1
|
Mäkitie AA, Alabi RO, Pulkki-Råback L, Almangush A, Beitler JJ, Saba NF, Strojan P, Takes R, Guntinas-Lichius O, Ferlito A. Psychological Factors Related to Treatment Outcomes in Head and Neck Cancer. Adv Ther 2024; 41:3489-3519. [PMID: 39110309 PMCID: PMC11349815 DOI: 10.1007/s12325-024-02945-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/04/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Patients with head and neck cancer (HNC) often demonstrate stress, distress, anxiety, depression, and are at risk for suicide. These affect their quality of life (QoL) but less attention has been given to psychological variables that may impact response to treatment. OBJECTIVES This study aims to systematically review publications during 2013-2023 to collate evidence on the effects of psychological variables on HNC treatment outcomes. METHODS We searched Ovid Medline, PubMed, Scopus, and Web of Science for articles that examined psychological factors related to treatment outcomes in patients with HNC. RESULTS There were 29 studies (5 before treatment, 2 during, 17 after, and 5 covering the whole management trajectory) including 362,766 patients. The psychological factors were either behavioral (adjustment and coping strategy, unrealistic ideas, self-blame), cognitive (elevated risk of psychiatric co-comorbidity), or emotional (distress, depression, anxiety, nervousness, and fear of disfigurement and complications). It was found that there was a relationship between depression and decreased survival in patients with HNC. Pretreatment pain was an independent predictor of decreased survival in a large sample of patients. The distress level was approximately 54%, emotional problems ranged between 10 and 44%, while financial difficulties were identified in 54% of the patients. Sixty-nine percent of patients were reported to have used at least one cost-coping strategy within 6 months after treatment initiation. During post-treatment period, depression increased from 15% at the baseline to 29%, while the fear of recurrence was found among at least 35% of patients. DISCUSSION AND CONCLUSION Several psychological factors predict QoL and survival among HNC survivors. Distress encompasses depression and anxiety, and physical burden from HNC diagnosis and treatment. Routine screening and early interventions that target distress could improve HNC survivors' QoL. A systematic and standardized measurement approach for QoL is warranted to homogenize these findings and to understand the underlying relationships.
Collapse
Affiliation(s)
- Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O.Box 263, 00029 HUS, Helsinki, Finland.
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
| | - Rasheed Omobolaji Alabi
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | | | - Alhadi Almangush
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Department of Pathology, University of Helsinki, Helsinki, Finland
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
| | - Jonathan J Beitler
- Harold Alfond Center for Cancer Care, Maine General Hospital, Augusta, ME, USA
- Dept of Radiation Oncology, John J. Cochran Veterans Hospital, St. Louis, MO, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, 30322, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Robert Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
2
|
Bhatt N, Yang J, DeBaere L, Wang RS, Most A, Zhang Y, Dayanov E, Yang W, Santacatterina M, Kamberi M, Mojica J, Kamen E, Savitski J, Stein J, Jacobson A. Reducing Length of Stay in Reconstructive Head and Neck Surgery Patients: A Quality Improvement Initiative. Otolaryngol Head Neck Surg 2024. [PMID: 39118499 DOI: 10.1002/ohn.933] [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: 11/16/2023] [Revised: 06/14/2024] [Accepted: 06/24/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To investigate whether a new preoperative education and discharge planning protocol reduced unexpected discharge delays for patients undergoing reconstructive surgery for head and neck cancer. METHODS A quality improvement (QI) intervention was implemented in January 2021 with several components to address historically prolonged observed lengths of stay (LOS) with head and neck cancer patients. The intervention added a preoperative educational visit with a head and neck cancer advanced practice provider, a standardized preoperative speech and swallow assessment, a personalized patient care plan document, discussion of inpatient hospital stay expectations, and early discharge planning. The intervention group included patients who underwent the preoperative education protocol from February to December 2021. For comparison, an age and sex-matched control group was constructed from inpatients who had been admitted for similar procedures in the 2 years prior to the QI intervention (2019-2020) and received standard of care counseling. RESULTS Our study demonstrated a significant reduction in observed to expected LOS ratio after implementation of the intervention (1.24 ± 0.74 control, 0.95 ± 0.52 intervention; P = .012). DISCUSSION We discuss a preoperative education QI intervention at our institution. Our findings demonstrate that our intervention was associated with decreased LOS for patients undergoing head and neck reconstructive surgeries. IMPLICATIONS FOR PRACTICE This QI study shows the benefit of a new standardized preoperative education and discharge planning protocol for patients undergoing head and neck reconstructive surgeries.
Collapse
Affiliation(s)
- Nupur Bhatt
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Jackie Yang
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Lauren DeBaere
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Ronald Shen Wang
- New York University Grossman School of Medicine, New York City, New York, USA
| | - Allison Most
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Yan Zhang
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Elan Dayanov
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | - Wenqing Yang
- Department of Population Health, NYU Langone Health, New York City, New York, USA
| | | | - Maria Kamberi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Jacqueline Mojica
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Emily Kamen
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Justin Savitski
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - John Stein
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| | - Adam Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York City, New York, USA
| |
Collapse
|
3
|
Ray H, Sexton E, Frowen J, Gough K, Turnbull S, Abo S, Ftanou M, Loeliger J. Study protocol for a single-site feasibility study evaluating the adoption and fidelity of Prep-4-RT: prehabilitation for head and neck cancer patients undergoing radiotherapy. Pilot Feasibility Stud 2024; 10:106. [PMID: 39095879 PMCID: PMC11295311 DOI: 10.1186/s40814-024-01531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/15/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Prep-4-RT is a co-designed stepped-care multimodal prehabilitation program for people scheduled to receive radiotherapy for head and neck cancer (HNC). Prehabilitation, which occurs between diagnosis and treatment commencement, aims to improve a patient's health to reduce the incidence and severity of current and future impairments. HNC treatment can be distressing and has detrimental impacts on function and quality of life. HNC patients have increased social vulnerabilities including higher rates of socio-economic disadvantage and engagement in lifestyle habits which increase cancer risk. High levels of physical and psychological impacts of HNC treatment and increased social vulnerabilities of this population warrant investigation of optimal pathways of care, such as prehabilitation. This paper describes a research protocol to evaluate the feasibility of Prep-4-RT, which was designed to prepare HNC patients for the physical and psychological impacts of radiotherapy. METHODS AND ANALYSIS At least sixty adult HNC patients, scheduled to receive radiotherapy (with or without chemotherapy), will be recruited over a five-month period. All participants will receive access to Prep-4-RT self-management resources. Participants identified through screening as high-risk will also be offered individualised interventions with relevant allied health professionals prior to the commencement of radiotherapy (psychologists, dietitians, speech pathologists and physiotherapists). Participants will complete evaluation surveys assessing their experiences with Prep-4-RT resources and interventions. Clinicians will also complete program evaluation surveys. Primary feasibility outcomes include adoption (uptake and intention to try) and fidelity (adherence to the specialist prehabilitation pathway). Secondary feasibility outcomes include acceptability (patient and clinician) of and satisfaction (patient) with Prep-4-RT as well as operational costs. Feasibility outcome data will be analysed using exact binomial and one-sample t tests, as appropriate. ETHICS AND DISSEMINATION Ethics approval has been obtained at the Peter MacCallum Cancer Centre in Melbourne, Australia. Results will be presented at national conferences and published in peer-reviewed journal(s) so that it can be accessed by clinicians involved in the care of HNC patients receiving radiotherapy. If the model of care is found to be feasible and acceptable, the transferability and scalability to other cancer centres, or for other cancer types, may be investigated. REGISTRATION DETAILS ANZCTA (Australian New Zealand Clinical Trials Registry) ACTRN12623000770662.
Collapse
Affiliation(s)
- H Ray
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - E Sexton
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Frowen
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - K Gough
- Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - S Turnbull
- Consumer Register, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - S Abo
- Physiotherapy & Occupational Therapy Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - M Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - J Loeliger
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
4
|
Henry M, Chen LM, Ducharme L, Devault-Tousignant C, Rosberger Z, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Richardson K, Chartier G, Mascarella M, Sadeghi N, Sultanem K, Shenouda G, Cury FL, Meaney M. Genetic Risk For Depression and Quality of Life in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2024; 150:598-606. [PMID: 38814668 PMCID: PMC11140576 DOI: 10.1001/jamaoto.2024.0376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 04/05/2024] [Indexed: 05/31/2024]
Abstract
Importance Although patients with head and neck cancer (HNC) have been shown to experience high distress, few longitudinal studies include a comprehensive evaluation of biopsychosocial factors affecting quality of life (QoL), including genetic risk for depression. Objective To identify factors at the time of cancer diagnosis associated with QoL scores at 3 months after treatment in patients newly diagnosed with a first occurrence of HNC. Design, Setting, and Participants This prospective longitudinal study of 1464 participants with a 3-month follow-up, including structured clinical interviews and self-administered measures was carried out at the Department of Otolaryngology Head and Neck Surgery at 2 tertiary care McGill University Affiliated Hospitals, McGill University Health Centre, and Jewish General Hospital. Eligible patients were adults newly diagnosed within 2 weeks with a primary first occurrence of HNC, had a Karnofsky Performance Scale score higher than 60, and an expected survival of more than 6 months. Two hundred and twenty-three patients (72%) consented to participate and completed the baseline questionnaire, and 71% completed the 3-month follow-up measures. Exposures An a priori conceptual model including sociodemographics, medical variables, psychosocial risk factors, and a polygenic risk score for depression (PRS-D) was tested. Main outcomes and measures The Functional Assessment of Cancer Therapy-Head and Neck measured QoL at baseline and at 3 months. Results Participants were mostly men (68.7%), with a mean (range) age of 62.9 (31-92) years, 36.6% having a university degree, 35.6% living alone, and 71.4% diagnosed with advanced HNC with mostly cancers being of the oropharynx (42.2%), oral cavity (17%), and larynx (16.3%). QoL at 3 months after HNC diagnosis was associated with higher PRS-D (B = -4.71; 95% CI, -9.18 to -0.23), and a diagnosis of major depressive disorder within 2 weeks of an HNC diagnosis (B = -32.24; 95% CI, -51.47 to 13.02), lifetime suicidal ideation (B = -22.39; 95% CI, -36.14 to -8.65), living with someone (B = 12.48; 95% CI, 3.43-21.52), having smoked cigarettes in the past 30 days pre-HNC diagnosis (B = -15.50; 95% CI, -26.07 to -4.93), chemotherapy type (B = -11.13; 95% CI, -21.23 to -1.02), and total radiotherapy dose (Gy) (B = -0.008; 95% CI, -0.01 to -0.002). Conclusions and relevance This study identified the predictive value of a genetic predisposition to depression on QoL and function immediately after oncologic treatments. These findings highlight the potential importance of genetic profiling pretreatment to identify those most susceptible to experience QoL and functional compromise. Depression is a clear area of public health concern and should be a central focus in the treatment of patients with HNC.
Collapse
Affiliation(s)
- Melissa Henry
- McGill University, Montreal, Quebec, Canada
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | | | - Laurence Ducharme
- McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | | | - Zeev Rosberger
- McGill University, Montreal, Quebec, Canada
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Saul Frenkiel
- McGill University, Montreal, Quebec, Canada
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- McGill University, Montreal, Quebec, Canada
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Karen Kost
- McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- McGill University, Montreal, Quebec, Canada
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | | | - Marco Mascarella
- McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Nader Sadeghi
- McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- McGill University, Montreal, Quebec, Canada
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Georges Shenouda
- McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Fabio L. Cury
- McGill University, Montreal, Quebec, Canada
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Michael Meaney
- McGill University, Montreal, Quebec, Canada
- Douglas Hospital, Montreal, Quebec, Canada
| |
Collapse
|
5
|
Wang S, Zhu Y, Wang Z, Zheng M, Li X, Zhang Y, Wan H. Efficacy of meaning-centered group psychotherapy in Chinese patients with cancer: A randomized controlled trial. Palliat Support Care 2023; 21:773-781. [PMID: 37558651 DOI: 10.1017/s1478951523000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVES Meaninglessness is one of the most common psychological problems in cancer patients, which can lead to anxiety, depression and psychological distress, and diminished quality of life. Recent evidence indicates that meaning-centered group psychotherapy (MCGP) effectively enhances the meaning in life among cancer patients. This study aimed to evaluate the impact of MCGP on the meaning in life, post-traumatic growth, psychological distress, and fear of recurrence among Chinese cancer patients with a favorable prognosis. METHODS Sixty-six cancer patients were randomly assigned to either the MCGP group (n = 33) or the control group (n = 33). Participants in the MCGP group underwent a 4-week, 8-session MCGP, while those in the control group received usual care. Meaning in life, post-traumatic growth, psychological distress, and fear of recurrence were assessed at both baseline and postintervention to evaluate the impact of the intervention. The intervention outcomes were analyzed using paired t-tests or analysis of covariance, as appropriate. RESULTS Patients in the MCGP group demonstrated significant improvements in meaning in life, post-traumatic growth, and fear of recurrence from baseline to postintervention. In comparison to the control group, the MCGP group displayed positive effects on meaning in life and post-traumatic growth following the intervention. However, no significant effects were observed in terms of psychological distress and fear of recurrence. SIGNIFICANCE OF RESULTS Our research offers evidence supporting the effectiveness of MCGP in enhancing meaning in life and post-traumatic growth among Chinese cancer patients with a favorable prognosis.
Collapse
Affiliation(s)
- Shuman Wang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Yu Zhu
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Ziying Wang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Mimi Zheng
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Xiaoru Li
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Yu Zhang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Hongwei Wan
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| |
Collapse
|
6
|
Bobevski I, Kissane DW, Desroches J, De Simone A, Henry M. Validation of the Canadian Version of the Shame and Stigma Scale for Head and Neck Cancer Patients. Curr Oncol 2023; 30:7553-7565. [PMID: 37623029 PMCID: PMC10453664 DOI: 10.3390/curroncol30080548] [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: 07/13/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Cancers of the head and neck and their treatment can cause disfigurement and loss of functioning, with a profound negative impact on the person's self-image and psychosocial wellbeing. This can lead to experiences of shame and stigma, which are important targets for psychosocial interventions. Accurate measurement and identification of these problems enables clinicians to offer appropriate interventions and monitor patients' progress. This study aimed to validate the Canadian version of the Shame and Stigma Scale (SSS) among French- and English-speaking head and neck cancer patients. Data from 254 patients from two major Canadian hospitals were analysed. The existing four-factor structure of the SSS was supported, with the following subscales: Shame with Appearance, Sense of Stigma, Regret, and Social/Speech Concerns. The Canadian SSS showed adequate convergent and divergent validity and test-retest reliability. Rasch analysis suggested scale improvement by removing two misfitting items and two items with differential functioning between French- and English-speaking patients. The final 16-item scale version was an adequate fit with the Rasch model. The SSS provides more accurate measures for people with high levels of shame and stigma, and thus has utility in identifying patients with more severe symptoms who may be in need of psychosocial interventions.
Collapse
Affiliation(s)
- Irene Bobevski
- School of Medicine, University of Notre Dame Australia, Darlinghurst, NSW 2010, Australia;
- Department of Psychiatry, School of Clinical Sciences, Monash Health and Monash University, Clayton, VIC 3168, Australia
| | - David W. Kissane
- School of Medicine, University of Notre Dame Australia, Darlinghurst, NSW 2010, Australia;
- Department of Psychiatry, School of Clinical Sciences, Monash Health and Monash University, Clayton, VIC 3168, Australia
| | - Justin Desroches
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada; (J.D.)
| | - Avina De Simone
- Faculty of Medicine, McGill University, Montreal, QC H3A 0G4, Canada; (J.D.)
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
- Lady-Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| |
Collapse
|
7
|
Henry M, Harvey R, Chen LM, Meaney M, Nguyen TTT, Kao HT, Rosberger Z, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Richardson K, Greenwood CMT, Melnychuk D, Gold P, Chartier G, Black M, Mascarella M, MacDonald C, Sadeghi N, Sultanem K, Shenouda G, Cury F, O'Donnell KJ. Genetic predisposition to depression and inflammation impacts symptom burden and survival in patients with head and neck cancer: A longitudinal study. J Affect Disord 2023; 331:149-157. [PMID: 36948466 DOI: 10.1016/j.jad.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The primary purpose of this study was to investigate the contribution of genetic predispositions to depression and inflammation, as measured through polygenic risk scores, on symptom burden (physical and psychological) in patients with head and neck cancer in the immediate post-treatment period (i.e., at three months post-diagnosis), as well as on 3-, 6-, 12-, 24- and 36-month survival. METHODS Prospective longitudinal study of 223 adults (72 % participation) newly diagnosed with a first occurrence of primary head and neck cancer, paired with genetic data (Illumina PsychArray), validated psychometric measures, Structured Clinical Interviews for DSM Disorders (SCID-I), and medical chart reviews. RESULTS Symptom burden at 3 months was predicted by (R2 adj. = 0.38, p < 0.001): a baseline SCID-I Anxiety Disorder (b = 1.69, B = 0.23, 95%CI = 0.43-2.94; p = 0.009), baseline levels of HADS anxiety (b = 0.20, B = 0.29, 95%CI = 0.07-0.34; p = 0.003), the polygenic risk score (PRS) for depression (b = 0.66, B = 0.18, 95%CI = 0.003-1.32; p = 0.049), and cumulated dose of radiotherapy (b = 0.002, B = 0.46, 95%CI = 0.001-0.003; p < 0.001). When controlling for factors known to be associated with cancer survival, patients with a higher PRS associated with depression and inflammation, respectively, presented higher risk of death within 36 months (b = 1.75, Exp(B) = 5.75, 95%CI = 1.55-21.27, p = 0.009 and b = 0.14, Exp(B) = 1.15, 95%CI = 1.01-1.30, p = 0.03). CONCLUSIONS Our results outline three potential pathways of symptom burden in patients with head and neck cancer: a genetic predisposition towards depression; an initial anxiety disorder upon being diagnosed with cancer or high levels of anxiety upon diagnosis; and a dose-related response to radiotherapy. One may want to investigate early interventions in these areas to alleviate symptom burden in patients faced with a life-threatening disease, as well as consider targeting genetic predisposition towards depression and inflammation implicated in survival. The high prevalence of distress in patients with head and neck cancer is an opportunity to study genetic predispositions, which could potentially be broadly generalized to other cancers and diseases.
Collapse
Affiliation(s)
- Melissa Henry
- McGill University, Canada; Jewish General Hospital, Canada; Lady-Davis Institute for Medical Research, Canada.
| | | | | | | | | | - Han-Tin Kao
- McGill University, Canada; Douglas Hospital, Canada
| | - Zeev Rosberger
- McGill University, Canada; Jewish General Hospital, Canada; Lady-Davis Institute for Medical Research, Canada
| | - Saul Frenkiel
- McGill University, Canada; Jewish General Hospital, Canada; Douglas Hospital, Canada
| | - Michael Hier
- McGill University, Canada; Jewish General Hospital, Canada; Lady-Davis Institute for Medical Research, Canada
| | - Anthony Zeitouni
- McGill University, Canada; McGill University Health Centre, Canada
| | - Karen Kost
- McGill University, Canada; McGill University Health Centre, Canada
| | - Alex Mlynarek
- McGill University, Canada; Jewish General Hospital, Canada; McGill University Health Centre, Canada
| | - Keith Richardson
- McGill University, Canada; McGill University Health Centre, Canada
| | - Celia M T Greenwood
- McGill University, Canada; Lady-Davis Institute for Medical Research, Canada
| | | | - Phil Gold
- McGill University, Canada; Jewish General Hospital, Canada
| | | | - Martin Black
- McGill University, Canada; Jewish General Hospital, Canada
| | - Marco Mascarella
- McGill University, Canada; McGill University Health Centre, Canada
| | | | - Nader Sadeghi
- McGill University, Canada; McGill University Health Centre, Canada
| | - Khalil Sultanem
- McGill University, Canada; McGill University Health Centre, Canada
| | - Georges Shenouda
- McGill University, Canada; McGill University Health Centre, Canada
| | - Fabio Cury
- McGill University, Canada; McGill University Health Centre, Canada
| | - Kieran John O'Donnell
- McGill University, Canada; Douglas Hospital, Canada; Yale Child Study Center, Yale School of Medicine, Yale University, United States of America; Department of Obstetrics Gynecology & Reproductive Sciences, Yale School of Medicine, Yale University, United States of America
| |
Collapse
|
8
|
Alves CGB, Ribeiro ACP, Brandão TB, Tonaki JO, Pedroso CM, Rivera C, Epstein JB, Migliorati CA, Kowalski LP, Mak MP, Castro G, Lopes MA, Santos-Silva AR. Patient's perceptions of oral and oropharyngeal cancer diagnosis disclosure: communication aspects based on SPIKES protocol. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:518-529. [PMID: 36740563 DOI: 10.1016/j.oooo.2022.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/28/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Breaking bad medical news is a complex task of clinical practice. The manner in which this is done has a significant impact on patients. This study aimed to assess patient's perceptions regarding oral and oropharyngeal cancer diagnosis disclosure according to the "SPIKES" protocol. STUDY DESIGN This cross-sectional study used a questionnaire with 21 SPIKES-based items. The questionnaire was administered to 100 patients with recently diagnosed oral and oropharyngeal squamous cell carcinoma who evaluated each item according to their preference and experience. RESULTS Nineteen items showed a significant difference between patient's preference and recalled experience. Eighteen of these items showed lower experience scores primarily related to the amount of information desired by patients, presence of a companion, time to express feelings, and summary of information. Most patients preferred receiving as much information as possible about the diagnosis. However, only 35% reported that they had obtained sufficient information. Patients who were aware of cancer diagnostic suspicion had better communication experiences. CONCLUSIONS Protocols may be useful to guide health professionals to support patient-centered strategies to disclose oral cancer diagnoses.
Collapse
Affiliation(s)
- Carolina G B Alves
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Ana Carolina Prado Ribeiro
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Thaís Bianca Brandão
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil; Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Juliana O Tonaki
- Psychology Service, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Caique Mariano Pedroso
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - César Rivera
- Oral Medicine and Pathology Research Group, Faculty of Health Sciences, University of Talca (UTALCA), Talca, Maule Region, Chile
| | - Joel B Epstein
- Cedars-Sinai Health System, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | | | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - Milena Perez Mak
- Department of Medical Oncology, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Gilberto Castro
- Department of Medical Oncology, Instituto do Câncer do Estado de São Paulo, University of São Paulo Medical School (ICESP-FMUSP), São Paulo, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Semiology Area, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| |
Collapse
|
9
|
Biopsychosocial Markers of Body Image Concerns in Patients with Head and Neck Cancer: A Prospective Longitudinal Study. Curr Oncol 2022; 29:4438-4454. [PMID: 35877213 PMCID: PMC9319375 DOI: 10.3390/curroncol29070353] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
(1) Background: Patients and survivors of head and neck cancer (HNC) are at a high risk of developing body image concerns. Despite the prevalence of body image concerns in patients with HNC, there is a lack of longitudinal research exploring the wide array of its associated determinants. The current longitudinal study examined the determinants and longitudinal course of body image dissatisfaction in patients with HNC. (2) Methods: Patients participated in Structured Clinical Interviews and self-administered questionnaires at four time-points: (T1) upon cancer diagnosis, (T2) at 3 months post-diagnosis, (T3) at 6 months post-diagnosis, and (T4) at 12 months post-diagnosis. They also underwent a disfigurement rating on an objective scale. (3) Results: Two hundred and twenty-four patients participated in our study. Fourteen percent to twenty-eight percent of patients reported at least moderate body image concerns across time points, with the lowest rates at baseline and the highest at 3 months (T1). It was found that patients more predisposed to developing higher levels of body image concerns presented physical markers (i.e., advanced cancer stage, lower physical functioning, higher disfigurement), psychosocial markers (i.e., higher depression, higher anxiety, and higher levels of coping with denial), and health disparities (i.e., younger age, female sex, French language, and marital status, with divorced and widowers most affected). (4) Conclusions: The findings of this study highlight the multifaceted nature of body image concerns in patients with HNC and its biopsychosocial determinants. Clinicians should pay specific attention to these biopsychosocial markers in their clinics to predict high levels of body image concerns and tailor communication/refer for support accordingly.
Collapse
|
10
|
Cherba M, Brummans BHJM, Hier MP, Giguère L, Chartier G, Jacobs H, Forest VI, Mlynarek A, Sultanem K, Henry M. Framing Concerns about Body Image during Pre- and Post-Surgical Consultations for Head and Neck Cancer: A Qualitative Study of Patient–Physician Interactions. Curr Oncol 2022; 29:3341-3363. [PMID: 35621662 PMCID: PMC9139818 DOI: 10.3390/curroncol29050272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 12/04/2022] Open
Abstract
Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains.
Collapse
Affiliation(s)
- Maria Cherba
- Department of Communication, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | | | - Michael P. Hier
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Lauriane Giguère
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Gabrielle Chartier
- Department of Nursing, Oncology Division, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Hannah Jacobs
- Department of Audiology and Speech-Language Pathology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Véronique-Isabelle Forest
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Alex Mlynarek
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Khalil Sultanem
- Division of Radiation Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| |
Collapse
|
11
|
Henry M, Albert JG, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Richardson K, Mascarella M, Morand GB, Chartier G, Sadeghi N, Lo C, Rosberger Z. Body Image Concerns in Patients With Head and Neck Cancer: A Longitudinal Study. Front Psychol 2022; 13:816587. [PMID: 35401366 PMCID: PMC8988682 DOI: 10.3389/fpsyg.2022.816587] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Head and neck cancer (HNC) treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: (1) the prevalence, level, and course of body image concerns; (2) correlates of upon cancer diagnosis (pre-treatment) body image concerns; (3) predictors of immediate post-treatment body image concerns; and (4) association between body image concerns and levels of anxiety, depression, suicidal ideation, support (i.e., satisfaction with support from physician, social/family wellbeing, and unmet support needs), and alcohol and drug misuse. Methods Two hundred and twenty-three (participation rate = 72%), newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model. Results Sixty-eight percent of patients with HNC (n = 148 of 218) presented some level of body image concerns. Body image concerns at baseline (i.e., upon cancer diagnosis, pre-treatment) and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment (i.e., at 3 month follow-up), 89% (n = 132 of 148) presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism. Conclusion This longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions.
Collapse
Affiliation(s)
- Melissa Henry
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Oncology, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Justine G. Albert
- Department of Oncology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Saul Frenkiel
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Michael Hier
- Department of Oncology, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Karen Kost
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Martin Black
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Christina MacDonald
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Marco Mascarella
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Gregoire B. Morand
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Gabrielle Chartier
- Department of Otolaryngology – Head and Neck Surgery, Jewish General Hospital, Montreal, QC, Canada
- Department of Nursing, Jewish General Hospital, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology – Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Otolaryngology – Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Christopher Lo
- Department of Psychology, College of Healthcare Sciences, James Cook University, Singapore, Singapore
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Zeev Rosberger
- Department of Oncology, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
| |
Collapse
|
12
|
Nugent SM, Morasco BJ, Handley R, Clayburgh D, Hooker ER, Ganzini L, Knight SJ, Chen JI, Sullivan DR, Slatore CG. Risk of Suicidal Self-directed Violence Among US Veteran Survivors of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 147:981-989. [PMID: 34617963 DOI: 10.1001/jamaoto.2021.2625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Head and neck cancer (HNC) survivors are about twice as likely to die by suicide compared with other cancer survivors. Objective To examine the associations between precancer mental health and pain and postcancer receipt of mental health, substance use disorder (SUD), or palliative care services with risk of suicidal self-directed violence (SSDV). Design, Setting, and Participants This retrospective cohort study used the Veterans Health Administration data of 7803 veterans with a diagnosis of HNC (stage I-IVB) who received cancer treatment between January 1, 2012, and January 1, 2018. Data were analyzed between May 2020 and July 2021. Exposures Presence of precancer chronic pain and SUD diagnoses, and postcancer SUD, mental health, or palliative care treatment. Exposures were defined using International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes in Veterans Health Administration administrative data. Main Outcomes and Measures Documented SSDV event, including suicide attempt or death by suicide, after HNC diagnosis. Results Among the cohort of 7803 veterans (7685 [98.4%] male; mean [SD] age, 65 [10.7] years), 72 (0.9%) had at least 1 documented SSDV event following their cancer diagnosis, and 51 (0.7%) died by suicide. Four adjusted modified Poisson regression analyses identified that precancer chronic pain (incidence rate ratio [IRR], 2.58; 95% CI 1.54-4.32) or mood disorder diagnoses (IRR, 1.95; 95% CI, 1.17-3.24) were associated with higher risk of postcancer SSDV. Those who had at least 1 documented mental health (IRR, 2.73; 95% CI, 1.24-6.03) or SUD (IRR, 3.92; 95% CI, 2.46-6.24) treatment encounter in the 90 days following HNC diagnosis were at higher risk for SSDV. A palliative care encounter within 90 days of postcancer diagnosis was associated with decreased risk of SSVD (IRR, 0.49; 95% CI, 0.31-0.78). Conclusions and Relevance In this cohort study, a high proportion of HNC survivors with an SSVD event died from their injuries. Identification of risk factors for SSDV among HNC survivors may help direct additional resources to those who are at high risk. Referral to palliative care appears to be an important component of supportive oncologic care to reduce the risk of SSDV.
Collapse
Affiliation(s)
- Shannon M Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland.,Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland
| | - Robert Handley
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Daniel Clayburgh
- Operative Care Division, VA Portland Health Care System, Portland, Oregon.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Oregon Health & Science University, Portland
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Linda Ganzini
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland
| | - Sara J Knight
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah.,Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City
| | - Jason I Chen
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, School of Medicine, Oregon Health & Science University, Portland
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Knight Cancer Institute, Oregon Health & Science University, Portland.,Division of Pulmonology and Critical Care Medicine, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.,Knight Cancer Institute, Oregon Health & Science University, Portland.,Division of Pulmonology and Critical Care Medicine, Department of Medicine, School of Medicine, Oregon Health & Science University, Portland
| |
Collapse
|
13
|
Henry M, Sargi E, Frenkiel S, Hier M, Zeitouni A, Kost K, Mlynarek A, Black M, MacDonald C, Richardson K, Chartier G, Sadeghi N, Rosberger Z. Longitudinal study indicating antecedent psychosocial vulnerability as predictor of anxiety disorders post-treatment in people with head and neck cancer. Psychooncology 2021; 30:1910-1919. [PMID: 34190381 DOI: 10.1002/pon.5760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to: (1) determine the contribution of pre-cancer psychosocial vulnerability as an independent predictor of anxiety disorder (AD) onset immediately post-treatment in patients diagnosed with a first occurrence of head and neck cancer (HNC), controlling for sociodemographics and medical variables; and (2) estimate prevalence of AD and identify trajectories from the moment of diagnosis to the immediate post-treatment (i.e., over a period of 3 months) in this population. METHODS Two-hundred twenty-four consecutive patients (participation rate = 72%) newly diagnosed with a primary HNC were assessed with a structured clinical interview for a mental disorder, validated psychometric measures, and medical chart reviews. RESULTS Twenty-five percent of patients presented a lifetime AD, 19.4% within 2 weeks of HNC diagnosis, and 16.6% immediately post-treatment; representing 26.7% of patients with AD at any timepoint from the moment of diagnosis to immediately post-treatment. Patients were more likely to present an AD immediately post-treatment when they: were diagnosed with advanced-stage cancer (OR = 3.40, p = 0.006), presented a upon cancer diagnosis AD (OR = 2.45, p = 0.008) and/or experienced childhood abuse (OR = 1.96, p = 0.03). CONCLUSIONS Several AD trajectories may arise when patients are diagnosed with primary HNC. Health professionals should address AD and screen for risk factors (i.e., advanced stage cancer, AD upon cancer diagnosis, history of childhood abuse) as early as possible to assure optimal mental health care in this vulnerable population.
Collapse
Affiliation(s)
- Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Segal Cancer Centre, Jewish General Hospital, Montreal, Quebec, Canada
| | - Elyonora Sargi
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Saul Frenkiel
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Karen Kost
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Martin Black
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Christina MacDonald
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Nursing, Jewish General Hospital, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Gabrielle Chartier
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Nursing, Jewish General Hospital, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Zeev Rosberger
- Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.,Lady-Davis Institute for Medical Research, Montreal, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
14
|
Heft Neal ME, Gao RW, Brennan JR, Haring CT, Chinn SB, Shuman AG, Casper KA, Malloy KM, Stucken CL, Mclean SA, Chad Brenner J, Lyden T, Blakely A, Mierzwa ML, Shah J, Schonewolf C, Swiecicki PL, Worden FP, Wolf GT, Bradford CR, Prince MEP, Rosko AJ, Spector ME. Functional outcomes and tracheostomy dependence following salvage oropharyngeal surgery. Oral Oncol 2021; 113:105034. [PMID: 33041214 PMCID: PMC10471134 DOI: 10.1016/j.oraloncology.2020.105034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022]
Abstract
Purpose: Salvage surgical treatment of oropharyngeal cancer is associated with significant morbidity. We aim to identify predictive factors of functional outcomes to improve patient selection and counseling when contemplating salvage oropharyngectomy. Methods: Patients with a history of radiation requiring salvage oropharyngeal surgery were identified. Primary outcomes were determined at one year post-salvage surgery and included Gastric tube (G-tube) dependence, dietary restrictions, tracheostomy dependence, and speech intelligibility. Multivariate analyses were performed to identify predictors of the primary outcomes. Results: At one year, 45% (22/49) of patients had a G-tube, 68% (33/48) had dietary restrictions, 10% (5/49) remained tracheostomy dependent, and 15% (4/26) had difficulty with speech intelligibility. On univariate analysis, pre-operative G-tube (83% vs. 40%, p=0.04), reconstruction with a free flap (54% vs. 0%, p=0.005), and bony resection (69% vs. 36%, p=0.04) were significantly associated with G-tube dependence at one year. On multivariate analysis, concurrent bony resection remained a significant predictor of G-tube dependence (HR 5.4, 95% CI 1.2–24, p=0.03). Predictors of dietary restriction included free-flap reconstruction (78% vs. 25%, HR 0.13, 95% CI 0.02–0.87, p=0.04) and recurrence after two years (85% vs. 48%, HR 4.9, 95% CI 1.2–21, p=0.03). Supraglottic laryngectomy was significantly associated with tracheostomy dependence on univariate (67% vs. 7%, p=0.001) and multivariate analysis (HR 44.4, 95% CI 2.0–986, p=0.02). Conclusion and Relevance: Functional outcomes are suboptimal after salvage oropharyngectomy. Specific patient and disease factors are independently associated with worse speech and swallowing outcomes and may aid in pre-operative patient selection, risk stratification, and shared decision-making.
Collapse
Affiliation(s)
- Molly E Heft Neal
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Rebecca W Gao
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Julia R Brennan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Catherine T Haring
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Scott A Mclean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Teresa Lyden
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Anna Blakely
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Caitlin Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Paul L Swiecicki
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Frank P Worden
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Mark E P Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, United States.
| |
Collapse
|
15
|
Liao J, Wu B, Mao J, Ni P. Preference for Aggressive End-of-Life Care among Advanced Cancer Patients in Wuhan, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186592. [PMID: 32927824 PMCID: PMC7560226 DOI: 10.3390/ijerph17186592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022]
Abstract
Life-sustaining treatments (LSTs) and end-of-life (EOL) care’s goal for prolonging one’s life are defined as aggressive EOL care among critically ill patients. They have limited effects and add unnecessary financial burden to advanced cancer patients. A questionnaire survey was conducted to collect information on demographics, disease conditions, preference for LSTs, and goal of EOL care among advanced cancer patients of comprehensive grade-A tertiary hospitals in Wuhan, mainland China. Most patients preferred to accept LSTs when they were in a critical condition, including cardiopulmonary resuscitation (89.9%), mechanical ventilation support (85.7%), nasogastric tube feeding (84.1%), blood transfusion (89.8%), general surgery (87.5%), and hemodialysis (85.8%). Most (88%) preferred prolonging life as the goal of EOL care. Logistic regression showed common influencing factors were participants who completed junior high/high school or below and were financially adequate had higher reference for aggressive EOL care. Patients whose physician had accurately disclosed prognosis; however, showed a decrease trend for aggressive EOL care. Most advanced cancer patients preferred to accept aggressive EOL care. Discussions about prognosis disclosure among physicians and patients should be improved. Education about LSTs’ limitations and comfort-oriented care’s benefits should be promoted among the advanced cancer patients in mainland China.
Collapse
Affiliation(s)
- Jing Liao
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, NY 10010, USA;
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
- Correspondence: ; Tel.: +86-1387-154-0316
| |
Collapse
|
16
|
Immediate post-treatment supportive care needs of patients newly diagnosed with head and neck cancer. Support Care Cancer 2020; 28:5557-5567. [PMID: 32189100 DOI: 10.1007/s00520-020-05368-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aimed at identifying supportive care needs of patients with head and neck cancer (HNC-P) immediately post-treatment, finding early predictors of unmet needs, and contrasting how immediate post-treatment needs differed from needs in longer-term survivorship. METHODS Prospective longitudinal study of 223 consecutive adults (313 approached; 72% participation) newly diagnosed with a first occurrence of primary HNC. Patients completed the Supportive Care Needs Survey-Short Form (SCNS), the Structured Clinical Interview for DSM-IV, and other outcomes. Medical chart reviews were conducted. RESULTS A total of 68% of patients (n = 145/223) completed the SCNS. The multiple linear regression indicated that when controlled for medical variables, patients presented higher levels of unmet needs when they presented with higher level of anxiety upon HNC diagnosis (p = 0.03), higher neuroticism (p = 0.03), and more stressful life events in the year pre-diagnosis (p = 0.01). Patients immediately post-treatment had a wider variety of unmet needs compared with those in extended survivorship, with psychological unmet needs most prevalent at both time points. Immediately post-treatment, patients needed more support regarding pain (p = 0.04) and worries about treatment results (p = 0.05), whereas patients in longer-term survivorship needed more support regarding anxiety (p = 0.02), changes in sexual relationships (p = 0.04), and fear of death and dying (p = 0.001). CONCLUSION This study identifies areas needing further development to improve quality of care for HNC-P in the immediate post-treatment period, as well as early determinants of unmet needs. HNC clinics may want to routinely screen for anxiety, neuroticism, and burden from other life events, to pro-actively address needs upon treatment completion and alleviate disease burden.
Collapse
|
17
|
Strategies for communicating oral and oropharyngeal cancer diagnosis: why talk about it? Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:347-356. [PMID: 31928903 DOI: 10.1016/j.oooo.2019.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 12/09/2022]
Abstract
OBJECTIVE This review aimed to explore the paradigms of disclosing a cancer diagnosis with a focus on oral and oropharyngeal cancer and patient-related considerations. STUDY DESIGN A search of MEDLINE, Embase, and Scopus was conducted using the following keywords: oral cancer; mouth lesions; oncology; breaking bad news; truth disclosure; and communication skills training. English and Spanish language studies published through October 2019 were included. RESULTS The way bad news is conveyed to patients with cancer may affect their comprehension of information, emotional distress, treatment adherence, and health outcomes. Models of communication that are focused on patients' preferences may result in better treatment outcomes. Available protocols, such as SPIKES and ABCDE, have useful recommendations for health care professionals communicating an oral cancer diagnosis. However, it is important to be attentive to the particular information needs of patients. CONCLUSIONS When communicating a cancer diagnosis, providers should employ validated methods of information delivery and support for oncology patients. Further studies are needed to evaluate the experiences and preferences of patients with oral cancer during these communications.
Collapse
|
18
|
Zebralla V, Meuret S, Wiegand S. Monitoring and Evaluation of Late Functional Outcome in Post-treatment Follow-Up in Clinical Routine Setting. Front Oncol 2019; 9:700. [PMID: 31417873 PMCID: PMC6682590 DOI: 10.3389/fonc.2019.00700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/15/2019] [Indexed: 12/12/2022] Open
Abstract
Patients treated for head and neck cancer (HNC) often suffer from severe and visible loss of function as the cancer itself and the side effects of aggressive treatments have the potential to severely affect quality of life. Therefore, the aim of follow-up is not only the early detection of potentially curable recurrences and second primary tumors but also the diagnosis and rehabilitation of functional impairments. Clear guidelines determining the frequency of follow-up visits are missing, and the impact of follow-up visits on patient's prognosis is unclear. An intensive post-treatment follow-up is needed to detect functional impairments and to initiate their treatment. The aim is an optimal rehabilitation of the patients. This article focusses on goals of aftercare treatment and describes the spectrum of long-term sequelae, and the impact of Patient Reported Outcome (PRO) instruments of which three will be introduced.
Collapse
Affiliation(s)
- Veit Zebralla
- Clinic of Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | | | | |
Collapse
|
19
|
You EL, Henry M, Zeitouni AG. Human papillomavirus-associated oropharyngeal cancer: review of current evidence and management. ACTA ACUST UNITED AC 2019; 26:119-123. [PMID: 31043814 DOI: 10.3747/co.26.4819] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Oropharyngeal cancer (opc) has become the leading site for human papillomavirus (hpv)-associated cancers in humans. It is an epidemic that remains relatively unfamiliar to most physicians, potentially delaying diagnosis and treatment. Traditionally, cancers involving the head and neck have occurred in smokers and in those with a significant alcohol history. Typically, hpv-positive opc presents in a younger, healthier population with a different set of risk factors and good prognosis for survival. However, many head-and-neck cancer patients, including those with hpv-positive disease, develop lifelong disabilities because of the morbid nature of their treatments, and those patients have the highest level of unmet needs in studies spanning cancer sites. Knowledge of this epidemic, a high index of suspicion, and an understanding of how the tumours present in clinical practice can help physicians to make an early diagnosis, thus sparing the patient significant morbidity from treatments associated with more advanced disease stages. Furthermore, recognizing that these patients have distinct psychosocial needs and implementing a collaborative team approach is critical to providing optimal care and improving quality of life in the survivorship period.
Collapse
Affiliation(s)
- E L You
- McGill University, Montreal, QC
| | - M Henry
- McGill University, Montreal, QC.,McGill Department of Otolaryngology- Head and Neck Surgery, Montreal, QC
| | - A G Zeitouni
- McGill University, Montreal, QC.,McGill Department of Otolaryngology- Head and Neck Surgery, Montreal, QC
| |
Collapse
|