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Contrera KJ, Tam S, Pytynia K, Diaz EM, Hessel AC, Goepfert RP, Lango M, Su SY, Myers JN, Weber RS, Eguia A, Pisters PWT, Adair DK, Nair AS, Rosenthal DI, Mayo L, Chronowski GM, Zafereo ME, Shah SJ. Impact of Cancer Care Regionalization on Patient Volume. Ann Surg Oncol 2023; 30:2331-2338. [PMID: 36581726 DOI: 10.1245/s10434-022-13029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cancer centers are regionalizing care to expand patient access, but the effects on patient volume are unknown. This study aimed to compare patient volumes before and after the establishment of head and neck regional care centers (HNRCCs). METHODS This study analyzed 35,394 unique new patient visits at MD Anderson Cancer Center (MDACC) before and after the creation of HNRCCs. Univariate regression estimated the rate of increase in new patient appointments. Geospatial analysis evaluated patient origin and distribution. RESULTS The mean new patients per year in 2006-2011 versus 2012-2017 was 2735 ± 156 patients versus 3155 ± 207 patients, including 464 ± 78 patients at HNRCCs, reflecting a 38.4 % increase in overall patient volumes. The rate of increase in new patient appointments did not differ significantly before and after HNRCCs (121.9 vs 95.8 patients/year; P = 0.519). The patients from counties near HNRCCs, showed a 210.8 % increase in appointments overall, 33.8 % of which were at an HNRCC. At the main campus exclusively, the shift in regional patients to HNRCCs coincided with a lower rate of increase in patients from the MDACC service area (33.7 vs. 11.0 patients/year; P = 0.035), but the trend was toward a greater increase in out-of-state patients (25.7 vs. 40.3 patients/year; P = 0.299). CONCLUSIONS The creation of HNRCCs coincided with stable increases in new patient volume, and a sizeable minority of patients sought care at regional centers. Regional patients shifted to the HNRCCs, and out-of-state patient volume increased at the main campus, optimizing access for both local and out-of-state patients.
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Affiliation(s)
- Kevin J Contrera
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samantha Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Kristen Pytynia
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo M Diaz
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miriam Lango
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arturo Eguia
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | | | - Deborah K Adair
- Department of Global Business Development, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ajith S Nair
- Department of Global Business Development, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren Mayo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory M Chronowski
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Shalin J Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Chhabria K, Bonnen M, Asper J, Carnaby GD. Feasibility and value of salivary cortisol sampling to reflect distress in head and neck cancer patients undergoing chemoradiation: A proof-of-concept study. INTERNATIONAL JOURNAL OF ONCOLOGY RESEARCH 2022; 5:043. [PMID: 36408337 PMCID: PMC9671390 DOI: 10.23937/2643-4563/1710043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Head and neck cancer (HNC) patients undergoing chemo/radiation commonly experience severe and persistent distress associated with treatment related fear and physical side effects such as xerostomia, dysphagia, and dryness of mouth. Cortisol, a stress sensitive hormone, can be easily measured in saliva to reflect biobehavioral responses to such stressors. Unfortunately, it has not been used in this population due to concerns associated with chemoradiation (C/RT) related xerostomia. METHODS In a proof-of-concept study, we explored the feasibility of collecting salivary cortisol as a marker of fear and distress in HNC patients. Ten HNC subjects undergoing C/RT provided saliva samples for 3 consecutive days across three timepoints (pre-treatment, 3-weeks and 1-month post-treatment) and completed concurrent depression, anxiety and swallowing related fear measures. RESULTS Salivary cortisol collection adherence was between 80-60%. It was not impacted by xerostomia. Diurnal cortisol pattern demonstrated dysregulation at pretreatment in 62%, and flattened aberrant slopes continued at 3-weeks and beyond in 50% of subjects. CONCLUSIONS Our study supports the feasibility and utility of salivary cortisol measurement in HNC patients across the treatment trajectory. Diurnal cortisol measures may be a valuable tool to detect and monitor treatment distress during C/RT in this population.
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Affiliation(s)
- Karishma Chhabria
- Department of Management, Policy and Community Health, University of Texas Health Science Center, Houston, TX, USA
| | - Mark Bonnen
- Radiation Oncology, University of Texas health Science Center, San Antonio, TX USA
| | - Joshua Asper
- Radiation Oncology, University of Texas health Science Center, San Antonio, TX USA
| | - Giselle D Carnaby
- School of Health Sciences, University of Texas Health Science Center, San Antonio, TX, USA
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3
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Miller J, Szalacha LA, Hartranft SR, Rodriguez C. Radiation Therapy: Predictors of Nonadherence to Treatment Schedules Among Patients With Head and Neck Cancer. Clin J Oncol Nurs 2021; 25:305-313. [PMID: 34019027 DOI: 10.1188/21.cjon.305-313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with head and neck cancer (HNC) often undergo a demanding treatment schedule, including radiation therapy (RT). Nonadherence to RT schedules is a documented problem among patients with HNC and can negatively affect patient outcomes. OBJECTIVES This retrospective, descriptive study aimed to examine whether demographic or clinical characteristics or physical and psychological symptoms were associated with nonadherence to RT among patients with HNC. METHODS Electronic health records of 262 patients with HNC who received treatment at a cancer center in the southeastern United States were reviewed to determine whether nonadherence was related to symptom scores and other patient- and clinical-related factors. FINDINGS Patients at highest risk for nonadherence included women, those admitted as inpatients during treatment, and those who received outpatient IV fluids during treatment. Nonadherent patients reported higher mean scores on 9 of 12 symptoms measured during treatment, indicating a higher symptom burden. Patients with tongue tumors, greater spiritual well-being, and less constipation were less likely to be nonadherent.
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Krekeler BN, Vitale K, Yee J, Powell R, Rogus-Pulia N. Adherence to Dysphagia Treatment Recommendations: A Conceptual Model. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:1641-1657. [PMID: 32432958 PMCID: PMC7839030 DOI: 10.1044/2020_jslhr-19-00270] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 05/14/2023]
Abstract
Purpose Conceptual models of complex health problems are useful when designing targeted clinical interventions and focused research studies. Understanding and studying patient adherence often involves interplay among many factors that influence whether a patient successfully follows recommendations or completes a therapy program. Functional frameworks serve to arrange these factors visually, increasing interpretability and allowing for empirical testing of relationships among concepts. The purpose of this article is to integrate relevant factors from the literature into a comprehensive framework that describes adherence to dysphagia treatment. Method Using peer-reviewed, published guidelines regarding conceptual model construction, the authors created a list of potential factors that influence patient adherence to dysphagia-related treatment recommendations. During model construction, following extensive review of the literature and existing theories that have been applied in other areas of health care, factors were identified and grouped into conceptually similar domains (clusters). Clusters were arranged into larger categories that emerged during model optimization. Ultimately, two models were created: one that illustrates the interrelated factors of patient adherence and another that illustrates a subset of modifiable risk factors that a clinical speech-language pathologist may influence when developing a dysphagia treatment plan. Results Three general categories from 14 factors emerged based on relationships between factors and aspects of patient care: health factors, individual patient factors, and contextual factors. A second model consisting of modifiable risk factors included access, treatment type, patient perceptions, self-efficacy, health literacy, support factors, and provider bias. Conclusions This conceptual model allows clinicians and researchers to identify and explore the mechanisms driving adherence. Continual refinements of this model should be made as future studies uncover how the interconnectedness of factors affects adherence in dysphagia management. The models we have presented here are ready for clinical application and should also serve researchers as they generate hypotheses and design targeted research questions.
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Affiliation(s)
- Brittany N. Krekeler
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Otolaryngology–Head & Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Kailey Vitale
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
| | - Joanne Yee
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
| | - Ryan Powell
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
| | - Nicole Rogus-Pulia
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
- Otolaryngology–Head & Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, WI
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5
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Harris A, Lyu L, Wasserman-Winko T, George S, Johnson JT, Nilsen ML. Neck Disability and Swallowing Function in Posttreatment Head and Neck Cancer Patients. Otolaryngol Head Neck Surg 2020; 163:763-770. [DOI: 10.1177/0194599820923630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective To examine the relationship between symptoms of neck disability and swallowing dysfunction among head and neck cancer (HNC) survivors. Study Design Cross-sectional analysis. Setting Single-center, university-affiliated HNC survivorship clinic. Subjects and Methods Survivors’ patient-reported symptoms of neck disability and swallowing dysfunction were prospectively collected from March 2017 to May 2018. Neck disability and swallowing dysfunction were measured using the Neck Disability Index and Eating Assessment Tool (EAT-10), respectively. Linear regression was used to analyze the association between neck disability and swallowing dysfunction. Results A total of 179 survivors, predominantly male (n = 130, 72.6%) with an average age of 64.64 ± 9.91 years, were included in the analysis. Primary cancer sites were oropharynx (n = 85, 47.5%), oral cavity (n = 59, 33.0%), and larynx/hypopharynx (n = 35, 19.5%). Mean EAT-10 score was 10.07 ± 10.89 (range = 0-40; >2 indicative of swallowing dysfunction). Survivors treated for early stage cancer had lower EAT-10 scores than those with advanced stage (early = 3.55 ± 7.46; advanced = 11.95 ± 11.02, P < .001). After controlling for age, time since treatment, American Joint Committee on Cancer stage, and treatment modality, the EAT-10 score for patients with mild neck disability was 6.88 (95% confidence interval [CI], 3.71-10.06; P < .001) points higher than those without neck disability, and the score for those with moderate-complete neck disability was 13.65 (95% CI, 9.47-17.83; P < .001) points higher than those without neck disability. Conclusions Swallowing dysfunction is a commonly recognized effect of HNC treatment. The prevalence and burden of neck disability are shown to be highly correlated with swallowing dysfunction. These results support the need for comprehensive, multidisciplinary rehabilitation interventions for patients with HNC.
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Affiliation(s)
- Alexandria Harris
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lingyun Lyu
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tamara Wasserman-Winko
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan George
- Centers for Rehab Services, UPMC, Pittsburgh, Pennsylvania, USA
| | - Jonas T. Johnson
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marci Lee Nilsen
- Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Krekeler BN, Broadfoot CK, Johnson S, Connor NP, Rogus-Pulia N. Patient Adherence to Dysphagia Recommendations: A Systematic Review. Dysphagia 2018; 33:173-184. [PMID: 28965240 PMCID: PMC5866734 DOI: 10.1007/s00455-017-9852-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022]
Abstract
Patient adherence to treatment recommendations is an important issue for healthcare providers, in a multitude of specialties, and is critical when assessing the efficacy and effectiveness of a particular treatment approach. Patients who have swallowing impairment often require complex and specific interventions requiring altered daily patterns of behavior. Patients with dysphagia who do not follow recommendations or prescribed exercises may not receive maximum benefit of an intervention. Poor adherence also makes it more difficult to evaluate efficacy of a treatment both clinically and in experimental settings. Further, swallow safety can be compromised if certain recommendations are not followed. Our purpose was to systematically review the literature to understand what is known about adherence within the field of dysphagia treatment. We systematically identified 12 studies that tracked and reported patient-specific adherence. In this review, we found that the average adherence rate from these studies ranges between 21.9 and 51.9%. Adherence to prophylactic treatment recommendations for patients with head and neck cancer was the focus in 9/12 studies. The findings of this review identify a large gap in knowledge regarding adherence to dysphagia treatment. Few studies account for adherence within their study designs. When planning dysphagia treatment studies, it is imperative that investigators include information regarding patient adherence to accurately interpret findings. Given the variable adherence rates found in this review, factors influencing patient adherence with dysphagia treatments should be identified to increase adherence in future trials.
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Affiliation(s)
- Brittany N Krekeler
- Department of Communication Sciences and Disorders, Medical Science Center, University of Wisconsin, 1300 University Avenue, Room 483, Madison, WI, 53706, USA.
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, 1975 Willow Drive, 361 Goodnight Hall, Scott H, Madison, WI, 53706-1103, USA.
| | - Courtney K Broadfoot
- Department of Communication Sciences and Disorders, Medical Science Center, University of Wisconsin, 1300 University Avenue, Room 483, Madison, WI, 53706, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, 1975 Willow Drive, 361 Goodnight Hall, Scott H, Madison, WI, 53706-1103, USA
| | - Stephen Johnson
- Ebling Library, Health Sciences Learning Center, University of Wisconsin, Room 2336, 750 Highland Avenue, Madison, WI, 53705-2221, USA
| | - Nadine P Connor
- Department of Communication Sciences and Disorders, Medical Science Center, University of Wisconsin, 1300 University Avenue, Room 483, Madison, WI, 53706, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, 1975 Willow Drive, 361 Goodnight Hall, Scott H, Madison, WI, 53706-1103, USA
| | - Nicole Rogus-Pulia
- Department of Communication Sciences and Disorders, Medical Science Center, University of Wisconsin, 1300 University Avenue, Room 483, Madison, WI, 53706, USA
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin, 1975 Willow Drive, 361 Goodnight Hall, Scott H, Madison, WI, 53706-1103, USA
- Department of Medicine-Geriatrics and Gerontology, University of Wisconsin-Madison, Madison, WI, 53705, USA
- Geriatric Research Education and Clinical Center (GRECC) Veterans Administration Hospital, William S. Middleton Memorial Hospital, D5216, 2500 Overlook Terrace, Madison, WI, 53705, USA
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Zimmaro LA, Sephton SE, Siwik CJ, Phillips KM, Rebholz WN, Kraemer HC, Giese-Davis J, Wilson L, Bumpous JM, Cash ED. Depressive symptoms predict head and neck cancer survival: Examining plausible behavioral and biological pathways. Cancer 2018; 124:1053-1060. [PMID: 29355901 DOI: 10.1002/cncr.31109] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/25/2017] [Accepted: 10/10/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Head and neck cancers are associated with high rates of depression, which may increase the risk for poorer immediate and long-term outcomes. Here it was hypothesized that greater depressive symptoms would predict earlier mortality, and behavioral (treatment interruption) and biological (treatment response) mediators were examined. METHODS Patients (n = 134) reported depressive symptomatology at treatment planning. Clinical data were reviewed at the 2-year follow-up. RESULTS Greater depressive symptoms were associated with significantly shorter survival (hazard ratio, 0.868; 95% confidence interval [CI], 0.819-0.921; P < .001), higher rates of chemoradiation interruption (odds ratio, 0.865; 95% CI, 0.774-0.966; P = .010), and poorer treatment response (odds ratio, 0.879; 95% CI, 0.803-0.963; P = .005). The poorer treatment response partially explained the depression-survival relation. Other known prognostic indicators did not challenge these results. CONCLUSIONS Depressive symptoms at the time of treatment planning predict overall 2-year mortality. Effects are partly influenced by the treatment response. Depression screening and intervention may be beneficial. Future studies should examine parallel biological pathways linking depression to cancer survival, including endocrine disruption and inflammation. Cancer 2018;124:1053-60. © 2018 American Cancer Society.
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Affiliation(s)
- Lauren A Zimmaro
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Sandra E Sephton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky.,James Graham Brown Cancer Center, Louisville, Kentucky
| | - Chelsea J Siwik
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Kala M Phillips
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Whitney N Rebholz
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky
| | - Helena C Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, California
| | - Janine Giese-Davis
- Alberta Health Services Center Care (Holy Cross Site), Calgary, Alberta, Canada.,Division of Psychosocial Oncology, Department of Oncology, Faculty of Medicine, University of Calgary, Alberta, Canada.,Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Liz Wilson
- James Graham Brown Cancer Center, Louisville, Kentucky.,Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jeffrey M Bumpous
- James Graham Brown Cancer Center, Louisville, Kentucky.,Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky
| | - Elizabeth D Cash
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky.,James Graham Brown Cancer Center, Louisville, Kentucky.,Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky
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Mak M, Bell K, Ng W, Lee M. Nutritional status, management and clinical outcomes in patients with esophageal and gastro-oesophageal cancers: A descriptive study. Nutr Diet 2016; 74:229-235. [PMID: 28731604 DOI: 10.1111/1747-0080.12306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 05/21/2016] [Accepted: 06/13/2016] [Indexed: 12/30/2022]
Abstract
AIM The aims of this study were to investigate the nutritional management practice and nutritional status of patients with oesophageal and gastro-oesophageal cancers, and to propose strategies for improving their nutritional and clinical outcomes. METHODS All patients diagnosed with oesophageal and gastro-oesophageal cancers and treated with chemotherapy and/or radiotherapy at the Liverpool Cancer Therapy Centre (between August 2010 and February 2014) were included in this retrospective study. Patient and tumour characteristics, nutritional status and management were compared to clinical outcomes. RESULTS A total of 69 patients met the inclusion criteria. The median weight loss prior to treatment commencement was 10.5% (Interquartile Range (IQR) = 6.6-15.4). A decline in nutritional status continued throughout the treatment course. The median percentage of weight loss during treatment was 3.53% (IQR = 0.00-6.84). Seven and 19 patients required nutrition intervention using a feeding tube or stent insertion to manage dysphagia, respectively. In patients treated with a curative intent, radiotherapy was completed in 100% of those with a nasogastric tube insertion as compared to 80% who had a stent insertion. There was a higher percentage of patients from culturally and linguistically diverse (CALD) background, experiencing significant weight loss when compared with their non-CALD counterparts (P = 0.04). CONCLUSIONS Patients with oesophageal and gastro-oesophageal cancers commonly present with significant weight loss and this continues during the course of their anti-cancer treatment. A standardised protocol of nutrition management for these cancer patients is recommended, focusing on assisting patients from CALD backgrounds.
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Affiliation(s)
- May Mak
- Dietetics Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Katherine Bell
- Dietetics Department, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Weng Ng
- Department of Medical Oncology, Liverpool Cancer Therapy Centre, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, University of Western Sydney, Liverpool, New South Wales, Australia
| | - Mark Lee
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Davis RM, Sowers AL, DeGraff W, Bernardo M, Thetford A, Krishna MC, Mitchell JB. A novel nitroxide is an effective brain redox imaging contrast agent and in vivo radioprotector. Free Radic Biol Med 2011; 51:780-90. [PMID: 21664459 PMCID: PMC3131550 DOI: 10.1016/j.freeradbiomed.2011.05.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 05/10/2011] [Accepted: 05/16/2011] [Indexed: 10/18/2022]
Abstract
Individuals are exposed to ionizing radiation during medical procedures and nuclear disasters, and this exposure can be carcinogenic, toxic, and sometimes fatal. Drugs that protect individuals from the adverse effects of radiation may therefore be valuable countermeasures against the health risks of exposure. In the current study, the LD(50/30) (the dose resulting in 50% of exposed mice surviving 30 days after exposure) was determined in control C3H mice and mice treated with the nitroxide radioprotectors Tempol, 3-CP, 16c, 22c, and 23c. The pharmacokinetics of 22c and 23c were measured with magnetic resonance imaging (MRI) in the brain, blood, submandibular salivary gland, liver, muscle, tongue, and myocardium. It was found that 23c was the most effective radioprotector of the five studied: 23c increased the LD(50/30) in mice from 7.9±0.15Gy (treated with saline) to 11.47±0.13Gy (an increase of 45%). Additionally, MRI-based pharmacokinetic studies revealed that 23c is an effective redox imaging agent in the mouse brain, and that 23c may allow functional imaging of the myocardium. The data in this report suggest that 23c is currently the most potent known nitroxide radioprotector, and that it may also be useful as a contrast agent for functional imaging.
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Affiliation(s)
- Ryan M Davis
- Radiation Biology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
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10
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McNeely ML, Parliament MB, Seikaly H, Jha N, Magee DJ, Haykowsky MJ, Courneya KS. Predictors of adherence to an exercise program for shoulder pain and dysfunction in head and neck cancer survivors. Support Care Cancer 2011; 20:515-22. [DOI: 10.1007/s00520-011-1112-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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11
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Wilson FL, Mood D, Nordstrom CK, Risk J. The effect of low literacy on the self-care behaviors of men receiving radiation therapy. Nurs Sci Q 2011; 23:326-33. [PMID: 20871005 DOI: 10.1177/0894318410380254] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Using Orem's theory as the framework, two purposes guided the study: (a) to test the effectiveness of an audio-visual education program and behavioral contracting to promote self-care behaviors in managing radiation side effects and (b) to determine the extent to which low literacy affects self-care abilities. Seventy men diagnosed with prostate cancer participated in this experimental study. The nursing interventions of education and behavioral contracting significantly increased the self-care behaviors of men in managing radiation side effects. An increase in self-care behaviors was especially shown in men with low-literacy skills.
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12
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Fox E, Barrett-McNeil K, Khoo LH, Middleton M. Nurse led electronic toxicity scoring in head and neck radiotherapy. Eur J Oncol Nurs 2010; 15:112-7. [PMID: 20678960 DOI: 10.1016/j.ejon.2010.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/22/2010] [Accepted: 06/24/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE OF THE STUDY In order to improve 'adherence' to a course of treatment for head and neck radiotherapy, patients need to be managed frequently. In order to achieve this in a busy clinical environment streamlined electronic tools must be utilised. By providing nursing teams with the capacity to conduct electronic toxicity scoring on a bi-weekly basis, adherence can be improved and closer attention paid to head and neck radiotherapy toxicities. METHODS AND MATERIALS A convenience sample of 20 patients undergoing head and neck radiotherapy was analysed. Each of these patients had electronic toxicity data recorded on a bi-weekly basis for dysphagia, mucositis, skin reaction and weight loss. This information was then extracted from the ARIA™ patient information system and analysed. Additionally the time taken for the nursing team to undertake each patient review was also extracted from ARIA™. RESULTS The efficiencies offered by an electronic medical record allow comprehensive toxicity data to be recorded and analysed effortlessly. The average time taken to review these patients on a bi-weekly basis was 6.97 min and contained on average 60 words of toxicity description and action. CONCLUSION Electronic toxicity scoring offers many advantages to the radiation oncology nurse, increased efficiency allows more frequent patient interaction which will in turn aid adherence. In order to better manage the treatment course of head and neck radiotherapy patients, nurses must be provided with streamlined and efficient electronic means of recording data. In this way it is possible to review head and neck radiotherapy patients bi-weekly.
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Affiliation(s)
- Emily Fox
- Radiation Oncology Queensland, Toowoomba 4350, Australia.
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