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Raggini E, Mattavelli D, Zigliani G, Bossi P, Piazza C. Measuring financial toxicity in head and neck cancer: a systematic review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:1-12. [PMID: 38420716 PMCID: PMC10914354 DOI: 10.14639/0392-100x-n2762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024]
Abstract
Objective The current study systematically reviews the literature about financial toxicity (FT) in head and neck cancer patients. Three databases were reviewed: PubMed, Scopus and Web of Science. Methods Full text English papers published from 2000 to 2022 reporting on quantitative results about FT in head and neck cancer survivors collected through structured questionnaires or interviews were included. Results Twenty-seven articles were included. Most of the articles were published after 2015 and from United States. There was a slight prevalence of papers dealing with oropharyngeal cancer, squamous-cell carcinoma and locally advanced head and neck cancer. Measures of FT were obtained through validated questionnaires like COST, FIT and FDQ. Collected data were mostly referrable to financial spending, financial resources, psychosocial aspect, support seeking, coping care and coping lifestyle subdomain. FT scores by COST were found to be worse in the COVID era. Financial counseling and adequate information about the costs of treatment were two effective strategies to mitigate FT. Conclusions FT is a relatively new challenge in head and neck cancer treatment, whose expenses are higher than therapies for other cancers. A universal method to assess FT and a unified guideline for the administration of questionnaires are needed to mitigate FT and to improve patient outcomes.
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Affiliation(s)
- Elisa Raggini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Gabriele Zigliani
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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2
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Lorenz FJ, King TS, Engle L, Beauchamp‐Perez F, Goyal N. Predictors of Quality of Life for Head and Neck Cancer Patients at an Academic Institution. OTO Open 2023; 7:e82. [PMID: 37794985 PMCID: PMC10546382 DOI: 10.1002/oto2.82] [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: 10/25/2022] [Revised: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023] Open
Abstract
Objective Quality of life (QOL) is an important consideration in head and neck cancer (HNC) due to lasting disease and treatment-related toxicities. We performed a comprehensive review of predictors of QOL in this population, including distance to care. Study Design Retrospective cohort study from 2017 to 2022. Setting Academic medical center. Methods QOL was quantified in patients treated for HNC utilizing the University of Washington Quality of Life and 20-Item Short Form surveys completed at subsequent clinic visits. Distance to treatment center and other demographic, socioeconomic, disease-specific, and behavioral data were analyzed. Results There were 176 patients in the cohort (69% male; mean age, 64 ± 10.8 years). There was no association between miles traveled and any of the QOL subscales. Marital status was the strongest predictor of QOL, significantly associated with 7/8 QOL domains and favoring those who were married. Other significant predictors of decreased QOL included emotional/physical abuse, current tobacco use, documented religious affiliation, and treatment involving surgery plus adjuvant therapy. A significant positive trend over time existed for multiple QOL subscales. Conclusion QOL is unchanged in patients who travel greater distances for care. QOL is more closely linked to factors such as marital status, physical/emotional abuse, tobacco use, religious affiliation, treatment intensity, and time following surgery. This highlights the importance of a strong support structure and the influence of certain socioeconomic and lifestyle factors on patients, with opportunities for screening and intervention throughout their cancer care.
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Affiliation(s)
- F. Jeffrey Lorenz
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Tonya S. King
- Department of Public Health SciencesPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Linda Engle
- Department of Public Health SciencesPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Francis Beauchamp‐Perez
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Neerav Goyal
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
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3
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Graboyes EM, Barbon CEA. Optimizing Function and Appearance After Head and Neck Reconstruction: Measurement and Intervention. Otolaryngol Clin North Am 2023; 56:835-852. [PMID: 37246027 PMCID: PMC10330938 DOI: 10.1016/j.otc.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Approximately 50% of head and neck cancer (HNC) survivors are left with dysphagia as a result of treatment sequele, and 25% of survivors experience clinically significant body image distress (BID). Both dysphagia and BID adversely affect quality of life and should be tracked using validated clinician- and patient-reported outcome measures such as the Performance Status Scale for Head and Neck Cancer, MD Anderson Dysphagia Inventory, and Inventory to Measure and Assess imaGe disturbancE-Head & Neck (IMAGE-HN). Subjective and objective evaluation measures are critical to dysphagia workup and management. Building a renewed image after head and neck cancer treatment, a brief telemedicine-based cognitive behavioral therapy, has become the first evidence-based treatment for BID among HNC survivors.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, MSC 550, Charleston, SC 29425, USA; Department of Public Health Sciences, Medical University of South Carolina
| | - Carly E A Barbon
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Unit 1445, 1515 Holcombe Boulevard, Houston, TX 77030-400, USA.
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4
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Mali SB. Surveillance of head neck cancer: Case for personalized and standardized surveillance. Oral Oncol 2023; 139:106354. [PMID: 36878144 DOI: 10.1016/j.oraloncology.2023.106354] [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: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
Although surgery, radiotherapy, chemotherapy, or combined treatment often elicits an initial satisfactory response, relapses are frequently observed within two years. Current surveillance methods, including clinical exams and imaging evaluations, have not unambiguously demonstrated a survival benefit, most probably due to a lack of sensitivity in detecting very early recurrence. Current guidelines advise post-treatment surveillance of head and neck cancer (HNC) patients should involve scheduled appointments with a variety of practitioners. The benefits of prolonged routine follow-up on survival have not been proven. Increasing numbers of HNC survivors raise the burden to provide efficient and effective care.
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Affiliation(s)
- Shrikant B Mali
- Mahatma Gandhi Vidya Mandir's Dental College and Hospital Nashik, India.
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5
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Rosi-Schumacher M, Patel S, Phan C, Goyal N. Understanding Financial Toxicity in Patients with Head and Neck Cancer: A Systematic Review. Clin Med Insights Oncol 2023; 17:11795549221147730. [PMID: 36710886 PMCID: PMC9880590 DOI: 10.1177/11795549221147730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/06/2022] [Indexed: 01/24/2023] Open
Abstract
Background Cancer treatment often results in financial burdens for patients including healthcare costs as well as treatment-induced disability leading to "financial toxicity" (FT) and decreased quality of life. The purpose of this review is to describe FT related to head and neck cancer (HNC) treatment, including quantifications of direct and indirect costs and descriptions of measurement tools. Methods PubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify articles published before April 2022. Full-text published studies were included if they assessed direct or indirect costs of HNC treatment; studies were excluded if they did not focus on HNC or financial burden. The risk of bias was assessed, and the results of the studies were synthesized. Results Database searches yielded 530 unique studies, and 33 studies met the criteria for inclusion. Medical expenses for patients with HNC were higher than for patients with other cancers or controls in several studies. Major surgical procedures, neck dissection, free-flap reconstruction, and intensive care unit admission increased hospital costs. Trimodal therapy with surgery plus chemoradiation represented the most expensive treatment, and chemoradiation increased complication-related health care costs. In several studies, >50% of patients treated for HNC were disabled and did not return to work. One of the greatest contributors to the indirect cost of HNC treatment is the loss of lifetime wages. Patients with HNC are at risk for depression, anxiety, and social isolation, which are linked to a decreased quality of life and treatment non-adherence. The only tools used to assess FT in patients with HNC are the Comprehensive Score for financial Toxicity (COST) and the Financial Index of Toxicity (FIT). Conclusion Financial toxicity is highly prevalent among patients with HNC. Further research is needed to validate the assessment tools for quantifying FT in HNC patients.
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Affiliation(s)
- Mattie Rosi-Schumacher
- Department of Otolaryngology—Head and
Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, The State
University of New York at Buffalo, Buffalo, NY, USA
| | - Shivam Patel
- Pennsylvania State University College
of Medicine, Hershey, PA, USA
| | - Chandat Phan
- Pennsylvania State University College
of Medicine, Hershey, PA, USA
| | - Neerav Goyal
- Pennsylvania State University College
of Medicine, Hershey, PA, USA,Department of Otolaryngology—Head and
Neck Surgery, Penn State Milton S Hershey Medical Center, Pennsylvania State
University, Hershey, PA, USA,Neerav Goyal, Department of
Otolaryngology—Head and Neck Surgery, Penn State Milton S Hershey Medical
Center, Pennsylvania State University, Hershey, PA 17033, USA.
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6
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Mavragani A, Imanguli M, Kashy D, Pesanelli M, Frederick S, Van Cleave JH, Paddock L, Hudson S, Steinberg M, Clifford P, Domider M, Singh N. Enhancing Self-care Among Oral Cancer Survivors: Protocol for the Empowered Survivor Trial. JMIR Res Protoc 2023; 12:e39996. [PMID: 36662561 PMCID: PMC9898837 DOI: 10.2196/39996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Survivors of oral cavity and oropharyngeal cancer frequently experience difficulties in swallowing; tasting; speaking; chewing; and maintaining comfortable movements of the head, neck, and shoulder. Engagement in regular self-care can reduce further loss of function and mitigate late effects. Despite the substantial self-care requirements, there are no empirically based interventions to enhance the skills and confidence of these survivors in managing their ongoing care. OBJECTIVE The aim of this study is to describe the rationale and methodology for a randomized controlled trial evaluating Empowered Survivor (ES) versus Springboard Beyond Cancer, a general web-based program for cancer survivors, on self-efficacy in managing care, preparedness for managing survivorship, and health-related quality of life (QOL). METHODS This study will recruit a total of 600 individuals who were diagnosed with oral cavity or oropharyngeal cancer in the past 3 years and are currently cancer free primarily from state cancer registries; these individuals will be randomly assigned to either the ES or Springboard Beyond Cancer condition. The participants complete measures of self-efficacy in managing care, preparedness for survivorship, health-related QOL, and engagement in oral self-examination and head and neck strengthening and flexibility exercises at baseline and 2 and 6 months after baseline. The primary aim of this study is to evaluate the impact of ES versus Springboard Beyond Cancer on self-efficacy, preparedness, and health-related QOL. The secondary aim is to examine the mediators and moderators of ES's impact on self-efficacy in managing care, preparedness, and health-related QOL at 6 months. The exploratory aim is to conduct a process evaluation of ES to identify potential oncology or community settings for future implementation. RESULTS Multilevel modeling will be used to examine whether there are significant differences between the ES and Springboard Beyond Cancer interventions over time. Mediational models will evaluate the indirect effects of ES on outcomes. Quantitative analyses will evaluate the predictors of ES use, and qualitative analyses will evaluate the preferred timing and settings for the implementation of ES. CONCLUSIONS This randomized controlled trial evaluates a completely web-based intervention, ES, versus a general web-based program for cancer survivors, Springboard Beyond Cancer, on self-efficacy in managing care, preparedness for managing survivorship, and health-related QOL and identifies the putative mediators and moderators of the intervention's effects. If an effect on the primary outcomes is illustrated, the next step could be an implementation trial to evaluate the intervention's uptake in and impact on an oncology care setting or nonprofit organizations. TRIAL REGISTRATION ClincalTrials.gov NCT04713449; https://clinicaltrials.gov/ct2/show/NCT04713449. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39996.
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Affiliation(s)
| | - Matin Imanguli
- Division of Head and Neck Oncologic and Reconstructive Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Deborah Kashy
- College of Social Science, Department of Psychology, Michigan State University, Lansing, MI, United States
| | - Morgan Pesanelli
- School of Public Health, Rutgers State University of New Jersey, Piscataway, NJ, United States
| | - Sara Frederick
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Janet H Van Cleave
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Lisa Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Shawna Hudson
- Department of Family Medicine and Community Health, Institute for Health Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Michael Steinberg
- Department of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Patrick Clifford
- Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers State University of New Jersey, Piscataway, NJ, United States
| | - Mara Domider
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Neetu Singh
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
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7
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Massa ST, Chidambaram S, Luong P, Graboyes EM, Mazul AL. Quantifying Total and Out-of-Pocket Costs Associated With Head and Neck Cancer Survivorship. JAMA Otolaryngol Head Neck Surg 2022; 148:1111-1119. [PMID: 36264567 PMCID: PMC9585466 DOI: 10.1001/jamaoto.2022.3269] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/28/2022] [Indexed: 01/10/2023]
Abstract
Importance Oncologic treatment is costly to the health care system and to individuals, but patients with head and neck cancer (HNC) also have long-term care needs after treatment. Survivors of HNC require specific consideration given their rapidly growing numbers. This subpopulation of cancer survivors often experiences long-term treatment-associated morbidity. Objective To describe the total and out-of-pocket (OOP) costs associated with HNC survivorship and the risk factors for financial toxicity among this population. Design, Setting, and Participants This was a retrospective review and economic evaluation of a cohort of US adults with a diagnosis of HNC from 2006 to 2018. The study used data the from IBM MarketScan Commercial Claims Database. Data were analyzed from November 2020 to June 2022. Exposures Treatment for HNC. Main Outcomes and Measures Total and OOP medical costs were assessed monthly and reported relative to the date of HNC diagnosis. The primary outcome was the difference between a patient's mean monthly survivorship costs (13-60 months after diagnosis) and mean monthly baseline costs (7-12 months before diagnosis). Univariate and multivariable linear regression models were created for total and OOP costs to generate coefficient estimates with 95% CIs. Results The study cohort of this economic evaluation included 19 098 patients with HNC (median [range] age, 56 [18-64] years; 14 144 [74.1%] men and 4954 [25.9%] women; race and ethnicity were not considered). Throughout the survivorship period, median total and OOP costs were $372 per month and $31 per month higher than baseline costs, respectively, with variation in expenses by demographic information, health plan type, and oncologic variables. In the multivariable model, greater total and OOP excess survivorship costs were associated with female sex ($343/mo; 95% CI, $126 to $560 and $9/mo; 95% CI, $4 to $14). Highest and lowest total excess survivorship costs associated with cancer site were seen for hypopharyngeal ($1908/mo; 95% CI, $1102 to $2714) and oropharyngeal cancers (-$703/mo; 95% CI, -$967 to -$439) vs oral cavity cancers. Compared with surgery or radiation therapy alone, multimodal treatment was generally associated with excess OOP survivorship costs. Conclusions and Relevance The findings of this retrospective economic evaluation review suggest that the costs of HNC survivorship remain persistently elevated above baseline costs for at least 5 years after diagnosis. High survivorship costs were associated with female sex, hypopharyngeal tumors, and treatment with multimodal therapy. Practitioners should seek to minimize costs for these patients at higher-risk of financial toxicity after treatment and work to provide directed supportive services.
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Affiliation(s)
- Sean T. Massa
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
| | - Smrithi Chidambaram
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
- Department of Otolaryngology−Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Peter Luong
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
| | - Evan M. Graboyes
- Department of Otolaryngology−Head and Neck Surgery, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Angela L. Mazul
- Department of Otolaryngology−Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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8
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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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9
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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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10
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Cherba M, Brummans BHJM, Hier MP, Giguère L, Chartier G, Jacobs H, Forest VI, Mlynarek A, Sultanem K, Henry M. Framing Concerns about Body Image during Pre- and Post-Surgical Consultations for Head and Neck Cancer: A Qualitative Study of Patient–Physician Interactions. Curr Oncol 2022; 29:3341-3363. [PMID: 35621662 PMCID: PMC9139818 DOI: 10.3390/curroncol29050272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 12/04/2022] Open
Abstract
Patients with head and neck cancer report high unmet psychosocial needs as they undergo lifesaving treatments that can significantly alter their appearance and cause functional impairments. This qualitative analysis of recordings of 88 pre- and post-surgical consultations involving 20 patients respond to the need for empirical studies of patient–provider conversations about body image concerns. It indicates that the emphasis on concerns about survival, cure, and physical recovery during clinical consultations may leave concerns about the impacts of surgery on appearance and function unexplored and even silenced. The interviews with patients and medical team members that complement the analysis of the recordings suggest that an emphasis on survival, cure, and physical recovery can respond to the need for reassurance in the context of serious illness. However, it can also be problematic as it contributes to the silencing of patients’ concerns and to a potential lack of preparedness for the consequences of surgery. The results of this study can contribute to raising surgeons’ awareness of the interactional dynamics during clinical consultations. Moreover, the results highlight the unique role that surgeons can play in validating patients’ psychosocial concerns to support patients’ rehabilitation in both physical and psychosocial domains.
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Affiliation(s)
- Maria Cherba
- Department of Communication, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | | | - Michael P. Hier
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Lauriane Giguère
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Gabrielle Chartier
- Department of Nursing, Oncology Division, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Hannah Jacobs
- Department of Audiology and Speech-Language Pathology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
| | - Véronique-Isabelle Forest
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Alex Mlynarek
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montreal, QC H3A 0G4, Canada; (M.P.H.); (V.-I.F.); (A.M.)
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Khalil Sultanem
- Division of Radiation Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada;
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Melissa Henry
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada;
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
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11
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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Seaman AT, Seligman KL, Nguyen KK, Al-Qurayshi Z, Kendell ND, Pagedar NA. Characterizing head and neck cancer survivors' discontinuation of survivorship care. Cancer 2022; 128:192-202. [PMID: 34460935 PMCID: PMC8678194 DOI: 10.1002/cncr.33888] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Little is known about cancer survivors who discontinue survivorship care. The objective of this study was to characterize patients with head and neck cancer who discontinue survivorship care with their treating institution and identify factors associated with discontinuation. METHODS This was a retrospective cohort study of patients diagnosed with head and neck cancer between January 1, 2014, and December 31, 2016, who received cancer-directed therapy at the University of Iowa Hospitals and Clinics (UIHC). Eligible patients achieved a cancer-free status after curative-intent treatment and made at least 1 visit 90+ days after treatment completion. The primary outcome was discontinuation of survivorship care, which was defined as a still living survivor who had not returned to a UIHC cancer clinic for twice the expected interval. Demographic and oncologic factors were examined to identify associations with discontinuation. RESULTS Ninety-seven of the 426 eligible patients (22.8%) discontinued survivorship care at UIHC during the study period. The mean time in follow-up for those who discontinued treatment was 15.4 months. Factors associated with discontinuation of care included an unmarried status (P = .036), a longer driving distance to the facility (P = .0031), and a single-modality cancer treatment (P < .0001). Rurality was not associated with discontinuation (24.3% vs 21.6% for urban residence; P = .52), nor was age, gender, or payor status. CONCLUSIONS The study results indicate that a sizeable percentage of head and neck cancer survivors discontinue care with their treating institution. Both demographic and oncologic factors were associated with discontinuation at the treating institution, and this points to potential clinical and care delivery interventions.
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Affiliation(s)
- Aaron T. Seaman
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Kristen L. Seligman
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Khanh K. Nguyen
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Zaid Al-Qurayshi
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Nicholas D. Kendell
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
| | - Nitin A. Pagedar
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Iowa City, IA, USA
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McLaren O, Perkins C, Zhu Y, Smith M, Williams R. Patient perspectives on surveillance after head and neck cancer treatment: A systematic review. Clin Otolaryngol 2021; 46:1345-1353. [PMID: 34363645 DOI: 10.1111/coa.13846] [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: 02/04/2021] [Revised: 06/30/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Current guidelines advise post-treatment surveillance of head and neck cancer (HNC) patients should involve scheduled appointments with a variety of practitioners. Increasing numbers of HNC survivors raise the burden to provide efficient and effective care. With resource limitation, there is growing importance to identify how surveillance can be justified and optimised for survivors. This systematic review presents current evidence on patient perspectives of post-treatment HNC surveillance, aiming to inform future work putting patient priorities at the forefront of surveillance planning. DESIGN MEDLINE, Embase, the Cochrane Library, NIHR Dissemination Centre, The Kings Fund Library, Clinical Evidence, NHS Evidence and NICE Clinical Evidence were searched to identify publications regarding patient perspectives of HNC post-treatment surveillance. Studies not reporting on both surveillance and patient perspectives were excluded. RESULTS Three thousand five hundred fifty-eight citations were screened and 49 full-text articles reviewed. Sixteen studies were included in the final review. Three authors reviewed all articles prior to final analysis to ensure all met inclusion criteria. Most evidence was low quality. Study models returned included cross-sectional surveys, structured interviews and one systematic review. Overall, positive perceptions of HNC surveillance were mostly related to increased reassurance. Negative perceptions predominantly focused on anxiety and fear of recurrence, but a lack of psychological support and inadequate access to certain aspects of care were also reported. CONCLUSIONS This systematic review demonstrates that patients' perceptions of surveillance after HNC are mostly positive, feeling it provides reassurance. However, several studies report unmet needs, particularly regarding managing anxiety.
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Affiliation(s)
| | | | - Yinan Zhu
- University Hospital Plymouth NHS Trust, Plymouth, UK
| | - Mary Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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14
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Freije SL, Holmes JA, Rachidi S, Ellsworth SG, Zellars RC, Lautenschlaeger T. Demographic factors associated with missed follow-up among solid tumor patients treated at a large multi-site academic institution. Future Oncol 2020; 16:2635-2643. [PMID: 32976060 DOI: 10.2217/fon-2020-0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To identify demographic predictors of patients who miss oncology follow-up, considering that missed follow-up has not been well studies in cancer patients. Methods: Patients with solid tumors diagnosed from 2007 to 2016 were analyzed (n = 16,080). Univariate and multivariable logistic regression models were constructed to examine predictors of missed follow-up. Results: Our study revealed that 21.2% of patients missed ≥1 follow-up appointment. African-American race (odds ratio [OR] 1.33; 95% CI: 1.17-1.51), Medicaid insurance (OR 1.59; 1.36-1.87), no insurance (OR 1.66; 1.32-2.10) and rural residence (OR 1.78; 1.49-2.13) were associated with missed follow-up. Conclusion: Many cancer patients miss follow-up, and inadequate follow-up may influence cancer outcomes. Further research is needed on how to address disparities in follow-up care in high-risk patients.
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Affiliation(s)
- Samantha L Freije
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Jordan A Holmes
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Saleh Rachidi
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.,Department of Dermatology, Johns Hopkins Medicine, Baltimore, MD 21287, USA
| | - Susannah G Ellsworth
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Richard C Zellars
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Tim Lautenschlaeger
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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15
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Essue BM, Iragorri N, Fitzgerald N, de Oliveira C. The psychosocial cost burden of cancer: A systematic literature review. Psychooncology 2020; 29:1746-1760. [PMID: 32783287 PMCID: PMC7754376 DOI: 10.1002/pon.5516] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 12/21/2022]
Abstract
Background and Objective Psychosocial costs, or quality of life costs, account for psychological distress, pain, suffering and other negative experiences associated with cancer. They contribute to the overall economic burden of cancer that patients experience. But this category of costs remains poorly understood. This hinders opportunities to make the best cancer control policy decisions. This study explored the psychosocial cost burden associated with cancer, how studies measure psychosocial costs and the impact of this burden. Methods A systematic literature review of academic and grey literature published from 2008 to 2018 was conducted by searching electronic databases, guided by the Institute of Medicine’s conceptualization of psychosocial burden. Results were analyzed using a narrative synthesis and a weighted proportion of populations affected was calculated. Study quality was assessed using the Ottawa‐Newcastle instrument. Results A total of 25 studies were included. There was variation in how psychosocial costs were conceptualized and an inconsistent approach to measurement. Most studies measured social dimensions and focused on the financial consequences of paying for care. Fewer studies assessed costs associated with the other domains of this burden, including psychological, physical, and spiritual dimensions. Fourty‐four percent of cancer populations studied were impacted by psychosocial costs and this varied by disease site (38%‐71%). Two studies monetized the psychosocial cost burden, estimating a lifetime cost per case ranging from CAD$427753 to CAD$528769. Studies were of varying quality; 60% of cross‐sectional studies had a high risk of bias. Conclusions Consistency in approach to measurement would help to elevate this issue for researchers and decision makers. At two‐thirds of the total economic burden of cancer, economic evaluations should account for psychosocial costs to better inform decision‐making. More support is needed to address the psychosocial cost burden faced by patients and their families.
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Affiliation(s)
- Beverley M Essue
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas Iragorri
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Natalie Fitzgerald
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada.,University of York, York, England
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16
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Schorn L, Lommen J, Sproll C, Krüskemper G, Handschel J, Nitschke J, Prokein B, Gellrich NC, Holtmann H. Evaluation of patient specific care needs during treatment for head and neck cancer. Oral Oncol 2020; 110:104898. [PMID: 32674039 DOI: 10.1016/j.oraloncology.2020.104898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/19/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Tumorous diseases of the head and neck region annually occur in more than 550.000 cases worldwide. Little is known about patient specific care needs and potential relationships between non-fulfillment of those following therapeutic and especially surgical treatment of head and neck cancer (HNC). OBJECTIVES This study aimed to evaluate potential correlations between patient specific care needs, regarding physiological rehabilitation, family/social support, economic needs, and their impact on health-related quality of life (HRQoL). METHODS A total of 1359 patients were included in this retrospective analysis. Data derived from the exploratory international multicenter rehabilitation study of the German-Austrian-Swiss Cooperative Group on Tumors of the Maxillofacial Region (DÖSAK), including 43 oral and maxillofacial departments in Germany, Austria, and Switzerland using the Bochum patient questionnaire on rehabilitation and a questionnaire on tumor and treatment related data. RESULTS Results showed a significant correlation of a patient's social bonds and depression, coping with depression, and anxiety. Patients' needs for speech therapy, physiotherapy or respiratory training were hardly ever met and patients had to compensate for financial losses during hospitalization for acute treatment. CONCLUSION In conclusion, this study describes social, physical, and socio-economic care needs. A multidisciplinary approach managing cancer and treatment related side effects is necessary, as well as enhanced awareness of care needs of practitioners during early recovery after surgery.
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Affiliation(s)
- Lara Schorn
- Department of Oral-, Maxillo- and Plastic Facial Surgery, University Clinic Düsseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Julian Lommen
- Department of Oral-, Maxillo- and Plastic Facial Surgery, University Clinic Düsseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany.
| | - Christoph Sproll
- Department of Oral-, Maxillo- and Plastic Facial Surgery, University Clinic Düsseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Gertrud Krüskemper
- Department of Medical Psychology, Ruhr University of Bochum, Universitätsstr. 150, Building MA 0/145, 44780 Bochum, Germany
| | - Jörg Handschel
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Kaiserteich Medical Center, Reichstr. 59, 40217 Duesseldorf, Germany; Medical School, Heinrich-Heine-University, Universitätsstr. 1, 40225 Düsseldorf, Germany
| | - Julia Nitschke
- Department of Neurosurgery, University Clinic Düsseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Benjamin Prokein
- Department of Oral-, Maxillo- and Plastic Facial Surgery, University Medicine Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Nils-Claudius Gellrich
- Department for Oral-, Maxillo- and Plastic Facial Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Henrik Holtmann
- Department of Oral-, Maxillo- and Plastic Facial Surgery, Malteser Clinic St. Johannes, Johannisstraße 21, 47198 Duisburg, Germany
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