS Among 100 patients, 36% were affected by osteoporosis (OSTEO group) and 64% were affected by cancer (ONC group). Considering T0, QoL scores were higher in the OSTEO group then in the ONC group. At T1, GOHS and VAS increased in both groups (OSTEO group: +9.9% and +39.9%; ONC group: +35.4 and +97.2%, respectively). Pharmacological treatment was effective in reducing pain (OSTEO group: -22.0%; ONC group: -44.8%), and social contact troubles (OSTEO group: -40.3%; ONC group: -26.7%). At T2, GOHS and VAS further increased. Scores related to 'pain' and the troubles related to the 'social dimension' also decreased (OSTEO group: -91.3% and -72.0%; ONC group: 50.8% and -16.4%, respectively). CONCLUSIONS MR-ONJ-related QoL increased after pharmacological treatment and, more notably, after surgery, which may offer benefits to selected patients. QoL data may help clinicians in promoting tailored management of MR-ONJ.
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Affiliation(s)
- Giacomo Oteri
- Unit of Dentistry, AOU Policlinico "G.Martino", Messina, Italy.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy. .,Unit of Clinical Pharmacology, AOU Policlinico "G. Martino", Messina, Italy. .,Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Matteo Peditto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | | | - Ilaria Marcianò
- Unit of Clinical Pharmacology, AOU Policlinico "G. Martino", Messina, Italy
| | | | - Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.,Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Antonia Marcianò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
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Oral-Health-Related Quality of Life After Surgical Treatment of Osteonecrosis of the Jaws. J Craniofac Surg 2018; 29:403-408. [PMID: 29135723 DOI: 10.1097/scs.0000000000004087] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The aim of this study is to analyze the clinical outcome and the change in oral-health-related quality of life (QoL) of osteoporotic patients affected by medication-related osteonecrosis of the jaws (MRONJ). Forty-one patients, consecutively treated for a 10-year period, were retrospectively analyzed. All the patients underwent a marginal osseous resective jaw surgery. A clinical 12 months postoperative evaluation has been performed and the complete mucosal healing, the absence of swelling and suppuration, and no signs of disease recurrence were defined like success parameters. Quality-of-life surveys tests like EORTC QQ-C30 and QLQ-HN35 appendices in conjunction with a perceived oral health visual analog scale (VAS) were administered before (time of diagnosis of MRONJ) and after surgery (at least 6 months) in order to record the different oral health status of the treated patients. The majority of MRONJ-diagnosed patients complained symptoms like pain, eating discomfort, and sense problems, with occasional involvement of the social dimension. There was a prevalence of troubles with social eating and social contact.The complete mucosal healing was achieved in 100% of the patients and the administered survey tests reported a significant improvement in all the investigated spheres. Similarly, an increased mean score of perceived oral health VAS was reported.Marginal-resective surgery of the necrotic jaw bone can be an effective treatment of osteoporotic patients affected by localized MRONJ. Quality-of-life parameters are demonstrated to be useful for recording the patient-centered outcome of MRONJ treatment.
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Fitchett RC, Aldus EJ, Fitchett LR, Cross J. The lived experience of head and neck cancer patients receiving curative radiotherapy: A systematic review and meta-ethnography. Psychooncology 2018; 27:2077-2086. [DOI: 10.1002/pon.4790] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Russell C. Fitchett
- Radiotherapy Department; Norfolk and Norwich University Hospital; Norwich UK
| | - Edward J. Aldus
- Radiotherapy Department; Norfolk and Norwich University Hospital; Norwich UK
| | - Lucy R. Fitchett
- Radiotherapy Department; Norfolk and Norwich University Hospital; Norwich UK
| | - Jane Cross
- School of Health Sciences, Queen's Building; University of East Anglia; Norwich UK
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Maleki S, Alexander M, Fua T, Liu C, Rischin D, Lingaratnam S. A systematic review of the impact of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies. J Oncol Pharm Pract 2018; 25:130-139. [PMID: 29938594 DOI: 10.1177/1078155218783814] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients receiving anticancer therapies are frequently prescribed complex and high-risk medication regimens, which at times can result in medication misadventures. The objective of this review was to assess the effect of outpatient clinical pharmacy services on medication-related outcomes in patients receiving anticancer therapies, including patients undergoing radiotherapy. METHODS A systematic review of original publications indexed in EMBASE, MEDLINE and Cochrane Library from June 2007 to June 2017. Eligible studies evaluated outpatient pharmacy clinic services for cancer patients and reported at least one medication-related quantitative outcome measure. Two authors independently reviewed full-text articles for inclusion, then extracted data and performed quality and risk of bias assessments. RESULTS Of 908 identified publications, 13 met predefined eligibility criteria; 1 randomised control trial, 2 controlled cohort studies and 10 uncontrolled before-after studies. Many excluded studies described outpatient pharmacy services but lacked medication-related outcomes. All included studies had informative practice model designs, with interventions for drug-related problems including drug dose optimisation ( n = 8), reduced drug interaction ( n = 6) and adverse drug reaction reporting ( n = 3). Most studies ( n = 11) reported on symptom improvement, commonly nausea ( n = 7) and pain ( n = 5). Of four studies in radiotherapy cohorts, pharmacist involvement was associated with improved symptoms, satisfaction and wellbeing scores. CONCLUSION Few studies have objectively assessed outpatient pharmacy cancer services, even fewer in the radiotherapy settings. Although the results support these services, significant heterogeneity and bias in the study designs prohibit robust conclusions and further controlled trials are required.
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Affiliation(s)
- Sam Maleki
- 1 Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Marliese Alexander
- 1 Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Tsien Fua
- 2 Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Chen Liu
- 2 Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Danny Rischin
- 3 Department of Medical Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Senthil Lingaratnam
- 1 Department of Pharmacy, Peter MacCallum Cancer Centre, Victoria, Australia
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Genome-wide association study identifies genes associated with neuropathy in patients with head and neck cancer. Sci Rep 2018; 8:8789. [PMID: 29884837 PMCID: PMC5993794 DOI: 10.1038/s41598-018-27070-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/21/2018] [Indexed: 12/18/2022] Open
Abstract
Neuropathic pain (NP), defined as pain initiated or caused by a primary lesion or dysfunction in the nervous system, is a debilitating chronic pain condition often resulting from cancer treatment. Among cancer patients, neuropathy during cancer treatment is a predisposing event for NP. To identify genetic variants influencing the development of NP, we conducted a genome-wide association study in 1,043 patients with squamous cell carcinoma of the head and neck, based on 714,494 tagging single-nucleotide polymorphisms (SNPs) (130 cases, 913 controls). About 12.5% of the patients, who previously had cancer treatment, had neuropathy-associated diagnoses, as defined using the ICD-9/ICD-10 codes. We identified four common SNPs representing four genomic regions: 7q22.3 (rs10950641; SNX8; P = 3.39 × 10−14), 19p13.2 (rs4804217; PCP2; P = 2.95 × 10−9), 3q27.3 (rs6796803; KNG1; P = 6.42 × 10−9) and 15q22.2 (rs4775319; RORA; P = 1.02 × 10−8), suggesting SNX8, PCP2, KNG1 and RORA might be novel target genes for NP in patients with head and neck cancer. Future experimental validation to explore physiological effects of the identified SNPs will provide a better understanding of the biological mechanisms underlying NP and may provide insights into novel therapeutic targets for treatment and management of NP.
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Lefkowits C, Buss MK, Ramzan AA, Fischer S, Urban RR, Fisher CM, Duska LR. Opioid use in gynecologic oncology in the age of the opioid epidemic: Part I - Effective opioid use across clinical settings, a society of gynecologic oncology evidence-based review. Gynecol Oncol 2018; 149:394-400. [DOI: 10.1016/j.ygyno.2018.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/16/2018] [Accepted: 01/23/2018] [Indexed: 02/07/2023]
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34
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Brennan MT, Hasséus B, Hovan AJ, Raber-Durlacher JE, Blijlevens NM, Huysmans MC, Garming Legert K, Johansson JE, Moore CG, von Bültzingslöwen I. Impact of Oral Side Effects from Conditioning Therapy Before Hematopoietic Stem Cell Transplantation: Protocol for a Multicenter Study. JMIR Res Protoc 2018; 7:e103. [PMID: 29685874 PMCID: PMC5938569 DOI: 10.2196/resprot.8982] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 01/26/2018] [Indexed: 11/24/2022] Open
Abstract
Background The oral cavity is a common site of complications related to the cytotoxic effect of high-dose chemotherapy and radiation therapy. Considering our limited understanding of the burden of illness in the oral cavity from various cytotoxic therapies, it is difficult to produce evidence-based, preventive and management protocols. A prospective multicenter study is necessary to collect data on the burden of illness from various cytotoxic regimens. Objective The objectives of this prospective international observational multicenter study in hematopoietic stem cell transplant (HSCT) patients are to establish the nature, incidence and temporal relationship of oral complications related to conditioning regimens (chemotherapy with or without total body irradiation), stem cell transplantation and the immunologic reactions (mainly graft-vs-host-disease) that may follow, and to determine what subjective and objective oral complications related to treatment can predict negative clinical and economic outcomes and reduced quality of life. Methods Adult patients at six study sites receiving full intensity conditioning, reduced intensity conditioning or nonmyeloablative conditioning, followed by autologous or allogeneic hematopoietic stem cell infusion, are included. A pre-treatment assessment includes medical conditions, planned chemo- and radiation therapy regimen, medications, allergies, social history, patient report of oral problems, dental history, subjective oral complaints, objective measures of oral conditions, current laboratory values, dental treatment recommended and untreated dental disease. Starting 1-3 days after hematopoietic stem cell infusion, a bedside assessment is completed 3 days per week until resolution of neutropenia. A patient questionnaire is also completed during hospitalization. Beyond this time, patients with continued oral mucositis or other oral problems are followed 1 day per week in an inpatient or outpatient setting. Additional visits for urgent care for acute oral problems after hospitalization are documented. Autologous transplant patients are being followed up at 100 days (SD 30 days) and at 1 year (SD 30 days) post-transplantation to identify any long-term side effects. Patients treated with allogeneic transplantation are being followed at 100 days (SD 30 days), 6 months (SD 30 days), and 12 months (SD 30 days). The follow-up assessments include cancer response to therapy, current medical conditions, medications, subjective and objective oral findings, quality of life measures and laboratory values. The targeted enrollment is 254 patients who have received HSCT. Results A total of 260 participants have been enrolled, with 233 (91%) who have received HSCT. We anticipate enrollment of 20-30 additional participants to obtain the sample size of 254 enrolled participants who have received HSCT. Conclusions The results of the ongoing prospective study will provide a unique dataset to understand the impact of oral complications on patients undergoing HSCT and provide needed evidence for guidelines regarding the management of this patient cohort.
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Affiliation(s)
- Michael T Brennan
- Department of Oral Medicine, Carolinas Healthcare System, Charlotte, NC, United States
| | - Bengt Hasséus
- Department of Oral Medicine and Pathology, University of Gothenburg, Gothenburg, Sweden
| | | | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry, Amsterdam, Netherlands.,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, Netherlands
| | | | | | | | - Jan-Erik Johansson
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charity G Moore
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
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Maximiano C, López I, Martín C, Zugazabeitia L, Martí-Ciriquián JL, Núñez MA, Contreras J, Herdman M, Traseira S, Provencio M. An exploratory, large-scale study of pain and quality of life outcomes in cancer patients with moderate or severe pain, and variables predicting improvement. PLoS One 2018; 13:e0193233. [PMID: 29614068 PMCID: PMC5882102 DOI: 10.1371/journal.pone.0193233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/07/2018] [Indexed: 12/19/2022] Open
Abstract
Background There have been few large-scale, real world studies in Spain to assess change in pain and quality of life (QOL) outcomes in cancer patients with moderate to severe pain. This study aimed to assess changes on both outcomes after 3 months of usual care and to investigate factors associated with change in QoL. Patients and methods Large, multi-centre, observational study in patients with lung, head and neck, colorectal or breast cancer experiencing a first episode of moderate to severe pain while attending one of the participating centres. QoL was assessed using the EuroQol-5D questionnaire and pain using the Brief Pain Inventory (BPI). Instruments were administered at baseline and after 3 months of follow up. Multivariate analyses were used to assess the impact of treatment factors, demographic and clinical variables, pain and other symptoms on QoL scores. Results 1711 patients were included for analysis. After 3 months of usual care, a significant improvement was observed in pain and QoL in all four cancer groups (p<0.001). Effect sizes were medium to large on the BPI and EQ-5D Index and Visual Analogue Scale (VAS). Improvements were seen on the majority of EQ-5D dimensions in all patient groups, though breast cancer patients showed the largest gains. Poorer baseline performance status (ECOG) and the presence of anxiety/depression were associated with significantly poorer QOL outcomes. Improvements in BPI pain scores were associated with improved QoL. Conclusion In the four cancer types studied, pain and QoL outcomes improved considerably after 3 months of usual care. Improvements in pain made a substantial contribution to QoL gains whilst the presence of anxiety and depression and poor baseline performance status significantly constrained improvement.
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Affiliation(s)
| | - Iker López
- Hospital Universitario Virgen del Rocío, Medical Oncology, Sevilla, Spain
| | - Cristina Martín
- Hospital de la Santa Creu i Sant Pau, Medical Oncology, Barcelona, Spain
| | | | | | | | - Jorge Contreras
- Complejo Hospitalario Regional Carlos Haya, Radiation Oncology, Málaga, Spain
| | | | - Susana Traseira
- Mundipharma Pharmaceuticals S.L., Medical Department, Madrid, Spain
| | - Mariano Provencio
- Hospital Puerta de Hierro de Majadahonda, Medical Oncology, Madrid, Spain
- * E-mail:
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Smith DK, Castellanos EH, Murphy BA. Financial and socio-economic factors influencing pre- and post-cancer therapy oral care. Support Care Cancer 2018; 26:2143-2148. [PMID: 29372394 DOI: 10.1007/s00520-017-4033-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/25/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The primary objective of this study is to evaluate how attendance at dental visits may change as cancer patients move through pre-diagnosis, diagnosis, and into survivorship. METHODS The Health and Retirement Study consists of longitudinal survey data collected biannually detailing financial and health information in subjects over 51 years old. We assessed a subset of 4195 patients who received a new cancer diagnosis during the study period. The odds of reporting a dental visit were examined using a mixed effects logistic regression model. A propensity score weighted analysis of the association between dental attendance and survival was also undertaken. RESULTS The odds of attending a dental visit were substantially lower in the peri-diagnosis period OR = 0.784 (0.700, 0.876) and the post-diagnosis period OR = 0.734 (0.655, 0.823) compared to pre-diagnosis. This effect persisted in patients who survived for at least 2 years indicating that the decline in oral health visits was not due to low expected survival. After propensity score weighting, patients who attended a dental visit in the peri-diagnosis period demonstrated a reduced hazard of all-cause mortality HR = 0.825 (0.681, 0.979) compared with those with no attendance. CONCLUSIONS Dental attendance decreases by a statistically and clinically significant amount both during and after cancer therapy despite guideline recommendations encouraging dental referral and monitoring for many types of cancer therapy. Attendance at dental appointments during cancer therapy is associated with improved survival, which is likely due to a combination of direct and indirect effects.
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Affiliation(s)
- Derek K Smith
- Departments of Biostatistics and Oral Maxillofacial Surgery, Vanderbilt University Medical Center, 2525 West End Ave, Ste 11000, Nashville, TN, 37203, USA.
| | - Emily H Castellanos
- Department of Oncology, Vanderbilt University Medical Center, Nashville, TN, 37221, USA
| | - Barbara A Murphy
- Department of Oncology, Vanderbilt University Medical Center, Nashville, TN, 37221, USA
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Reyes-Gibby CC, Melkonian SC, Hanna EY, Yeung SCJ, Lu C, Chambers MS, Banala SR, Gunn GB, Shete SS. Cohort study of oncologic emergencies in patients with head and neck cancer. Head Neck 2017; 39:1195-1204. [PMID: 28346771 PMCID: PMC5429871 DOI: 10.1002/hed.24748] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Treatments for head and neck squamous cell carcinoma (HNSCC) are associated with toxicities that lead to emergency department presentation. METHODS We utilized data from an ongoing prospective cohort of newly diagnosed, previously untreated patients (N = 298) with HNSCC to evaluate the association between clinical and epidemiologic factors and risk for and frequency of emergency department presentation. Time to event was calculated from the date of treatment initiation to emergency department presentation, date of death, or current date. Frequency of emergency department presentation was the sum of emergency department visits during the follow-up time. RESULTS History of hypertension, normal/underweight body mass index (BMI), and probable depression predicted increased risk for emergency department presentation. BMI and severe pain were associated with higher frequency of emergency department presentations. CONCLUSION Clinical and epidemiologic factors can help predict patients with HNSCC who will present to the emergency department. Such knowledge may improve treatment-related patient outcomes and quality of life. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1195-1204, 2017.
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Affiliation(s)
- Cielito C. Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephanie C. Melkonian
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sai-ching J. Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles Lu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark S. Chambers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Srinivas R. Banala
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary B. Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanjay S. Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
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Nolan MW, Long CT, Marcus KL, Sarmadi S, Roback DM, Fukuyama T, Baeumer W, Lascelles BDX. Nocifensive Behaviors in Mice with Radiation-Induced Oral Mucositis. Radiat Res 2017; 187:397-403. [PMID: 28186468 DOI: 10.1667/rr14669.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Oral mucositis can result in significant dysphagia, and is the most common dose-limiting acute toxicity in head and neck cancer patients receiving chemoradiotherapy. There is a critical need to determine the cellular and molecular mechanisms that underlie radiotherapy-associated discomfort in patients with mucositis. The objective was to induce oral mucositis in mice, using a clinical linear accelerator, and to quantify resultant discomfort, and characterize peripheral sensitization. A clinical linear accelerator was used to deliver ionizing radiation to the oral cavity of mice. Mucositis severity scoring, and various behavioral assays were performed to quantify bouts of orofacial wiping and scratching, bite force, gnawing behavior and burrowing activity. Calcium imaging was performed on neurons of the trigeminal ganglia. Glossitis was induced with a single fraction of at least 27 Gy. Body weight decreased and subsequently returned to baseline, in concert with development and resolution of mucositis, which was worst at day 10 and 11 postirradiation, however was resolved within another 10 days. Neither bite force, nor gnawing behavior were measurably affected. However, burrowing activity was decreased, and both facial wiping and scratching were increased while mice had visible mucositis lesions. Sensory nerves of irradiated mice were more responsive to histamine, tumor necrosis factor alpha and capsaicin. Radiation-induced glossitis is associated with hyper-reactivity of sensory neurons in the trigeminal ganglia of mice, and is accompanied by several behaviors indicative of both itch and pain. These data validate an appropriate model for cancer treatment related discomfort in humans.
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Affiliation(s)
- Michael W Nolan
- North Carolina State University, College of Veterinary Medicine, a Department of Clinical Sciences, Raleigh, North Carolina 27607.,b Department of Comparative Medicine Institute, Raleigh, North Carolina 27607
| | - C Tyler Long
- c Molecular and Biomedical Sciences, Raleigh, North Carolina 27607
| | - Karen L Marcus
- North Carolina State University, College of Veterinary Medicine, a Department of Clinical Sciences, Raleigh, North Carolina 27607
| | - Shayan Sarmadi
- North Carolina State University, College of Veterinary Medicine, a Department of Clinical Sciences, Raleigh, North Carolina 27607
| | - Donald M Roback
- d Rex Cancer Center, Department of Radiation Oncology, Raleigh, North Carolina
| | - Tomoki Fukuyama
- d Rex Cancer Center, Department of Radiation Oncology, Raleigh, North Carolina
| | - Wolfgang Baeumer
- b Department of Comparative Medicine Institute, Raleigh, North Carolina 27607.,c Molecular and Biomedical Sciences, Raleigh, North Carolina 27607
| | - B Duncan X Lascelles
- North Carolina State University, College of Veterinary Medicine, a Department of Clinical Sciences, Raleigh, North Carolina 27607.,b Department of Comparative Medicine Institute, Raleigh, North Carolina 27607
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Sayan M, Cassidy RJ, Switchenko JM, Kayode OA, Saba NF, Steuer CE, Shin DM, Wadsworth JT, El-Deiry M, Patel M, Beitler JJ, Higgins KA. Development of Late Toxicities in Patients with Oral Tongue Cancer Treated with Surgical Resection and Adjuvant Radiation Therapy. Front Oncol 2017; 6:272. [PMID: 28123995 PMCID: PMC5225102 DOI: 10.3389/fonc.2016.00272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/21/2016] [Indexed: 12/18/2022] Open
Abstract
Objectives The late effects of RT are not well reported in patients with oral tongue cancer (OTC). This study reports the incidence of late effects and factors associated with the development of late effects in OTC patients. Methods Patients with OTC treated in our institution from 2003 to 2013 were evaluated. The association between RT doses, including mandible maximum and minimum doses and total 3D maximum dose, and late toxicity, defined as development of osteoradionecrosis (ORN), percutaneous endoscopic gastrostomy (PEG) tube dependence for >6 months after treatment, and narcotic dependency >6 months posttreatment were assessed using both univariate and multivariable (MV) analysis. Results Seventy-six patients with OTC (45% males and 55% females) were treated with definitive surgical resection followed by adjuvant RT. The median follow-up was 4.3 years. Combined late toxicities were reported in 38% of patients. Thirty-four percent of the patients had narcotic dependency and, 3.9% of the patients had ORN of the mandible. Thirteen percent of patients developed PEG tube dependency that was significantly associated with a higher 3D maximum radiation dose on univariate analysis (p < 0.01). On MV analysis, 3D maximum dose remained significantly associated with long-term PEG tube dependency (p = 0.05). Conclusion Patients with OTC treated with adjuvant RT are at significant risk for development of late toxicities. Increasing maximum dose is associated with long-term PEG tube dependence, and care should be taken to reduce the “hot spot” within radiation treatment plans as much as possible.
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Affiliation(s)
- Mutlay Sayan
- University of Vermont Medical Center , Burlington, VT , USA
| | - Richard J Cassidy
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey M Switchenko
- Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Biostatistics and Bioinformatics Shared Resource, Emory University, Atlanta, GA, USA
| | | | - Nabil F Saba
- Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Conor E Steuer
- Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Dong M Shin
- Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - J Trad Wadsworth
- Department of Otolaryngology - Head and Neck Surgery, Emory University , Atlanta, GA , USA
| | - Mark El-Deiry
- Department of Otolaryngology - Head and Neck Surgery, Emory University , Atlanta, GA , USA
| | - Mihir Patel
- Department of Otolaryngology - Head and Neck Surgery, Emory University , Atlanta, GA , USA
| | - Jonathan J Beitler
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA; Department of Otolaryngology - Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Pugh SL, Wyatt G, Wong RKW, Sagar SM, Yueh B, Singh AK, Yao M, Nguyen-Tan PF, Yom SS, Cardinale FS, Sultanem K, Hodson DI, Krempl GA, Chavez A, Yeh AM, Bruner DW. Exploratory Factor Analysis of NRG Oncology's University of Washington Quality of Life Questionnaire-RTOG Modification. J Pain Symptom Manage 2017; 53:139-145.e2. [PMID: 27899312 PMCID: PMC5191964 DOI: 10.1016/j.jpainsymman.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/24/2016] [Accepted: 08/02/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT The 15-item University of Washington Quality of Life questionnaire-Radiation Therapy Oncology Group (RTOG) modification (UW-QOL-RTOG modification) has been used in several trials of head and neck cancer conducted by NRG Oncology such as RTOG 9709, RTOG 9901, RTOG 0244, and RTOG 0537. OBJECTIVES This study is an exploratory factor analysis (EFA) to establish validity and reliability of the instrument subscales. METHODS EFA on the UW-QOL-RTOG modification was conducted using baseline data from NRG Oncology's RTOG 0537, a trial of acupuncture-like transcutaneous electrical nerve stimulation in treating radiation-induced xerostomia. Cronbach α coefficient was calculated to measure reliability; correlation with the University of Michigan Xerostomia Related Quality of Life Scale was used to evaluate concurrent validity; and correlations between consecutive time points were used to assess test-retest reliability. RESULTS The 15-item EFA of the modified tool resulted in 11 items split into four factors: mucus, eating, pain, and activities. Cronbach α ranged from 0.71 to 0.93 for the factors and total score, consisting of all 11 items. There were strong correlations (ρ ≥ 0.60) between consecutive time points and between total score and the Xerostomia Related Quality of Life Scale total score (ρ > 0.65). CONCLUSION The UW-QOL-RTOG modification is a valid tool that can be used to assess symptom burden of head and neck cancer patients receiving radiation therapy or those who have recently completed radiation. The modified tool has acceptable reliability, concurrent validity, and test-retest reliability in this patient population, as well as the advantage of having being shortened from 15 to 11 items.
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Affiliation(s)
- Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania, USA.
| | - Gwen Wyatt
- Michigan State University, East Lansing, Michigan, USA
| | - Raimond K W Wong
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Stephen M Sagar
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Bevan Yueh
- University of Minnesota/Masonic Cancer Center, Minneapolis, Minnesota, USA
| | | | - Min Yao
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Sue S Yom
- UCSF Medical Center, San Francisco, California, USA
| | | | | | - D Ian Hodson
- Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Greg A Krempl
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ariel Chavez
- John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Alexander M Yeh
- Indiana University Hospital/Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, USA
| | - Deborah W Bruner
- Emory University/Winship Cancer Institute, Atlanta, Georgia, USA
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Reyes-Gibby CC, Wang J, Silvas MRT, Yu RK, Hanna EY, Shete S. Genome-wide association study suggests common variants within RP11-634B7.4 gene influencing severe pre-treatment pain in head and neck cancer patients. Sci Rep 2016; 6:34206. [PMID: 27670397 PMCID: PMC5037456 DOI: 10.1038/srep34206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/09/2016] [Indexed: 12/20/2022] Open
Abstract
Pain is often one of the first signs of squamous cell carcinoma of the head and neck (HNSCC). Pain at diagnosis is an important prognostic marker for the development of chronic pain, and importantly, for the overall survival time. To identify variants influencing severe pre-treatment pain in 1,368 patients newly diagnosed with HNSCC, we conducted a genome-wide association study based on 730,525 tagging SNPs. The patients were all previously untreated for cancer. About 15% of the patients had severe pre-treatment pain, defined as pain score ≥7 (0 = “no pain” and 10 = “worst pain”). We identified 3 common genetic variants in high linkage disequilibrium for severe pre-treatment pain, representing one genomic region at 1q44 (rs3862188, P = 3.45 × 10−8; rs880143, P = 3.45 × 10−8; and rs7526880, P = 4.92 × 10−8), which maps to the RP11-634B7.4 gene, a novel antisense gene to three olfactory receptor genes. Olfactory receptor genes, upstream effectors of the MAPK signaling cascade, might be novel target genes for pain in HNSCC patients. Future experimental validation to explore biological mechanisms will be key to defining the role of the intronic variants and non-coding RNA for pain in patients with HNSCC.
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Affiliation(s)
- Cielito C Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Jian Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Mary Rose T Silvas
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Robert K Yu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Ehab Y Hanna
- Department of Head &Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy. Pain 2016; 156:967-979. [PMID: 25719616 DOI: 10.1097/j.pain.0000000000000142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pain is a common symptom in patients with head and neck cancer (HNC) that is associated with significant decrements in physical and psychological functioning. Only 4 studies have evaluated for changes in and predictors of different pain characteristics in these patients. In this longitudinal study of patients with HNC, changes in pain intensity (i.e., average pain, worst pain), pain interference with function, and pain relief were evaluated from the initiation of radiotherapy and through the following 6 months. Hierarchical linear modeling was used to evaluate for changes over time in these 4 pain characteristics, as well as to identify predictors of interindividual variability in each characteristic. Overall, pain intensity and interference with function scores were in the mild-to-moderate range, while pain relief scores were in the moderate range. The occurrence of pain, as well as scores for each pain characteristic, increased from the initiation to the completion of radiotherapy, followed by a gradual decrease to near pretreatment levels at 6 months. However, interindividual variability existed in patients' ratings of each pain characteristic. Predictors of more severe pain characteristic scores were more comorbidities, worse physical functioning, not having surgery before radiotherapy, difficulty swallowing, mouth sores, sleep disturbance, fatigue, more energy, and less social support. Patients with more depressive symptoms had better pain relief. Although some of the predictors cannot be modified (e.g., rrence of surgery), other predictors (e.g., symptoms) can be treated. Therefore, information about these predictors may result in decreased pain in patients with HNC.
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Samdariya S, Lewis S, Kauser H, Ahmed I, Kumar D. A Randomized Controlled Trial Evaluating the Role of Honey in Reducing Pain Due to Radiation Induced Mucositis in Head and Neck Cancer Patients. Indian J Palliat Care 2015; 21:268-73. [PMID: 26600693 PMCID: PMC4617032 DOI: 10.4103/0973-1075.164892] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: There are various drugs tried for relieving pain associated with radiation-induced mucositis. This paper aims to study role of honey in relieving pain due to radiation induced mucositis in head and neck cancer patients receiving concomitant chemoradiation. Materials and Methods: A randomized controlled trial on 78 subjects (40 in test group and 38 in control group) was undertaken to study the analgesic effect of honey, but the analysis of 69 patients was done as nine patients (four in test and five in control group) were lost to follow-up or left treatment in between the study. All patients were advised to do salt-soda and benzydamine mouth gargles, alternatively every 3 hours. Test group patients additionally received 20 ml honey three times a day during the entire course of radiation treatment and 3 months following radiation therapy (RT). Results: Honey significantly reduced the severity of mucositis associated pain and resulted in lesser treatment gaps and a decrease in overall radiotherapy treatment duration. None of the test group and majority of controls (51.5%) had severe pain score during the 7th week of RT. The same pattern was seen in the post-RT period. Mean pain score was significantly different in both groups during all weeks during and upto 6 weeks post-RT (mean score of 3.08 and 6.54 for test and control respectively at 7th week RT, P < 0.001). Conclusion: Honey being a cheap, palatable, and natural medicament can be used for decreasing pain associated with radiation-induced mucositis in cancer patients.
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Affiliation(s)
- Saurabh Samdariya
- Department of Radiation Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shirley Lewis
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Heena Kauser
- Department of Radiotherapy, Indo-American Cancer Institute, Hyderabad, Telangana, India
| | - Iqbal Ahmed
- Department of Radiation Oncology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Dewesh Kumar
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Gussgard AM, Jokstad A, Wood R, Hope AJ, Tenenbaum H. Symptoms Reported by Head and Neck Cancer Patients during Radiotherapy and Association with Mucosal Ulceration Site and Size: An Observational Study. PLoS One 2015; 10:e0129001. [PMID: 26060992 PMCID: PMC4465350 DOI: 10.1371/journal.pone.0129001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 05/03/2015] [Indexed: 11/30/2022] Open
Abstract
Background Self-reported pain and impairment of oral functions varies markedly and often in spite of extensive oral mucositis (OM). The aim of the current study was to appraise how patient-reported debilitation caused by OM is influenced by the extent and possibly location of the OM lesions. Methods Patients with head and neck cancer undergoing radiotherapy were examined before treatment, twice weekly during 6-7 weeks of therapy, and 3-4 weeks after therapy completion. OM signs of 33 participants were evaluated using the Oral Mucositis Assessment Scale (OMAS), while OM symptoms were recorded using Patient-Reported Oral Mucositis Symptom (PROMS)-questionnaires. Changes in OM experience as a function of OM signs was undertaken by comparing the aggregated and individual PROMS scale values at the point of transition of OMAS ulceration scores between 0 to 1, 1 to 2 and 2 to 3, respectively in the nine intra-oral locations designated in the OMAS. ANOVA with pairwise contrasts using the LSD procedure was applied for comparisons of mean changes of PROMS scale values for the participants who experienced an OMAS score of 2 or more during therapy (n=24). Results Impairment of eating hard foods was more when the OMAS score for ulceration anywhere in the mouth or in the soft palate changed from 1 to 2, compared to between score 0 and 1 (p=.002 and p=.05) or between score 2 and 3 (p=.001 and p=.02). Mouth pain increased more upon transition of OMAS score anywhere in the mouth from 1 to 2 compared to 0 to 1 (p=.05). Conclusion The relationship between patient-reported impairment of oral function and pain caused by OM ulceration is not linear, but rather curvilinear. Our findings should prompt investigators of future interventional trials to consider using a less severe outcome than maximum OM scores as the primary study outcome.
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Affiliation(s)
| | - Asbjorn Jokstad
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Robert Wood
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Andrew J. Hope
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Howard Tenenbaum
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Periodontology, Tel Aviv University, Tel Aviv, Israel
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Schaller A, Larsson B, Lindblad M, Liedberg GM. Experiences of Pain: A Longitudinal, Qualitative Study of Patients with Head and Neck Cancer Recently Treated with Radiotherapy. Pain Manag Nurs 2015; 16:336-45. [DOI: 10.1016/j.pmn.2014.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 08/17/2014] [Accepted: 08/19/2014] [Indexed: 11/25/2022]
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Reliability and validity of the Head and Neck Cancer Inventory (HNCI) in Japanese patients. Palliat Support Care 2015; 13:1373-80. [PMID: 25620032 DOI: 10.1017/s1478951514001345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This project evaluated the psychometric properties of a translated version of the Head and Neck Cancer Inventory (HNCI) for use with Japanese patients. The HNCI is a measure for assessing the quality of life (QoL) of head and neck cancer patients and survivors. The present study was aimed at investigating the reliability and validity of this translated instrument. METHOD Some 165 patients with head and neck cancer (HNC) were enrolled at the Tokyo Medical and Dental University Hospital. The instrument's internal consistency and test-retest reliability were evaluated. Criterion-related validity was assessed by correlations between the HNCI and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) scales. RESULTS Some 29 of the 30 items in the original version were selected to comprise the Japanese version of the HNCI (Japanese HNCI). Investigation of criterion-related validity using the FACT-H&N demonstrated significant correlations (Spearman's ρ = 0.47-0.63). The value of Cronbach's α for each subscale ranged from 0.84 to 0.87. Test-retest reliability showed an intraclass correlation coefficient (ICC) of 0.62-0.79. SIGNIFICANCE OF RESULTS The reliability and validity of the Japanese HNCI were evaluated. Although its classification is different from the original U.S. version, the Japanese HNCI is a self-administered questionnaire that can assess quality of life (QoL) in patients with head and neck cancer.
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Elad S, Raber-Durlacher JE, Brennan MT, Saunders DP, Mank AP, Zadik Y, Quinn B, Epstein JB, Blijlevens NMA, Waltimo T, Passweg JR, Correa MEP, Dahllöf G, Garming-Legert KUE, Logan RM, Potting CMJ, Shapira MY, Soga Y, Stringer J, Stokman MA, Vokurka S, Wallhult E, Yarom N, Jensen SB. Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer 2015; 23:223-36. [PMID: 25189149 PMCID: PMC4328129 DOI: 10.1007/s00520-014-2378-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/30/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Hematology-oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications which may cause significant morbidity and a potential risk of mortality. This emphasizes the importance of basic oral care prior to, during and following chemotherapy/HSCT. While scientific evidence is available to support some of the clinical practices used to manage the oral complications, expert opinion is needed to shape the current optimal protocols. METHODS This position paper was developed by members of the Oral Care Study Group, Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT) in attempt to provide guidance to the health care providers managing these patient populations. RESULTS The protocol on basic oral care outlined in this position paper is presented based on the following principles: prevention of infections, pain control, maintaining oral function, the interplay with managing oral complications of cancer treatment and improving quality of life. CONCLUSION Using these fundamental elements, we developed a protocol to assist the health care provider and present a practical approach for basic oral care. Research is warranted to provide robust scientific evidence and to enhance this clinical protocol.
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Affiliation(s)
- Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave., Rochester, NY, 14620, USA,
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Expérimentation du parcours personnalisé des patients atteints d’un cancer des voies aéro-digestives supérieures. Bull Cancer 2014; 101:910-5. [DOI: 10.1684/bdc.2014.2040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Inhestern J, Schuerer J, Illge C, Thanos I, Meissner W, Volk GF, Guntinas-Lichius O. Pain on the first postoperative day after head and neck cancer surgery. Eur Arch Otorhinolaryngol 2014; 272:3401-9. [PMID: 25261106 DOI: 10.1007/s00405-014-3307-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/22/2014] [Indexed: 11/27/2022]
Abstract
Postoperative pain within the first 24 h after head and neck cancer (HNC) surgery was assessed. Factors influencing postoperative pain were identified. In a prospective cohort single center study 145 HNC patients rated their pain on the first postoperative day using questionnaires of the German-wide project Quality Improvement in Postoperative Pain Treatment (QUIPS) including numeric rating scales (NRS, 0-10) for the determination of patient's pain on ambulation, his maximal and minimal pain. QUIPS allowed a standardized assessment of patients' characteristics and pain-related parameters. The influence of these parameters on the patients' postoperative pain was estimated by univariate and multivariate statistical analysis. One-third had already pain prior to the surgical intervention. Overall, the mean pain on ambulation, maximal pain and minimal pain were 2.55 ± 2.36, 3.18 ± 2.86, and 1.38 ± 2.86 (NRS), respectively. 53 % of the patients had maximal pain scores >3. Multivariate analysis revealed independent predictors for more postoperative pain on ambulation: intensity of chronic preoperative pain, usage of non-opioids on ward, and existence of pain documentation on ward. Intensity of chronic preoperative pain and usage of non-opioids on ward were independent risk factors for more maximal pain. Intensity of chronic preoperative pain was independently associated to more minimal pain. Concerning pain management side effects, the risk for drowsiness increased with longer time of surgery. Postoperative pain after HNC surgery is highly variable and seems often to be unnecessarily high. Many patients seem to receive less analgesia than needed or ineffective analgesic drug regimes.
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Affiliation(s)
- Johanna Inhestern
- Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany
| | - Jenny Schuerer
- Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany
| | - Christina Illge
- Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany
| | - Ira Thanos
- Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany
| | - Winfried Meissner
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Lessingstrasse 2, 07740, Jena, Germany.
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Survival patterns in squamous cell carcinoma of the head and neck: pain as an independent prognostic factor for survival. THE JOURNAL OF PAIN 2014; 15:1015-22. [PMID: 25043982 DOI: 10.1016/j.jpain.2014.07.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/02/2014] [Accepted: 07/08/2014] [Indexed: 11/24/2022]
Abstract
UNLABELLED Survival outcomes in patients with squamous cell carcinoma of the head and neck (HNSCC) vary by extent of disease, behavioral factors, and socioeconomic factors. We assessed the extent to which pretreatment pain influences survival in 2,340 newly diagnosed patients with HNSCC, adjusting for disease stage, symptoms, pain medications, comorbidities, smoking, alcohol consumption, age, sex, and race/ethnicity. Patients rated their pain at presentation to the cancer center (0 = "no pain" and 10 = "pain as bad as you can imagine"). Survival time was calculated from the date of diagnosis to the date of death of any cause or last follow-up. Five-year overall survival was calculated for all the variables assessed in the study. Severe pain (≥7) was most prevalent among those with oral cancer (20.4%; pharynx = 18.8%; larynx = 16.1%) and significantly varied by tumor stage, fatigue severity, smoking status, comorbid lung disease, and race (all P < .05) across cancer diagnoses. Overall 5-year survival varied by pain for oral (severe pain = 31% vs nonsevere pain = 52%; P < .001) and pharyngeal cancer (severe pain = 33% vs nonsevere pain = 53%; P < .001). Multivariable analyses showed that pain persisted as an independent prognostic factor for survival. Pain reported prior to treatment should be considered in understanding survival outcomes in HNSCC patients. PERSPECTIVE Pretreatment pain was an independent predictor of survival in a large sample of HNSCC patients even after accounting for tumor node metastasis stage, fatigue, age, race/ethnicity, smoking, and alcohol intake. Therefore, symptoms at presentation and before cancer treatment are important factors to be considered in understanding survival outcomes in HNSCC patients.
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