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McDowell L, Gough K, White I, Corry J, Rischin D. Sexual Health, sexuality and sexual intimacy in patients with head and neck cancer - A narrative review. Oral Oncol 2024; 157:106975. [PMID: 39083855 DOI: 10.1016/j.oraloncology.2024.106975] [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: 03/05/2024] [Revised: 06/21/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
Sexuality and sexual intimacy are important aspects of cancer survivorship. In head and neck cancer (HNC), concerns around sexual health, sexuality and sexual intimacy are infrequently raised or addressed in standard HNC consultations, either before embarking on treatment or during survivorship. The changing demographic of HNC patients, largely due to the increasing proportion of patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPVOPSCC), has driven renewed interest in some specific survivorship issues, including sexual behaviours and lifestyles, which may account for both the primary mode of HPV transmission and the younger and less comorbid population affected by this disease. While HNC survivors may have many complex needs in the short and longer term, some patients may prioritise preserving sexual function above other more HNC-specific issues, such as swallowing and xerostomia. Beyond HPVOPSCC, there is evidence to suggest that impairment of sexual health is a pervasive survivorship issue across all HNC cancer types, and this narrative review article highlights publications reporting quantitative assessments of sexual health outcomes in HNC patients. There are also limited studies evaluating whether current sexual health models of care are adequate for HNC patients or whether new or adapted models are needed. Future research will also need to define the impact of our treatments on the sexuality and sexual intimacy concerns of specific HNC cohorts with more granularity to enhance pre- and post-treatment counselling.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Karla Gough
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Australia
| | | | - June Corry
- Genesis Care St Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Green L, McDowell L, Ip F, Tapia M, Zhou M, Fahey MT, Dixon B, Magarey M. Early return to work is possible after transoral robotic surgery (TORS) in carefully selected patients with oropharyngeal squamous cell carcinoma. Oral Oncol 2024; 159:107032. [PMID: 39293101 DOI: 10.1016/j.oraloncology.2024.107032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/26/2024] [Accepted: 09/09/2024] [Indexed: 09/20/2024]
Abstract
INTRODUCTION The aims of this study were to investigate the rate and time to return to work (RTW) after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) and to explore the impact of disease or work-related factors leading to variations in RTW outcomes. METHODS Cross-sectional survey of disease, socioeconomic, work-related and health-related quality of life (HR-QOL). Qualitative analysis of responses for facilitators and barriers to RTW. RESULTS A total of 47 participants employed at diagnosis were included in the study, with an average age 56 years. Median survey time 3.2 years. 22 participants underwent TORS only with 25 undergoing TORS with adjuvant therapy. 93.6 % had stage 1 disease. 95.7 % of participants RTW after TORS with a mean time of 13.6 weeks. Patients returned earlier after TORS alone compared to those requiring adjuvant treatment (10 weeks vs. 17 weeks; p = 0.13) Overall high HR-QOL metrics for all patients, with those undergoing adjuvant having significantly poorer outcomes for the dry mouth/sticky saliva (9.1 vs 41.3, p=<0.001) items. Qualitative analysis of free text responses showed facilitators and barriers to RTW fell under four main categories: physical, phycological/emotional, financial and workplace. CONCLUSION High rate of RTW amongst patients after TORS, which is the highest reported amongst head and neck cancer literature to date. Participants returned earlier after surgery only compared to adjuvant treatment, but both groups reported high HR-QOL metrics. Physical effects of treatment, including fatigue and oral dysfunction were some of the main barriers to RTW; whereas flexible working arrangements and support from employer/colleagues were major facilitators.
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Affiliation(s)
- Lorne Green
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lachlan McDowell
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Fiona Ip
- Pinnacle Surgery, Epworth Richmond Hospital, Melbourne, VIC, Australia
| | - Mario Tapia
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Hospital Clinico Regional de Concepcion Dr. Guillermo Grant Benavente, Concepcion, Chile
| | - Meiling Zhou
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael T Fahey
- Peter MacCallum Cancer Centre, Centre for Biostatistics and Clinical Trials (BaCT), Melbourne, VIC, Australia
| | - Benjamin Dixon
- Pinnacle Surgery, Epworth Richmond Hospital, Melbourne, VIC, Australia; Department of ENT Head & Neck Surgery, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia; Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Magarey
- Department of Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Pinnacle Surgery, Epworth Richmond Hospital, Melbourne, VIC, Australia; Department of Medical Education, University of Melbourne, Melbourne, VIC, Australia
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Lin MG, Zhu A, Read PW, Garneau J, McLaughlin C. Novel HPV Associated Oropharyngeal Squamous Cell Carcinoma Surveillance DNA Assay Cost Analysis. Laryngoscope 2023; 133:3006-3012. [PMID: 37070629 DOI: 10.1002/lary.30701] [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: 12/02/2022] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES We aim to propose a modified surveillance strategy using a novel blood assay that detects plasma circulating tumor-specific HPV DNA with reported 100% NPV and 94% PPV as the main method of detection to understand the cost implications of potentially avoiding routine imaging and surveillance visits at our institution. METHODS We performed a retrospective chart review focusing on recurrences in p16+ patients with OPSCC and defined two surveillance strategies: "Strategy A", follow-up visits with flexible laryngoscopy (FL) plus regular imaging studies; "Strategy B", follow-up visits with FL plus regular NavDx assays and imaging used at the discretion of the physician(s) in cases of high clinical suspicion. RESULTS Of the p16+ OPSCC patients (n = 214), 23 had confirmed recurrence (11%). Standard work-flow model determined 72 imaging studies and 2198 physical examinations with FL were needed to detect one recurrence. Potential individual patient cost reduction during surveillance was 42%. CONCLUSION Implementing NavDx for HPV + OPSCC surveillance would benefit patients by reducing costs and unnecessary diagnostic testing. LEVEL OF EVIDENCE Step/Level 3 Laryngoscope, 133:3006-3012, 2023.
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Affiliation(s)
- Michael G Lin
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Alexander Zhu
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Paul W Read
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Jonathan Garneau
- Department of Otolaryngology, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher McLaughlin
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
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Granström B, Isaksson J, Westöö N, Holmlund T, Tano K, Laurell G, Tiblom Ehrsson Y. Perceptions of life and experiences of health care support among individuals one year after head and neck cancer treatment - An interview study. Eur J Oncol Nurs 2023; 66:102383. [PMID: 37506610 DOI: 10.1016/j.ejon.2023.102383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/09/2023] [Accepted: 07/01/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE To examine how individuals treated for head and neck cancer perceive life one year after the end of treatment and how they experience supportive efforts from health care. METHODS A semi-structured interview study of 21 patients was performed one year after the end of treatment. The patients gave their views concerning physical, psychological, and return-to-work issues, and their experiences concerning rehabilitative efforts from health care and particularly the contact nurse were captured. A thematic analysis was conducted. RESULTS One year after treatment the patients were still suffering from side effects and from fear of recurrence, but they strived to live as they did before the cancer diagnosis, such as having returned to work and resuming leisure activities. Moreover, the rehabilitative efforts from health care had ended. Having access to a contact nurse, also known as a clinical nurse specialist, was positive, however, the participants lacked regular long-term follow-ups with the contact nurse regarding rehabilitation needs. Improvement possibilities were seen in clarifying the role of the contact nurse and that the contact nurse should show engagement and make the initial contact with the patients. CONCLUSION Despite the sequelae from treatment, the patients strived to live as before their diagnosis. By regular, engaged, and long-term follow-ups by the contact nurse, remaining needs may be uncovered, and appropriate individualized support and rehabilitation can be offered.
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Affiliation(s)
- Brith Granström
- Department of Clinical Science, Otorhinolaryngology, Umeå University, Umeå, Sweden.
| | - Joakim Isaksson
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Nilla Westöö
- Ear, Nose, and Throat Clinic, Uppsala University Hospital, Uppsala, Sweden
| | - Thorbjörn Holmlund
- Department of Clinical Science, Otorhinolaryngology, Umeå University, Umeå, Sweden
| | - Krister Tano
- Department of Clinical Science/ENT/Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Ylva Tiblom Ehrsson
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
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Manne SL, Hudson SV, Preacher KJ, Imanguli M, Pesanelli M, Frederick S, Singh N, Schaefer A, Van Cleave JH. Prevalence and correlates of fear of recurrence among oral and oropharyngeal cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01449-3. [PMID: 37584880 PMCID: PMC10921339 DOI: 10.1007/s11764-023-01449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Fear of recurrence (FoR) is a prevalent and difficult experience among cancer patients. Most research has focused on FoR among breast cancer patients, with less attention paid to characterizing levels and correlates of FoR among oral and oropharyngeal cancer survivors. The purpose was to characterize FoR with a measure assessing both global fears and the nature of specific worries as well as evaluate the role of sociodemographic and clinical factors, survivorship care transition practices, lifestyle factors, and depressive symptoms in FoR. METHODS Three hundred eighty-nine oral and oropharyngeal survivors recruited from two cancer registries completed a survey assessing demographics, cancer treatment, symptoms, alcohol and tobacco use, survivorship care practices, depression, and FoR. RESULTS Forty percent reported elevated global FoR, with similar percentages for death (46%) and health worries (40.3%). Younger, female survivors and survivors experiencing more physical and depressive symptoms reported more global fears and specific fears about the impact of recurrence on roles, health, and identity, and fears about death. Depression accounted for a large percent of the variance. Lower income was associated with more role and identity/sexuality worries, and financial hardship was associated with more role worries. CONCLUSIONS FoR is a relatively common experience for oral and oropharyngeal cancer survivors. Many of its correlates are modifiable factors that could be addressed with multifocal, tailored survivorship care interventions. IMPLICATIONS FOR CANCER SURVIVORS Assessing and addressing depressive symptoms, financial concerns, expected physical symptoms in the first several years of survivorship may impact FoR among oral and oropharyngeal cancer survivors.
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Affiliation(s)
- Sharon L Manne
- Rutgers Cancer Institute of New Jersey, 120 Albany St, 8th Floor, New Brunswick, NJ, 08901, USA.
| | - Shawna V Hudson
- Institute for Health, Health Care Policy and Aging Research, Robert Wood Johnson Medical School, 112 Paterson St, New Brunswick, NJ, 08901, USA
| | - Kristopher J Preacher
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Matin Imanguli
- Rutgers Cancer Institute of New Jersey, 120 Albany St, 8th Floor, New Brunswick, NJ, 08901, USA
- Department of Otolaryngology-Head and Neck Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Morgan Pesanelli
- Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
| | - Sara Frederick
- Rutgers Cancer Institute of New Jersey, 120 Albany St, 8th Floor, New Brunswick, NJ, 08901, USA
| | - Neetu Singh
- Rutgers Cancer Institute of New Jersey, 120 Albany St, 8th Floor, New Brunswick, NJ, 08901, USA
| | - Alexis Schaefer
- Rutgers Cancer Institute of New Jersey, 120 Albany St, 8th Floor, New Brunswick, NJ, 08901, USA
| | - Janet H Van Cleave
- NYU Rory Meyers College of Nursing, 433 First Avenue, New York, NY, 10010, USA
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Margalit DN, Salz T, Venchiarutti R, Milley K, McNamara M, Chima S, Wong J, Druce P, Nekhlyudov L. Interventions for head and neck cancer survivors: Systematic review. Head Neck 2022; 44:2579-2599. [PMID: 35848095 PMCID: PMC9796901 DOI: 10.1002/hed.27142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions for head/neck cancer (HNC) survivors may not address their cancer-related and general health needs. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guided this systematic review of studies from 2000 to 2021 of interventions targeting cancer survivors treated with curative-intent, using MEDLINE, Embase, Emcare, and PsycINFO. Interventions were categorized into domains of the Quality of Cancer Survivorship Care Framework to characterize the scope and quality of interventions. RESULTS We identified 28 studies for inclusion: 13 randomized and 15 non-randomized. Most targeted surveillance/management of physical effects (n = 24) including 13 that also targeted psychosocial effects. Four studies addressed prevention/surveillance for recurrence/new cancers, one addressed health promotion/disease prevention, and one addressed chronic medical conditions. Most studies (n = 27) had medium-high risk of bias. CONCLUSIONS There are few high-quality studies addressing HNC survivorship. Future rigorously designed studies should address broader areas of care, including chronic disease management and health promotion/disease prevention.
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Affiliation(s)
- Danielle N. Margalit
- Department of Radiation Oncology, Head and Neck Oncology ProgramDana‐Farber Cancer Institute/Brigham & Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Talya Salz
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Rebecca Venchiarutti
- Sydney Head and Neck Cancer Institute, Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia,School of Public Health, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - Kristi Milley
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia
| | - Mairead McNamara
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia,Department of Cancer Imaging, Peter MacCallum Cancer CentreMelbourneVICAustralia
| | - Sophie Chima
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia
| | - Jamieson Wong
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia
| | - Paige Druce
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia,Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Larissa Nekhlyudov
- Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Manne SL, Hudson SV, Kashy DA, Imanguli M, Pesanelli M, Frederick S, Van Cleave J. Self-efficacy in managing post-treatment care among oral and oropharyngeal cancer survivors. Eur J Cancer Care (Engl) 2022; 31:e13710. [PMID: 36151904 PMCID: PMC9788355 DOI: 10.1111/ecc.13710] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/25/2022] [Accepted: 09/07/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Physical and psychosocial effects of oral cancer result in long-term self-management needs. Little attention has been paid to survivors' self-efficacy in managing their care. Study goals were to characterise self-care self-efficacy and evaluate socio-demographics, disease, attitudinal factors and psychological correlates of self-efficacy and engagement in head and neck self-exams. METHODS Two hundred thirty-two oral cancer survivors completed measures of socio-demographics, self-care self-efficacy, head and neck self-exams and attitudinal and psychological measures. Descriptive statistics characterised self-efficacy. Hierarchical regressions evaluated predictors of self-efficacy. RESULTS Survivors felt moderately confident in the ability to manage self-care (M = 4.04, SD = 0.75). Survivors with more comorbidities (β = -0.125), less preparedness (β = 0.241), greater information (β = -0.191), greater support needs (β = -0.224) and higher depression (β = -0.291) reported significantly lower self-efficacy. Head and neck self-exam engagement (44% past month) was relatively low. Higher preparedness (OR = 2.075) and self-exam self-efficacy (OR = 2.606) were associated with more engagement in self-exams. CONCLUSION Many survivors report low confidence in their ability to engage in important self-care practices. Addressing unmet information and support needs, reducing depressive symptoms and providing skill training and support may boost confidence in managing self-care and optimise regular self-exams.
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Affiliation(s)
- Sharon L. Manne
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Shawna V. Hudson
- Institute for Health, Health Care Policy and Aging ResearchRobert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Deborah A. Kashy
- Department of PsychologyMichigan State UniversityEast LansingMichiganUSA
| | - Matin Imanguli
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA,Department of Otolaryngology‐Head and Neck SurgeryRobert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Morgan Pesanelli
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Sara Frederick
- Rutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
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Fodor LA, Todea D, Podina IR. Core Fear of Cancer recurrence symptoms in Cancer Survivors: a network approach. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tran MJ, Jefford M, Smith B, Lynch F, Dhillon HM, Shaw J, McDowell L, White A, Halloran C, Wiesenfeld D, Ftanou M. Study protocol for the evaluation of Fear-Less: a stepped-care program for fear of cancer recurrence in survivors with early-stage disease. Pilot Feasibility Stud 2022; 8:177. [PMID: 35948952 PMCID: PMC9364569 DOI: 10.1186/s40814-022-01123-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) is a significant unmet need amongst cancer survivors and is consistently associated with psychological distress and impaired quality of life. Psychological interventions for FCR, such as ConquerFear, have demonstrated efficacy in reducing FCR and improving emotional wellbeing. Unfortunately, there are barriers to the uptake of evidence-based FCR treatments in clinical practice. A stepped-care FCR treatment model may overcome these barriers and has demonstrated potential in people with advanced melanoma. This study aims to evaluate the acceptability, feasibility, and impact of a stepped-care FCR treatment model (Fear-Less) in people with other cancer types, who have completed treatment with curative intent. METHODS Sixty people with early-stage cancer (defined as individuals who have received treatment with curative intent and with no metastatic disease) will be screened for FCR using the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). Individuals reporting moderate FCR (FCRI-SF between 13 and 21) will be offered a clinician-guided self-management resource; those reporting high FCR (FCRI-SF ≥ 22) will be offered individual therapy according to the ConquerFear protocol. Participants will complete purpose-built evaluation surveys assessing their FCR screening and intervention experiences. Clinicians will also complete a survey regarding their experiences of the treatment model. Fear-Less will be evaluated in terms of (1) acceptability (i.e., patient and clinician experience), (2) feasibility (i.e., referral uptake, treatment adherence, and time taken to screen and deliver interventions), and (3) impact (i.e., pre- to post-intervention FCR changes). DISCUSSION The Fear-Less stepped-care model is a novel framework for screening FCR and stratifying survivors to the appropriate level of treatment. Our study will provide an indication of whether Fear-Less is a feasible and acceptable FCR model of care amongst survivors with early-stage disease and inform further investigations of this model. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR); ACTRN12622000818730 .
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Affiliation(s)
- Mei Jun Tran
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Ben Smith
- Ingham Institute for Applied Medical Research and South West Sydney Clinical Campuses, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Lynch
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Andrew Love Cancer Centre, Barwon Health, Geelong, Victoria, Australia
| | - Haryana M Dhillon
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Camperdown, NSW, Australia.,Faculty of Science, School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Camperdown, NSW, Australia
| | - Joanne Shaw
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, The University of Sydney, Camperdown, NSW, Australia
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan White
- Consumer Representative, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Consumer Representative, Continence Foundation of Australia, Melbourne, Victoria, Australia
| | - Clare Halloran
- Consumer Representative, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Wiesenfeld
- Director Head and Neck Tumour Stream, Melbourne Health and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Lead in Research and Education Head and Neck, VCCC Alliance, Melbourne, Victoria, Australia.,Honorary Clinical Professor, The University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Howren MB, Christensen AJ, Pagedar NA. Examination of risk factors for discontinuation of follow-up care in patients with head and neck cancer. Cancer Med 2022; 12:631-639. [PMID: 35692193 PMCID: PMC9844614 DOI: 10.1002/cam4.4944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Little research has examined discontinuation of follow-up care in patients with head and neck cancer. This exploratory study sought to examine key demographic, disease, and behavioral factors as possible correlates of discontinuation (N = 512). METHODS Cross-sectional study examined correlates of discontinuation of follow-up care within 1 year. The primary outcome was defined as a disease-free survivor not returning to cancer clinic for two consecutive follow-up appointments within the first year of care and not reentering oncologic care at any point thereafter. Demographic, disease, and behavioral factors were examined using multivariable logistic regression. RESULTS One hundred twenty-six (24.6%) patients discontinued by 12-month follow-up. Being unmarried (OR = 1.28, 95% CI = 1.01-1.63, p = 0.041) and having elevated depressive symptomatology (OR = 1.04, 95% CI = 1.01-1.07, p = 0.034) were significantly associated with discontinuation. Receipt of a single (vs. multimodal) treatment approached significance (OR = 1.71, 95% CI = 0.96-3.07, p = 0.071). CONCLUSION Approximately one quarter of patients disengaged from important follow-up care within 1 year. Lack of social support, depressive symptomatology, and single treatment modality may be important correlates of discontinuation of care in patients with head and neck cancer. Additional studies of this outcome are needed. Improved understanding of correlates associated with discontinuation could facilitate the identification of at-risk patients and further development of interventions to keep patients engaged at a crucial time in the survivorship care trajectory.
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Affiliation(s)
- M. Bryant Howren
- Department of Behavioral Sciences & Social Medicine, College of MedicineFlorida State UniversityTallahasseeFloridaUSA,Florida Blue Center for Rural Health Research & Policy, College of MedicineFlorida State UniversityTallahasseeFloridaUSA
| | | | - Nitin A. Pagedar
- Department of Otolaryngology—Head and Neck Surgery, Carver College of MedicineThe University of IowaIowa CityIowaUSA
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11
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Price K, Van Abel KM, Moore EJ, Patel SH, Hinni ML, Chintakuntlawar AV, Graner D, Neben-Wittich M, Garces YI, Price DL, Janus JR, Foster NR, Ginos BF, Foote RL, Ma D. Long-term Toxicity, Swallow Function, and Quality of Life on MC1273, a Phase II Study of Dose De-escalation for Adjuvant Chemoradiation in HPV-Positive Oropharyngeal Cancer (HPV-OPC). Int J Radiat Oncol Biol Phys 2022; 114:256-265. [PMID: 35675850 DOI: 10.1016/j.ijrobp.2022.05.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with HPV-OPC are highly curable but risk significant long-term toxicity with standard therapy. This study investigated a de-escalation strategy of decreased adjuvant radiotherapy (RT) and chemotherapy after transoral robotic surgery, and reports on long-term functional and quality of life (QOL) outcomes. METHODS Eligible patients had a p16-positive OPC and ≤10 pack-year smoking history and underwent surgery followed by treatment with either 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks with weekly docetaxel (15 mg/m2) if they had intermediate pathologic risk factors or 36 Gy in 1.8-Gy fractions twice per day over 2 weeks with the same chemotherapy if they had extranodal extension. Toxicity, swallow function, and QOL were measured longitudinally. RESULTS Seventy-nine patients (89.9% male) were treated and eligible for toxicity and functional evaluation. Dry mouth was the most common grade 1 toxicity at 1 year (55.6%), 2 years (53.3%) and 3 years (49.2%). The cumulative rates of grade 2 toxicities at 1, 2, and 3 years, were 1.4%, 6.7%, and 6.8%. There were only two grade 3 toxicities at ≥ 1 year, including a grade 3 fatigue at 2 ½ years, and a grade 3 superficial soft tissue fibrosis at 4 years. There were no grade 4-5 toxicities. No patients were PEG dependent. Swallow function improved by 12 months post-treatment. QOL improved over time by all measurement tools and most patients returned to baseline level of function and QOL. CONCLUSION De-escalated adjuvant therapy for select patients with HPV-OPC resulted in low rates of long-term toxicity, excellent swallow outcomes, and preservation of global and xerostomia-related QOL.
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Affiliation(s)
- Katharine Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
| | | | - Eric J Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Michael L Hinni
- Department of Otolaryngology, Mayo Clinic, Scottsdale, Arizona
| | | | - Darlene Graner
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | - Yolanda I Garces
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel L Price
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey R Janus
- Department of Otolaryngology, Mayo Clinic, Jacksonville, Florida
| | - Nathan R Foster
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Brenda F Ginos
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Corrigan KL, De B, Rooney MK, Ludmir EB, Das P, Smith GL, Taniguchi CM, Minsky BD, Koay EJ, Koong AC, Holliday EB. Patient-Reported Outcomes Following Chemoradiation in Patients with Anal Cancer: A Qualitative Analysis. Adv Radiat Oncol 2022; 7:100986. [PMID: 35662810 PMCID: PMC9157211 DOI: 10.1016/j.adro.2022.100986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
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13
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McDowell L, Rischin D, Gough K, Henson C. Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer. Front Oncol 2022; 12:834068. [PMID: 35242716 PMCID: PMC8885992 DOI: 10.3389/fonc.2022.834068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the most common cancer involving the mucosal surfaces of the head and neck and is associated with a number of etiological factors, including cigarette smoking, alcohol and betel nut consumption and exposure to high-risk human papillomavirus. The risk of HNSCC increases with age, peaking in the seventh and eighth decade, but this varies by anatomical and histological subtype. While several advancements have been made in the treatment of head and neck cancer (HNC) in recent decades, undertaking curative treatment still subjects the majority of HNSCC patients to substantial treatment-related toxicity requiring patients to tolerate a gamut of physical, psychological, and emotional demands on their reserves. In conjunction with other patient-related factors, clinicians involved in treating patients with HNSCC may incorporate advancing chronological age into their decision-making process when determining treatment recommendations. While advancing chronological age may be associated with increased concerns regarding physical treatment tolerability, clinicians may also be concerned about heightened vulnerability in various health and wellbeing outcomes. The available literature, however, does not provide evidence of this vulnerability in patients with advancing age, and, in many instances, older patients self-report greater resilience compared to their younger counterparts. While this data is reassuring it is limited by selection bias and heterogeneity in trial and study design and the absence of a consistent definition of the elderly patient with HNSCC. This narrative review article also includes a review of the measures used to assess HRQL, psychosocial outcomes and unmet needs in elderly or older patients with HNSCC.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
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14
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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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