Perioperative Symptom Burden and Its Influencing Factors in Patients with Oral Cancer: A Longitudinal Study

Current status and influencing factors of fear of surgery in patients with oral and maxillofacial tumors

OBJECTIVES

This study aimed to investigate the incidence and severity of surgical fear in patients with oral and maxillofacial tumors.

METHODS

The survey participants were composed of patients with oral and maxillofacial tumors, who were scheduled to undergo surgery. A general information questionnaire, the Surgical Fear Questionnaire (SFQ), the Patient Health Questionnaire (PHQ)-9, and the Generalized Anxiety Disorder (GAD)-7 score were used for the investigation.

RESULTS

A total of 203 patients were investigated. Among them, 85.22% had fear of surgery. The median score of SFQ was 20, and the quartile was (6, 36). The patients were categorized into none, mild, moderate, and severe groups according fear level. Gender, diabetes, obvious discomfort before surgery, PHQ-9, and GAD-7 scores were the variables with statistical difference in each fear level. Multifactor analysis showed that women were more likely to have moderate and severe fear than men (OR=2.19, P=0.03; OR=2.72, P=0.01), patients with obvious preoperative discomfort symptoms were more inclined to have no fear (OR=4.73, P=0.02), and patients with diabetes were more likely to have severe fear (OR=3.33, P=0.02). The incidence rates of depression and anxiety were 31.03% and 24.63%, respectively. The incidence of anxiety and depression in patients with severe fear was 40.00%. Surgical fear was moderately positively correlated with anxiety (r=0.491, P<0.001) and depression (r=0.514, P<0.001).

CONCLUSIONS

The fear of surgery in patients with oral and maxillofacial tumors is common and distributed in all levels. Medical staff can screen and assess patients with moderate and severe fear of surgery in accordance with the influencing factors and implement targeted interventions to reduce fear of surgery, anxiety, and depression on the basis of the source of fear.

Perioperative change trajectories and predictors of swallowing function and swallowing-related quality of life in patients with oral cancer: a longitudinal observational study

OBJECTIVE

To determine change trajectories and predictors of swallowing function and swallowing-related quality of life (QoL) in perioperative patients with oral cancer.

DESIGN

Longitudinal observational study.

SETTING

A tertiary cancer hospital in Hunan Province, China.

PARTICIPANTS

Patients with oral cancer scheduled for surgery were recruited using convenience sampling.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcomes were swallowing function and swallowing-related QoL. The secondary outcomes were the predictors of the swallowing function and swallowing-related QoL.

METHODS

The participants completed the sociodemographic and clinical data questionnaire, Nutritional Risk Screening 2002 and MD Anderson Dysphagia Inventory before surgery, 7 days after operation and 1 month after operation. Data were analysed using t-test, analysis of variance and generalised linear models.

RESULTS

Among 138 participants who completed all the three surveys, 41 (29.71%) had moderate to severe dysphagia before surgery. Swallowing function and swallowing-related QoL changed over time, showing the trend of decline first and then increase. Preoperative swallowing function and swallowing-related QoL were affected by sex, lymphocyte level, preoperative nutritional risk and primary tumour site. At 7 days postoperatively, tracheotomy affected swallowing function. At 1 month postoperatively, age and marital status influenced swallowing function, whereas age, type of job and preoperative nutritional risk influenced swallowing-related QoL.

CONCLUSIONS

Our study demonstrates that perioperative patients with oral cancer generally faced swallowing disorders, especially in the acute phase after surgery. Healthcare providers should pay attention to the swallowing function of perioperative patients with oral cancer, especially those with preoperative nutritional risk, tongue tumour, tracheotomy, age <60 years, and no spouse and the employed patients, and provide available interventions, such as swallowing and nutritional therapy, as early as possible to improve their swallowing function. Meanwhile, doctors should recommend the most evidence-based treatment options, such as reconstruction or not, preoperative chemotherapy or not, to patients.

Symptom Cluster Experiences of Patients Operated for Oral Cancer: A Mixed Methods Study

OBJECTIVE

This convergent mixed methods study aimed to obtain a comprehensive understanding of symptom cluster experiences in patients with oral cancer. Survey and phenomenological interviews were conducted in parallel to identify distinct patient subgroups based on symptom cluster experiences along with their predictors and explore experiences of living with symptom clusters, respectively.

DATA SOURCES

A convenience sample of 300 patients with oral cancer who had completed surgery provided the quantitative data, and a maximum variation purposive subsample of 20 participants, drawn from the survey sample, provided the qualitative data. Agglomerative hierarchical cluster analysis was used to identify subgroups, multivariate analyses were done to identify predictors, and thematic analysis was used for patient narratives.

CONCLUSION

Almost 94% of the survey participants had two or more co-occurring symptoms. The four most severe and prevalent symptoms were dysphagia, problems with teeth or gums, speech difficulty, and dry mouth. A distinct subgroup consisting of 61% of patients reported severe dysphagia and teeth problems, which was associated with age, oral cancer stage and site. Interviews revealed the causes and the context influencing the perception and response to these symptoms. Thus, the quantitative data provided information on severity and patient subgroups based on symptom cluster experiences, while the qualitative data validated these conclusions and additionally provided in-depth details and meaningful insight on perceived causes and contextual influences of their experiences. This comprehensive picture of symptom cluster experiences can aid in the development of patient-centered interventions for people with oral cancer.

IMPLICATIONS FOR NURSING PRACTICE

An interdisciplinary approach to targeting concurrent symptoms incorporating psychological and physical interventions is necessary. Older patients treated for Stage IV cancers and for buccal mucosa tumors are at high-risk of having severe dysphagia postoperatively, and these patients should be targeted for dysphagia interventions. The contextual factors play an important role in developing patient-centered interventions.

Impact of Preemptive Postoperative Pressure Support Ventilation and Physiotherapy on Postoperative Pulmonary Complications after Major Cervicofacial Cancer Surgery: A before and after Study

Introduction: Complex cervicofacial cancer surgery with free flap reconstruction is known to have a high incidence of postoperative pulmonary complications (PPCs). We hypothesized that by implementing an optimized respiratory protocol, including preemptive postoperative pressure support ventilation, physiotherapy, and critical respiratory support and follow-up, we could decrease the incidence of PPCs. Patients and methods: We evaluated the incidence of PPCs over two periods in two groups of patients having a routine or optimized postoperative respiratory protocol: 156 adult patients undergoing major cervicofacial cancer surgery were assessed; 91 were in Group 1 (routine) and 65 were in Group 2 (optimized). In Group 1, no ventilatory support sessions were performed. The incidence of pulmonary complications in both groups was compared using a multivariate analysis. Mortality was also compared until one year postoperatively. Results: In Group 2 with an optimized protocol, the mean number of ventilatory support sessions was 3.7 ± 1 (minimum 2, maximum 6). The incidence of respiratory complications, which was 34% in Group 1 (routine), was reduced by 59% OR = 0.41 (0.16; 0.95), p = 0.043) to 21% for the optimized Group 2. No difference in mortality was found. Conclusions: The present retrospective study showed that using an optimized preemptive respiratory pressure support ventilation combined with physiotherapy after a major cervicofacial surgery could possibly help reduce the incidence of pulmonary complications. Prospective studies are needed to verify these findings.

Speech disorders in patients with Tongue squamous cell carcinoma: A longitudinal observational study based on a questionnaire and acoustic analysis

BACKGROUND

Speech disorders are common dysfunctions in patients with tongue squamous cell carcinoma (TSCC) that can diminish their quality of life. There are few studies with multidimensional and longitudinal assessments of speech function in TSCC patients.

METHODS

This longitudinal observational study was conducted at the Hospital of Stomatology, Sun Yat-sen University, China, from January 2018 to March 2021. A cohort of 92 patients (53 males, age range: 24-77 years) diagnosed with TSCC participated in this study. Speech function was assessed from preoperatively to one year postoperatively using the Speech Handicap Index questionnaire and acoustic parameters. The risk factors for postoperative speech disorder were analyzed by a linear mixed-effects model. A t test or Mann‒Whitney U test was applied to analyze the differences in acoustic parameters under the influence of risk factors to determine the pathophysiological mechanisms of speech disorders in patients with TSCC.

RESULTS

The incidence of preoperative speech disorders was 58.7%, which increased up to 91.4% after surgery. Higher T stage (P＜0.001) and larger range of tongue resection (P = 0.002) were risk factors for postoperative speech disorders. Among the acoustic parameters, F2/i/decreased remarkably with higher T stage (P = 0.021) and larger range of tongue resection (P = 0.009), indicating restricted tongue movement in the anterior-posterior direction. The acoustic parameters analysis during the follow-up period showed that F1 and F2 were not significantly different of the patients with subtotal or total glossectomy over time.

CONCLUSIONS

Speech disorders in TSCC patients is common and persistent. Less residual tongue volume led to worse speech-related QoL, indicating that surgically restoring the length of the tongue and strengthening tongue extension postoperatively may be important.

Psychosocial Adjustment Changes and Related Factors in Postoperative Oral Cancer Patients: A Longitudinal Study

Disease and treatment-related symptoms and dysfunctions can interfere with the psychosocial adjustment of patients with oral cancer. Identifying factors influencing psychosocial maladjustment is important because at-risk individuals can be targeted for early intervention. This prospective longitudinal study investigated psychosocial adjustment changes and associated factors in postoperative oral cancer patients. Data on psychosocial adjustment, facial disfigurement, symptoms, and social support were collected before surgery (T1) at one month (T2), three months (T3), and five months after discharge (T4). Fifty subjects completed the study, and their data were included in the analysis. Psychosocial maladjustment was reported in 50%, 59.2%, 66%, and 62% of subjects at T1, T2, T3, and T4, respectively. The subjects' psychosocial adjustment deteriorated after surgery. Results from generalized estimating equations indicated that financial status, cancer stage, pain, speech problems, social eating problems, and less sexuality were significant predictors of changes in psychosocial adjustment. Patients with insufficient income, stage III/IV cancer, severe pain, speech problems, social eating problems, and less sexuality were at higher risk for postoperative psychosocial maladjustment. Continued psychosocial assessment and appropriate supportive measures are needed to strengthen the psychosocial adjustment of these high-risk groups.