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Salz T, Chimonas S, Jinna S, Brens J, Kriplani A, Salner A, Rabinowits G, Currier B, Daly B, Korenstein D. Pain management for post-treatment survivors of complex cancers: a qualitative study of opioids and cannabis. Pain Manag 2024; 14:87-99. [PMID: 38318666 PMCID: PMC10918509 DOI: 10.2217/pmt-2023-0067] [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: 07/11/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024] Open
Abstract
Aim: We aimed to understand experiences with opioids and cannabis for post-treatment cancer survivors. Patients & methods: We conducted seven focus groups among head and neck and lung cancer survivors, using standard qualitative methodology to explore themes around 1) post-treatment pain and 2) utilization, perceived benefits and perceived harms of cannabis and opioids. Results & conclusion: Survivors (N = 25) experienced addiction fears, stigma and access challenges for both products. Opioids were often perceived as critical for severe pain. Cannabis reduced pain and anxiety for many survivors, suggesting that anxiety screening, as recommended in guidelines, would improve traditional pain assessment. Opioids and cannabis present complex harms and benefits for post-treatment survivors who must balance pain management and minimizing side effects.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Susan Chimonas
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Sankeerth Jinna
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Jessica Brens
- Memorial Sloan Kettering Cancer Center, Department of Advanced Practice Providers, New York, NY 10065, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY 10065, USA
| | - Andrew Salner
- Hartford Hospital, Department of Radiation Oncology, Hartford, CT 06106, USA
| | - Guilherme Rabinowits
- Moffit Cancer Center, Department of Head and Neck-Endocrine Oncology, Tampa, FL 33612, USA
| | - Beatriz Currier
- Miami Cancer Institute, Department of Medicine, Miami, FL 33176, USA
| | - Bobby Daly
- Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY 10065, USA
| | - Deborah Korenstein
- Mount Sinai Hospital, Department of Internal Medicine, New York, NY 10001, USA
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Gaxiola-García MA, Kushida-Contreras BH, Albornoz CR, Manrique OJ. Quality of life assessment after microvascular head and neck reconstruction: a systematic review of available tools. Br J Oral Maxillofac Surg 2024; 62:23-29. [PMID: 38042715 DOI: 10.1016/j.bjoms.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/13/2023] [Accepted: 10/26/2023] [Indexed: 12/04/2023]
Abstract
In this study, we aimed to appraise the quality and psychometric properties of quality of life (QOL) assessment tools used after microsurgical reconstruction for head and neck cancers. A systematic review of QOL assessment tools used in head and neck cancer patients after microsurgical reconstruction was performed; emphasis was placed on psychometric properties and validity. Fifty-four studies published between January 2010 and February 2023 fulfilled the criteria; in these, twenty-three different QOL assessment tools were identified. The most commonly used instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck version (EORTC-H&N). No assessment tool fulfilled all the quality criteria; no single tool presented evidence from all the components of validity. Almost all reported reliability coefficients were above 0.7; most papers reported an internal consistency coefficient (Cronbach's alpha) for the global score. The array of available tools allows for the choice of the most appropriate one depending on the context faced by the clinician or researcher.
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Affiliation(s)
- Miguel Angel Gaxiola-García
- Plastic and Reconstructive Surgery Department, Mexico's Children Hospital (Hospital Infantil de México "Federico Gómez"), Mexico City, Mexico.
| | | | | | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, United States
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Hernández L, Estévez-Priego E, López-Pérez L, Fernanda Cabrera-Umpiérrez M, Arredondo MT, Fico G. HeNeCOn: An ontology for integrative research in Head and Neck cancer. Int J Med Inform 2024; 181:105284. [PMID: 37981440 DOI: 10.1016/j.ijmedinf.2023.105284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/14/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Head and Neck Cancer (HNC) has a high incidence and prevalence in the worldwide population. The broad terminology associated with these diseases and their multimodality treatments generates large amounts of heterogeneous clinical data, which motivates the construction of a high-quality harmonization model to standardize this multi-source clinical data in terms of format and semantics. The use of ontologies and semantic techniques is a well-known approach to face this challenge. OBJECTIVE This work aims to provide a clinically reliable data model for HNC processes during all phases of the disease: prognosis, treatment, and follow-up. Therefore, we built the first ontology specifically focused on the HNC domain, named HeNeCOn (Head and Neck Cancer Ontology). METHODS First, an annotated dataset was established to provide a formal reference description of HNC. Then, 170 clinical variables were organized into a taxonomy, and later expanded and mapped to formalize and integrate multiple databases into the HeNeCOn ontology. The outcomes of this iterative process were reviewed and validated by clinicians and statisticians. RESULTS HeNeCOn is an ontology consisting of 502 classes, a taxonomy with a hierarchical structure, semantic definitions of 283 medical terms and detailed relations between them, which can be used as a tool for information extraction and knowledge management. CONCLUSION HeNeCOn is a reusable, extendible and standardized ontology which establishes a reference data model for terminology structure and standard definitions in the Head and Neck Cancer domain. This ontology allows handling both current and newly generated knowledge in Head and Neck cancer research, by means of data linking and mapping with other public ontologies.
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Affiliation(s)
- Liss Hernández
- Universidad Politécnica de Madrid-Life Supporting Technologies Research Group, ETSIT, 28040 Madrid, Spain
| | - Estefanía Estévez-Priego
- Universidad Politécnica de Madrid-Life Supporting Technologies Research Group, ETSIT, 28040 Madrid, Spain
| | - Laura López-Pérez
- Universidad Politécnica de Madrid-Life Supporting Technologies Research Group, ETSIT, 28040 Madrid, Spain
| | | | - María Teresa Arredondo
- Universidad Politécnica de Madrid-Life Supporting Technologies Research Group, ETSIT, 28040 Madrid, Spain
| | - Giuseppe Fico
- Universidad Politécnica de Madrid-Life Supporting Technologies Research Group, ETSIT, 28040 Madrid, Spain.
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Ihara Y, Kato H, Tashimo Y, Iizumi Y, Fukunishi Y, Sato H, Shimane T, Takahashi K. Changes in oral function, swallowing function, and quality of life in patients with head and neck cancer: a prospective cohort study. BMC Oral Health 2022; 22:293. [PMID: 35843950 PMCID: PMC9288711 DOI: 10.1186/s12903-022-02329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Head and neck cancer (HNC) treatment can cause oral morbidities, such as oral dryness and dysphagia, affecting the patient’s quality of life (QOL). The relationship between oral functions and QOL in patients with early-stage HNC remains poorly studied. This study aimed to evaluate changes in the QOL of patients with early-stage HNC and identify factors that affect the QOL of these patients. Methods In this prospective cohort study, 37 patients who underwent early-stage (Stage I/Stage II) HNC treatment were evaluated for their oral function, swallowing function, and the QOL score at baseline (BL) and 12 months after surgical treatment (12 M). The participants were divided into two groups: patients who returned to the BL QOL score at 12 M (RE; n = 26) and those who did not (NR; n = 11). Results In total, 29.7% (11/37) patients with early-stage HNC did not return to the BL QOL score at 12 M. There was no significant difference between the RE and NR groups regarding the oral and swallowing function. Moreover, oral and swallowing function of all patients returned to the BL at 12 M. The NR group showed lower QOL scores than the RE group in the global health status, and “sticky saliva” parameters in the questionnaires. Conclusion Restoration of the oral function is insufficient to improve the QOL of patients with early-stage HNC. The treatment of these patients should instead consider several factors that affect their QOL.
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Barker CL, Price GJ, Lee LW, McPartlin A. Baseline MD Anderson Symptom Inventory Score is Strongly Associated With Patient-reported Acute and Late Toxicity Following (Chemo) Radiotherapy for Head and Neck Cancers. Clin Oncol (R Coll Radiol) 2022; 34:683-689. [PMID: 35688777 DOI: 10.1016/j.clon.2022.05.018] [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: 12/31/2021] [Revised: 03/07/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
AIMS Patient-reported outcomes measures (PROMs) are an increasingly recognised end point of radiotherapy studies. We hypothesised that the baseline PROMs score is the strongest predictor for acute and late scores after treatment. We assessed the strength of association of baseline MD Anderson Symptom Inventory (MDASI) scores, alongside other known factors for patient- or clinician-reported toxicity, with acute (6-week) and late (12-month) scores in head and neck cancer (HNC) patients following (chemo)radiotherapy. MATERIALS AND METHODS This was a retrospective analysis of longitudinal MDASI scores for 247 patients receiving (chemo)radiotherapy for HNC via multivariable linear regression. The factors investigated were: baseline symptom score, age, sex, concurrent chemotherapy, disease stage, radiotherapy fractionation, prior definitive surgery and performance status. Patients with a baseline score >4 in any item were defined as symptomatic in that category. RESULTS Patients rated symptomatic for an MDASI item pre-treatment on average reported statistically (P < 0.0005) and clinically (>-1.5) significant reductions in scores 6 weeks and 12 months after (chemo)radiotherapy for all considered sub-items except taste, dryness of mouth and problems with teeth. Conversely patients asymptomatic at baseline reported a worsening of scores at both time points. Other investigated factors showed little association with changes in MDASI scores following treatment. CONCLUSIONS Our data show that baseline MDASI scores are strongly associated with patient-reported toxicity 6 weeks and 12 months after (chemo)radiotherapy for HNC. Patients who are symptomatic at baseline can experience an early and durable benefit from treatment. This finding can inform discussions with patients before therapy and has implications for use of PROMs scores for the assessment of toxicity in randomised trials.
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Affiliation(s)
- C L Barker
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - G J Price
- Manchester Cancer Research Centre, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - L W Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A McPartlin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
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McDowell L, Casswell G, Bressel M, Drosdowsky A, Rischin D, Coleman A, Shrestha S, D'Costa I, Fua T, Tiong A, Liu C, Gough K. Symptom burden, quality of life, functioning and emotional distress in survivors of human papillomavirus associated oropharyngeal cancer: An Australian cohort. Oral Oncol 2021; 122:105560. [PMID: 34653749 DOI: 10.1016/j.oraloncology.2021.105560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This cross-sectional study examines patient-reported outcomes and functioning-based subgroups in human papillomavirus-associated oropharyngeal cancer survivors treated with chemoradiotherapy ≥12 months prior. METHOD Survivors completed EORTC QLQ-C30, MDASI-HN and PROMIS-Emotional distress questionnaires. Subgroups were identified via two-step clustering of QLQ-C30 functioning scales. RESULTS 136 patients were enrolled. Clinicians' graded 19/136 (14%) patients as having at least one severe (Grade 3 CTCAE) toxicity, whereas 68/136 (50%) patients self-reported at least one toxicity in the severe range (MDASI-HN ≥ 7). QLQ-C30 Global health status score (mean 76, SD = 20) was comparable to population norms. Rates of moderate/severe anxiety (10%/1%) and depression (4%/1%) were low. Two functioning-based subgroups were formed based on auto-clustering statistics: high- (n = 93) and low-functioning (n = 41). Differences on all functioning scales were large (d: 1.57-2.29), as were differences on the remaining QLQ-C30 scales/items, most MDASI-HN symptom severity/interference scales, and PROMIS scales (d: 0.80-2.03). Differences and associations with patient/clinical characteristics were not significant. CONCLUSION In this Australian cohort of HPV-OPC survivors there was significant discordance between clinician- and patient-reported toxicity. We observed population comparable global quality of life and low rates of emotional distress. However, we identified a low-functioning subgroup reporting significantly worse outcomes on a range of patient-reported measures who may benefit from targeted support.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.
| | - Georgina Casswell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Mathias Bressel
- Centre of Biostatistics and Clinical Trials (BaCT) Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
| | - Allison Drosdowsky
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Andrew Coleman
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Sudichhya Shrestha
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Ieta D'Costa
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Tsien Fua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Albert Tiong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Chen Liu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Karla Gough
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Victoria, Australia.
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Bahig H, Gunn BG, Garden AS, Ye R, Hutcheson K, Rosenthal DI, Phan J, Fuller CD, Morrison WH, Reddy JP, Ng SP, Gross ND, Sturgis EM, Ferrarotto R, Gillison M, Frank SJ. Patient-Reported Outcomes after Intensity-Modulated Proton Therapy for Oropharynx Cancer. Int J Part Ther 2021; 8:213-222. [PMID: 34285948 PMCID: PMC8270092 DOI: 10.14338/ijpt-20-00081.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/02/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To report patient-reported outcomes (PROs) derived from the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) tool, in patients with oropharynx cancer (OPC) treated with intensity-modulated proton therapy (IMPT) in the context of first-course irradiation. MATERIALS AND METHODS Patients with locally advanced OPC treated with radical IMPT between 2011 and 2018 were included in a prospective registry. FACT-HN scores were measured serially during and 24 months following IMPT. PRO changes in the FACT-HN scores over time were assessed with mixed-model analysis. RESULTS Fifty-seven patients met inclusion criteria. Median age was 60 years (range, 41-84), and 91% had human papillomavirus-associated disease. In total, 28% received induction chemotherapy and 68% had concurrent chemotherapy. Compliance to FACT-HN questionnaire completion was 59%, 48%, and 42% at 6, 12, and 24 months after treatment, respectively. The mean FACT-General (G), FACT-Total, and FACT-Trial Outcome Index (TOI) score changes were statistically and clinically significant relative to baseline from week 3 of treatment up to week 2 after treatment. Nadir was reached at week 6 of treatment for all scores, with maximum scores dropping by 15%, 20%, and 39% compared to baseline for FACT-G, FACT-Total, and FACT-TOI, respectively. Subdomain scores of physical well-being, functional well-being, and head and neck additional concerns decreased from baseline during treatment and returned to baseline at week 4 after treatment. CONCLUSIONS IMPT was associated with a favorable PRO trajectory, characterized by an acute decline followed by rapid recovery to baseline. This study establishes the expected acute, subacute, and chronic trajectory of PROs for patients undergoing IMPT for OPC.
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Affiliation(s)
- Houda Bahig
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
,Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Brandon G. Gunn
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S. Garden
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rong Ye
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate Hutcheson
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jack Phan
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Jay Paul Reddy
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sweet Ping Ng
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
,Peter MacCallum Cancer Center, Melbourne, Australia
| | - Neil D. Gross
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erich M. Sturgis
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Maura Gillison
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J. Frank
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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McDowell L, Gough K, King M, Corry J, Rischin D. Patient-reported quality of life and symptom burden measures in human papillomavirus associated oropharyngeal cancer - A review of the literature and PRO methodology. Oral Oncol 2021; 118:105309. [PMID: 33933778 DOI: 10.1016/j.oraloncology.2021.105309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/13/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
The emergence of human papillomavirus-associated oropharyngeal cancer (HPVOPC) has resulted in an explosion of clinical research offering reduced toxicity and improved health-related quality of life (HRQL) through treatment de-escalation. At the heart of this objective are patient-reported outcomes (PROs) which aim to quantify the patient experience, usually through the measurement of HRQL or symptom burden. A number of PRO measures (PROMs) are available to HNC researchers and selection of the optimal instrument relies on a detailed understanding of their content and psychometric properties matched to the clinical endpoint of interest. As PROMs become increasingly favoured as the primary or co-primary endpoints of interest in HNC clinical trials, particularly those focussed on HPVOPC, future treatment paradigms will be determined by these measures and it is imperative that they are applied with sophistication and rigor. This review draws attention to the limitations and challenges our specialty faces in PRO application, analysis and reporting. These shortfalls typically include a reliance on statistical rather than clinically relevant differences, multiple hypothesis testing, a lack of evidence-based minimal clinically important differences for the commonly used tools, as well as variations in PROM selection. The aim of this review is to provide: (1) an overview of PRO/PROM terminology and methodology in the HNC setting; (2) to provide a summary of HRQL and symptom burden reports in the HPVOPC literature; and (3) to draw attention to the unmet research need of refining PROM development, application and interpretation to guide our treatment decisions based on what matters to patients.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Melbourne, Australia.
| | - Karla Gough
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Madeleine King
- The University of Sydney, Faculty of Science, School of Psychology, Sydney Quality of Life Office, Sydney, Australia
| | - June Corry
- GenesisCare Radiation Oncology, Division Radiation Oncology, St. Vincent's Hospital, Melbourne, Victoria Australia; Department of Medicine St Vincent's, The University of Melbourne, Victoria, Australia
| | - Danny Rischin
- The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Farrugia M, Erickson K, Wendel E, Platek ME, Ji W, Attwood K, Ma SJ, Gu F, Singh AK, Ray AD. Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy. Cancers (Basel) 2021; 13:cancers13071638. [PMID: 33915867 PMCID: PMC8037640 DOI: 10.3390/cancers13071638] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Quality of life (QoL) scores and frailty status are becoming increasingly important criterion with implications on both how patients are treated and survival in head and neck cancer (HNC). Despite this, physicians lack tools to identify patients who are at risk of suffering declines in QoL and becoming frail following treatment. Therefore, we investigated whether functional decline, as measured by a series of physical tests called the Short Physical Performance Battery (SPPB), correlated with a reduction in QoL and increased risk of frailty. In the current study, patients who experienced a decline in SPPB scores were significantly more likely to have changes in physical functioning QoL measures as well as transition to frail status following treatment. In conclusion, the SPPB may be a useful tool to identify patients who may benefit from additional rehabilitation in future studies. Abstract Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in HNC and was the focus of this investigation. Methods: Patients who underwent radiation therapy for HNC from 2018 to 2020 were evaluated as a prospective observational cohort. Functional decline, QoL, and the frailty phenotype were measured via the Short Physical Performance Battery (SPPB), European Organization for Research and Treatment of Cancer (EORTC) qlq-C30, and Fried Frailty index, respectively. Results: A total of 106 HNC patients were included, 75 of which received concurrent chemoradiation therapy (CCRT) and 31 received radiation alone, both with and without surgery. There was a decrease in SPPB overall (p < 0.001) from the beginning to the end of treatment in the CCRT group but not the radiation group (p = 0.43). Change in overall SPPB points following treatment correlated with the decline in physical QoL for both groups (p < 0.05) as well as transition frail status in the CCRT group (p < 0.001) with a trend in the radiation group (p = 0.08). Conclusions: Change in SPPB correlates with QoL and transition to frailty status in patients undergoing definitive CCRT for HNC with similar trends in those receiving radiation alone. Decline in SPPB could potentially be useful in identification of those who may benefit from rehabilitation in future studies.
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Affiliation(s)
- Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Kayleigh Erickson
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Elizabeth Wendel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Dietetics, D’Youville College, Buffalo, NY 14203, USA
| | - Wenyan Ji
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Fangyi Gu
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Andrew D. Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Rehabilitation Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
- Correspondence: ; Tel.: +1-716-845-2381; Fax: +1-716-845-8487
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10
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Assessment of clinical radiosensitivity in patients with head-neck squamous cell carcinoma from pre-treatment quantitative ultrasound radiomics. Sci Rep 2021; 11:6117. [PMID: 33731738 PMCID: PMC7969626 DOI: 10.1038/s41598-021-85221-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/23/2021] [Indexed: 12/24/2022] Open
Abstract
To investigate the role of quantitative ultrasound (QUS) radiomics to predict treatment response in patients with head and neck squamous cell carcinoma (HNSCC) treated with radical radiotherapy (RT). Five spectral parameters, 20 texture, and 80 texture-derivative features were extracted from the index lymph node before treatment. Response was assessed initially at 3 months with complete responders labelled as early responders (ER). Patients with residual disease were followed to classify them as either late responders (LR) or patients with persistent/progressive disease (PD). Machine learning classifiers with leave-one-out cross-validation was used for the development of a binary response-prediction radiomics model. A total of 59 patients were included in the study (22 ER, 29 LR, and 8 PD). A support vector machine (SVM) classifier led to the best performance with accuracy and area under curve (AUC) of 92% and 0.91, responsively to define the response at 3 months (ER vs. LR/PD). The 2-year recurrence-free survival for predicted-ER, LR, PD using an SVM-model was 91%, 78%, and 27%, respectively (p < 0.01). Pretreatment QUS-radiomics using texture derivatives in HNSCC can predict the response to RT with an accuracy of more than 90% with a strong influence on the survival. Clinical trial registration: clinicaltrials.gov.in identifier NCT03908684.
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A Principal Component of Quality of Life Measures Is Associated with Survival for Head and Neck Cancer Patients Treated with Radiation Therapy. Cancers (Basel) 2021; 13:cancers13051155. [PMID: 33800256 PMCID: PMC7962523 DOI: 10.3390/cancers13051155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Health-related quality of life (HRQOL) surveys describe the patient experience of disease and treatment. The relationship between post-treatment recovery of HRQOL and outcome in head and neck cancer is not well characterized. Impaired recovery of numerous individual components of HRQOL were associated with increased mortality. To obtain a better understanding how HRQOL (as a whole) impacts survival, we utilized a statistical technique called principal component analysis (PCA). PCA generated a total score of several HRQOL domains, named principal component 1 (PC1), to more accurately describe the cumulative impact of poor HRQOL recovery on outcome. PC1 was associated with survival and may be a useful tool in future studies to identify at-risk patients. Abstract Background: Health-related quality of life (HRQOL) metrics can be associated with survival in head and neck cancer (HNC); however, the impact of HRQOL recovery and the relevant HRQOL domains regarding outcome are unclear. Methods: Using a single-institution database, we retrospectively reviewed HNC patients treated with definitive or postoperative radiation therapy between 2013 and 2018. The recovery of individual HRQOL domains were determined by the ratio of the post-treatment to baseline scores. Univariate and Multivariate Cox regression were used to analyze survival outcomes. Principal component analysis was used to adjust for multicollinearity of HRQOL domains. Results: In 218 HNC patients who received radiation therapy, median follow-up was 24.8 months (interquartile range (IQR) 14.5–32.0). Principal component analysis evaluating the recovery of HRQOL domains revealed two independent principal components (PC), PC1 and PC2. PC1, which received contributions from the functional domains; physical (PF), role (RF), emotional (EF), cognitive (CF), and global health status (GQOL) was significantly associated with disease-free (HR = 0.77, 95% CI 0.61–0.98, p = 0.034) and overall survival (HR = 0.76, 95% CI 0.65–0.91, p = 0.004) on multivariate analysis and PC2, had no correlation with outcome and was mainly represented by social functioning. Unplanned hospitalization was significantly associated with lower PC1 scores (β = −0.997, Std. Error = 0.244, p < 0.001). Conclusion: Our study provides evidence that post-treatment recovery of HRQOL domains were associated with overall survival (OS) in HNC. PC1 is an attractive clinical tool to assess the recovery across multiple different HRQOL and the relationship with survival. Future prospective studies may identify patients who could benefit from additional rehabilitation based on PC1 score.
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Santos M, Oliveira e Silva LF, Kohler HF, Curioni O, Vilela R, Fang M, Passos Lima CS, Gomes JP, Chaves A, Resende B, Trindade K, Collares M, Obs F, Brollo J, Cavalieri R, Ferreira E, Brust L, Rabello D, Domenge C, Kowalski LP. Health-Related Quality of Life Outcomes in Head and Neck Cancer: Results From a Prospective, Real-World Data Study With Brazilian Patients Treated With Intensity Modulated Radiation Therapy, Conformal and Conventional Radiation Techniques. Int J Radiat Oncol Biol Phys 2021; 109:485-494. [DOI: 10.1016/j.ijrobp.2020.09.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/13/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
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Swallowing exercises for head and neck cancer patients: A systematic review and meta-analysis of randomized control trials. Int J Nurs Stud 2020; 114:103827. [PMID: 33352439 DOI: 10.1016/j.ijnurstu.2020.103827] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 07/02/2020] [Accepted: 11/04/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Extensive surgery and chemo/radiation therapy (C/RT) to manage head and neck cancer (HNC) patients affects their ability to swallow food and liquids, risk of aspiration and greatly influences their quality of life (QOL). OBJECTIVES Ascertain the effectiveness of swallowing exercises on improving swallowing function, performance status, mouth opening, risk of aspiration/penetration and QOL in HNC patients. DESIGN Systematic review and meta-analysis of randomized controlled trials DATA SOURCES: PubMed, Ovid-Medline, Embase, Cochrane Library, CINAHL and Web of Science and included all available RCTs. REVIEW METHODS We followed the PRISMA guidelines and standard methods for conducting a systematic review and meta-analysis. Comprehensive Meta-analysis 3.0 using the random effects model was used for data analysis. RESULTS In total, 19 RCTs with 1100 participants were identified and included in the current review. Swallowing exercises had significant small effect on swallowing function 0.33 (95%CI = 0.00-0.65) and moderate effect on mouth opening 0.60 (95%CI = 0.21-0.99) immediately after intervention and small effect at 6-month follow-up 0.46 (95%CI = 0.11-0.81). However, non-significant effects were observed on risk of aspiration/penetration, performance status and all domains of QOL. CONCLUSION Swallowing exercises demonstrated effectiveness in improving swallowing function and mouth opening in HNC patients undergoing multimodal treatment. This is the first comprehensive systematic review and meta-analysis of RCTs to assess the effect of swallowing exercises in HNC patients undergoing multimodal treatment. Nurses can play an important role in assisting the delivery of oropharyngeal swallowing exercises including jaw exercises, tongue exercises and swallowing maneuvers with assistance and guidance from speech pathologists to help improve HNC complications and QOL for HNC survivors.
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14
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Patient-reported outcome measures in patients undergoing radiotherapy for head and neck cancer. Support Care Cancer 2020; 29:2537-2547. [DOI: 10.1007/s00520-020-05778-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
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Quantitative ultrasound delta-radiomics during radiotherapy for monitoring treatment responses in head and neck malignancies. Future Sci OA 2020; 6:FSO624. [PMID: 33235811 PMCID: PMC7668124 DOI: 10.2144/fsoa-2020-0073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: We investigated quantitative ultrasound (QUS) in patients with node-positive head and neck malignancies for monitoring responses to radical radiotherapy (RT). Materials & methods: QUS spectral and texture parameters were acquired from metastatic lymph nodes 24 h, 1 and 4 weeks after starting RT. K-nearest neighbor and naive-Bayes machine-learning classifiers were used to build prediction models for each time point. Response was detected after 3 months of RT, and patients were classified into complete and partial responders. Results: Single-feature naive-Bayes classification performed best with a prediction accuracy of 80, 86 and 85% at 24 h, week 1 and 4, respectively. Conclusion: QUS-radiomics can predict RT response at 3 months as early as 24 h with reasonable accuracy, which further improves into 1 week of treatment. Patients with head and neck cancer are often treated with radiation, which usually spans over 6–7 weeks. The response is usually measured 3 months after treatment completion. In this study, we had performed ultrasound scans from the patient’s neck node during radiation treatment (after 24 h, 1 and 4 weeks). Artificial intelligence was used to interpret the ultrasound imaging and predict the response to radiation at the end of 3 months. The scans obtained after the first week were able to predict the treatment response with reasonable accuracy (86%).
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Arbab M, Chen YH, Criscitiello S, Glass J, Fugazzotto JA, Killoran JH, Hanna G, Lorch J, Haddad RI, Margalit DN, Tishler RB, Schoenfeld JD. Patient reported outcomes in patients with head and neck cancer treated with concurrent chemoradiation with weekly versus bolus cisplatin. Head Neck 2020; 42:3670-3677. [PMID: 32815253 DOI: 10.1002/hed.26432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/30/2020] [Accepted: 08/03/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Patient Reported Outcome (PRO) data comparing bolus (B-CP) with weekly (W-CP) cisplatin concurrent with radiation are lacking. METHODS We performed a retrospective study comparing PRO among 99 patients with head and neck radiation, 26% who received concurrent B-CP and 73% treated with W-CP. RESULTS W-CP patients had a higher Charlson comorbidity index (CCI) (P = .004). There were no differences in median cisplatin dose, PROs, percutaneous endoscopic gastrostomy (PEG) dependence or hospitalization between arms. Patients with a greater decline in their self-reported dysphagia score were more often PEG dependent at the end of radiation therapy (P = .03). There was also a trend toward PEG dependence with a higher maximum dysphagia score and greater change in aspiration score (P = .06). The maximum decline in white cell count and absolute neutrophil count were greater in the W-CP group (P = .04, P = .01). CONCLUSION Both B-CP and W-CP are well tolerated. PROs do not suggest a benefit to W-CP.
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Affiliation(s)
- Mona Arbab
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiation Oncology, Indiana University, Indianapolis, Indiana, USA
| | - Yu-Hui Chen
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shana Criscitiello
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jason Glass
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Glenn Hanna
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jochen Lorch
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Robert I Haddad
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Danielle N Margalit
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Roy B Tishler
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jonathan D Schoenfeld
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Salz T, Schnall RB, McCabe MS, Oeffinger KC, Corcoran S, Vickers AJ, Salner AL, Dornelas E, Raghunathan NJ, Fortier E, McKiernan J, Finitsis DJ, Chimonas S, Baxi S. Incorporating Multiple Perspectives Into the Development of an Electronic Survivorship Platform for Head and Neck Cancer. JCO Clin Cancer Inform 2019; 2:1-15. [PMID: 30652547 DOI: 10.1200/cci.17.00105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To improve the care of survivors of head and neck cancer, we developed the Head and Neck Survivorship Tool: Assessment and Recommendations (HN-STAR). HN-STAR is an electronic platform that incorporates patient-reported outcomes into a clinical decision support tool for use at a survivorship visit. Selections in the clinical decision support tool automatically populate a survivorship care plan (SCP). We aimed to refine HN-STAR by eliciting and incorporating feedback on its ease of use and usefulness. METHODS Human-computer interaction (HCI) experts reviewed HN-STAR using think-aloud testing and the Nielsen Heuristic Checklist. Nurse practitioners (NPs) thought aloud while reviewing the clinical decision support tool and SCP and responded to an interview. Survivors used HN-STAR as part of a routine visit and were interviewed afterward. We analyzed themes from the feedback. We described how we addressed each theme to improve the usability of HN-STAR. RESULTS Five HCI experts, 10 NPs, and 10 cancer survivors provided complementary usability insight that we categorized into themes of improvements. For ease of use, themes included technical design considerations to enhance user interface, ease of completion of a self-assessment, streamlining text, disruption of the clinic visit, and threshold for symptoms to appear on the SCP. The theme addressing usefulness was efficiency and comprehensiveness of the clinic visit. For each theme, we report revisions to HN-STAR in response to the feedback. CONCLUSION HCI experts provided key technical design insights into HN-STAR, whereas NPs and survivors provided usability feedback and clinical perspectives. We incorporated the feedback into the preparation for additional testing of HN-STAR. This method can inform and improve the ease of use and usefulness of the survivorship applications.
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Affiliation(s)
- Talya Salz
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Rebecca B Schnall
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Mary S McCabe
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Kevin C Oeffinger
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Stacie Corcoran
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Andrew J Vickers
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Andrew L Salner
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Ellen Dornelas
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Nirupa J Raghunathan
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Elizabeth Fortier
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Janet McKiernan
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - David J Finitsis
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Susan Chimonas
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
| | - Shrujal Baxi
- Talya Salz, Mary S. McCabe, Stacie Corcoran, Andrew J. Vickers, Nirupa J. Raghunathan, Elizabeth Fortier, Janet McKiernan, Susan Chimonas, and Shrujal Baxi, Memorial Sloan Kettering Cancer Center; Rebecca B. Schnall, Columbia University School of Nursing, New York, NY; Kevin C. Oeffinger, Duke University Medical Center, Durham, NC; Andrew L. Salner, Ellen Dornelas, and David J. Finitsis, Hartford HealthCare Cancer Institute, Hartford, CT; and Shrujal Baxi, Weill-Cornell School of Medicine, New York, NY
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Verdonck-de Leeuw IM, Jansen F, Brakenhoff RH, Langendijk JA, Takes R, Terhaard CHJ, Baatenburg de Jong RJ, Smit JH, Leemans CR. Advancing interdisciplinary research in head and neck cancer through a multicenter longitudinal prospective cohort study: the NETherlands QUality of life and BIomedical Cohort (NET-QUBIC) data warehouse and biobank. BMC Cancer 2019; 19:765. [PMID: 31382921 PMCID: PMC6683500 DOI: 10.1186/s12885-019-5866-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022] Open
Abstract
Background Worldwide, over 500,000 people are diagnosed with head and neck cancer each year, a disease with major impact on life expectancy and quality of life. The purpose of the Netherlands Quality of life and Biomedical Cohort study (NET-QUBIC) is to advance interdisciplinary research that aims to optimize diagnosis, treatment, and supportive care for head and neck cancer patients and their informal caregivers. Methods Using an extensive assessment protocol (electronic clinical record form, patient reported outcome measures and fieldwork (interviews and physical tests)), clinical data and data on quality of life, demographic and personal factors, psychosocial (depression, anxiety, fatigue, pain, sleep, mental adjustment to cancer, posttraumatic stress), physical (speech, swallowing, oral function, malnutrition, physical fitness, neurocognitive function, sexual function), lifestyle (physical activity, nutrition, smoking, alcohol, drugs), and social factors (social function, social support, work, health care use, and costs) are collected and stored in the data warehouse. A longitudinal biobank is built with tumor tissue, blood and blood components, saliva samples, and oral rinses. An infrastructure for fieldwork and laboratory protocols is established at all participating centers. All patients fill out patient reported outcome measures before treatment and at 3, 6, 12, 24, 36, 48, and 60 months follow-up. The interviews, physical tests and biological sample collection are at baseline and 6, 12, and 24 months follow-up. The protocol for caregivers includes blood sampling and oral rinses at baseline and a tailored list of questionnaires, administered at the same time points as the patients. In total, 739 HNC patients and 262 informal caregivers have been included in 5 out of the 8 HNC centers in the Netherlands. Discussion By granting access to researchers to the NET-QUBIC data warehouse and biobank, we enable new research lines in clinical (e.g. treatment optimization in elderly patients), biological (e.g. liquid biopsy analysis for relapse detection), health related quality of life (e.g. the impact of toxicity on quality of life), and interrelated research (e.g. health related quality of life in relation to biomarkers and survival).
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Affiliation(s)
- I M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, PO BOX 7057, 1007, MB, Amsterdam, The Netherlands. .,Department of Clinical, Neuro and Development Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - F Jansen
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, PO BOX 7057, 1007, MB, Amsterdam, The Netherlands.,Department of Clinical, Neuro and Development Psychology, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - R H Brakenhoff
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, PO BOX 7057, 1007, MB, Amsterdam, The Netherlands
| | - J A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C H J Terhaard
- Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands
| | - R J Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus Cancer Institute, ErasmusMC, Rotterdam, the Netherlands
| | - J H Smit
- Department of Psychiatry, Neuroscience Campus Amsterdam and Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, Amsterdam, The Netherlands
| | - C R Leemans
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, PO BOX 7057, 1007, MB, Amsterdam, The Netherlands
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Amdur RJ, Chera BS. Misuse of Quality of Life Evaluation in Oncology Studies: Reification, Adaptation, and the U-shaped Curve. Pract Radiat Oncol 2019; 9:191-192. [DOI: 10.1016/j.prro.2018.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/18/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
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Abstract
Radiotherapy is used in >50% of patients with cancer, both for curative and palliative purposes. Radiotherapy uses ionizing radiation to target and kill tumour tissue, but normal tissue can also be damaged, leading to toxicity. Modern and precise radiotherapy techniques, such as intensity-modulated radiotherapy, may prevent toxicity, but some patients still experience adverse effects. The physiopathology of toxicity is dependent on many parameters, such as the location of irradiation or the functional status of organs at risk. Knowledge of the mechanisms leads to a more rational approach for controlling radiotherapy toxicity, which may result in improved symptom control and quality of life for patients. This improved quality of life is particularly important in paediatric patients, who may live for many years with the long-term effects of radiotherapy. Notably, signs and symptoms occurring after radiotherapy may not be due to the treatment but to an exacerbation of existing conditions or to the development of new diseases. Although differential diagnosis may be difficult, it has important consequences for patients.
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21
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Margalit DN, Wong SJ. Reirradiation for Head and Neck Cancer: The Who and the How. Int J Radiat Oncol Biol Phys 2019; 100:618-620. [PMID: 29413275 DOI: 10.1016/j.ijrobp.2017.12.279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Danielle N Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Stuart J Wong
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Ahmad I, Singh P, Bhatt CP, Bashir I. Case of metastatic small cell carcinoma of the oropharynx successfully treated with image-guided volumetric modulated arc therapy (IG-VMAT): pushing the limits of technology to match treatment intent. BMJ Case Rep 2018; 11:11/1/bcr-2018-226522. [PMID: 30567165 DOI: 10.1136/bcr-2018-226522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Extrapulmonary small cell carcinomas (EPSCC) are a rare subtype of neuroendocrine tumours which have been documented to arise from a multitude of sites and treatment outcomes are disappointing. The most common site involved in the head and neck region is the larynx and the oropharynx as a primary site has been infrequently reported. The patient presented with bilateral neck swelling and an ulcerated lesion was noted in the base of tongue (BOT). A biopsy revealed small cell carcinoma (SCC) and was confirmed with immunohistochemistry. The final diagnosis after workup was SCC of BOT stage IVc. He received induction chemotherapy to which the tumour responded partially, followed by curative intent chemoradiotherapy and adjuvant chemotherapy. The patient achieved a radiological complete response to treatment and almost all treatment-induced toxicities resolved. An aggressive approach to managing EPSCC is possible with modern radiotherapy techniques, with tolerable treatment-induced toxicities.
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Affiliation(s)
- Irfan Ahmad
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
| | - Pavel Singh
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Chandi Prasad Bhatt
- Department of Radiation Oncology, Batra Hospital & Medical Research Centre, New Delhi, Delhi, India
| | - Irfan Bashir
- Department of Radiation Oncology, Batra Hospital & Medical Research Centre, New Delhi, Delhi, India
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Ringash J, Bernstein LJ, Devins G, Dunphy C, Giuliani M, Martino R, McEwen S. Head and Neck Cancer Survivorship: Learning the Needs, Meeting the Needs. Semin Radiat Oncol 2018; 28:64-74. [DOI: 10.1016/j.semradonc.2017.08.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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