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Alvarez IA, Ordoyne L, Borne G, Fabian I, Adilbay D, Kandula RA, Asarkar A, Nathan CA, Pang J. Chronic heart failure in patients undergoing major head and neck surgery: A hospital-based study. Am J Otolaryngol 2024; 45:104043. [PMID: 37734364 DOI: 10.1016/j.amjoto.2023.104043] [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: 05/10/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To investigate the effects of chronic heart failure on various post-operative outcomes in head and neck cancer patients undergoing major cancer surgery. STUDY DESIGN For this retrospective cohort study of patients undergoing major head and neck cancer surgery, a sample of 10,002 patients between 2017 and 2019 were identified through the Nationwide Inpatient Sample. SETTING Patients were selected as undergoing major head and neck cancer surgery, defined as laryngectomy, pharyngectomy, glossectomy, neck dissection, mandibulectomy, and maxillectomy, then separated based on pre-surgical diagnosis of chronic heart failure. METHODS The effects of pre-operative chronic heart failure on post-surgical outcomes in these patients were investigated by univariable and multivariable logistic regression using ICD-10 codes and SPSS. RESULTS A diagnosis of chronic heart failure was observed in 265 patients (2.6 %). Patients with chronic heart failure had more preexisting comorbidities when compared to patients without chronic heart failure (mean ± SD; 4 ± 1 vs. 2 ± 1). Multivariable logistic regression showed that chronic heart failure patients had significantly greater odds of dying during hospitalization (OR 2.86, 95 % CI 1.38-5.91) and experiencing non-routine discharge from admission (OR 1.89, 95 % CI 1.41-2.54) after undergoing major head and neck cancer surgery. CONCLUSION Chronic heart failure is associated with greater length of stay and hospital charges among head and neck cancer patients undergoing major head and neck cancer surgeries. Chronic heart failure patients have significantly greater rates of unfavorable post-operative outcomes, including death during hospitalization and non-routine discharge from admission.
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Affiliation(s)
- Ivan A Alvarez
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Liam Ordoyne
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Grant Borne
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Isabella Fabian
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Dauren Adilbay
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Rema A Kandula
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Ameya Asarkar
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America; Feist Weiller Cancer Center, United States of America
| | - Cherie-Ann Nathan
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America; Feist Weiller Cancer Center, United States of America
| | - John Pang
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America; Feist Weiller Cancer Center, United States of America.
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List MA, Calligas JP, Pang J, Asarkar AA, Nathan CAO. Why Wait Until After Surgery? The Case for Pre-habilitation in Head and Neck Cancer Care. Laryngoscope 2023; 133:3235-3236. [PMID: 37334876 DOI: 10.1002/lary.30827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Marna A List
- Department of Otolaryngology Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Jason P Calligas
- Department of Otolaryngology Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - John Pang
- Department of Otolaryngology Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Ameya A Asarkar
- Department of Otolaryngology Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
| | - Cherie-Ann O Nathan
- Department of Otolaryngology Head and Neck Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana, USA
- Ochsner LSU Health- Feist-Weiller Cancer Center, Shreveport, Louisiana, USA
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List MA, Knackstedt M, Liu L, Kasabali A, Mansour J, Pang J, Asarkar AA, Nathan C. Enhanced recovery after surgery, current, and future considerations in head and neck cancer. Laryngoscope Investig Otolaryngol 2023; 8:1240-1256. [PMID: 37899849 PMCID: PMC10601592 DOI: 10.1002/lio2.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/15/2022] [Indexed: 10/31/2023] Open
Abstract
Objectives Review of the current and relevant literature to develop a list of evidence-based recommendations that can be implemented in head and neck surgical practices. To provide rationale for the multiple aspects of comprehensive care for head and neck surgical patients. To improve postsurgical outcomes for head and neck surgical patients. Methods Extensive review of the medical literature was performed and relevant studies in both the head and neck surgery and other surgical specialties were considered for inclusion. Results A total of 18 aspects of perioperative care were included in this review. The literature search included 276 publications considered to be the most relevant and up to date evidence. Each topic is concluded with recommendation grade and quality of evidence for the recommendation. Conclusion Since it's conception, enhanced recovery after surgery (ERAS) protocols have continued to push for comprehensive and evidence based postsurgical care to improve patient outcomes. Head and neck oncology is one of the newest fields to develop a protocol. Due to the complexity of this patient population and their postsurgical needs, a multidisciplinary approach is needed to facilitate recovery while minimizing complications. Current and future advances in head and neck cancer research will serve to strengthen and add new principles to a comprehensive ERAS protocol. Level of Evidence 2a.
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Affiliation(s)
- Marna A. List
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Mark Knackstedt
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Lucy Liu
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Ahmad Kasabali
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
- College of MedicineLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Jobran Mansour
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - John Pang
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Ameya A. Asarkar
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
- Feist‐Weiller Cancer CenterShreveportLouisianaUSA
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Midgley AW, Levy AR, Rogers SN, Brooker RC, Bryant V, Cherry MG, Lane S, Nugent MM, Price R, Schache AG, Young B, Patterson JM. ACTivity as medicine In Oncology for Head and Neck (ACTIOHN): Protocol for a feasibility study investigating a patient-centred approach to exercise for people with head and neck cancer. PLoS One 2023; 18:e0289911. [PMID: 37624789 PMCID: PMC10456155 DOI: 10.1371/journal.pone.0289911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND AIM Attempts at personalisation of exercise programmes in head and neck cancer (HaNC) have been limited. The main aim of the present study is to investigate the feasibility and acceptability of introducing a remotely delivered, fully personalised, collaborative, and flexible approach to prescribing and delivering exercise programmes into the HaNC usual care pathway. METHODS This is a single arm, feasibility study. Seventy patients diagnosed with HaNC will be recruited from two regional HaNC centres in the United Kingdom. Patients will undertake an 8-week exercise programme designed and delivered by cancer exercise specialists. The exercise programme will start any time between the time of diagnosis and up to 8 weeks after completing treatment, depending on patient preference. The content of the exercise programme will be primarily based on patient needs, preferences, and goals, but guided by current physical activity guidelines for people with cancer. The primary outcome measure is retention to the study. Secondary quantitative outcomes are uptake to the exercise programme, different measures of exercise adherence, pre- and post-intervention assessments of fatigue (Multidimensional Fatigue Symptom Inventory-Short Form), quality of life (SF-36), physical activity levels (International Physical Activity Questionnaire-Short Form), and various components of physical fitness. The outcomes of the nested qualitative study are acceptability and feasibility of the intervention evaluated via interviews with patients, health care professionals, and the cancer exercise specialists. Intervention and participant fidelity will be determined using checklists and scrutiny of each patient's logbook and the cancer exercise specialists' meeting notes. Analysis of quantitative data will be via standard summary statistics. Qualitative data will be analysed using thematic analysis. EXPECTED RESULTS This feasibility study will inform the design and conduct of a future randomised controlled trial. Success will be defined according to a traffic light system for identifying the appropriateness of progression to a randomised controlled trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number registry (ISRCTN82505455).
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Affiliation(s)
- Adrian W. Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, United Kingdom
- Health Research Institute, Edge Hill University, Ormskirk, Lancashire, United Kingdom
| | - Andrew R. Levy
- Health Research Institute, Edge Hill University, Ormskirk, Lancashire, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Simon N. Rogers
- Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - Rachel C. Brooker
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Valerie Bryant
- Cancer of Head and Neck Group Experience (CHANGE) Patient and Public Involvement Group, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Mary Gemma Cherry
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Steven Lane
- Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Michael M. Nugent
- Oral and Maxillofacial Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Ruth Price
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew G. Schache
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - Bridget Young
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Joanne M. Patterson
- Liverpool Head and Neck Centre, School of Health Science, University of Liverpool, Liverpool, United Kingdom
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Saraiva PSDS, Silveira JD, Moratelli JA, Alexandre KH, Dias M, Guimarães ACDA. An Overview on the Evidence of Physical Activity Interventions in the Health of Individuals with Head and Neck Cancer: Literature Systematic Review. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2023v69n1.2652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Head and neck cancer is considered a global public health problem, which arises in aesthetically and functionally critical areas. The practice of physical exercise has been considered one of the significant and effective non-pharmacological strategies to minimize the physical and psychological consequences. Objective: To analyze the evidence of physical activity interventions in the physical and psychological health of individuals with head and neck cancer. Method: A systematic review was conducted blindly and independently, from March to May 2021, according to the PRISMA guidelines. The search was performed in the following databases: PubMed Central®; Cochrane Library; Web of Science, Scopus, ScienceDirect. Results: Of the 515 selected studies, 15 were included in this systematic review with a total of 670 participants aged between 18 and 76 years old. The studies included aerobic exercises, endurance, mobility, stretching, strengthening, and yoga. Conclusion: Evidence proves that physical activity interventions performed with individuals with head and neck cancer may be beneficial in the treatment and physical/psychological health of this population. This study may help new researches considering the detailed information described previously regarding the interventions applied, in addition to discussing the most used instruments with this public and indicating the modalities that are being safely performed. It is suggested that more randomized trials be conducted to obtain more concise results.
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Nett H, Steegmann J, Tollkühn-Prott B, Hölzle F, Modabber A. A prospective randomized comparative trial evaluating postoperative nutritional intervention in patients with oral cancer. Sci Rep 2022; 12:14213. [PMID: 35987809 PMCID: PMC9392772 DOI: 10.1038/s41598-022-18292-8] [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: 03/13/2022] [Accepted: 08/09/2022] [Indexed: 11/14/2022] Open
Abstract
Extensive surgical treatment of oral cancer results in significant deterioration of nutritional status with concomitant increased nutrient requirements. The consequences are an elevated risk of postoperative complaints as well as morbidity and mortality. The aim of this study was to investigate an additional postoperative nutritional intervention through professional nutritional advice and nutritional supplementation in patients with oral cancer for at least six months. 62 patients with oral cancer in the department of oral and maxillofacial surgery were randomized into two groups. The intervention group received nutritional supplements, protein-rich, high-fiber diet and care by a professional nutritionist in addition to the standard treatment. The control group received only the standard treatment. Statistical analysis includes the evaluation of means and standard deviations as well as the calculation of p values with a significance level of 0.05. A deficiency of protein, albumin, vitamin D, zinc and iron was noticed in both groups immediately after surgery. Patients in the intervention group recorded significantly less weight loss (pT2 = 0.0031, pT4 = 0.0424), a more stable BMI (pT2 = 0.0496), better values for albumin (pT2 = 0.0265), vitamin A (pT3 = 0.0248, pT4 = 0.0007) and calcium (pT3 = 0.0362) during the follow-ups. The patients in the intervention group showed significantly fewer digestive problems (p = 0.0062) and muscular complaints (p = 0.0448). They showed better eating habits (p = 0.0348) and were capable of more physical activity (p = 0.0045) than patients in the control group. Patients with oral cancer can have a benefit from postoperative nutritional intervention. Early screening, appropriate care by a nutritionist and supplementation with vitamin D, zinc, calcium and protein-rich food are recommended.
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Impact of Early Mobilization on Recovery after Major Head and Neck Surgery with Free Flap Reconstruction. Cancers (Basel) 2021; 13:cancers13122852. [PMID: 34201003 PMCID: PMC8227616 DOI: 10.3390/cancers13122852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary For patients diagnosed with head and neck cancer (HNC), surgery to remove the tumour is a standard treatment. The surgery is complex-in most cases, the mouth and throat need to be rebuilt using tissue from another area of the body to restore appearance and function. Recovery from HNC surgery is challenging, and complications occur frequently. It is recommended that patients get out of bed and move (are “mobilized”) as early as possible after surgery (within 24 h) to improve recovery. However, evidence for this recommendation mainly comes from other types of cancer. Therefore, this study investigated whether early mobilization impacts recovery in patients undergoing HNC surgery. We found that delaying mobilization (after 24 h) was linked with more complications and a longer stay in the hospital. Helping patients mobilize within 24 h after HNC surgery should be a priority for healthcare teams. Abstract Surgery with free flap reconstruction is a standard treatment for head and neck cancer (HNC). Because of the complexity of HNC surgery, recovery can be challenging, and complications are common. One of the foundations of enhanced recovery after surgery (ERAS) is early postoperative mobilization. The ERAS guidelines for HNC surgery with free flap reconstruction recommend mobilization within 24 h. This is based mainly on evidence from other surgical disciplines, and the extent to which mobilization within 24 h improves recovery after HNC surgery has not been explored. This retrospective analysis included 445 patients from the Calgary Head and Neck Enhanced Recovery Program. Mobilization after 24 h was associated with more complications of any type (OR = 1.73, 95% CI [confidence interval] = 1.16–2.57) and more major complications (OR = 1.76; 95% CI = 1.00–3.16). When accounting for patient and clinical factors, mobilization after 48 h was a significant predictor of major complications (OR = 2.61; 95% CI = 1.10–6.21) and prolonged length of stay (>10 days; OR = 2.85, 95% CI = 1.41–5.76). This comprehensive analysis of the impact of early mobilization on postoperative complications and length of stay in a large HNC cohort provides novel evidence supporting adherence to the ERAS early mobilization recommendations. Early mobilization should be a priority for patients undergoing HNC surgery with free flap reconstruction.
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Hunter M, Kellett J, Toohey K, D’Cunha NM, Isbel S, Naumovski N. Toxicities Caused by Head and Neck Cancer Treatments and Their Influence on the Development of Malnutrition: Review of the Literature. Eur J Investig Health Psychol Educ 2020; 10:935-949. [PMID: 34542427 PMCID: PMC8314324 DOI: 10.3390/ejihpe10040066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023] Open
Abstract
Malnutrition poses a significant problem for oncology patients, resulting in fatalities within this population. Patients with head and neck cancer (HNC) are at high risk, with up to 90% developing malnutrition. Common treatments used for HNC can often lead to adverse side effects, including oral health conditions, gastrointestinal upsets, and several metabolic changes. Consequently, treatments can cause inadequate nutritional intake, resulting in a reduction in energy consumption, and alterations in energy utilization, contributing to the development of malnutrition. Furthermore, the presence of these treatment toxicities, and the related malnutrition can lead to reduced quality of life, weight loss, and psychological distress. There are interventions available (nutritional, medicinal, and physical therapies) that have demonstrated potential effectiveness in reducing the severity of symptomatic toxicities, reducing the risk of malnutrition, and improving survival outcomes of patients with HNC. Based on the findings of this review, there is an urgent need for the implementation or continuation of multi-disciplinary strategies, as well as updated and improved guidelines to assist in the prevention and treatment of malnutrition caused by treatment-related toxicities in patients with HNC.
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Affiliation(s)
- Maddison Hunter
- Faculty of Health, University of Canberra, Bruce, 2617 ACT, Australia; (M.H.); (J.K.); (K.T.); (S.I.)
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, 2617 ACT, Australia
| | - Jane Kellett
- Faculty of Health, University of Canberra, Bruce, 2617 ACT, Australia; (M.H.); (J.K.); (K.T.); (S.I.)
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, 2617 ACT, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, 2617 ACT, Australia
| | - Kellie Toohey
- Faculty of Health, University of Canberra, Bruce, 2617 ACT, Australia; (M.H.); (J.K.); (K.T.); (S.I.)
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, 2617 ACT, Australia
| | - Nathan M. D’Cunha
- Faculty of Health, University of Canberra, Bruce, 2617 ACT, Australia; (M.H.); (J.K.); (K.T.); (S.I.)
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, 2617 ACT, Australia
| | - Stephen Isbel
- Faculty of Health, University of Canberra, Bruce, 2617 ACT, Australia; (M.H.); (J.K.); (K.T.); (S.I.)
| | - Nenad Naumovski
- Faculty of Health, University of Canberra, Bruce, 2617 ACT, Australia; (M.H.); (J.K.); (K.T.); (S.I.)
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Bruce, 2617 ACT, Australia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Athens, Greece
- Correspondence: ; Tel.: +61 (0)2-6206-8719
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