Cancer Rehabilitation:: Acute and Chronic Issues, Nerve Injury, Radiation Sequelae, Surgical and Chemo-Related, Part 2

Gold nanomaterials for oral cancer diagnosis and therapy: Advances, challenges, and prospects

Early diagnosis and treatment of oral cancer are vital for patient survival. Since the oral cavity accommodates the second largest and most diverse microbiome community after the gut, the diagnostic and therapeutic approaches with low invasiveness and minimal damage to surrounding tissues are keys to preventing clinical intervention-related infections. Gold nanoparticles (AuNPs) are widely used in the research of cancer diagnosis and therapy due to their excellent properties such as surface-enhanced Raman spectroscopy, surface plasma resonance, controlled synthesis, the plasticity of surface morphology, biological safety, and stability. AuNPs had been used in oral cancer detection reagents, tumor-targeted therapy, photothermal therapy, photodynamic therapy, and other combination therapies for oral cancer. AuNPs-based noninvasive diagnosis and precise treatments further reduce the clinical intervention-related infections. This review is focused on the recent advances in research and application of AuNPs for early screening, diagnostic typing, drug delivery, photothermal therapy, radiotherapy sensitivity treatment, and combination therapy of oral cancer. Distinctive reports from the literature are summarized to highlight the latest advances in the development and application of AuNPs in oral cancer diagnosis and therapy. Finally, this review points out the challenges and prospects of possible applications of AuNPs in oral cancer diagnosis and therapy.

Rehabilitation in Advanced Cancer Patients with Bone Metastases and Neural Compromise: Current Status and Future Directions

PURPOSE OF REVIEW

This review aimed to increase the understanding of oncologists and physiatrists about the necessity, efficacy, and safety of rehabilitation in advanced cancer patients with bone metastases and neural compromise.

RECENT FINDINGS

Recently, there are growing evidence supporting the safety and efficacy of rehabilitation in patients with bone metastases and neural compromise. Despite the potential benefits of rehabilitation, however, rehabilitative services are considerably underutilized in clinical practice. Many oncologists are not familiar with functional issues and have limited understanding of the available rehabilitative services. Moreover, medical professionals, even physiatrists, have uncertainties and concerns about skeletal complications and often regard rehabilitation as a contraindication in this patient group. This review aimed to raise awareness on the role of rehabilitation in the continuum of cancer treatment, to improve its use in clinical practice. A multidisciplinary team approach involving physiatrist may facilitate integration of relevant clinicians.

Chronic pain, functionality and quality of life in cancer survivors

The increasing number of cancer survivors associated to a longer average life-span after diagnosis of an oncological disease facilitates the observation of deleterious long-term effects of both oncological disease and its treatment. Among these effects, chronic pain emerges as one of the most prevalent and, with its onset, there is a decrease in these patients' functionality and quality of life. The main focus in oncological disease treatment has been tumour eradication and average life expectancy extension after diagnosis, neglecting these deleterious long-term effects. This study aims at assessing the prevalence and characteristics of chronic pain in cancer survivors as well as pain interference in their quality of life and functionality. The study selected cancer survivors (n = 85) after dismissal from oncology service to assess the presence and characteristics of chronic pain, their health-related quality of life (HRQoL) and pain-related disability through a combination of different questionnaires. Chronic pain prevalence was 23.5%. In total, 85% of patients reported neuropathic pain descriptors and 45% presented diagnostic criteria for neuropathic pain. Of these patients, 45% were followed-up for pain surveillance and 35% underwent analgesic medication. There was a median pain disability index of 20.50 (14.50-35.00) and an average HRQoL of 0.5338 in chronic pain patients and 0.8872 in patients without pain. We found that chronic pain was the main negative predictor of HRQoL and was associated with decreased functionality. This study also concluded that these patients often were not offered the appropriate long-term medical follow-up. These findings highlight a need to raise awareness among health professionals to the importance of timely diagnosis and treatment of pain and its impact on HRQoL and functionality of long-term cancer survivors as well as the need to change clinical practice in order to improve healthcare provided to these patients.

Identification and management of late dysfunction in survivors of head and neck cancer: Implementation and outcomes of an interdisciplinary quality of life (IQOL) clinic

BACKGROUND

Identifying and treating late dysfunction in survivors of head and neck cancer (HNC) is important; however, an effective way to do so is not established.

METHODS

A quality improvement initiative altering our HNC survivorship clinic to include surveillance by rehabilitation providers was undertaken. The nature of dysfunction identified, along with the number and type of referrals to ancillary/support services were collected and compared to baseline.

RESULTS

The baseline, single-provider, clinic evaluated 61 patients and referred 2 (3%) to ancillary/support services. Fifty-seven patients were evaluated in the interdisciplinary clinic, with 36 (63%) referred to at least one ancillary/support service for new/progressive dysfunction. Of 59 referrals made, 22 (37%) were for dysphagia, 17(29%) were for neck/shoulder dysfunction, and 28 (47%) were attended by the patient.

CONCLUSION

Many HNC survivors exhibit late dysfunction appropriate for referral to ancillary/support services. A survivorship clinic including surveillance by rehabilitation specialists may optimize identification of dysfunction.