1
|
Philipsen BB, Korsholm M, Rohde M, Wessel I, Forner L, Johansen J, Godballe C. The effect of hyperbaric oxygen therapy in head and neck cancer patients with radiation induced dysphagia-a systematic review. Clin Transl Oncol 2024:10.1007/s12094-024-03449-w. [PMID: 38704813 DOI: 10.1007/s12094-024-03449-w] [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: 01/06/2024] [Accepted: 03/04/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE The aim of this systematic review was to assess the role of hyperbaric oxygen therapy (HBOT) in patients with dysphagia after radiation therapy for head and neck cancer. METHOD A systematic search was conducted in the electronic databases Ovid MEDLINE, Ovid Embase, and Cochrane Central Register of Controlled Trials for relevant studies until March 14, 2023. No restriction on language or publication date. The criteria for inclusion: patients with HNC who had received both radiation therapy and HBOT as 1) a preventive treatment against swallowing difficulties, 2) to preserve swallowing function, or 3) to promote swallowing difficulties. RESULTS We identified 1396 records. After removal of 31 duplicates, 1365 records were accessible for title and abstract screening. This yielded 53 studies for full text assessment. Six studies met the eligibility criteria and were included for qualitative analysis. CONCLUSION Evidence of HBOT benefits in patients with dysphagia after radiation therapy for head and neck cancer is inconsistent. Well-designed studies using validated outcome measures and long-term follow-up are warranted.
Collapse
Affiliation(s)
- Bahareh Bakhshaie Philipsen
- Department of ORL - Head & Neck Surgery and Audiology, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Malene Korsholm
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Max Rohde
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| | - Irene Wessel
- Department of ORL Head & Neck Surgery and Audiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lone Forner
- Department Of Oral and Maxillofacial Surgery Oral and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark
| | - Christian Godballe
- Department of ORL - Head & Neck Surgery and Audiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark
| |
Collapse
|
2
|
Bernardez B, Mangues-Bafalluy I, Callejo VM, Ávila JJF, Rodríguez JAM, Aradilla MAP, Bautista MJM. Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. FARMACIA HOSPITALARIA 2024; 48:T108-T115. [PMID: 38461113 DOI: 10.1016/j.farma.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE We aimed to develop of a risk stratification model for the pharmaceutical care (PC) of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through three workshops and a pilot study. Variables were defined, grouped into four dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into three priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score =11); social and health variables and cognitive and functional status (maximum = 19); clinical and health services utilization (maximum = 25); and treatment-related (maximum = 41). From the results of applying the model to the 199 patients enrolled, the cutoff points for categorization were 28 or more points for priority 1, 16 to 27 points for priority 2 and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of 'clinical and health services utilization' and 'treatment-related'. Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
Collapse
Affiliation(s)
- Beatriz Bernardez
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, España; Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo de Farmacología, Instituto de Investigación Santiago de Compostela (IDIS), Santiago de Compostela, España.
| | - Irene Mangues-Bafalluy
- Servicio de Farmacia, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, España; Grupo de Farmacoepidemiología y Farmacodinamia, Institut de Recerca Biomèdica, IRBLleida, Lleida, España
| | - Virginia Martínez Callejo
- Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander, España
| | | | | | | | | |
Collapse
|
3
|
Bernardez B, Mangues-Bafalluy I, Callejo VM, Ávila JJF, Rodríguez JAM, Aradilla MAP, Bautista MJM. Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. FARMACIA HOSPITALARIA 2024; 48:108-115. [PMID: 37884399 DOI: 10.1016/j.farma.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE We aimed to develop of a risk stratification model for the pharmaceutical care of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through 3 workshops and a pilot study. Variables were defined, grouped into 4 dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into 3 priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score=11); social and health variables and cognitive and functional status (maximum=19); clinical and health services utilization (maximum=25); and treatment-related (maximum=41). From the results of applying the model to the 199 patients enrolled, the cut-off points for categorization were 28 or more points for priority 1, 16-27 points for priority 2, and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of "clinical and health services utilization" and "treatment-related." Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
Collapse
Affiliation(s)
- Beatriz Bernardez
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago, Spain; Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Clínico, Universitario de Santiago de Compostela, Santiago, Spain; Grupo de Farmacología, Instituto de Investigación Santiago de Compostela (IDIS), Santiago, Spain.
| | - Irene Mangues-Bafalluy
- Servicio de Farmacia, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Grupo de Farmacoepidemiología y Farmacodinamia, Institut de Recerca Biomèdica, IRBLleida, Lleida, Spain
| | - Virginia Martínez Callejo
- Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | |
Collapse
|
4
|
Leclair V, Notarnicola A, Kryštůfková O, Mann H, Andersson H, Diederichsen LP, Vencovský J, Holmqvist M, Lundberg IE, Steele RJ, Hudson M. Effect modification of cancer on the association between dysphagia and mortality in early idiopathic inflammatory myopathies. Semin Arthritis Rheum 2024; 65:152408. [PMID: 38335694 DOI: 10.1016/j.semarthrit.2024.152408] [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: 12/03/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE The interplay between dysphagia, cancer, and mortality in idiopathic inflammatory myopathies (IIM) has not been carefully studied. The aim of this study was to investigate possible effect modification of cancer on the association between dysphagia and mortality in early IIM. METHODS A multi-center cohort of 230 adult IIM patients with dysphagia assessment within 6 months of disease onset was assembled. Crude mortality rates in IIM patients exposed or not to dysphagia were estimated for the 5-year period following cohort entry. To explore possible effect modification of cancer on the association between dysphagia and mortality, adjusted Cox models stratified on cancer status were performed as well as an interaction model. RESULTS Mortality rates per 100 person-years for IIM patients exposed to dysphagia were 2.3 (95 %CI 1.0 to 4.5) in those without cancer compared to 33.3 (95 %CI 16.6 to 59.5) in those with cancer. In stratified Cox models, the main effect of dysphagia was HR 0.5 (95 %CI 0.2 to 1.5) in non-cancer and 3.1 (95 %CI 1.0 to 10.2) in cancer patients. In the interaction model, the combination of dysphagia and cancer yielded a HR of 6.4 (1.2 to 35.1). CONCLUSION In this IIM cohort, dysphagia in non-cancer patients was not associated with increased mortality, while it was in presence of cancer, supporting effect modification of cancer on the association between dysphagia and mortality. This suggests that IIM patients with and without cancer differ and separate analyses for the two groups should be conducted when the outcome of interest is mortality.
Collapse
Affiliation(s)
- Valérie Leclair
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden; Jewish General Hospital and Lady Davis Institute, Montreal, Canada; Department of Medicine, McGill University, Montreal, Canada.
| | - Antonella Notarnicola
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastro, Dermatology and Rheumatology, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Olga Kryštůfková
- Institute of Rheumatology and Department of Rheumatology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Herman Mann
- Institute of Rheumatology and Department of Rheumatology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Helena Andersson
- Department of Rheumatology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Louise Pyndt Diederichsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Jiri Vencovský
- Institute of Rheumatology and Department of Rheumatology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Marie Holmqvist
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden; Department of Gastro, Dermatology and Rheumatology, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Gastro, Dermatology and Rheumatology, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Russell J Steele
- Department of Mathematics and Statistics, McGill University, Montreal, Canada
| | - Marie Hudson
- Jewish General Hospital and Lady Davis Institute, Montreal, Canada; Department of Medicine, McGill University, Montreal, Canada
| |
Collapse
|
5
|
Ottaviani G, Targato G, Rupel K, Gobbo M, Generali D, Guglielmi A, Dicorato A, Adamo D, Canfora F, Di Lenarda R, Biasotto M. Oral Problems in Oncology Patients Undergoing Chemotherapy for Solid Tumors: A Prospective Observational Study. Cancers (Basel) 2023; 16:176. [PMID: 38201603 PMCID: PMC10778343 DOI: 10.3390/cancers16010176] [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] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE Oral problems in a group of oncological patients undergoing chemotherapy (CT) for solid tumors have been examined. Incidence and severity of patients' self-reported oral problems have been evaluated along their interaction with age, gender, tumor diagnosis and stage, presence of mestastasis, CT agent type, and number of CT cycle. We also analyzed the presence of paraesthesia and anaesthesia and their predisposing factors associated with clinical and treatment-related variables. METHODS Patients were asked to fill in a questionnaire to evaluate the onset and the intensity of oral and perioral pain, oral mucositis, salivary gland hypofunction, dysgeusia, dysphagia, dysphonia, and sensitivity neuropathy (paraesthesia or dysaesthesia) since the last CT infusion. We also investigated which types of medications have possibly been used and who recommended it, as well as patients' degree of awareness about the possibility of oral problems arising during CT. RESULTS We recruited 194 patients and obtained 491 questionnaires. We found that a metastatic disease was a risk factor for OM (OR 2.02, p = 0.026) and salivary gland hypofunction (OR 1.66, p = 0.042) and that platinum agents, compared to mitotic inhibitors, increased the risk of developing salivary gland hypofunction (OR 2.16, p = 0.013), dysphagia (OR 3.26, p = 0.001), and anaesthesia (OR 5.16, p = 0.041). Young age was a slight protective factor for most symptoms. The 80% of enrolled patients were informed by the oncologist about possible oral problems arising during CT. CONCLUSIONS Our study highlighted the importance of collecting observational data from the patients' perspective on oral problems arising during the routine oncology practice, across a range of solid tumors and CT regimens. The relevance of these findings focused on the key role of the multidisciplinary team in advising the patients on the possible occurrence of oral problems, also by recommending their management.
Collapse
Affiliation(s)
- Giulia Ottaviani
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Giada Targato
- Department od Medicine (DAME), University of Udine, 33100 Udine, Italy
- Department of Oncology, Udine Academic Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Katia Rupel
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Margherita Gobbo
- Unit of Oral and Maxillofacial Surgery, Ca’ Foncello Hospital, 31100 Treviso, Italy
| | - Daniele Generali
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Alessandra Guglielmi
- Department of Oncology, Maggiore Hospital, Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Angela Dicorato
- Department of Oncology, Maggiore Hospital, Piazza dell’Ospitale 1, 34125 Trieste, Italy
| | - Daniela Adamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 5 Via Pansini, 80131 Naples, Italy
| | - Federica Canfora
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 5 Via Pansini, 80131 Naples, Italy
| | - Roberto Di Lenarda
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Matteo Biasotto
- Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| |
Collapse
|
6
|
Costa DR, Guedes RLV, Mituuti CT, Rubira CMF, da Silva Santos PS, Berretin-Felix G. Symptoms of oropharyngeal dysphagia, efficiency, and safety of swallowing in patients after treatment for head and neck cancer. Support Care Cancer 2023; 32:21. [PMID: 38093087 DOI: 10.1007/s00520-023-08215-2] [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: 05/17/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE The aim of this study is to investigate the relation between symptoms and signs of oropharyngeal dysphagia after treatment for head and neck cancer. METHODS An observational analytical study with retrospective and prospective components was carried out including 25 adult and elderly patients with head and neck cancer who had completed the treatment at least 3 months before data collection. Data from the Eating Assessment Tool (EAT-10) protocol were analyzed, as well as from the videofluoroscopic swallowing exams. Based on videofluoroscopy, the degree of oropharyngeal dysphagia was classified, as well as the safety and efficiency grade using the DIGEST (Dynamic Imaging Grade of Swallowing Toxicity) scale. Pearson's correlation test was applied, adopting a significance level of 5%. RESULTS There was a significant correlation between question 4 of the EAT-10 (swallowing solids takes extra effort) and the efficiency profile (p = 0.004), as well as between question 4 and the DIGEST score (p = 0.002). No significant relation was found between the DIGEST score and EAT-10 total score (p = 0.180) and not even between EAT-10 total score and efficiency (p = 0.129) or safety grade (p = 0.878). CONCLUSION In conclusion, no relation was found between most of the dysphagia signs and symptoms investigated, demonstrating that the individual's perception of the swallowing function may not be consistent with the findings of the instrumental evaluation after long-term treatment for head and neck cancer.
Collapse
Affiliation(s)
- Danila Rodrigues Costa
- Speech-Language Pathology Department, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | | | | | - Cassia Maria Fischer Rubira
- Department of Surgery, Stomatology, Pathology and Radiology of Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology of Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Giédre Berretin-Felix
- Speech-Language Pathology Department, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| |
Collapse
|
7
|
Silva DNM, Vicente LCC, Glória VLP, de Lima Friche AA. Swallowing disorders and mortality in adults with advanced cancer outside the head and neck and upper gastrointestinal tract: a systematic review. BMC Palliat Care 2023; 22:150. [PMID: 37798715 PMCID: PMC10557219 DOI: 10.1186/s12904-023-01268-4] [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: 08/05/2022] [Accepted: 09/22/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Although oncological palliative care is increasingly being offered by multidisciplinary teams, there is still a lack of data about some symptoms handled by these teams, such as dysphagia, in patients with advanced cancer outside swallow regions. This study aimed to estimate the occurrence of dysphagia in prognosis studies of adults with advanced cancer outside the head, neck, and upper gastrointestinal tract, and to determine if there is an association with mortality. METHODS A systematic review of studies that evaluated dysphagia and mortality was conducted (PROSPERO: CRD42021257172). DATA SOURCES BVS, PubMed, CINAHL, Web of Science, and Scopus. Data between 2011 and 2023 were selected. RESULTS Among the 608 articles screened, only 14 were included, which covered different types of cancer, primarily Lung, and Genitourinary, Skin, Hematological, and Central Nervous System as well. Dysphagia demonstrated a variable frequency, and almost half of the studies found a percentage of dysphagia above 60%, appearing most as a symptom that affects health-related quality of life and prove to be a toxicity of treatment. The association between dysphagia and mortality was only evaluated in three articles that studied advanced lung cancer, in which, after controlling for covariates, swallowing disorders were associated with worse survival, with prevalences of dysphagia and hazard ratios of 78.5% (1.12 [1.04-1.20]), 4% (1.34 [1.28-1.35]), and 3% (1.40 [1.07-1.81]), respectively. CONCLUSIONS The occurrence of dysphagia in advanced cancer outside the head, neck, and upper GI tract is common, and there seems to be an association with significantly decreased survival in patients with advanced lung cancer.
Collapse
Affiliation(s)
- Danielle Nunes Moura Silva
- Universidade Federal de Minas Gerais (UFMG), Pós-Graduação Em Ciências Fonoaudiológicas, Faculdade de Medicina, 190 Alfredo Balena Avenue, Santa Efigênia, Belo Horizonte City, Minas Gerais State, 30130-100, Brazil.
| | - Laélia Cristina Caseiro Vicente
- Universidade Federal de Minas Gerais (UFMG), Pós-Graduação Em Ciências Fonoaudiológicas, Faculdade de Medicina, 190 Alfredo Balena Avenue, Santa Efigênia, Belo Horizonte City, Minas Gerais State, 30130-100, Brazil
| | - Vanessa Laís Pontes Glória
- Instituto de Previdência Dos Servidores Do Estado de Minas Gerais (IPSEMG), IPSEMG Hospital, 225 Alameda Ezequiel Dias, Centro, Belo Horizonte City, Minas Gerais State, 30130-110, Brazil
| | - Amélia Augusta de Lima Friche
- Universidade Federal de Minas Gerais (UFMG), Pós-Graduação Em Ciências Fonoaudiológicas, Faculdade de Medicina, 190 Alfredo Balena Avenue, Santa Efigênia, Belo Horizonte City, Minas Gerais State, 30130-100, Brazil
| |
Collapse
|
8
|
Baudelet M, Van den Steen L, Wouters S, De Bodt M, Vanderveken O, Duprez F, Van Nuffelen G. Supportive care among head and neck cancer patients: An initial validation of the Dutch version of the Performance Status Scale for Head and Neck Cancer (D-PSS-HN). INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1668-1679. [PMID: 37189297 DOI: 10.1111/1460-6984.12894] [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: 10/10/2022] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Acute and late toxicities in patients treated with (chemo)radiotherapy for head and neck cancer (HNC) is common and can negatively impact quality of life and performance. Performance status instruments measure the functional ability to perform daily life activities and are important tools in the oncologic population. AIMS Since Dutch performance status scales for the HNC population are lacking, we conducted this study to translate the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) into Dutch (D-PSS-HN) and to validate this version. METHODS & PROCEDURES The D-PSS-HN was translated into Dutch according to the internationally described cross-cultural adaptation process. It was administered to HNC patients and together with the Functional Oral Intake Scale completed by a speech and language pathologist at five different time points during the first 5 weeks of (chemo)radiotherapy. Patients were asked each time to complete the Functional Assessment of Cancer Therapy and the Swallowing Quality of Life Questionnaire. Pearson correlation coefficients were used to calculate convergent and discriminant validity and the evolution of D-PSS-HN scores was assessed by means of linear mixed models. OUTCOMES & RESULTS A total of 35 patients were recruited and > 98% of the clinician-rated scales were completed. Convergent and discriminant validity were demonstrated, with all correlations rs between 0.467 and 0.819, and between 0.132 and 0.256, respectively. The subscales of the D-PSS-HN are sensitive to detect changes through time. CONCLUSION & IMPLICATIONS The D-PSS-HN is a valid and reliable instrument to assess performance status in patients with HNC treated with (chemo)radiotherapy. It is a useful tool to measure HNC patients' current diet level and functional abilities to perform daily life activities. WHAT THIS PAPER ADDS What is already known on the subject Acute and late toxicities in patients treated with (chemo)radiotherapy for HNC are common and can negatively impact quality of life and performance. Performance status instruments measure the functional ability to perform daily life activities and are important tools in the oncologic population. However, Dutch performance status scales for the HNC population are lacking. Therefore, we translated the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) into Dutch (D-PSS-HN) and validated this version. What this paper adds to existing knowledge We translated the PSS-HN and demonstrated its convergent and discriminant validity. The subscales of the D-PSS-HN are sensitive to detect changes through time. What are the potential or actual clinical implications of this work? The D-PSS-HN is a useful tool to measure HNC patients' functional abilities to perform daily life activities. The tool can easily be used in clinical settings: since data collection duration is very short, this facilitates clinical (and research-related) implementation of the scale. Patients' individual needs could be identified by using the D-PSS-HN, resulting in more appropriate approaches and (early) referrals if needed. Interdisciplinary communication could be facilitated.
Collapse
Affiliation(s)
- Margot Baudelet
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otolaryngology and Head & Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Sophie Wouters
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otolaryngology and Head & Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otolaryngology and Head & Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
- Multi-Disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otolaryngology and Head & Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
9
|
Kwon S, Kim G, Cha S, Han K, Paik NJ, Kim WS. Incidence of dysphagia requiring medical attention in various types of cancers: A nationwide population-based cohort study. Support Care Cancer 2023; 31:309. [PMID: 37115351 DOI: 10.1007/s00520-023-07778-4] [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: 12/21/2022] [Accepted: 04/25/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Most previous reports on dysphagia in cancer have focused on specific cancer types, particularly head and neck cancer. Therefore, we aimed to investigate the incidence of dysphagia in patients with various cancers using a nationwide database in South Korea. METHODS This was a retrospective cohort study using the National Health Insurance Service database. Claim codes were used for the selection criteria and operational definitions. The total population data from 2010 to 2015 were extracted. The crude incidence of dysphagia was calculated per 1,000 person-years. The multivariate adjusted Cox proportional hazards regression was used to determine the effects of different cancers on the incidence of dysphagia. RESULTS People with cancer had a lower income and suffered from a higher risk of comorbidities compared to people without cancer. The risk of dysphagia increased in all types of cancers, particularly in the oral cavity and pharynx (hazard ratio [HR]: 20.65, 95% confidence interval [CI]: 17.73-24.06), esophagus (HR: 18.25, 95% CI: 15.66-21.26), larynx (HR: 12.87, 95% CI: 10.33-16.02), and central nervous system (HR: 12.42, 95% CI: 10.33-14.94). CONCLUSIONS The risk of dysphagia was significantly higher in the cancer group than in the non-cancer group. As the survival of cancer patients is improving with the development of new treatments, more attention should be paid to dysphagia in the management of cancer. Prompt and appropriate multidisciplinary interventions for dysphagia are necessary to improve the recovery and quality of life in cancer patients.
Collapse
Affiliation(s)
- SuYeon Kwon
- Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, School of Medicine, Seoul, Republic of Korea
| | - Gowun Kim
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| |
Collapse
|
10
|
Brisson-McKenna M, Jefferson GD, Siddiqui SH, Adams S, Afanasieva Sonia S, Chérid A, Burns J, Di Gironimo C, Mady LJ. Swallowing Function After Treatment of Laryngeal Cancer. Otolaryngol Clin North Am 2023; 56:371-388. [PMID: 37030949 DOI: 10.1016/j.otc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Dysphagia is a common functional outcome following treatment of laryngeal cancer. Despite curative advances in both nonsurgical and surgical approaches, preserving and optimizing swallowing function is critical. Understanding the nature and severity of dysphagia depending on initial tumor staging and treatment modality and intensity is crucial. This chapter explores current evidence on the acute and chronic impacts of treatments for laryngeal cancer on swallow function, as well as the medical and nonmedical management of dysphagia in this population.
Collapse
Affiliation(s)
- Maude Brisson-McKenna
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada.
| | - Gina D Jefferson
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, 2500 N. State St.Jackson, MS 39216-4505, USA
| | - Sana H Siddiqui
- Head & Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Sarah Adams
- Voice and Swallowing Center, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA
| | - Sofia Afanasieva Sonia
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Aïda Chérid
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Jesse Burns
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Carla Di Gironimo
- Department of Speech-Language Pathology, McGill University Health Centre, Glen site, D04.7510-1001 boul. Décarie, Montréal, QC, H4A 3J1, Canada
| | - Leila J Mady
- Head & Neck Surgery, Thomas Jefferson University Hospitals, 925 Chestnut Street, 6th Floor, Philadelphia, PA 19107, USA; Cancer Risk and Control Program of Excellence, Sidney Kimmel Cancer Center, 233 S 10th Street, Philadelphia, PA 19107, USA
| |
Collapse
|
11
|
Kuhn MA, Gillespie MB, Ishman SL, Ishii LE, Brody R, Cohen E, Dhar SI, Hutcheson K, Jefferson G, Johnson F, Rameau A, Sher D, Starmer H, Strohl M, Ulmer K, Vaitaitis V, Begum S, Batjargal M, Dhepyasuwan N. Expert Consensus Statement: Management of Dysphagia in Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2023; 168:571-592. [PMID: 36965195 DOI: 10.1002/ohn.302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/16/2023] [Accepted: 02/01/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To develop an expert consensus statement (ECS) on the management of dysphagia in head and neck cancer (HNC) patients to address controversies and offer opportunities for quality improvement. Dysphagia in HNC was defined as swallowing impairment in patients with cancers of the nasal cavity, paranasal sinuses, nasopharynx, oral cavity, oropharynx, larynx, or hypopharynx. METHODS Development group members with expertise in dysphagia followed established guidelines for developing ECS. A professional search strategist systematically reviewed the literature, and the best available evidence was used to compose consensus statements targeted at providers managing dysphagia in adult HNC populations. The development group prioritized topics where there was significant practice variation and topics that would improve the quality of HNC patient care if consensus were possible. RESULTS The development group identified 60 candidate consensus statements, based on 75 initial proposed topics and questions, that focused on addressing the following high yield topics: (1) risk factors, (2) screening, (3) evaluation, (4) prevention, (5) interventions, and (6) surveillance. After 2 iterations of the Delphi survey and the removal of duplicative statements, 48 statements met the standardized definition for consensus; 12 statements were designated as no consensus. CONCLUSION Expert consensus was achieved for 48 statements pertaining to risk factors, screening, evaluation, prevention, intervention, and surveillance for dysphagia in HNC patients. Clinicians can use these statements to improve quality of care, inform policy and protocols, and appreciate areas where there is no consensus. Future research, ideally randomized controlled trials, is warranted to address additional controversies related to dysphagia in HNC patients.
Collapse
Affiliation(s)
- Maggie A Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, California, USA
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stacey L Ishman
- Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lisa E Ishii
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University Medical Institute, Cockeysville, Maryland, USA
| | - Rebecca Brody
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, West Linn, Oregon, USA
| | - Ezra Cohen
- Moores Cancer Center at UC San Diego Health, La Jolla, California, USA
| | | | - Kate Hutcheson
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Center, Houston, Texas, USA
| | - Gina Jefferson
- Department of Otolaryngology-Head & Neck Surgery, Division of Head & Neck Surgical Oncology/Microvascular Reconstruction, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Anais Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York City, New York, USA
| | - David Sher
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Madeleine Strohl
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Karen Ulmer
- Milton J Dance, Jr Head and Neck Cancer at GBMC, Baltimore, Maryland, USA
| | - Vilija Vaitaitis
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Charleston, South Carolina, USA
| | - Sultana Begum
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Misheelt Batjargal
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
12
|
Kost KM, Jefferson GD. Larynx Cancer. Otolaryngol Clin North Am 2023; 56:xix-xx. [PMID: 37030952 DOI: 10.1016/j.otc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
Affiliation(s)
- Karen M Kost
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Centre, 1001 Decarie Boulevard, H4A 3J1, Montreal, Quebec H4A 3J1, Canada.
| | - Gina D Jefferson
- Department of Otolaryngology-Head & Neck Surgery, University of Mississippi, 2500 N State Street, Jackson, MS 39216 USA.
| |
Collapse
|
13
|
Ursino S, Calistri E, De Felice F, Bonomo P, Desideri I, Franco P, Arcadipane F, Colosimo C, Mazzola R, Maddalo M, Gonnelli A, Malfatti G, Morganti R, Musio D, Paiar F. Patient-Reported Outcomes After Swallowing (SWOARs)-Sparing IMRT in Head and Neck Cancers: Primary Results from a Prospective Study Endorsed by the Head and Neck Study Group (HNSG) of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Dysphagia 2023; 38:159-170. [PMID: 35587295 PMCID: PMC9118191 DOI: 10.1007/s00455-022-10434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/25/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To prospectively investigate changes in M.D. Anderson Dysphagia Inventory (MDADI) scores in patients affected by naso- and oropharynx cancer after definitive radiochemotherapy (ChemoRT) using swallowing organs at risk (SWOARs)-sparing IMRT. METHODS MDADI questionnaires were collected at baseline and at 6 and 12 months after treatment. MDADI scores were categorized as follows: ≥ 80 "optimal," 80-60 "adequate," < 60 "poor" deglutition-related quality of life (QoL) group, and dichotomized as "optimal" vs "adequate/poor" for the analysis. A mean MDADI composite (MDADI-C) change of 10 points was considered as minimal clinically important difference (MCID). RESULTS Sixty-three patients were enrolled of which 47 were considered for the analysis. At baseline, 26 (55%) were "optimal" and 21 (45%) were "adequate/poor." The mean baseline MDADI-C score was 93.6 dropping to 81 at 6 months (p = 0.013) and slightly rising to 85.5 at 12 months (p = 0.321) for the "optimal" group. Indeed, the mean baseline MDADI-C score was 64.3 rising to 77.5 at 6 months (p = 0.006) and stabilizing at 76 at 12 months (p = 0.999) for the "adequate/poor" group. A statistically significant but not clinically relevant worsening of the MDADI-C score was reported for the "optimal" group, whereas both a statistically significant and clinically meaningful improvement of the MDADI-C score were reported for the "adequate/poor" group from before to post-treatment. CONCLUSION Our results suggest a doubly clinical benefit of dose optimization to SWOARs to minimize the RT sequalae in patients with a baseline "optimal" deglutition-related QoL and to recover from cancer dysphagia in those with a baseline "adequate/poor" deglutition-related QoL.
Collapse
Affiliation(s)
- Stefano Ursino
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy.
| | - Elisa Calistri
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
| | - Francesca De Felice
- Radiation Oncology Unit, University Hospital La Sapienza, Viale del Policlinico 155, 00161, Rome, Italy
| | - Pierluigi Bonomo
- Radiation Oncology Unit, University Hospital Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, University Hospital Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Francesca Arcadipane
- Department of Oncology, Radiation Oncology, University of Turin, Via Camillo Benso di Cavour 31, 10123, Turin, Italy
| | - Caterina Colosimo
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
- Radiation Oncology Unit, S.Luca Hospital, Via Guglielmo Lippi Francesconi 556, 55100, Lucca, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore-Don Calabria Hospital Cancer Care Center, Via Sempreboni 5, 37024, Verona, Italy
| | - Marta Maddalo
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Via del Medolo 2, 25123, Brescia, Italy
| | - Alessandra Gonnelli
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
| | - Giulia Malfatti
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, Via Roma 67, 56100, Pisa, Italy
| | - Daniela Musio
- Radiation Oncology Unit, University Hospital La Sapienza, Viale del Policlinico 155, 00161, Rome, Italy
| | - Fabiola Paiar
- Radiation Oncology Unit, University Hospital Santa Chiara, Via Roma 67, 56100, Pisa, Italy
| |
Collapse
|
14
|
Krebbers I, Pilz W, Vanbelle S, Verdonschot RJCG, Baijens LWJ. Affective Symptoms and Oropharyngeal Dysphagia in Head-and-Neck Cancer Patients: A Systematic Review. Dysphagia 2023; 38:127-144. [PMID: 35796877 PMCID: PMC9873770 DOI: 10.1007/s00455-022-10484-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/10/2022] [Indexed: 01/28/2023]
Abstract
Oropharyngeal dysphagia (OD) is a high impact morbidity in head-and-neck cancer (HNC) patients. A wide variety of instruments are developed to screen for affective symptoms and OD. The current paper aims to systematically review and appraise the literature to obtain insight into the prevalence, strength, and causal direction of the relationship between affective symptoms and OD in HNC patients. This review was conducted in accordance with the PRISMA statement. A systematic search of the literature was performed using PubMed, PsycINFO, Cochrane, and Embase. All available publications reporting on the relationship between affective conditions and swallowing function in HNC patients were included. Conference papers, tutorials, reviews, and studies with less than 5 patients were excluded. Fifteen studies met the inclusion criteria. The level of evidence and methodological quality were assessed using the ABC-rating scale and QualSyst critical appraisal tool. Eleven studies reported a positive relationship between affective symptoms and OD. The findings of this paper highlight the importance of affective symptom screening in dysphagic HNC patients as clinically relevant affective symptoms and OD seems to be prevalent and coincident in this population. Considering the impact of affective symptoms and OD on patients' daily life, early detection and an integrated interdisciplinary approach are recommended. However, due to the heterogeneity of study designs, outcomes, and outcome measures, the generalization of study results is limited.
Collapse
Affiliation(s)
- Iris Krebbers
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- School for Oncology and Developmental Biology-GROW, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Oncology and Developmental Biology-GROW, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience-MHeNs, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sophie Vanbelle
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute-CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rob J C G Verdonschot
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Emergency Department, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- School for Oncology and Developmental Biology-GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
15
|
Kenny C, Regan J, Balding L, Higgins S, O'Leary N, Kelleher F, McDermott R, Armstrong J, Mihai A, Tiernan E, Westrup J, Thirion P, Walsh D. Dysphagia in Solid Tumors Outside the Head, Neck or Upper GI Tract: Clinical Characteristics. J Pain Symptom Manage 2022; 64:546-554. [PMID: 36058400 DOI: 10.1016/j.jpainsymman.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT Dysphagia is common in cancer, but underlying pathophysiology and manifestations within patients are unknown. OBJECTIVES To examine dysphagia characteristics in those with solid malignancies outside the head, neck and upper gastrointestinal tract. METHODS Seventy-three individuals with dysphagia (46 male, 27 female, aged 37-91) were recruited from a parent trial conducted in two acute hospitals and one hospice. Cranial nerve function, Oral Health Assessment Tool (OHAT), Mann Assessment of Swallowing Ability (MASA) and Functional Oral Intake Scale (FOIS) evaluated swallow profile. RESULTS Only 9/73 (12%) had documented dysphagia prior to study enrollment. MASA risk ratings found n=61/73 (84%) with dysphagia risk and n=22/73 (30%) with aspiration risk. Food texture modification was required for n=34/73 (47%), fluid texture modification for n=1/73 (1%). Compensatory strategies for food were needed by n=13/73 (18%) and for fluids by n=24/73 (33%). Cranial nerve deficits were present in n=43/73 (59%). Oral health problems were common, with xerostomia in two-thirds. Worse dysphagia on MASA was associated with disease progression, affecting hospice, and palliative care the most. Worse performance status was indicative of poorer MASA raw score (P<0.001, OR 2.2, 95% CI 1.5-3.4), greater risk of aspiration (P=0.005, OR 2.1, 95% CI 1.3-3.6) and lower FOIS (P=0.004, OR 2.0, 95% CI 1.2-3.2). CONCLUSION Dysphagia management in those with cancer requires robust assessment to uncover clinically important needs like food texture modification and safe swallowing advice. Better assessment tools should be developed for this purpose. Oral health problems should be routinely screened in this population since they exacerbate dysphagia.
Collapse
Affiliation(s)
- Ciarán Kenny
- Department of Clinical Speech and Language Studies (C.K., J.R.), Trinity College Dublin, Ireland; Academic Department of Palliative Medicine (C.K., D.W.), Our Lady's Hospice & Care Services, Ireland; School of Medicine (C.K., D.W.), Trinity College Dublin, Ireland.
| | - Julie Regan
- Department of Clinical Speech and Language Studies (C.K., J.R.), Trinity College Dublin, Ireland
| | - Lucy Balding
- Department of Palliative Medicine (L.B., S.H., N.O.), Our Lady's Hospice & Care Services, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine (L.B., S.H., N.O.), Our Lady's Hospice & Care Services, Ireland
| | - Norma O'Leary
- Department of Palliative Medicine (L.B., S.H., N.O.), Our Lady's Hospice & Care Services, Ireland
| | | | - Ray McDermott
- Tallaght University Hospital (F.K., R.M.), Ireland; Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - John Armstrong
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - Alina Mihai
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - Eoin Tiernan
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | | | - Pierre Thirion
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - Declan Walsh
- Academic Department of Palliative Medicine (C.K., D.W.), Our Lady's Hospice & Care Services, Ireland; School of Medicine (C.K., D.W.), Trinity College Dublin, Ireland; Department of Supportive Oncology (D.W.), Levine Cancer Institute, Atrium Health, North Carolina, USA
| |
Collapse
|
16
|
Shafi O, Edirisinghe M, Brako F. Polysorbate enhanced progesterone loaded drug diffusion from macromolecular fibrous patches for applications in obstetrics and gynaecology. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.104062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
17
|
Robijns J, Nair RG, Lodewijckx J, Arany P, Barasch A, Bjordal JM, Bossi P, Chilles A, Corby PM, Epstein JB, Elad S, Fekrazad R, Fregnani ER, Genot MT, Ibarra AMC, Hamblin MR, Heiskanen V, Hu K, Klastersky J, Lalla R, Latifian S, Maiya A, Mebis J, Migliorati CA, Milstein DMJ, Murphy B, Raber-Durlacher JE, Roseboom HJ, Sonis S, Treister N, Zadik Y, Bensadoun RJ. Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022. Front Oncol 2022; 12:927685. [PMID: 36110957 PMCID: PMC9468822 DOI: 10.3389/fonc.2022.927685] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
DisclaimerThis article is based on recommendations from the 12th WALT Congress, Nice, October 3-6, 2018, and a follow-up review of the existing data and the clinical observations of an international multidisciplinary panel of clinicians and researchers with expertise in the area of supportive care in cancer and/or PBM clinical application and dosimetry. This article is informational in nature. As with all clinical materials, this paper should be used with a clear understanding that continued research and practice could result in new insights and recommendations. The review reflects the collective opinion and, as such, does not necessarily represent the opinion of any individual author. In no event shall the authors be liable for any decision made or action taken in reliance on the proposed protocols.ObjectiveThis position paper reviews the potential prophylactic and therapeutic effects of photobiomodulation (PBM) on side effects of cancer therapy, including chemotherapy (CT), radiation therapy (RT), and hematopoietic stem cell transplantation (HSCT).BackgroundThere is a considerable body of evidence supporting the efficacy of PBM for preventing oral mucositis (OM) in patients undergoing RT for head and neck cancer (HNC), CT, or HSCT. This could enhance patients’ quality of life, adherence to the prescribed cancer therapy, and treatment outcomes while reducing the cost of cancer care.MethodsA literature review on PBM effectiveness and dosimetry considerations for managing certain complications of cancer therapy were conducted. A systematic review was conducted when numerous randomized controlled trials were available. Results were presented and discussed at an international consensus meeting at the World Association of photobiomoduLation Therapy (WALT) meeting in 2018 that included world expert oncologists, radiation oncologists, oral oncologists, and oral medicine professionals, physicists, engineers, and oncology researchers. The potential mechanism of action of PBM and evidence of PBM efficacy through reported outcomes for individual indications were assessed.ResultsThere is a large body of evidence demonstrating the efficacy of PBM for preventing OM in certain cancer patient populations, as recently outlined by the Multinational Association for Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Building on these, the WALT group outlines evidence and prescribed PBM treatment parameters for prophylactic and therapeutic use in supportive care for radiodermatitis, dysphagia, xerostomia, dysgeusia, trismus, mucosal and bone necrosis, lymphedema, hand-foot syndrome, alopecia, oral and dermatologic chronic graft-versus-host disease, voice/speech alterations, peripheral neuropathy, and late fibrosis amongst cancer survivors.ConclusionsThere is robust evidence for using PBM to prevent and treat a broad range of complications in cancer care. Specific clinical practice guidelines or evidence-based expert consensus recommendations are provided. These recommendations are aimed at improving the clinical utilization of PBM therapy in supportive cancer care and promoting research in this field. It is anticipated these guidelines will be revised periodically.
Collapse
Affiliation(s)
- Jolien Robijns
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Raj G. Nair
- Oral Medicine, Oral Pathology and Oral Oncology, Griffith University, Department of Haematology and Oncology, Gold Coast University Hospital, Gold Coast, QL, Australia
| | - Joy Lodewijckx
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Praveen Arany
- School of Dental Medicine, Oral Biology and Biomedical Engineering, University at Buffalo, Buffalo, NY, United States
| | - Andrei Barasch
- Harvard School of Dental Medicine, Division of Oral Medicine and Dentistry, Boston, MA, United States
| | - Jan M. Bjordal
- Physiotherapy Research Group, IGS, University of Bergen, Bergen, Norway
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Anne Chilles
- Radiotherapy Department, Institut Curie, Paris, France
| | - Patricia M. Corby
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, United States
| | - Joel B. Epstein
- City of Hope Duarte, CA and Cedars-Sinai Health System, Los Angeles, CA, United States
| | - Sharon Elad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | - Reza Fekrazad
- Department of Periodontology, Dental Faculty – Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran
| | | | - Marie-Thérèse Genot
- Laser Therapy Unit, Institut Jules Bordet, Centre des Tumeurs de l’Université Libre de Bruxelles, Brussels, Belgium
| | - Ana M. C. Ibarra
- Postgraduate Program on Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, Brazil
| | - Michael R. Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Vladimir Heiskanen
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Ken Hu
- Department of Radiation Oncology, NYU Langone Health, New York, NY, United States
| | | | - Rajesh Lalla
- Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, United States
| | - Sofia Latifian
- Department of Medicine, Institut Jules Bordet, Universiteí Libre de Bruxelles, Brussels, Belgium
| | - Arun Maiya
- Manipal College of Health Professions, MAHE, Manipal, India
| | - Jeroen Mebis
- UHasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Cesar A. Migliorati
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, Florida, United States
| | - Dan M. J. Milstein
- Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Barbara Murphy
- Department of Oncology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Judith E. Raber-Durlacher
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Hendrik J. Roseboom
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Department of Oral Medicine, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Stephen Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine; Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine; Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Yehuda Zadik
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel, and Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - René-Jean Bensadoun
- Department of Radiation Oncology, Centre de Haute Energie, Nice, France
- *Correspondence: René-Jean Bensadoun,
| |
Collapse
|
18
|
Matsuo H, Sakuma K. Pathophysiology of Cachexia and Characteristics of Dysphagia in Chronic Diseases. Asia Pac J Oncol Nurs 2022; 9:100120. [PMID: 36118624 PMCID: PMC9471339 DOI: 10.1016/j.apjon.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Haruyo Matsuo
- Departments of Nursing, Kagoshima Medical Association Hospital, Kagoshima, Japan
| | - Kunihiro Sakuma
- Institute for Liberal Arts, Environment and Society, Tokyo Institute of Technology, Tokyo, Japan
- Corresponding author.
| |
Collapse
|
19
|
Pattarapon P, Zhang M, Mujumdar AS. Application potential of 3D food printing to improve the oral intake for immunocompromised patients: A Review. Food Res Int 2022; 160:111616. [DOI: 10.1016/j.foodres.2022.111616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
|
20
|
Basu S, Akash M, Hochberg N, Senior B, Joseph-McCarthy D, Chakravarty A. From SARS-CoV-2 infection to COVID-19 morbidity: an in silico projection of virion flow rates to the lower airway via nasopharyngeal fluid boluses. RHINOLOGY ONLINE 2022. [DOI: 10.4193/rhinol/21.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: While the nasopharynx is initially the dominant upper airway infection site for SARS-CoV-2, the physiologic mechanism launching the infection at the lower airway is still not well-understood. Based on the rapidity of infection progression to the lungs, it has been hypothesized that the nasopharynx may be acting as the primary seeding zone for subsequent contamination of the lower airway via aspiration of virus-laden boluses of nasopharyngeal fluids. Methodology: To examine the plausibility of the aspiration-driven mechanism, we have computationally tracked the inhalation process in three anatomic airway reconstructions and have quantified the nasopharyngeal liquid volume transmitted to the lower airspace during each aspiration. Results: Extending the numerical trends on aspiration volume to earlier records on aspiration frequencies indicates a total aspirated nasopharyngeal liquid volume of 0.3 – 0.76 ml/day. Subsequently, for mean sputum viral load, our modeling projects that the number of virions reaching the lower airway will range over 2.1×106 – 5.3×106 /day; for peak viral load, the corresponding number hovers between 7.1×108 – 1.8×109. Conclusions: The virion transmission findings fill in a key piece of the mechanistic puzzle on the systemic progression of SARS-CoV-2, and subjectively point to health conditions like dysphagia, with proclivity to increased aspiration, as some of the potential underlying risk factors for aggressive lung infections.
Collapse
|
21
|
Functional Endoscopic Evaluation of Swallowing in Patients Treated by Total Laryngectomy and Adjuvant Treatment for Advanced Laryngeal and Hypopharyngeal Malignancies. Indian J Otolaryngol Head Neck Surg 2021; 73:413-418. [PMID: 34692453 DOI: 10.1007/s12070-020-01873-2] [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: 03/26/2020] [Accepted: 04/29/2020] [Indexed: 10/24/2022] Open
Abstract
Treatment of locally advanced laryngeal and hypopharyngeal cancers often requires total laryngectomy with partial pharyngectomy and adjuvant radiotherapy. Dysphagia is common after such aggressive treatment which is often under reported, but adversely affects the quality of life in these patients. The cause for this dysphagia is loss of pharyngeal mucosa, fibrosis, disruption of constrictors and loss of skeletal support to soft tissues. In this study 32 patients treated by laryngectomy with partial pharyngectomy and adjuvant radiotherapy underwent fibreoptic endoscopic evaluation of swallowing at 6 and 12 weeks after completion of treatment. Majority of them had delayed transit of bolus, dryness and edema and 6 of them had pharyngeal stenosis, 2 had fibrotic band and 2 had adynamic pharyngeal segments. These findings were the cause of dysphagia. The frequency of occurrence of the above findings and their association with extent of resection of pharyngeal mucosa and adjuvant treatment have been documented. Bilateral neck dissection, post operative chemotherapy with radiotherapy and use of myocutaneous flap for the reconstruction of neopharynx were found to cause severe dysphagia in our series. Some of these patients benefitted by swallowing therapy, diet modifications and nasogastric feeding. Therefore early identification of cause of dysphagia in these patients and timely intervention to facilitate rehabilitation can improve the quality of life and reduce the long term morbidity in these patients.
Collapse
|
22
|
Melgaço SDA, Vicente LCC, Gama ACC. Analysis of decannulation time and oral intake recovery in oral cancer patients. Codas 2021; 33:e20190236. [PMID: 34346947 DOI: 10.1590/2317-1782/20202019236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/12/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE to analyze the time of decannulation and oral diet release of patients undergoing oral cancer surgery at the Hospital Alberto Cavalcante and to verify which factors are associated with the time of decannulation and oral diet release. METHODS an observational study of the database of 33 adult patients surgically treated with oral cancer and served between 2012 and 2017. The socio-demographic variables (age and gender) and clinical variables (type of surgery, surgical extension, type of reconstruction, clinical conditions and times of decannulation and reintroduction of the oral route) were collected through electronic medical records analysis. Descriptive statistical analysis was performed with measures of central tendency, dispersion and proportions. For the association analysis, the non-parametric Mann-Whitney U test was used for independent samples. RESULTS of the 33 participants, male and elderly predominated, 69.8% underwent resection of more than one structure. The median time of decannulation among patients with oral cancer was 8 days, and oral clearance of 9.5 days. Resections with more than one structure, the presence of fistula and dehiscence interfered in the oral release time. CONCLUSION the median time of decannulation was eight days and oral release time of 9.5 days. Resections with more than one structure, the presence of fistula, and suture dehiscence are associated with increased oral release time.
Collapse
Affiliation(s)
- Silmara de Abreu Melgaço
- Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | - Laelia Cristina Caseiro Vicente
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | - Ana Cristina Côrtes Gama
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| |
Collapse
|
23
|
Frowen J, Gough K, Hughes R, Drosdowsky A, Duffy M, Kiss N, Phipps-Nelson J, Siva S, Solomon B, Ball D. Functional and patient-reported changes in swallowing and voice after combined chemotherapy and radiotherapy for limited-stage small-cell lung cancer. J Med Imaging Radiat Oncol 2021; 65:786-795. [PMID: 34291875 DOI: 10.1111/1754-9485.13290] [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: 04/20/2021] [Accepted: 07/02/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The purpose of this study was to describe the nature and impact of dysphagia and dysphonia in patients with limited-stage small-cell lung cancer (SCLC) before and after chemoradiation. METHODS A prospective cohort study was conducted on patients receiving chemoradiotherapy for limited-stage SCLC. Patients received either 40, 45 or 50 Gy, commencing the second cycle of chemotherapy. Outcomes included: videofluoroscopy (VFSS) to investigate aspiration, swallowing function and oesophageal motility; oral intake limitations; patient-reported dysphagia; and patient-reported dysphonia. Data were collected before treatment and one, three and six months post-treatment. RESULTS Twelve patients were enrolled. Oropharyngeal swallowing was safe and functional at all times. Three patients exhibited oesophageal motility disorders before treatment, and a further three post-treatment. Oral intake was most compromised one month post-treatment with five patients either tube dependent or eating very limited diets. At all other times patients were eating normal or near-normal diets. Despite normal oropharyngeal swallowing on VFSS, three patients reported moderate or severe dysphagia one month post-treatment. Three additional patients reported moderate or severe difficulties three and six months post-treatment. Patients who reported dysphagia one month post-treatment all received a mean and maximum oesophageal dose of ≥15.7 Gy and ≥42 Gy, respectively. Dose-response relationships were not apparent three and six months post-treatment. Voice problems varied, with worst scores reported one month post-treatment. CONCLUSIONS This study identified discordance between observed swallowing function and patient-reported problems, which has clinical implications for patient management, and highlights future research needs. Ongoing efforts to reduce mucosal toxicity in patients with lung cancer are essential.
Collapse
Affiliation(s)
- Jacqui Frowen
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rhys Hughes
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Allison Drosdowsky
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Mary Duffy
- Department of Nursing, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nicole Kiss
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Jo Phipps-Nelson
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Office of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Benjamin Solomon
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Ball
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
24
|
Molecular and Neural Mechanism of Dysphagia Due to Cancer. Int J Mol Sci 2021; 22:ijms22137033. [PMID: 34210012 PMCID: PMC8269194 DOI: 10.3390/ijms22137033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/21/2022] Open
Abstract
Cancer is one of the most common causes of death worldwide. Along with the advances in diagnostic technology achieved through industry–academia partnerships, the survival rate of cancer patients has improved dramatically through treatments that include surgery, radiation therapy, and pharmacotherapy. This has increased the population of cancer “survivors” and made cancer survivorship an important part of life for patients. The senses of taste and smell during swallowing and cachexia play important roles in dysphagia associated with nutritional disorders in cancer patients. Cancerous lesions in the brain can cause dysphagia. Taste and smell disorders that contribute to swallowing can worsen or develop because of pharmacotherapy or radiation therapy; metabolic or central nervous system damage due to cachexia, sarcopenia, or inflammation can also cause dysphagia. As the causes of eating disorders in cancer patients are complex and involve multiple factors, cancer patients require a multifaceted and long-term approach by the medical care team.
Collapse
|
25
|
Reflex vs. volitional cough differences amongst head and neck cancer survivors characterized by time since treatment and aspiration status. Respir Physiol Neurobiol 2021; 293:103702. [PMID: 34033947 DOI: 10.1016/j.resp.2021.103702] [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: 12/12/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to investigate differences in reflexive and volitional cough airflows in advanced stage head and neck cancer survivors as it relates to aspiration status and time since treatment. The hypothesis is that those who aspirate several years after treatment completion would demonstrate reduced airflows for all cough parameters compared to those recently status post treatment completion given the known progressive deterioration associated with radiotherapy. METHODS Demographic and airflow data during both reflexive and volitional cough tasks and aspiration status as determined during fiberoptic endoscopic evaluation of swallow function were collected from 33 Head and Neck Cancer (HNC) survivors. RESULTS Omnibus MANOVA for dependent airflow variables and independent variables aspiration status, time since treatment and cough type (reflex or volitional) was significant (F(3,1) = 184, p < 0.000) indicating that peak expiratory flow rates (PEFR) were reduced under reflex (mean PEFR 1.88 SD 0.7) versus volitional (mean PEFR 2.3, SD 0.7) cough types; reduced for aspirators versus non-aspirators (F(2,1) = 4.1, p = 0.04) and reduced for those in the subacute versus chronic phase status post Intensity Modulated Radiotherapy (IMRT) (F(2,1) = 10.05, p = 0.002). CONCLUSION Findings of reduced reflexive compared to volitional cough airflows in head and neck cancer survivors are consistent with those from both healthy and other diseased populations. Additional findings that aspirators demonstrate reduced cough airflows compared to non-aspirators supports the hypothesis. Surprisingly, those recently status post treatment completion show worse cough airflows compared to those remotely status post treatment completion.
Collapse
|
26
|
Mudie DM, Stewart AM, Rosales JA, Biswas N, Adam MS, Smith A, Craig CD, Morgen MM, Vodak DT. Amorphous Solid Dispersion Tablets Overcome Acalabrutinib pH Effect in Dogs. Pharmaceutics 2021; 13:pharmaceutics13040557. [PMID: 33921109 PMCID: PMC8071435 DOI: 10.3390/pharmaceutics13040557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022] Open
Abstract
Calquence® (crystalline acalabrutinib), a commercially marketed tyrosine kinase inhibitor (TKI), exhibits significantly reduced oral exposure when taken with acid-reducing agents (ARAs) due to the low solubility of the weakly basic drug at elevated gastric pH. These drug-drug interactions (DDIs) negatively impact patient treatment and quality of life due to the strict dosing regimens required. In this study, reduced plasma drug exposure at high gastric pH was overcome using a spray-dried amorphous solid dispersion (ASD) comprising 50% acalabrutinib and 50% hydroxypropyl methylcellulose acetate succinate (HPMCAS, H grade) formulated as an immediate-release (IR) tablet. ASD tablets achieved similar area under the plasma drug concentration-time curve (AUC) at low and high gastric pH and outperformed Calquence capsules 2.4-fold at high gastric pH in beagle dogs. In vitro multicompartment dissolution testing conducted a priori to the in vivo study successfully predicted the improved formulation performance. In addition, ASD tablets were 60% smaller than Calquence capsules and demonstrated good laboratory-scale manufacturability, physical stability, and chemical stability. ASD dosage forms are attractive for improving patient compliance and the efficacy of acalabrutinib and other weakly basic drugs that have pH-dependent absorption.
Collapse
Affiliation(s)
- Deanna M. Mudie
- Global Research & Development, Lonza, Bend, OR 97703, USA; (A.M.S.); (J.A.R.); (N.B.); (M.S.A.); (A.S.); (C.D.C.); (M.M.M.); (D.T.V.)
- Correspondence:
| | - Aaron M. Stewart
- Global Research & Development, Lonza, Bend, OR 97703, USA; (A.M.S.); (J.A.R.); (N.B.); (M.S.A.); (A.S.); (C.D.C.); (M.M.M.); (D.T.V.)
| | - Jesus A. Rosales
- Global Research & Development, Lonza, Bend, OR 97703, USA; (A.M.S.); (J.A.R.); (N.B.); (M.S.A.); (A.S.); (C.D.C.); (M.M.M.); (D.T.V.)
- Pharmaceutics Department, University of Washington, Seattle, WA 98195, USA
| | - Nishant Biswas
- Global Research & Development, Lonza, Bend, OR 97703, USA; (A.M.S.); (J.A.R.); (N.B.); (M.S.A.); (A.S.); (C.D.C.); (M.M.M.); (D.T.V.)
| | - Molly S. Adam
- Global Research & Development, Lonza, Bend, OR 97703, USA; (A.M.S.); (J.A.R.); (N.B.); (M.S.A.); (A.S.); (C.D.C.); (M.M.M.); (D.T.V.)
| | - Adam Smith
- Global Research & Development, Lonza, Bend, OR 97703, USA; (A.M.S.); (J.A.R.); (N.B.); (M.S.A.); (A.S.); (C.D.C.); (M.M.M.); (D.T.V.)
| | - Christopher D. Craig
- Global Research & Development, Lonza, Bend, OR 97703, USA; (A.M.S.); (J.A.R.); (N.B.); (M.S.A.); (A.S.); (C.D.C.); (M.M.M.); (D.T.V.)
| | - Michael M. Morgen
- Global Research & Development, Lonza, Bend, OR 97703, USA; (A.M.S.); (J.A.R.); (N.B.); (M.S.A.); (A.S.); (C.D.C.); (M.M.M.); (D.T.V.)
| | - David T. Vodak
- Global Research & Development, Lonza, Bend, OR 97703, USA; (A.M.S.); (J.A.R.); (N.B.); (M.S.A.); (A.S.); (C.D.C.); (M.M.M.); (D.T.V.)
| |
Collapse
|
27
|
Lin DJ, Altamimi J, Pearce K, Wilson JA, Patterson JM. Psychometric Properties of the MDADI-A Preliminary Study of Whether Less is Truly More? Dysphagia 2021; 37:323-332. [PMID: 33709289 PMCID: PMC8948102 DOI: 10.1007/s00455-021-10281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 02/27/2021] [Indexed: 11/28/2022]
Abstract
The MD Anderson Dysphagia Inventory (MDADI) is a 20-item dysphagia-specific QOL questionnaire with four subscales: global, emotional, functional, and physical. It is widely used in clinical practice and in research; however, its psychometric properties have been under-researched. We aim to evaluate the organisation of the MDADI subscales and identify any redundant items. The MDADI is a routinely collected outcome measure at two centres in northeast England. Questionnaires completed at three months following treatment were extracted from these existing databases. Factor analysis was carried out with the aim of reducing redundancy among the set of questionnaire items. Cases with missing values were excluded. A total of 196 complete patient questionnaires were used in factor analysis. A one-factor model accounted for around 50% of the total variance in item responses. The top five endorsed items (abbreviated by the questionnaire item keywords: Excluded, Irritate, Esteem, Social, and Why) in this one factor appeared in three (emotional, functional, and physical) of the four supposed MDADI subscales, i.e. global, emotional, functional, and physical. Our results suggest an overlap of three MDADI subscales across the top five endorsed items. The content of the top five questions all appear related to the psychosocial aspects of swallowing. This implies some redundancy of the items in the original subscales of the questionnaire. Using the most endorsed items, it appears feasible to abbreviate the 20-item MDADI questionnaire to a 5-item “MiniDADI” questionnaire, which is likely to have greater utility in routine clinical practice outside of research settings.
Collapse
Affiliation(s)
- Daniel J Lin
- Translational and Clinical Research Institute, Newcastle University, 3rd Floor, William Leech Building, Medical School, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
| | - Jenan Altamimi
- Faculty of Medical Sciences Graduate School, Newcastle University, Newcastle upon Tyne, UK
| | - Kim Pearce
- Faculty of Medical Sciences Graduate School, Newcastle University, Newcastle upon Tyne, UK
| | - Janet A Wilson
- Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | | |
Collapse
|
28
|
Mann D, Benbow JH, Gower NL, Trufan S, Watson M, Colcord ME, Squires MH, Raj VS, Hill JS, Salo JC. Swallowing dysfunction after minimally invasive oesophagectomy. BMJ Support Palliat Care 2020; 12:235-242. [PMID: 33093039 DOI: 10.1136/bmjspcare-2020-002626] [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: 08/06/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Patients undergoing oesophagectomy frequently experience malnutrition, which in combination with the catabolic effects of surgery can result in loss of muscle mass and function. Safe swallowing requires preservation of muscle mass. Swallowing dysfunction puts postoperative patients at risk for aspiration and pneumonia. Modified Barium Swallow Study (MBSS) enables assessment of postoperative swallowing impairments. The current study assessed incidence and risk factors associated with swallowing dysfunction and restricted diet at discharge in patients after oesophagectomy in a high-volume surgical centre. METHODS Patients with an MBSS after oesophagectomy were identified between March 2015 to April 2020 at a high-volume surgical centre. Swallowing was quantitatively evaluated on MBSS with the Rosenbek Penetration-Aspiration Scale (PAS). Muscle loss was evaluated clinically with preoperative hand grip strength (HGS). Univariable and multivariable logistic and linear regression analyses were performed. RESULTS 129 patients (87% male; median age 66 years) underwent oesophagectomy with postoperative MBSS. Univariate analysis revealed older age, preoperative feeding tube, lower preoperative HGS and discharge to non-home were associated with aspiration or penetration on MBSS. Age and preoperative feeding tube remained as independent predictors in the multivariable analysis. Both univariate and multivariable analyses revealed increased age and preoperative feeding tube were associated with diet restrictions at discharge. CONCLUSIONS Swallowing dysfunction after oesophagectomy is correlated with increased age and need for preoperative enteral feeding tube placement. Further research is needed to understand the relationship between muscle loss and aspiration with the goal of enabling preoperative physiological optimisation and patient selection.
Collapse
Affiliation(s)
- Della Mann
- Department of Supportive Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Jennifer H Benbow
- LCI Research Support, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Nicole L Gower
- LCI Research Support, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Sally Trufan
- Department of Biostatistics, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Michael Watson
- Department of Surgery, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Madison E Colcord
- LCI Research Support, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Malcolm H Squires
- Department of Surgery, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Vishwa S Raj
- Department of Physical Medicine & Rehabilitation, Levine Cancer Institute, Charlotte, North Carolina, USA.,Department of Supportive Care, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Joshua S Hill
- Department of Surgery, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Jonathan C Salo
- Department of Surgery, Levine Cancer Institute, Charlotte, North Carolina, USA
| |
Collapse
|
29
|
Ringer M, Pischel L, Azar MM. Diagnosis of oesophageal mucormycosis managed with medical therapy alone. BMJ Case Rep 2020; 13:13/10/e236869. [PMID: 33093060 DOI: 10.1136/bcr-2020-236869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mucormycosis is an invasive mould that can cause aggressive infection, particularly in immunocompromised patients. Though oesophageal mucormycosis is relatively rare, it remains an elusive and devastating manifestation of this disease. The management is also challenging, due to surgical morbidity and contraindications such as thrombocytopenia in immunocompromised hosts. In this report, we present the case of a 60-year-old Lebanese man with newly diagnosed acute myeloid leukaemia who developed oesophageal mucormycosis after induction chemotherapy with idarubicin/cytarabine (7+3). The diagnosis was made when the patient developed febrile neutropenia and odynophagia. CT scan of the chest revealed a thickened oesophagus. Oesophagogastroduodenoscopy with biopsy, histopathology and PCR were performed, resulting in the diagnosis of Rhizopus microsporus The patient was successfully treated with liposomal amphotericin B and salvage posaconazole therapy without surgical intervention. We reviewed the clinical characteristics of the six published oesophageal mucormycosis reports from the literature.
Collapse
Affiliation(s)
- Matthew Ringer
- Internal Medicine, Yale New Haven Health System, New Haven, Connecticut, USA
| | - Lauren Pischel
- Department of Internal Medicine, Section of Infectious Disease, Yale New Haven Health System, New Haven, Connecticut, USA
| | - Marwan Mikheal Azar
- Yale University School of Medicine, Yale New Haven Health System, New Haven, Connecticut, USA
| |
Collapse
|
30
|
Effectiveness of Different Application Parameters of Neuromuscular Electrical Stimulation for the Treatment of Dysphagia after a Stroke: A Systematic Review. J Clin Med 2020; 9:jcm9082618. [PMID: 32806675 PMCID: PMC7463982 DOI: 10.3390/jcm9082618] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Dysphagia causes severe complications among people with a stroke. Physiotherapy allows the cure of this pathology, and among the tools it offers is neuromuscular electrical stimulation. However, this is a technique that has not been protocolized. Therefore, it was considered necessary to carry out a systematic review on the efficacy of the various parameters of application of the neuromuscular electrical stimulation in dysphagia generated after a stroke. Methods: A systematic search for publications was conducted in March 2020 in the Pubmed, Cinahl, Medline, Web of Science and Scopus databases, using as search terms: Electric stimulation therapy, Deglutition disorders and Stroke. Results: 21 articles were obtained in which the application of neuromuscular electrical stimulation was applied in isolation (n = 7) or in combination with other techniques such as strengthening exercises and manual therapy techniques (n = 14), with this second modality of treatment having greater benefits for patients. Conclusion: The greatest efficacy of this technique is reached when applied at 60-80 Hz, 700 μs of pulse duration, at the motor intensity threshold and in sessions of 20–30 min.
Collapse
|
31
|
Sugiyama S, Sato K, Shibasaki Y, Endo Y, Uryu T, Toyoshima Y, Oya M, Miyanaga N, Saijo N, Gemma A, Akaza H. Real-world use of temsirolimus in Japanese patients with unresectable or metastatic renal cell carcinoma: recent consideration based on the results of a post-marketing, all-case surveillance study. Jpn J Clin Oncol 2020; 50:940-947. [PMID: 32458996 PMCID: PMC7401718 DOI: 10.1093/jjco/hyaa062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/17/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE A prospective, observational, post-marketing surveillance was conducted to assess the safety and effectiveness of temsirolimus in patients with renal cell carcinoma in Japan. METHODS Patients prescribed temsirolimus for advanced renal cell carcinoma were registered and received temsirolimus (25 mg weekly, intravenous infusion for 30-60 minutes) in routine clinical settings (observation period: 96 weeks). RESULTS Among 1001 patients included in the safety analysis data set (median age, 65.0 years; men, 74.8%; Eastern Cooperative Oncology Group performance status 0 or 1, 69.6%), 778 (77.7%) reported adverse drug reactions. The most common (≥10%) all-grade adverse drug reactions were stomatitis (26.7%), interstitial lung disease (17.3%) and platelet count decreased (11.1%). The incidence rate of grade ≥3 interstitial lung disease was 4.5%. The onset of interstitial lung disease was more frequent after 4-8 weeks of treatment or in patients with lower Eastern Cooperative Oncology Group performance status (21.6% for score 0 vs 8.3% for score 4, P < 0.001). Among 654 patients in the effectiveness analysis data set, the response and clinical benefit rates were 6.7% (95% confidence interval 4.9-8.9) and 53.2% (95% confidence interval 49.3-57.1), respectively. The median progression-free survival was 18.3 weeks (95% confidence interval 16.9-21.1). CONCLUSIONS The safety and effectiveness profile of temsirolimus observed in this study was similar to that observed in the multinational phase 3 study. The results are generalizable to the real-world scenario at the time of this research, and safety and effectiveness of temsirolimus as a subsequent anticancer therapy for renal cell carcinoma warrants further investigation. (ClinicalTrials.gov identifier NCT01210482, NCT01420601).
Collapse
Affiliation(s)
| | | | | | | | | | | | - Mototsugu Oya
- Department of Urology, Keio University Hospital, Tokyo, Japan
| | - Naoto Miyanaga
- Department of Urology, Mito Saiseikai General Hospital, Ibaraki, Japan
| | | | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Hideyuki Akaza
- Interfaculty Initiative in Information Studies, Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
32
|
van der Baan FH, Koldenhof JJ, de Nijs EJ, Echteld MA, Zweers D, Hesselmann GM, Vervoort SC, Vos JB, de Graaf E, Witteveen PO, Suijkerbuijk KP, de Graeff A, Teunissen SC. Validation of the Dutch version of the Edmonton Symptom Assessment System. Cancer Med 2020; 9:6111-6121. [PMID: 32643871 PMCID: PMC7476846 DOI: 10.1002/cam4.3253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The Utrecht Symptom Diary (USD) is a Dutch and adapted version of the Edmonton Symptom Assessment System, a patient-reported outcome measurement (PROM) tool to asses and monitor symptoms in cancer patients. This study analyses the validity and responsiveness of the USD and the cutoff points to determine the clinical significance of a symptom score. METHODS Observational longitudinal cohort study including adult in- and outpatients treated in an academic hospital in the Netherlands who completed at least one USD as part of routine care (2012-2019). The distress thermometer and problem checklist (DT&PC) was used as a reference PROM. Content, construct and criterion validity, responsiveness, and cutoff points are shown with prevalences, area under receiver operating characteristic (ROC) curve, Chi-squared test, Wilcoxon signed-rank test, and positive and negative predictive values, respectively. RESULTS A total of 3913 patients completed 22 400 USDs. Content validity was confirmed for all added USD items with prevalences of ≥22%. All USD items also present on the DT&PC demonstrated a good criterion validity (ROC >0.8). Construct validity was confirmed for the USD as a whole and for the items dry mouth, dysphagia and well-being (P < .0001). USD scores differed significantly for patients when improving or deteriorating on the DT&PC which confirmed responsiveness. Optimal cutoff points (3 or 4) differed per symptom. CONCLUSION The USD is a valid 12-item PROM for the most prevalent symptoms in cancer patients, which has content, criterion, and construct validity, and detects clinically important changes over time, in both curative and palliative phase.
Collapse
Affiliation(s)
- Frederieke H van der Baan
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Josephine J Koldenhof
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Ellen J de Nijs
- Center of Expertise Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael A Echteld
- Avans University of Applied Sciences, Breda/Tilburg, The Netherlands
| | - Danielle Zweers
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Ginette M Hesselmann
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Sigrid C Vervoort
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Jan B Vos
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Everlien de Graaf
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Karijn P Suijkerbuijk
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Saskia C Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| |
Collapse
|
33
|
Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, Bruce JY, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Eisele DW, Fenton M, Foote RL, Galloway T, Gillison ML, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Maghami E, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rocco JW, Rodriguez CP, Shah JP, Weber RS, Weinstein G, Witek M, Worden F, Yom SS, Zhen W, Burns JL, Darlow SD. Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:873-898. [DOI: 10.6004/jnccn.2020.0031] [Citation(s) in RCA: 313] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatment is complex for patients with head and neck (H&N) cancers with specific site of disease, stage, and pathologic findings guiding treatment decision-making. Treatment planning for H&N cancers involves a multidisciplinary team of experts. This article describes supportive care recommendations in the NCCN Guidelines for Head and Neck Cancers, as well as the rationale supporting a new section on imaging recommendations for patients with H&N cancers. This article also describes updates to treatment recommendations for patients with very advanced H&N cancers and salivary gland tumors, specifically systemic therapy recommendations.
Collapse
Affiliation(s)
| | | | - David Adelstein
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Douglas Adkins
- 4Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Yoshimi Anzai
- 5Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | | | - David W. Eisele
- 12The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Moon Fenton
- 13The University of Tennessee Health Science Center
| | | | | | | | | | | | | | | | - Debra Leizman
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Bharat B. Mittal
- 22Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - James W. Rocco
- 23The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | - Sue S. Yom
- 27UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | |
Collapse
|
34
|
Florie M, Pilz W, Kremer B, Verhees F, Waltman G, Winkens B, Winter N, Baijens L. EAT-10 Scores and Fiberoptic Endoscopic Evaluation of Swallowing in Head and Neck Cancer Patients. Laryngoscope 2020; 131:E45-E51. [PMID: 32246779 PMCID: PMC7754346 DOI: 10.1002/lary.28626] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/08/2020] [Accepted: 03/02/2020] [Indexed: 11/29/2022]
Abstract
Objective The purpose of this study was to determine the relationship between patient‐reported symptoms of oropharyngeal dysphagia (OD) using the Eating Assessment Tool (EAT)‐10 and the swallowing function using a standardized fiberoptic endoscopic evaluation of swallowing (FEES) protocol in head and neck cancer (HNC) patients with confirmed OD. Methods Fifty‐seven dysphagic HNC patients completed the EAT‐10 and a FEES. Two blinded clinicians scored the randomized FEES examinations. Exclusion criteria consisted of presenting with a concurrent neurological disease, scoring below 23 on a Mini‐Mental State Examination, being older than 85 years, having undergone a total laryngectomy, and being illiterate or blind. Descriptive statistics, linear regression, sensitivity, specificity, and predictive values were calculated. Results The majority of the dysphagic patients (N = 38; 66.7%) aspirated after swallowing thin liquid consistency. A large number of patients showed postswallow pharyngeal residue while swallowing thick liquid consistency. More specifically, 42 (73.0%) patients presented postswallow vallecular residue, and 39 (67.9%) patients presented postswallow pyriform sinus residue. All dysphagic patients had an EAT‐10 score ≥ 3. Linear regression analyses showed significant differences in mean EAT‐10 scores between the dichotomized categories (abnormal vs. normal) of postswallow vallecular (P = .037) and pyriform sinus residue (P = .013). No statistically significant difference in mean EAT‐10 scores between the dichotomized categories of penetration or aspiration was found (P = .966). Conclusion The EAT‐10 questionnaire seems to have an indicative value for the presence of postswallow pharyngeal residue in dysphagic HNC patients, and a value of 19 points turned out to be useful as a cutoff point for the presence of pharyngeal residue in this study population. Level of Evidence: 2b
Collapse
Affiliation(s)
- Michelle Florie
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center Maastricht, Maastricht, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center Maastricht, Maastricht, The Netherlands
| | - Femke Verhees
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ghislaine Waltman
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bjorn Winkens
- CAPHRI - Care and Public Health Research Institute, Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Naomi Winter
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laura Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center Maastricht, Maastricht, The Netherlands
| |
Collapse
|
35
|
Baudelet M, Van den Steen L, Duprez F, De Bodt M, Deschuymer S, Goeleven A, Hutsebaut I, Mariën S, Meersschout S, Nevens D, Nuyts S, Peeters M, Specenier P, Van den Brekel M, van der Molen L, Vandenbruaene C, Vanderveken O, Van Dinther J, Van Laer C, Vauterin T, Verstraete H, Van Nuffelen G. Study protocol for a randomized controlled trial: prophylactic swallowing exercises in head-and-neck cancer patients treated with (chemo)radiotherapy (PRESTO trial). Trials 2020; 21:237. [PMID: 32122397 PMCID: PMC7053144 DOI: 10.1186/s13063-020-4171-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/13/2020] [Indexed: 01/10/2023] Open
Abstract
Background Dysphagia is a common and serious complication after (chemo)radiotherapy (CRT) for head-and-neck cancer (HNC) patients. Prophylactic swallowing exercises (PSE) can have a significantly positive effect on post-treatment swallowing function. However, low adherence rates are a key issue in undermining this positive effect. This current randomized trial will investigate the effect of adherence-improving measures on patients’ swallowing function, adherence and quality of life (QOL). Methods This ongoing trial will explore the difference in adherence and swallowing-related outcome variables during and after PSE in HNC patients performing the same therapy schedule, receiving different delivery methods. One hundred and fifty patients treated in various hospitals will be divided into three groups. Group 1 performs PSE at home, group 2 practices at home with continuous counseling through an app and group 3 receives face-to-face therapy by a speech and language pathologist. The exercises consist of tongue-strengthening exercises and chin-tuck against resistance with effortful swallow. The Iowa Oral Performance Instrument and the Swallowing Exercise Aid are used for practicing. Patients are evaluated before, during and after treatment by means of strength measurements, swallowing and QOL questionnaires. Discussion Since low adherence rates undermine the positive impact of PSE on post-treatment swallowing function, there is need to develop an efficient PSE protocol maximizing adherence rates. Trial registration ISRCTN, ID: ISRCTN98243550. Registered retrospectively on 21 December 2018.
Collapse
Affiliation(s)
- Margot Baudelet
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | - Sarah Deschuymer
- Department of Radiation Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Ann Goeleven
- Department of ENT, University Hospitals Leuven, Swallowing Clinic, Leuven, Belgium.,Department of Head and Neck Surgery, University Hospitals Leuven, Swallowing Clinic, Leuven, Belgium
| | - Isabel Hutsebaut
- Department of Radiation Oncology, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Steven Mariën
- Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Sabine Meersschout
- Department of Radiation Oncology, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Radiation Oncology, Iridium Kanker Netwerk, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Sandra Nuyts
- Department of Radiation Oncology, KU Leuven, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Pol Specenier
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Michiel Van den Brekel
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Faculty of Humanities, University of Amsterdam, Spui 21, 1012 WX, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Caroline Vandenbruaene
- Department of Speech-Language Pathology and Audiology, Sint-Jan General Hospital, Bruges, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Joost Van Dinther
- Department of Otorhinolaryngology, Sint-Augustinus Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Tom Vauterin
- Department of Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan General Hospital, Bruges, Belgium
| | - Hilde Verstraete
- Department of Radiation Oncology, Iridium Kanker Netwerk, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery - Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, St. Pietersnieuwstraat 33, 9000, Ghent, Belgium
| | | |
Collapse
|
36
|
Stolze J, Vlaanderen KCE, Raber-Durlacher JE, Brand HS. The impact of hematological malignancies and their treatment on oral health-related quality of life as assessed by the OHIP-14: a systematic review. Odontology 2020; 108:511-520. [PMID: 31955297 DOI: 10.1007/s10266-019-00479-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
Abstract
Patients with hematologic cancers often develop acute and chronic oral complications from their disease and its treatment. These problems could change patients' oral health-related quality of life (OHRQoL) negatively. Quality of life (QoL) has become an increasingly important outcome measure in oncology. This systematic literature review evaluates the impact of hematological malignancies and their treatment on OHRQoL as assessed by the Oral Health Impact Profile (OHIP-14) questionnaire. Medline through Pubmed and Web of Science were searched through April 2017. Two randomized controlled trials, one cohort study, one cross-sectional study, and one case-control study were included. Heterogeneity across the included studies did not allow for meta-analysis. OHIP-14 domains that were frequently given the highest scores were functional limitation (67%), physical pain (50%), physical disability (50%), and psychological discomfort (33%). The domains that were frequently given the lowest scores were social handicap (100%), social disability (100%), and psychological disability (67%). Insufficient evidence is available to draw any robust conclusions regarding OHRQoL assessed by the OHIP-14 in individuals with hematological malignancies. However, functional limitations because of problems with oral mucosal tissues, the dentition, or dentures, seem to have a larger negative impact on the OHRQoL than social aspects associated with oral health problems. Well-designed larger studies are required to determine effects of hematological malignancies as well as acute and long-term effects of their treatment on patients' OHRQoL.
Collapse
Affiliation(s)
- Juliette Stolze
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.,Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands
| | - Kim C E Vlaanderen
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.,Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands
| | - Judith E Raber-Durlacher
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands.,Department of Oral Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Oral Medicine, Academic Centre for Dentistry (ACTA), Amsterdam, The Netherlands. .,Department of Oral Biochemistry, Academic Centre for Dentistry (ACTA), room 12N-37, Gustav Mahlerlaan 3004, 1081 LA, Amsterdam, The Netherlands.
| |
Collapse
|
37
|
Borrayo EA, Scott KL, Drennen A, Bendriss TM, Kilbourn KM, Valverde P. Treatment challenges and support needs of underserved Hispanic patients diagnosed with lung cancer and head-and-neck cancer. J Psychosoc Oncol 2020; 38:449-462. [PMID: 31920170 DOI: 10.1080/07347332.2019.1705453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: We explored the treatment challenges and support needs that Hispanic underserved lung cancer and head-and-neck cancer patients face while undergoing cancer treatment.Design: Qualitative design - ethnography.Sample: Using a sample of 29 participants, we conducted semi-structured interviews with nine lung cancer and head-and-neck cancer survivors and seven health care providers and focus group interviews with six caregivers and seven patient navigators.Method: Relevant themes were extracted with Ethnographic content analysis.Findings: Participants reported treatment challenges and support needs in four areas: medical, financial, socio-cultural, and mental health. Health care providers and navigators primarily identified medical and financial challenges that impact treatment adherence, while patients and caregivers expressed the need for support for mental health problems (i.e., depression, anxiety).Implications for psychosocial providers: Understanding the experiences of underserved Hispanic cancer survivors can aid in creating psychosocial interventions that successfully target treatment-related challenges and provide them with the support they need.
Collapse
Affiliation(s)
- Evelinn A Borrayo
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katie L Scott
- Department of Neurology, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Ava Drennen
- Health Psychology Associates, P.C., Greeley, CO, USA
| | - Tiare M Bendriss
- Psychiatry, Fremont Medical Center, Kaiser Permanente, Fremont, CA, USA
| | - Kristin M Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Patricia Valverde
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
38
|
Ebersole B, Lango M, Ridge J, Handorf E, Farma J, Clark S, Jamal N. Dysphagia Screening for Pneumonia Prevention in a Cancer Hospital: Results of a Quality/Safety Initiative. Otolaryngol Head Neck Surg 2019; 162:220-229. [PMID: 31791195 DOI: 10.1177/0194599819889893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Hospital-acquired aspiration pneumonia remains a rare but potentially devastating problem. The best means by which to prevent aspiration in a cancer hospital population has not been evaluated. The aim of this study was to evaluate the impact of dysphagia screening on aspiration pneumonia rates in an acute care oncology hospital. METHODS A prospective single-institution quality improvement dysphagia screening protocol at a comprehensive cancer center. Effect of dysphagia screening implemented in 2016 on hospital-acquired aspiration pneumonia rates coded "aspiration pneumonitis due to food/vomitus" was compared with rates from 2014 to 2015 prior to implementation. Screening compliance, screening outcomes, patient demographics, and medical data were reviewed as part of a post hoc analysis. RESULTS Of 12,392 admissions in 2014 to 2016, 97 patients developed aspiration pneumonia during their hospitalization. No significant change in aspiration pneumonia rate was seen during the dysphagia screening year when compared to prior years (baseline, 7.36; screening year, 8.78 per 1000 discharges; P = .33). Sixty-eight of the cases (66%) were associated with emesis/gastrointestinal obstruction or perioperative aspiration and only 15 (15%) with oropharyngeal dysphagia. Multivariate analysis found that patients admitted to gastrointestinal surgery had an aspiration risk equivalent to patients admitted to head and neck, thoracic, and pulmonary services (odds ratio, 0.65; P = .2). DISCUSSION Nursing-initiated dysphagia screening did not decrease aspiration pneumonia rates. The causes of aspiration-associated pneumonia were heterogeneous. Aspiration of intestinal contents is a more common source of hospital-acquired pneumonia than oropharyngeal dysphagia.
Collapse
Affiliation(s)
- Barbara Ebersole
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Speech Pathology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Miriam Lango
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - John Ridge
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Jeffrey Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Sarah Clark
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Speech Pathology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Nausheen Jamal
- Department of Surgery, University of Texas Rio Grande Valley School of Medicine, University of Texas Health, Edinburg, Texas, USA
| |
Collapse
|
39
|
Brachytherapy in the Palliation of Oesophageal Cancer: Effective but Impractical? Clin Oncol (R Coll Radiol) 2019; 31:e87-e93. [PMID: 30982667 DOI: 10.1016/j.clon.2019.03.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 01/21/2023]
|
40
|
The prevalence of patient-reported dysphagia and oral complications in cancer patients. Support Care Cancer 2019; 28:1141-1150. [PMID: 31203510 DOI: 10.1007/s00520-019-04921-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/05/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Research investigating swallowing problems (dysphagia) and complications within the oral cavity in non-head and neck cancer patients is limited. The purpose of this study was to determine the prevalence of patient-reported dysphagia and oral complications in all cancer patients and to examine the relationships between cancer types, oral complications and dysphagia. METHODS A cross-sectional study was conducted at a specialist cancer centre in Australia. Data on patient-reported dysphagia and oral complications were collected using the Vanderbilt Head and Neck Symptom Survey (version 2.0) which was completed by participants in one of three settings: inpatients, ambulatory patients receiving chemotherapy, or ambulatory patients receiving radiotherapy. RESULTS Data were collected on 239 patients, receiving treatment for 14 cancer types. The proportion of patients who reported dysphagic symptoms were as follows: any dysphagia (54%); dysphagia for liquids (20%); and dysphagia for solids (46%). Significantly more head and neck patients and significantly fewer breast patients reported dysphagia, but there were no differences between other tumour types. Oral symptoms across all cancer types were reported at the following rates: taste changes (62%); xerostomia (56%); voice changes (37%); smell changes (35%); thick mucous (33%); difficulty with teeth/dentures (25%); mouth/throat pain (20%); and trismus (19%). CONCLUSIONS This is the first time comprehensive data on dysphagia and oral complications across all cancer patients have been collected. We have identified that dysphagic symptoms and oral complications-which have implications for quality of life and function-are common in all cancer patients, not just those with head and neck cancer.
Collapse
|
41
|
|
42
|
da Silva GM, Portas J, López RVM, Côrrea DF, Arantes LMRB, Carvalho AL. Study of Dysphagia in Patients with Advanced Oropharyngeal
Cancer Subjected to an Organ Preservation Protocol Based on
Concomitant Radiotherapy and Chemotherapy. Asian Pac J Cancer Prev 2019; 20:977-982. [PMID: 30912631 PMCID: PMC6825780 DOI: 10.31557/apjcp.2019.20.3.977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Organ preservation protocol (based on chemo-radiotherapy) for oropharyngeal tumors include dysphagia as a possible sequel leading to function impairment and changes in patient’s quality of life. Objectives: The aim of this study is to assess dysphagia severity after treatment in advanced oropharyngeal cancer patients treated with concurrent chemo-radiation. Methods: This prospective cross-sectional study included 64 participants who had been disease free for at least six months after primary treatment. Dysphagia severity was assessed by fibre-optic endoscopic evaluation of swallowing (FEES) and the Dysphagia Outcome and Severity Scale (DOSS); the occurrence of penetration/aspiration during swallowing was also investigated. All participants also completed the M. D. Anderson Dysphagia Inventory (MDADI). The correlation of FEES results with clinical-demographic variables and MDADI scores was assessed. Descriptive analysis was performed, and qualitative variables were compared using either the chi-square or Fisher’s exact test. Results: FEES revealed silent aspiration in 18.8% of the patients. Approximately 6.3% of the patients exhibited severe dysphagia (scores 1-2 in DOSS). Dysphagia severity was significantly associated with the MDADI physical domain scores. The participants with scores 5-7 in DOSS (no or mild dysphagia) exhibited less limitations in the MDADI physical domain (p=0.015). Conclusions: Silent aspiration was detected in one of every five patients treated with concurrent chemo-radiotherapy; almost half of the patients exhibit at least moderate dysphagia. Assessment of the participant’s quality of life via the MDADI revealed an association between the physical domain scores and dysphagia severity.
Collapse
Affiliation(s)
| | - Juliana Portas
- Speech Language Pathology Department, Barretos Cancer Hospital, Barretos – SP, Brazil
| | | | | | | | - André Lopes Carvalho
- Head and Neck Surgery Department, Barretos Cancer Hospital, Barretos – SP, Brazil
| |
Collapse
|
43
|
Badr H, Sobrero M, Chen J, Kotz T, Genden E, Sikora AG, Miles B. Associations between pre-, post-, and peri-operative variables and health resource use following surgery for head and neck cancer. Oral Oncol 2019; 90:102-108. [PMID: 30846167 DOI: 10.1016/j.oraloncology.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We examined associations between pre-, post-, and peri-operative variables and health resource use in head and neck cancer patients. METHODS Patients (N = 183) who were seen for a pre-surgical consult between January 2012 and December 2014 completed surveys that assessed medical history, a patient-reported outcome measure (PROM) of dysphagia, and quality of life (QOL). After surgery, peri-operative (e.g., tracheostomy, feeding tube) and post-operative (e.g., complications) variables were abstracted from patients' medical records. RESULTS Multivariate regression models using backward elimination showed that pre-surgical University of Washington Quality of Life (UW-QOL) Inventory and M.D. Anderson Dysphagia Inventory (MDADI) composite scores, documented surgical complications, and having a tracheostomy, were all significant predictors of hospital length of stay, explaining 57% of the total variance (F(5, 160) = 18.71, p < .001). Male gender, psychiatric history, and lower pre-surgical MDADI scores significantly predicted thirty-day unplanned readmissions (30dUR). Pre-surgical MDADI composite scores also significantly predicted emergencey department (ED) visits within 30 days of initial hospital discharge (p = .02). CONCLUSIONS Assessment of PROMs and QOL in the pre-surgical setting may assist providers in identifying patients at risk for prolonged LOS and increased health resource use after hospital discharge.
Collapse
Affiliation(s)
- Hoda Badr
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA.
| | | | - Joshua Chen
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA; Department of Psychology, University of St Thomas, Houston, TX, USA
| | - Tamar Kotz
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew G Sikora
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Brett Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
44
|
Huang YF, Liu SP, Muo CH, Chang CT, Tsai CH, Morisky DE. Sialadenitis May Be Associated With an Increased Risk for Osteoradionecrosis: A Nationwide Population-Based Cohort Study. J Oral Maxillofac Surg 2019; 77:1392-1400. [PMID: 30826391 DOI: 10.1016/j.joms.2019.01.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The impact of sialadenitis on osteoradionecrosis (ORN) is controversial. The aim of this study was to determine the association between sialadenitis and ORN. MATERIALS AND METHODS Participants were derived from the Taiwanese Longitudinal Health Insurance Database. From January 1, 2000 to December 31, 2008, cases of sialadenitis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 527.2, 527.3, 527.5 to 527.7, 527.9, and 710.2) and ORN (ICD-9-CM codes 526.89, 526.5, 730.0, and 730.1) were identified. Different treatment modalities, including surgery versus medicine, were used to distinguish the severity of sialadenitis. The primary predictor variable was sialadenitis. The secondary predictor variable was severity of sialadenitis. The primary outcome variable was time to developing ORN. Other study variables were grouped for age, gender, risk factor, and medical treatment. Cox proportional hazard regression was used to investigate the associations between sialadenitis and ORN after adjusting for statistical confounders. RESULTS The sample was composed of 47,385 patients with a mean age of 46.6 years (standard deviation, 19.9 yr) and 37.2% were men. Twenty percent had a diagnosis of sialadenitis and 1.13% had a diagnosis of ORN. Sialadenitis was associated with an increased risk of ORN (hazard ratio [HR] = 1.93; 95% confidence interval [CI], 1.61-2.31; P < .0001). After adjustment for confounders, sialadenitis was associated with ORN (multivariable HR = 1.83; 95% CI, 1.52-2.19; P < .0001). Severity of sialadenitis was associated with an increased risk of ORN; risks for ORN were 1.79 (95% CI, 1.49-2.16; P < .0001) and 3.52 (95% CI, 1.67-7.44; P < .001) in patients with mild and serious sialadenitis, respectively, compared with the no-sialadenitis cohort. For the joint effect of ORN between sialadenitis and malignancy type, patients with sialadenitis had 11.6-fold risk for ORN (95% CI, 5.58-23.9) compared with patients without malignancy. CONCLUSIONS Sialadenitis markedly increased the risk to develop ORN. The severity of sialadenitis was positively correlated with the incidence of ORN.
Collapse
Affiliation(s)
- Yi-Fang Huang
- Assistant Professor, Department of General Dentistry, Chang Gung Memorial Hospital, Linkou; Adjunct Lecturer, School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shih-Ping Liu
- Associate Professor, Graduate Institute of Basic Medical Science, China Medical University, Taichung; Associate Professor, Center for Neuropsychiatry, China Medical University Hospital, Taichung; Associate Professor, Department of Social Work, Asia University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Researcher, Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Ta Chang
- Adjunct Assistant Professor, School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei; Associate Professor, Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan.
| | - Chun-Hao Tsai
- Associate Professor, Department of Orthopedics, China Medical University Hospital, Taichung; Associate Professor, Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan
| | - Donald E Morisky
- Professor, Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
| |
Collapse
|
45
|
Cervenka B, Pipkorn P, Fagan J, Zafereo M, Aswani J, Macharia C, Kundiona I, Mashamba V, Zender C, Moore M. Oral cavity cancer management guidelines for low-resource regions. Head Neck 2019; 41:799-812. [DOI: 10.1002/hed.25423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 07/24/2018] [Accepted: 09/12/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery; University of California at Davis, Resident; Sacramento California
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery; Washington University, Assistant Professor; St. Louis Missouri
| | - Johannes Fagan
- Department of Otolaryngology-Head and Neck Surgery; The University of Cape Town, Professor; Cape Town South Africa
| | - Mark Zafereo
- Department of Head and Neck Surgery; The University of Texas, MD Anderson Cancer Center, Associate Professor; Houston Texas
| | - Joyce Aswani
- Department of Otolaryngology-Head and Neck Surgery; University of Nairobi; Nairobi Kenya
| | - Chege Macharia
- Department of General Surgery; AIC Kijabe Hospital; Kijabe Kenya
| | | | - Victor Mashamba
- Department of Otorhinolaryngology; Muhimbili National Hospital; Dar es Salaam Tanzania
| | - Chad Zender
- Department of Otolaryngology-Head and Neck Surgery; Case Western Reserve MC; Cleveland Ohio
| | - Michael Moore
- Department of Otolaryngology-Head and Neck Surgery; University of California at Davis, Associate Professor; Sacramento California
| |
Collapse
|
46
|
|
47
|
Carta F, Mariani C, Sambiagio GB, Chuchueva N, Lecis E, Gerosa C, Puxeddu R. CO 2 Transoral Microsurgery for Supraglottic Squamous Cell Carcinoma. Front Oncol 2018; 8:321. [PMID: 30234007 PMCID: PMC6131582 DOI: 10.3389/fonc.2018.00321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/27/2018] [Indexed: 02/05/2023] Open
Abstract
The present study analyzed the results of the endoscopic approach to T1, T2 and selected T3 supraglottic carcinoma with the aim of reviewing functional and oncologic outcomes after different types of endoscopic supraglottic laryngectomies. This is a retrospective clinical study of 42 consecutive patients (mean age of 61.8 years, 33 males, 9 females) treated by the senior author for supraglottic squamous cell carcinoma with a transoral CO2 laser approach and reviewed from November 2010 to September 2017. Surgical procedures were classified according to the European Laryngological Society. In addition to the standardized transoral supraglottic laryngectomies, we introduced a modified type IVb by sparing the inferior third of the arytenoid if not directly involved in the tumor. Swallowing was evaluated with the Swallowing Performance Status Scale reported by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. Survival probabilities were estimated using Kaplan-Meier curves. Two type I, 2 type IIa, 2 type IIb, 3 type IIIa, 12 type IIIb, 13 type IVa, 3 type modified IVb, and 5 type IVb supraglottic laryngectomies were performed. Twenty-one patients (50%) underwent primary neck dissection. The pathologic TNM classification according to the 8th edition of the American Joint Committee on Cancer system was as follows: 9 pT1cN0, 2 pT1N0, 1 pT1N1, 7 pT2cN0, 1 rypT2cN0, 9 pT2N0, 4 pT2N1, 2 ypT2N1, 2 pT3cN0, 2 rypT3cN0, 1 pT3N1, and 2 pT3N2b. Mean follow-up was 3.4 years (range of 9 months to 6 years). According to the Kaplan-Meier analysis, 5-year disease-specific survival, local-relapse-free survival, nodal-relapse-free survival, overall laryngeal preservation and overall survival of patients without previous head and neck radiotherapy/open surgery were 100%, 95.2%, 87.8%, 100%, and 64.6%, respectively. Patients who underwent type I, IIa, and IIb resections (n = 6) started oral feeding the day after surgery, patients who underwent type III-IVb modified resections (n = 31) started oral feeding 3-4 days after surgery, and patients who underwent standard type 4b resections (n = 5) started oral feeding 7 days after surgery. Three months after surgery, patients without a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed significantly better swallowing compared to patients who underwent standard type IVb resection: grade 4-6 impairment of swallowing in 8 and 66.7% of cases, respectively (p = 0.006072); patients with a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed not statistically significant better swallowing compared to patients who underwent standard type IVb resection: grade 4-6 impairment of swallowing at 3 months in 16.7% and 50% of cases, respectively (p = 0.23568). Transoral CO2 laser supraglottic laryngectomy is an oncologic sound alternative to traditional open neck surgery and chemo-radiotherapy. Recovery of swallowing is significantly worsened after total resection of the arytenoid. Modified type IVb procedure leaving intact, when possible, the inferior third of the arytenoid and consequently the glottic competence, improves functional outcome.
Collapse
Affiliation(s)
- Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | | | | | - Elisa Lecis
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Clara Gerosa
- Unit of Pathology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| |
Collapse
|
48
|
Li Y, Liu L, Huang L, Wang X, Hoffmann M, Reyes J, Palmisano M, Zhou S. A Phase I, open-label, randomized, crossover study in healthy subjects to evaluate the bioavailability of, and the food effect on, a pomalidomide oral liquid suspension. CLINICAL PHARMACOLOGY : ADVANCES AND APPLICATIONS 2018; 10:89-99. [PMID: 30050331 PMCID: PMC6055900 DOI: 10.2147/cpaa.s171735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to evaluate the bioavailability of a pomalidomide oral liquid suspension relative to the commercial capsule formulation and to assess the food effect on the pomalidomide oral liquid suspension when administered as a single 4 mg dose. Methods This was an open-label, randomized, three-period, two-sequence crossover study in healthy subjects consisting of a screening phase, a baseline assessment phase, a treatment phase with three periods, and a follow-up phone call phase. Blood samples for pharmacokinetics (PK) assessment were collected up to 48 h postdose during each treatment period. Safety was evaluated throughout the study. Results Pomalidomide exposures were comparable in healthy subjects administered with a single oral 4 mg dose as the reference capsule or as the test liquid suspension formulations, demonstrated as the 90% confidence intervals of the geometric mean ratios for area under the plasma concentration–time curve calculated from time 0 to the last measurable concentration at time t (AUC0–t), area under the plasma concentration–time curve from time 0 to infinity (AUC0–∞), and peak (maximum) plasma drug concentration (Cmax) were completely contained within the bioequivalence range of 80–125%. Administration of the pomalidomide liquid suspension with a high fat meal resulted in a 3.0 h delay in pomalidomide time to Cmax (tmax) and an ~ 34.5% reduction in Cmax. However, the AUCs were comparable after dose administration with and without food. Conclusion A single oral dose of 4 mg of liquid suspension was bioequivalent to a single oral dose of 4 mg of capsule formulation. There was no clinically relevant impact of food on pomalidomide liquid suspension. Single oral doses of 4 mg pomalidomide were safe and well tolerated when administered as a liquid suspension under fed and fasted conditions or as a capsule under fasted conditions.
Collapse
Affiliation(s)
- Yan Li
- Translational Development and Clinical Pharmacology,
| | | | - Lian Huang
- Pharmaceutical Science Drug Product Development
| | - Xiaomin Wang
- Non-Clinical Development, Celgene Corporation, Summit, NJ, USA
| | | | | | | | - Simon Zhou
- Translational Development and Clinical Pharmacology,
| |
Collapse
|
49
|
Pattern of dysphagia after swallowing-sparing intensity-modulated radiotherapy (IMRT) of head and neck cancers: results of a mono-institutional prospective study. Strahlenther Onkol 2018; 194:1114-1123. [DOI: 10.1007/s00066-018-1328-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
|
50
|
Mehrban N, Bowen J, Tait A, Darbyshire A, Virasami AK, Lowdell MW, Birchall MA. Silsesquioxane polymer as a potential scaffold for laryngeal reconstruction. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 92:565-574. [PMID: 30184783 PMCID: PMC6134134 DOI: 10.1016/j.msec.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 06/13/2018] [Accepted: 07/01/2018] [Indexed: 02/01/2023]
Abstract
Cancer, disease and trauma to the larynx and their treatment can lead to permanent loss of structures critical to voice, breathing and swallowing. Engineered partial or total laryngeal replacements would need to match the ambitious specifications of replicating functionality, outer biocompatibility, and permissiveness for an inner mucosal lining. Here we present porous polyhedral oligomeric silsesquioxane-poly(carbonate urea) urethane (POSS-PCUU) as a potential scaffold for engineering laryngeal tissue. Specifically, we employ a precipitation and porogen leaching technique for manufacturing the polymer. The polymer is chemically consistent across all sample types and produces a foam-like scaffold with two distinct topographies and an internal structure composed of nano- and micro-pores. While the highly porous internal structure of the scaffold contributes to the complex tensile behaviour of the polymer, the surface of the scaffold remains largely non-porous. The low number of pores minimise access for cells, although primary fibroblasts and epithelial cells do attach and proliferate on the polymer surface. Our data show that with a change in manufacturing protocol to produce porous polymer surfaces, POSS-PCUU may be a potential candidate for overcoming some of the limitations associated with laryngeal reconstruction and regeneration.
Collapse
Affiliation(s)
- Nazia Mehrban
- Division of Surgery, University College London, London, WC1E 6BT, United Kingdom.
| | - James Bowen
- School of Engineering and Innovation, The Open University, Milton Keynes, MK7 6AA, United Kingdom
| | - Angela Tait
- Department of Biochemical Engineering, University College London, London, WC1E 6BT, United Kingdom
| | - Arnold Darbyshire
- Division of Surgery, University College London, London, WC1E 6BT, United Kingdom
| | - Alex K Virasami
- Department of Histopathology, University College London, London, WC1N 3JH, United Kingdom
| | - Mark W Lowdell
- Department of Haematology, University College London, London, NW3 2QG, United Kingdom
| | - Martin A Birchall
- UCL Ear Institute, University College London, London, WC1X 8DA, United Kingdom
| |
Collapse
|