Prospective changes of the quality of life for patients newly diagnosed with oral cancer during the acute stage

Sexual health at 5 years after diagnosis of head and neck cancer

PURPOSE

Sexual health (SH) is an emerging concern in the assessment of quality of life in patients surviving head and neck cancer (HNC). Using data from the French National Prospective VICAN Survey, this study aimed to assess SH deterioration five years after HNC diagnosis and related factors.

METHODS

Using univariate and multivariate analyses were performed in the 241 HNC survivors. We studied the factors associated between the sexuality and intimate life of these patients with demographic and medical data from the national epidemiological survey VICAN 5.

RESULTS

Sexuality and body image were altered in 78.8% for men and 79.2% for women. This alteration in sexual quality of life affects both men and women. Dissatisfaction with the frequency of sexual intercourse was associated with being treated with radiotherapy (p=0.024), as well as decrease of sexual desire in patients treated with chemotherapy (p=0.044). Fatigue (p=0.002), impaired physical health (p=0.049), and high disease stage (p=0.001) remained significantly associated, after multivariate analysis, with decreased sexual desire. Among these 3 factors negatively influencing sexual quality of life, two are treatable with appropriate management.

CONCLUSION

Five years after the diagnosis of HNC, a decrease in sexuality and body image are frequent and significantly impact the quality of life of survivors. These observations imply an adaptation of the management of the professionals involved.

Changes in quality of life over time in patients diagnosed with oral leukoplakia: A prospective longitudinal study

BACKGROUND

Oral leukoplakia (OL) is one of the most prevalent oral potentially malignant disorders (OPMD). Although there is emerging evidence that quality of life (QoL) is impaired in subjects with OL; studies to date are based on single and heterogenous point-in-time assessments. The aim of this study was to ascertain if QoL scores change over time in individuals diagnosed with OL.

METHODS

Forty-one individuals with OL were administered the Short Generic Health Questionnaire (SF-12) and the discipline-specific Oral Potentially Malignant Disorder Questionnaire (OPMDQ) at four points in time: at the time of clinical diagnosis, at the post-biopsy review (confirmed diagnosis), and at 3- and 6-month follow-up appointments. Responses were compared between the four time points.

RESULTS

No significant differences were observed in the SF-12 questionnaire scores over time. However, a general improvement in the participants' life quality was evident over the 6-month period under investigation in the domains of psychological and social well-being (p = 0.0027) and effect of treatment on daily life (p = 0.0317) as well as in the total score (p = 0.0005) of the OPMDQ. Age, gender, medical status, tobacco/alcohol use, lesion site, size, the presence of dysplasia and treatment did not impact QoL scores over time.

CONCLUSIONS

QoL scores of OL subjects may improve with time. Our results suggest that studies examining QoL in individuals with OL should be controlled for time at which the participants are surveyed.

Quality of life during early radiotherapy in patients with head and neck cancer and pain

BACKGROUND

Patients with head and neck cancer (HNC) have a potentially severe diagnosis and often suffer from tumor-related pain as well as from adverse side effects of treatment such as radiotherapy (RT). Knowledge about quality of life (QoL) during early RT in this group is limited and should be assessed in relation to diagnosis and treatment.

PURPOSE

The purpose of this cross-sectional study was to identify potential factors that may influence QoL in patients with HNC during the early stages of RT (no later than two weeks of ongoing RT). We hypothesized that pain intensity, pain interference, catastrophizing, and mood disturbances are associated with QoL during early RT.

PATIENTS AND METHODS

In this study, 54 patients (53% of eligible patients) diagnosed with HNC were consecutively recruited from the regular flow to the Pain and Rehabilitation Center at Linköping University. The patients completed self-reported questionnaires on sociodemographics, pain intensity, pain interference, anxiety, depression, pain catastrophizing, and QoL.

RESULTS

The patients in this study scored high for QoL, low for pain intensity, and low for pain interference. The patients reported minor depressive symptoms and anxiety symptoms. Regression analyses showed that pain intensity and depressive symptoms negatively influenced QoL.

CONCLUSION

No later than two weeks of RT, pain intensity and depression negatively influenced QoL in patients with HNC. Early screening for pain and depression in a targeted preventive strategy might maintain QoL during the course of the RT for patients with HNC. This assumption needs to be further investigated.

Head and neck cancer patients' perceptions of quality of life and how it is affected by the disease and enteral tube feeding during treatment

AIM

To explore individual quality of life in patients with head and neck cancer from diagnosis up to 3 months after termination of radiotherapy.

RESEARCH QUESTIONS

1) Which areas in life are important to quality of life, and which are influenced by the disease and by having oral or enteral nutrition; and 2) Which areas in life are influenced by having a nasogastric feeding tube (NGT) or a percutaneous endoscopic gastrostomy (PEG) tube?

MATERIAL AND METHODS

Data were collected in 36 patients. Semi-structured interviews were conducted using an extended version of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) and analysed with content analysis.

RESULTS

Negative and positive experiences of quality of life in general were about relation to family, own health, and leisure activities. Negative impacts on physical, psychological, existential and social problems, but also positive experiences are described by the patients related to the disease. More than half expressed eating-related problems. Enteral nutrition entailed negative and positive experiences, and no greater variations were described by the patients with NGT or PEG tube. Overall, there were interindividual variations.

CONCLUSIONS

The patients' perception of general or disease-related quality of life was not affected by whether they had enteral nutrition or not. From the patients' perspective neither of the two feeding tubes (NGT or PEG) was clearly in favour. We suggest that more studies are needed on how the choice of enteral feeding tube can be evidence-based, and incorporating the patients' perspective.

Levels of scientific evidence of the quality of life in patients treated for oral cancer

Treatments used in cancer of the oral cavity have great impact on the physical, psychological and functional state of patients. There has been increasingly interest in evaluating the health-related quality of life using questionnaires among patients treated with oral cancer. Up to our knowledge no review on this theme has incorporated the level of evidence of the single identified studies. The objective of the present study is to determinate results and conclusions about the health-related quality of life of these patients, in view of scientific evidence. In general, the diversity of designs, level of evidence and questionnaires used for their assessment does not affect results, which indicate a decline in the health related quality of life after treatment. This decline is greater when the tumor is large in size, and when radiotherapy is used, though the situation is seen to improve over the span of a year. Questionnaires on health-related quality of life provide concrete information regarding the impact of cancer treatment on patients.

Supportive care in early rehabilitation for advanced-stage radiated head and neck cancer patients

OBJECTIVE

To investigate the health-related quality of life (HRQoL) and supportive follow-up care needs 1 month posttreatment for patients with advanced-stage (stage III or IV) radiated head and neck cancer (HNC) who were treated with curative intent.

STUDY DESIGN

An exploratory, descriptive analysis of HRQoL data obtained from 3 treatment groups: conventional radiotherapy (RT, n = 21), surgery + radiotherapy (SRT, n = 10), and chemoradiation (CRT, n = 21).

SETTING

The head and neck oncology center of a university hospital.

SUBJECTS AND METHODS

Fifty-two patients completed the EORTC QLQ-C30 and EORTC QLQ H&N35 self-report questionnaires 1 month posttreatment. Descriptive statistics and clinically relevant differences between the groups were analyzed.

RESULTS

The HRQoL outcomes between groups differed. Clinically relevant difference was observed in the RT and CRT groups with respect to dry mouth, coughing, feeling ill, use of painkillers, and the use of nutritional supplements. The RT group differed from the other groups with respect to pain and swallowing. The CRT group differed from the other groups regarding role functioning.

CONCLUSION

Health-related quality of life differs between RT, SRT, and CRT patients 1 month posttreatment. The RT- and CRT-treated patients reported higher impairment than the patients who were treated with SRT. Nutritional intake and oral function emphasize the importance of providing supportive care to radiated advanced-stage HNC patients throughout the treatment trajectory and the need for continuation during the first few posttreatment months.

Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQ-H&N35: a methodological review

PURPOSE

The EORTC QLQ-H&N35 (H&N35) is widely used to measure quality of life in head and neck cancer patients. The aims of this study were to obtain insight into a) the languages in which the H&N35 has been used and the psychometric properties in those languages, b) the study designs, and c) its acceptance by patients and investigators.

METHODS

A systematic literature review was performed searching for all original papers that had used at least one item of the H&N35. Identified papers were read and the information about methodological issues abstracted statistically analysed.

RESULTS

A total of 136 papers were identified. The H&N35 was administered in 19 different languages in 27 countries. The study design was cross-sectional in the majority of studies (53 %), prospective cohort studies (31 %), phase-II-trials (7 %), phase-III-trials (6 %) and case-control studies (1 %). The scales with the highest percentages of missing values were Sexuality (11.5 %) and Speech (7 %). The median Cronbach's alpha of the multi-item scales ranged from 0.61 (Senses) to 0.93 (Sexuality). Construct validity was rarely investigated. On average, 12 scales (range 0-18) of the instrument were used by the investigators. The scale most often used was swallowing (in 85 % of studies) and least often used was Weight Gain (39 %).

CONCLUSION

The H&N35 is widely used throughout the world, mainly in observational studies, and has demonstrated robust psychometric features in different languages. However, some methodological problems reported imply that the instrument can be improved in some areas.