Changes in health related quality of life in women and men undergoing radiation treatment for head and neck cancer and the impact of smoking status in the radiation treatment period

Tobacco smoking influences the side effects of radiation therapy-managed patients with various malignancies: A systematic review

BACKGROUND

Tobacco smoking may decrease the effectiveness of radiation therapy. This is because tobacco smoking can cause inflammation and damage to surrounding tissues, which may interfere with radiation delivery to the tumor. Our aim of this study is to investigate the effect of tobacco smoking use on complications in radiotherapy as a systematic review.

METHOD

The articles searched from the MEDLINE, PubMed, EMBASE, and Web of Science databases. The search terms used were "radiotherapy", "outcome", "radiation therapy", "tobacco", "smoking", "complications", "side effects", "cancer", and "malignancy". PRISMA check list was used to assess the overall quality of evidence for each outcome.

RESULT

The outcomes of radiotherapy-inducing tobacco smoking in smokers are more than non-smokers including; high SPC (second primary cancer), decreased median overall survival, higher infections during treatment, increased fatigue (p = 0.027), increased pain (p = 0.009), poorer cognitive function (0.041), affected mouth opening (0.049), more speech disturbances (p = 0.017), higher metastasis risk (p = 0.031 and 0.019), higher locoregional recurrence risk (p = 0.027), oral mucositis (p = 0.03), mucositis severity related to higher tobacco exposure (p = 0.008), severe acute radiation skin reactions, and myocardial infarction.

DISCUSSION

Tobacco smoking appears to be the most significant modifiable factor influencing cancer treatment outcomes. As such, healthcare providers should take detailed notes on patients' smoking histories during both routine and future clinical studies. Beyond immediate cessation, cancer patients should undertake comprehensive smoking cessation programs. These programs can significantly boost the efficacy of radiotherapy and enhance overall patient outcomes.

Impact of Tobacco Smoking on Outcomes of Radiotherapy: A Narrative Review

The carcinogenic role of tobacco smoking is well recognized, but the detrimental effects of continued smoking after a cancer diagnosis have been underestimated. Radiotherapy is among the main treatment modalities for cancer. We reviewed the literature data concerning the impact of tobacco smoking on treatment outcomes in radiotherapy-managed patients with various malignancies. Most of the analyzed studies demonstrated the detrimental effect of smoking on overall survival, tumor control, quality of life, treatment toxicity, and the incidence of second primary malignancies. Healthcare professionals should use the cancer diagnosis and treatment as a teachable moment and recommend their patients to immediately cease smoking. Wherever possible, cancer patients should undergo an intensive smoking-cessation program, including behavioral and pharmacologic therapy.

Therapeutic radiographers supporting individuals undergoing radiotherapy to stop smoking: Testing a training resource in clinical practice

INTRODUCTION

This study developed and piloted the first online training package to support implementation and delivery of brief smoking cessation interventions for therapeutic radiographers in four radiotherapy departments in England.

METHODS

A previously reported systematic literature review and data analysis from the previously reported pre-focus group questionnaire and focus groups enabled the development of an online training package. The questionnaire was repeated by the participating therapeutic radiographers following completion of the training resource (n = 31). The results of the comparative questions from the pre and post questionnaires were analysed using the Statistical Package for Social Sciences (SPSS Version 24).

RESULTS

In total, 43 therapeutic radiographer participants completed the pre-questionnaire and 31 participants continued to complete the post questionnaire, having completed the online training package. The previously conducted focus groups identified several barriers to the delivery of smoking cessation, that were addressed through the development of an online training package. Following the completion of the training; therapeutic radiographers had increased knowledge and confidence regarding smoking cessation, the number of therapeutic radiographers who believe that smoking cessation is part of their role increased and therapeutic radiographers more routinely have conversations about smoking cessation.

CONCLUSION

The training resource improved therapeutic radiographers' knowledge and confidence and increased awareness of the role of the therapeutic radiographer in the provision of smoking cessation interventions. Challenges remain that continue to prevent some therapeutic radiographers from delivering smoking cessation interventions and strong leadership and implementation of strategy and guidance is essential to ensure wider implementation. Recording and measuring impact of interventions remains an area to be addressed, alongside cultural changes and reassurance around the therapeutic relationship.

IMPLICATIONS FOR PRACTICE

This training tool has proven to be effective in the sample within this study and should be disseminated and evaluated more widely across radiotherapy provision within the United Kingdom.

From the carer's mouth: A phenomenological exploration of carer experiences with head and neck cancer patients

OBJECTIVE

Receiving a diagnosis of head and neck cancer is devastating for patients and family carers and causes high levels of distress. Previous studies report that carer distress levels exceed that of patients, but go largely unnoticed by health professionals. To date, there is a paucity of studies that have described carers' perspectives of the lived experience of caring for a loved one diagnosed with head and neck cancer. The aim of this study was to explore the lived experiences of carers of patients diagnosed with head and neck cancer.

METHODS

This qualitative study was informed by descriptive phenomenology. Carers of patients who had been diagnosed with head and neck cancer within the last 6 years were recruited from participating hospitals in Perth, Western Australia. Semi-structured interviews were conducted with 20 carers of patients diagnosed with head and neck cancer. Thematic analysis was conducted to gain an understanding of participants lived experiences.

RESULTS

Key themes identified were: Silent Suffering, Gamut of Emotions, Causal Attribution, Changing Priorities, Gaining Support, and Coping. The changing priorities themes highlights that carers prioritised (a) being available for their loved one and (b) taking an active role in managing head and neck cancer symptoms and side effects.

CONCLUSIONS

Carers of patients diagnosed with head and neck cancer experience distress. Instead of seeking support, carers often elected to suffer in silence. Implications for practice include screening for carer distress and providing specific interventions focused on caring for someone diagnosed with head and neck cancer.

Does smoking abstinence predict cancer patients' quality of life over time?

OBJECTIVE

Smoking cessation improves quality of life (QOL) in the general population. However, there is limited information on the role of smoking status on QOL among cancer patients. Moreover, previous studies tended to analyze smoking status dichotomously and at a single point in time, potentially reducing the strength of the relation between smoking cessation and QOL. This study examined the association of smoking abstinence and QOL over time, including depression, pain, and fatigue in patients with a wide variety of cancers.

METHODS

Participants were 332 cancer patients (eg, gynecologic, breast, thoracic, head and neck, and genitourinary) who had been abstinent for at least 24 hours. Days abstinent and QOL were assessed at baseline and 2, 6, and 12 months later. Latent growth curve models examined if days abstinent was associated with QOL at each assessment. Baseline demographics (eg, sex and income) and smoking history variables (eg, nicotine dependence) were used as time-invariant covariates.

RESULTS

The final model for each QOL component had good-to-excellent fit. More days abstinent was associated with lower depression at all follow-ups and with lower fatigue at 12 months but was not associated with pain.

CONCLUSIONS

QOL was better among patients who quit smoking for longer periods. Findings suggest different timelines, with smoking abstinence most immediately associated with lower depression, followed by lower fatigue. Although pain decreased over time, it was not associated with length of smoking abstinence. Results reinforce the relationship between sustained smoking cessation and QOL, which should be communicated to patients.

Therapeutic Radiographers' perceptions of the barriers and enablers to effective smoking cessation support

INTRODUCTION

Tobacco smoking during and post radiotherapy is associated with increased treatment toxicity and increased cancer related mortality. Routine delivery of smoking cessation advice is inconsistent in practice. This study identifies the key barriers and facilitators to the provision of effective smoking cessation conversations in radiotherapy practice.

METHODS

A baseline questionnaire (n = 43) was used to identify current practice, barriers and facilitators to smoking cessation in radiotherapy and to inform a topic guide for follow up focus groups (n = 5). Ethical approval was obtained through the 4 NHS trusts and the Health Research Authority. Focus group transcription was coded by two researchers.

RESULTS

Therapeutic Radiographers initiate health behaviour conversations with patients; there are a number of factors that facilitate the likelihood of a health behaviour conversation; indication that a patient smokes anatomical site and presence of acute effects. Key barriers to smoking cessation provision include; lack of training, limited knowledge, limitations as a result of poor clinical infrastructure, local culture and perceptions that patients do not prioritise smoking cessation during treatment.

CONCLUSION

Therapeutic Radiographers have the motivation to provide smoking cessation advice, however they require further training to develop knowledge and skills in relation to benefits of smoking cessation and cessation strategies. Therapeutic Radiographers also expect that patients will respond negatively to smoking cessation advice, and that this might be damaging to the therapeutic relationship. Departmental culture and trust infrastructure can also significantly inhibit the provision of smoking cessation in radiotherapy practice and further support to implement NICE guidance is required.

Development of a Targeted Smoking Relapse-Prevention Intervention for Cancer Patients

We describe the series of iterative steps used to develop a smoking relapse-prevention intervention customized to the needs of cancer patients. Informed by relevant literature and a series of preliminary studies, an educational tool (DVD) was developed to target the unique smoking relapse risk factors among cancer patients. Learner verification interviews were conducted with 10 cancer patients who recently quit smoking to elicit feedback and inform the development of the DVD. The DVD was then refined using iterative processes and feedback from the learner verification interviews. Major changes focused on visual appeal, and the inclusion of additional testimonials and graphics to increase comprehension of key points and further emphasize the message that the patient is in control of their ability to maintain their smoking abstinence. Together, these steps resulted in the creation of a DVD titled Surviving Smokefree®, which represents the first smoking relapse-prevention intervention for cancer patients. If found effective, the Surviving Smokefree® DVD is an easily disseminable and low-cost portable intervention which can assist cancer patients in maintaining smoking abstinence.

Oral complications at 6 months after radiation therapy for head and neck cancer

OBJECTIVE

To examine oral complications 6 months after modern radiation therapy (RT) for head and neck cancer (HNC).

METHODS

Prospective multicenter cohort study of patients with HNC receiving intensity-modulated radiation therapy or more advanced RT. Stimulated whole salivary flow, maximal mouth opening, oral mucositis, oral pain, oral health-related quality of life (OH-QOL), and oral hygiene practices were measured in 372 subjects pre-RT and 216 subjects at 6 months from the start of RT.

RESULTS

Mean stimulated whole salivary flow declined from 1.09 to 0.47 ml/min at 6 months (p < .0001). Mean maximal mouth opening reduced from 45.58 to 42.53 mm at 6 months (p < .0001). 8.1% of subjects had some oral mucositis at 6 months, including 3.8% with oral ulceration. Mean overall pain score was unchanged. OH-QOL was reduced at 6 months, with changes related to dry mouth, sticky saliva, swallowing solid foods, and sense of taste (p ≤ .0001). At 6 months, there was greater frequency of using dental floss and greater proportion using supplemental fluoride (p < .0001).

CONCLUSIONS

Despite advances in RT techniques, patients with HNC experience oral complications 6 months after RT, with resulting negative impacts on oral function and quality of life.

Smoking relapse-prevention intervention for cancer patients: Study design and baseline data from the surviving SmokeFree randomized controlled trial

Continued smoking after a cancer diagnosis contributes to several negative health outcomes. Although many cancer patients attempt to quit smoking, high smoking relapse rates have been observed. This highlights the need for a targeted, evidence-based smoking-relapse prevention intervention. The design, method, and baseline characteristics of a randomized controlled trial assessing the efficacy of a self-help smoking-relapse prevention intervention are presented. Cancer patients who had recently quit smoking were randomized to one of two conditions. The Usual Care (UC) group received the institution's standard of care. The smoking relapse-prevention intervention (SRP) group received standard of care, plus 8 relapse-prevention booklets mailed over a 3month period, and a targeted educational DVD developed specifically for cancer patients. Four hundred and fourteen participants were enrolled and completed a baseline survey. Primary outcomes will be self-reported smoking status at 6 and 12-months after baseline. Biochemical verification of smoking status was completed for a subsample. If found to be efficacious, this low-cost intervention could be easily disseminated with significant potential for reducing the risk of negative cancer outcomes associated with continued smoking.

Health-related quality of life before and after head and neck squamous cell carcinoma: Analysis of the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linkage

BACKGROUND

Understanding health-related quality of life (HRQOL) is crucial to providing high-quality survivorship care for patients with head and neck squamous cell carcinoma (HNSCC). Trends in and prognostic significance of HRQOL before and after HNSCC have not been well described.

METHODS

HRQOL for older individuals with HNSCC was examined using the linked Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey database. Surveys assessing HRQOL from 5 years prediagnosis to 10 years postdiagnosis were included. HRQOL over time was modeled using multilevel linear regression with restricted cubic splines and was reported as either total HRQOL or change in HRQOL (denoted Δ). The association of prediagnosis HRQOL with survival was examined.

RESULTS

In total, 1653 individuals were included; of these, 61% completed 1 survey, and 39% completed multiple surveys. Overall HRQOL decreased progressively until 13 months postdiagnosis, then recovered toward baseline between 2 and 5 years. However, after stratification by survival group, the postdiagnosis recovery was not observed. Individuals with shorter survival had lower HRQOL prediagnosis (<2-year survivors, 87.3; > 5-year survivors, 96.4; P = .004) with a steeper decline in HRQOL during diagnosis and treatment (<2-year survivors: Δ, -16.6; 95% confidence interval [CI], -23.8, -9.4; > 5-year survivors: Δ, -0.9; 95% CI, -1.8, 0.08). Radiotherapy and advanced stage were associated with greater declines in HRQOL during diagnosis and treatment (P < .001). Higher prediagnosis HRQOL was independently associated with improved overall survival (adjusted hazard ratio for 10-point increase, 0.91; 95% CI, 0.85-0.97).

CONCLUSIONS

HRQOL declines before and after HNSCC, whereas any observed posttreatment recovery is likely an artifact of shorter survival among individuals with the lowest HRQOL. The prognostic implication of prediagnosis HRQOL may inform patient counseling. Cancer 2016;122:1861-70. © 2016 American Cancer Society.

A clinical study to assess the efficacy of belly dancing as a tool for rehabilitation in female patients with malignancies

PURPOSE

This prospective, non-randomised follow-up study was designed to compare the health-related quality of life (HRQoL), perceived social support (PSS) and overall life satisfaction (OLS) in female patients receiving standard medical care for malignant diseases with or without additional belly dancing.

METHOD

The patients were recruited in the Outpatient Department of the National Institute of Oncology, Budapest, Hungary during the period of 2008-2009. 55 patients joined the one-year-long rehabilitation program (research group, RG) while 59 age-matched patients who received only standard medical care volunteered for clinical assessment (control group, CG). HRQoL, PSS and OLS were assessed using validated questionnaires: EORTC QLQ-C30, F-SozU-K14, and Campbell's OLS, respectively. The scores obtained in RG and CG were controlled for baseline socio-demographic characteristics and evaluated by ANCOVA analysis.

RESULTS

It was found that patients of the RG scored better at both the baseline and follow-up than the CG, and the differences between the two groups' measured parameters increased further during the course of the study. The respective baseline values in RG and CG were 56.6 ± 10.3 vs 63.5 ± 12 for HRQoL, 65.2 ± 5.5 vs 57.4 ± 8.8 for PSS and 57.4 ± 8.1 vs 48.4 ± 10.7 for OLS. The corresponding follow-up scores were 51.9 ± 4.4 vs 59.9 ± 11.2 (F = 10.637, p = 0.001) for HRQoL, 67.5 ± 2.7 vs 53.9 ± 10.5 (F = 2.646, p = 0.000) for PSS and 59.5 ± 9.6 vs 45.0 ± 11.5 (F = 2.402, p = 0.001) for OLS.

CONCLUSIONS

Belly dance intervention can be applied as a complementary rehabilitation method to improve HRQoL, PSS and OLS in female patients treated for malignant diseases.