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McDowell L, Gough K, White I, Corry J, Rischin D. Sexual Health, sexuality and sexual intimacy in patients with head and neck cancer - A narrative review. Oral Oncol 2024; 157:106975. [PMID: 39083855 DOI: 10.1016/j.oraloncology.2024.106975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/21/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
Sexuality and sexual intimacy are important aspects of cancer survivorship. In head and neck cancer (HNC), concerns around sexual health, sexuality and sexual intimacy are infrequently raised or addressed in standard HNC consultations, either before embarking on treatment or during survivorship. The changing demographic of HNC patients, largely due to the increasing proportion of patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPVOPSCC), has driven renewed interest in some specific survivorship issues, including sexual behaviours and lifestyles, which may account for both the primary mode of HPV transmission and the younger and less comorbid population affected by this disease. While HNC survivors may have many complex needs in the short and longer term, some patients may prioritise preserving sexual function above other more HNC-specific issues, such as swallowing and xerostomia. Beyond HPVOPSCC, there is evidence to suggest that impairment of sexual health is a pervasive survivorship issue across all HNC cancer types, and this narrative review article highlights publications reporting quantitative assessments of sexual health outcomes in HNC patients. There are also limited studies evaluating whether current sexual health models of care are adequate for HNC patients or whether new or adapted models are needed. Future research will also need to define the impact of our treatments on the sexuality and sexual intimacy concerns of specific HNC cohorts with more granularity to enhance pre- and post-treatment counselling.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Karla Gough
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Australia
| | | | - June Corry
- Genesis Care St Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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Jonklaas J, Carr AL, Luta G, Yu C, Jensen RE, Reasner E, Winslow J, Kuo CC, Davidson BJ, Esposito G, Bloom G, Diamond-Rossi SA, Graves KD. Salivary, lacrimal and nasal (SALANS) measure to assess side effects following radioactive iodine treatment: development, psychometric properties, and factor structure. Qual Life Res 2024; 33:2011-2023. [PMID: 38769210 DOI: 10.1007/s11136-024-03684-2] [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] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE This study aimed to develop and psychometrically evaluate a patient-reported outcome measure (PROM), SAlivary, LAcrimal, NaSal (SALANS), to document patients' symptoms after radioactive iodine (RAI) treatment for differentiated thyroid cancer (DTC). METHODS We generated and iteratively revised SALANS items based on expert input, focus group discussions and feedback from cognitive testing (n = 17). We administered an initial SALANS measure with 39 items to patients diagnosed with DTC in the past two years (n = 105). Exploratory factor analysis (EFA) examined the factor structure of the SALANS items. We assessed the consistency reliability and related the total and subscale scores of the final SALANS to existing PROMs to assess validity. RESULTS The final SALANS consisted of 33 items and six subscales (sialadenitis, taste, xerostomia, dry eyes, epiphora, and nasal) with six factors extracted by EFA. The six subscales demonstrated good internal reliability (α range = 0.87-0.92). The SALANS total score showed good convergent validity with the Xerostomia Inventory (r = 0.86) and good discriminant validity with a measure of spirituality (r = - 0.05). The mean SALANS total score was significantly higher (d = 0.5, p < 0.04) among patients who had RAI compared to those who did not have RAI. CONCLUSION Preliminary evidence suggests that SALANS is a novel and reliable PROM to assess the type and frequency all symptoms experienced after RAI treatment for DTC. Future work is needed to further validate and develop the scale.
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Affiliation(s)
- Jacqueline Jonklaas
- Division of Endocrinology, Department of Medicine, Georgetown University, Washington, DC, USA.
| | - Alaina L Carr
- Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University, Washington, DC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Chenlu Yu
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Roxanne E Jensen
- Outcomes Research Branch, National Cancer Institute, Bethesda, MD, USA
| | - Emma Reasner
- Department of Human Science, Georgetown University, Washington, DC, USA
| | - Justin Winslow
- Department of Biology, Georgetown University Human Science Georgetown University, Washington, DC, USA
| | - Charlene C Kuo
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Bruce J Davidson
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Giuseppe Esposito
- Division of Nuclear Medicine, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Gary Bloom
- ThyCa: Thyroid Cancer Survivors' Association, Inc., Olney, MD, USA
| | - Samantha A Diamond-Rossi
- Division of Endocrinology, INOVA Schar Cancer Institute, INOVA Fairfax Hospital, Fairfax, VA, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University, Washington, DC, USA
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Ücebakan NN, Erzurum Alim N, Güzeldir OT. Determination of Disease-Related Risk Factors, Malnutrition Status, and Quality of Life of Individuals Receiving Treatment for Head and Neck Cancer: A Case-Control Study. Nutr Cancer 2024; 76:831-839. [PMID: 38950591 DOI: 10.1080/01635581.2024.2365470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND This study aimed to investigate disease-related risk factors, malnutrition status, and life quality of individuals receiving treatment for head and neck cancer. METHODS This study which was done at a private hospital for 1 year, was comprised of 42 individuals, with 21 head and neck cancer patients (PG) and 21 controls (CG). Anthropometric measurements were taken, and biochemical parameters were analyzed. The NRS-2002 test was applied to assess malnutrition status. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC-QLQ-H&N-35) were used to determine individuals' life quality. RESULTS Smokers were 10.264 times more likely to develop the disease than nonsmokers. When serum albumin level increased by 1 unit, the risk of the disease decreased by 32.8%. Results indicated that patients with a risk of malnutrition exhibited statistically significant levels of pain, verbal communication, social-eating, sexuality, limited mouth-opening capacity, and weight-loss compared to those without a risk of malnutrition (p < 0.05). CONCLUSION Malnutrition status of individuals was found to affect quality of life. Smoking and low serum albumin levels have been found to be risk factors for head and neck cancer.
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Affiliation(s)
- Nisa Nur Ücebakan
- Department of Nutrition and Dietetics, Institute of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Nural Erzurum Alim
- Department of Nutrition and Dietetics, Institute of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Fatima J, Fatima E, Mehmood F, Ishtiaq I, Khan MA, Khurshid HMS, Kashif M. Comprehensive Analysis of Oral Squamous Cell Carcinomas: Clinical, Epidemiological, and Histopathological Insights With a Focus on Prognostic Factors and Survival Time. Cureus 2024; 16:e54394. [PMID: 38505442 PMCID: PMC10949903 DOI: 10.7759/cureus.54394] [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] [Accepted: 02/18/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Oral squamous cell carcinoma (OSCC) is one of the most common malignancies in the head and neck region. Particularly, high incidence rates are observed in South and Southeast Asia, attributed to the widespread use of the carcinogenic areca nut. This study aimed to investigate the clinical, epidemiological, and histopathological features of OSCC, identify prognostic factors impacting disease-free survival, and determine a post-diagnosis disease-free survival time of OSCC patients. METHODOLOGY Employing a descriptive cross-sectional design, the study conducted a thorough examination of the clinical, epidemiological, and histopathological aspects of OSCC among patients seeking care at a tertiary healthcare facility. Participants were personally interviewed if available, while information for unreachable or deceased individuals was extracted from archival patient records in the Oral and Maxillofacial Surgery Department, Bakhtawar Amin Medical and Dental College, Multan, Pakistan. Data analysis was performed with a significance level set at p ≤ 0.05. RESULTS The mean age of the patients was 54.16 ± 11.1, with a notable concentration in the 41 years and above age group, indicating a significant prevalence of OSCC in this population. The data revealed a gender bias toward males, and a substantial proportion of patients, particularly those aged 41 years and above, had unfortunately passed away. Statistical analysis using the Fisher exact test showed a significant association between age groups and patients' current living status (p-value < 0.05). CONCLUSION Histopathologically, moderately differentiated OSCC was the most frequently encountered grade, and surgery emerged as the predominant treatment modality. The majority of patients studied had a survival period of three years or less, emphasizing the need for further exploration of factors influencing prognosis and treatment outcomes in OSCC.
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Affiliation(s)
- Jia Fatima
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Ehda Fatima
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Fatima Mehmood
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Iman Ishtiaq
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Muhammad Athar Khan
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | | | - Muhammad Kashif
- Oral Pathology, Bakhtawar Amin Medical and Dental College, Multan, PAK
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Saghafi E, Andås CA, Bernson J, Kjeller G. Patients' experiences of adverse symptoms, emotions, and coping strategies in connection to treatment of head and neck cancer - an interview study. BMC Oral Health 2023; 23:641. [PMID: 37670339 PMCID: PMC10478420 DOI: 10.1186/s12903-023-03366-4] [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] [Received: 02/02/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE This study aimed to increase the understanding of emotions and coping strategies used by head and neck cancer patients before cancer treatment, and to explore their emotions and coping strategies in relation to symptoms and side effects after treatment. Furthermore, we aimed to investigate the patients' perceptions of received treatment and support. METHODS Semi-structured in-depth interviews were conducted with 10 patients who had been treated for head and neck cancer, which included radiotherapy, at the Department of Oncology and the Department of Oral and Maxillofacial Surgery at Sahlgrenska University Hospital in Gothenburg. The interviews were analyzed in accordance with the method for Qualitative Content Analysis. RESULTS The result picture revealed three head themes. The first theme "Management of simultaneously influencing mind-sets before cancer treatment" described the patients experiences of feeling "Scared and worried," "Lonely and disappointed," and "Relieved and confident", and how they tried to handle the diagnosis and preparations for treatment by "Applying a positive mind-set", "Searching for support," and "Trusting the healthcare system". The second theme "Experiences of becoming a pale shadow of oneself", illustrated experiences of affecting post-treatment symptoms and side effects. To which, the last theme "Handling contextual influencing experiences after cancer treatment" displayed post-treatment emotions of being "Shocked and disappointed" and "Concerned and unsupported" but also "Grateful and forward-thinking", where strategies such as "Appreciating Life", "Networking socially," and "Adapting to the new life" were used. CONCLUSIONS The results indicated the need for a more patient-centered care approach, with clearer structures and improved individual support both before and after treatment and in connection to rehabilitation. Patients' cognitive changes after cancer treatment should be considered in the aftercare, which should also include adaptation to situation and strengthening of patients' self-management as a goal.
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Affiliation(s)
- Ellie Saghafi
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 12A, Gothenburg, 413 90, Sweden.
- Department of Orofacial Pain, Region Västra Götaland, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Charlotte Andrén Andås
- Department of Orofacial Pain, Region Västra Götaland, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Bernson
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Kjeller
- Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 12A, Gothenburg, 413 90, Sweden
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Jansen F, Betz CS, Belau MH, Matnjani G, Clauditz TS, Dwertmann-Rico S, Stölzel K, Möckelmann N, Böttcher A. Outcomes following oropharyngeal squamous cell carcinoma resection and bilateral neck dissection with or without contralateral postoperative radiotherapy of the pathologically node-negative neck. Eur Arch Otorhinolaryngol 2023; 280:3843-3853. [PMID: 37133497 PMCID: PMC10313843 DOI: 10.1007/s00405-023-07972-4] [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] [Received: 02/02/2023] [Accepted: 04/06/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE There are no consensus guidelines regarding the postoperative treatment of the contralateral pathologically node-negative neck in oropharyngeal squamous cell carcinoma. This study aimed to determine if omission of postoperative irradiation of the contralateral pathologically node-negative neck affects oncological outcomes. METHODS We retrospectively identified 84 patients with primary surgical treatment including bilateral neck dissection and postoperative (chemo-)radiotherapy (PO(C)RT). Survival was analyzed using the log-rank test and the Kaplan-Meier method. RESULTS Patients showed no decrease in tumor-free, cause-specific (CSS), or overall survival (OS) when PO(C)RT of the contralateral pathologically node-negative neck was omitted. Increased OS was found in patients with unilateral PO(C)RT and especially an increased OS and CSS was found in unilateral PO(C)RT and in tumors arising from lymphoepithelial tissue. CONCLUSIONS Omitting the contralateral pathologically node-negative neck appears to be safe in terms of survival and our retrospective study advocates further prospective randomized control de-escalation trials.
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Affiliation(s)
- Florian Jansen
- Department of Otorhinolaryngology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Christian Stephan Betz
- Department of Otorhinolaryngology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Matthias Hans Belau
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gesa Matnjani
- Department of Radiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Katharina Stölzel
- Department of Otorhinolaryngology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Nikolaus Möckelmann
- Department of Otorhinolaryngology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Department of Otorhinolaryngology, Kath. Marienkrankenhaus GmbH, Hamburg, Germany
| | - Arne Böttcher
- Department of Otorhinolaryngology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Ninfa A, Jansen F, Delle Fave A, Lissenberg-Witte BI, Pizzorni N, Baatenburg de Jong RJ, Lamers F, Leemans CR, Takes RP, Terhaard CHJ, Schindler A, Verdonck-de Leeuw IM. The Change in Social Eating over Time in People with Head and Neck Cancer Treated with Primary (Chemo)Radiotherapy: The Role of Swallowing, Oral Function, and Nutritional Status. Cancers (Basel) 2023; 15:cancers15051603. [PMID: 36900393 PMCID: PMC10001042 DOI: 10.3390/cancers15051603] [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: 02/07/2023] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
This study aimed at investigating the change in social eating problems from diagnosis to 24 months after primary (chemo)radiotherapy and its associations with swallowing, oral function, and nutritional status, in addition to the clinical, personal, physical, psychological, social, and lifestyle dimensions. Adult patients from the NETherlands QUality of life and BIomedical Cohort (NET-QUBIC) treated with curative intent with primary (chemo)radiotherapy for newly-diagnosed HNC and who provided baseline social eating data were included. Social eating problems were measured at baseline and at 3-, 6-, 12-, and 24-month follow-up, with hypothesized associated variables at baseline and at 6 months. Associations were analyzed through linear mixed models. Included patients were 361 (male: 281 (77.8%), age: mean = 63.3, SD = 8.6). Social eating problems increased at the 3-month follow-up and decreased up to 24 months (F = 33.134, p < 0.001). The baseline-to-24 month change in social eating problems was associated with baseline swallowing-related quality of life (F = 9.906, p < 0.001) and symptoms (F = 4.173, p = 0.002), nutritional status (F = 4.692, p = 0.001), tumor site (F = 2.724, p = 0.001), age (F = 3.627, p = 0.006), and depressive symptoms (F = 5.914, p < 0.001). The 6-24-month change in social eating problems was associated with a 6-month nutritional status (F = 6.089, p = 0.002), age (F = 5.727, p = 0.004), muscle strength (F = 5.218, p = 0.006), and hearing problems (F = 5.155, p = 0.006). Results suggest monitoring social eating problems until 12-month follow-up and basing interventions on patients' features.
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Affiliation(s)
- Aurora Ninfa
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Femke Jansen
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Mental Health, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, 1081 HV Amsterdam, The Netherlands
| | - Antonella Delle Fave
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Birgit I. Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | | | - Femke Lamers
- Amsterdam Public Health Research Institute, Mental Health, 1081 HV Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - C. René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, 1081 HV Amsterdam, The Netherlands
| | - Robert P. Takes
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | | | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
- Correspondence:
| | - Irma M. Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Mental Health, 1081 HV Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, 1081 HV Amsterdam, The Netherlands
- Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 HV Amsterdam, The Netherlands
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Kim SS, Liu HC, Mell LK. Treatment Considerations for Patients with Locoregionally Advanced Head and Neck Cancer with a Contraindication to Cisplatin. Curr Treat Options Oncol 2023; 24:147-161. [PMID: 36696081 PMCID: PMC9992074 DOI: 10.1007/s11864-023-01051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/26/2023]
Abstract
OPINION STATEMENT Significant advancements have been made in the treatment of locally advanced head and neck cancer, predominantly driven by the integration of concurrent chemotherapy with radiation therapy as a standard of care for many patients. The most heavily investigated chemotherapeutic is cisplatin, yet many patients are ineligible for cisplatin due to the presence of pre-existing medical comorbidities. Moreover, given the toxicity profile of cisplatin, identifying which patients stand to benefit from cisplatin is challenging, which is particularly evident in older patients. Efforts to better risk-stratify patients based on age, performance status, and the degree of pre-existing comorbidities are ongoing and have been increasingly utilized in national clinical trials. In parallel, exploration into alternative systemic agents, including novel targeted therapies and immunotherapies, in cisplatin-ineligible patients are rapidly expanding. Cumulatively, identifying appropriate treatment paradigms in patients who harbor contraindications to cisplatin can not only improve clinical outcomes but also critically mitigate detrimental adverse effects.
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Affiliation(s)
- Sangwoo S Kim
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 3855 Health Sciences Drive, MC0843, La Jolla, CA, 92093, USA
| | - Hannah C Liu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 3855 Health Sciences Drive, MC0843, La Jolla, CA, 92093, USA
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 3855 Health Sciences Drive, MC0843, La Jolla, CA, 92093, USA.
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A 5-year prospective study of health-related quality of life in irradiated head and neck cancer patients: three trends of HRQL over time. Eur Arch Otorhinolaryngol 2023; 280:2617-2622. [PMID: 36627402 PMCID: PMC10066084 DOI: 10.1007/s00405-022-07789-7] [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: 10/03/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Head and neck cancer (HNC) is one of the fastest increasing cancer-types, where both disease and oncologic treatment have severe impact on health-related quality of life (HRQL). This study aimed to report HRQL prospectively up to 5-years following radiotherapy-treatment in HNC and to, if possible, identify trends in HRQL over time. METHODS This prospective study followed 211 patients receiving curatively intended radiotherapy pre-diagnosis, 3-, 6-, 12- and 60-months post-radiotherapy completion. HRQL was measured using EORTC QLQ-C30 and EORTC QLQ-HN35. RESULTS A deterioration three months post-radiotherapy was reported in 14/15 domains of EORTC QLQ-C30. Eight out of 12 domains had recovered to baseline-values at 12 months post-radiotherapy and remained unchanged up to study endpoint. Corresponding figures for EORTC QLQ-HN35 were deteriorations in 15/16 domains at three months post-radiotherapy, with recovery of 5 domain at 12-months, whereas the other 11 domains remained significantly worse at 5-years post-RT compared to baseline. CONCLUSION Following the deterioration in HRQL seen immediately following radiotherapy, the continued course of HRQL can be divided into three trends: short-term deterioration, long-term deterioration and long-term improvements. The combination of disease- and diagnosis-specific questionnaires is crucial when assessing HRQL in the HNC population.
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Peng C, Ye H, li Z, Duan X, Yang W, Yi Z. Multi-omics characterization of a scoring system to quantify hypoxia patterns in patients with head and neck squamous cell carcinoma. J Transl Med 2023; 21:15. [PMID: 36627705 PMCID: PMC9830846 DOI: 10.1186/s12967-022-03869-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The 5-year survival rate of patients with head and neck squamous cell carcinoma (HNSCC) remains < 50%. Hypoxia patterns are a hallmark of HNSCC that are associated with its occurrence and progression. However, the precise role of hypoxia during HNSCC, such as the relationship between hypoxia, tumor immune landscape and cell communication orchestration remains largely unknown. The current study integrated data from bulk and single-cell RNA sequencing analyses to define the relationship between hypoxia and HNSCC. METHODS A scoring system named the hypoxia score (HS) was constructed based on hypoxia-related genes (HRGs) expression. The predictive value of HS response for patient outcomes and different treatments was evaluated. Single-cell datasets and cell communication were utilized to rule out cell populations which hypoxia targeted on. RESULTS The survival outcomes, immune/Estimate scores, responses to targeted inhibitors, and chemotherapeutic, and immunotherapy responses were distinct between a high HS group and a low HS group (all P < 0.05). Single-cell datasets showed different distributions of HS in immune cell populations (P < 0.05). Furthermore, HLA-DPA1/CD4 axis was identified as a unique interaction between CD4 + T Conv and pDC cells. CONCLUSIONS Altogether, the quantification for hypoxia patterns is a potential biomarker for prognosis, individualized chemotherapeutic and immunotherapy strategies. The portrait of cell communication characteristics over the HNSCC ecosystem enhances the understanding of hypoxia patterns in HNSCC.
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Affiliation(s)
- Cong Peng
- grid.459540.90000 0004 1791 4503Department of Otolaryngology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Huiping Ye
- grid.459540.90000 0004 1791 4503Department of Otolaryngology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Zhengyang li
- grid.459540.90000 0004 1791 4503Department of Otolaryngology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Xiaofeng Duan
- grid.459540.90000 0004 1791 4503Department of Oral and Maxillofacial Surgery, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Wen Yang
- grid.452244.1Department of Pathology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhuguang Yi
- grid.459540.90000 0004 1791 4503Department of Otolaryngology, Guizhou Provincial People’s Hospital, Guiyang, China
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Zhou L, Zheng W, Huang S, Yang X. Integrated radiomics, dose-volume histogram criteria and clinical features for early prediction of saliva amount reduction after radiotherapy in nasopharyngeal cancer patients. Discov Oncol 2022; 13:145. [PMID: 36581739 PMCID: PMC9800672 DOI: 10.1007/s12672-022-00606-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Previously, the evaluation of xerostomia depended on subjective grading systems, rather than the accurate saliva amount reduction. Our aim was to quantify acute xerostomia with reduced saliva amount, and apply radiomics, dose-volume histogram (DVH) criteria and clinical features to predict saliva amount reduction by machine learning techniques. MATERIAL AND METHODS Computed tomography (CT) of parotid glands, DVH, and clinical data of 52 patients were collected to extract radiomics, DVH criteria and clinical features, respectively. Firstly, radiomics, DVH criteria and clinical features were divided into 3 groups for feature selection, in order to alleviate the masking effect of the number of features in different groups. Secondly, the top features in the 3 groups composed integrated features, and features selection was performed again for integrated features. In this study, feature selection was used as a combination of eXtreme Gradient Boosting (XGBoost) and SHapley Additive exPlanations (SHAP) to alleviate multicollinearity. Finally, 6 machine learning techniques were used for predicting saliva amount reduction. Meanwhile, top radiomics features were modeled using the same machine learning techniques for comparison. RESULT 17 integrated features (10 radiomics, 4 clinical, 3 DVH criteria) were selected to predict saliva amount reduction, with a mean square error (MSE) of 0.6994 and a R2 score of 0.9815. Top 17 and 10 selected radiomics features predicted saliva amount reduction, with MSE of 0.7376, 0.7519, and R2 score of 0.9805, 0.9801, respectively. CONCLUSION With the same number of features, integrated features (radiomics + DVH criteria + clinical) performed better than radiomics features alone. The important DVH criteria and clinical features mainly included, white blood cells (WBC), parotid_glands_Dmax, Age, parotid_glands_V15, hemoglobin (Hb), BMI and parotid_glands_V45.
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Affiliation(s)
- Lang Zhou
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong Province, China
- Department of Biomedical Engineering, South China University of Technology, Guangzhou, 510640, Guangdong Province, China
| | - Wanjia Zheng
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong Province, China
- Department of Radiation Oncology, Southern Theater Air Force Hospital of the People's Liberation Army, Guangzhou, 510050, Guangdong Province, China
| | - Sijuan Huang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong Province, China.
| | - Xin Yang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong Province, China.
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12
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The Prognostic and Predictive Significance of Tumor-Infiltrating Memory T Cells Is Reversed in High-Risk HNSCC. Cells 2022; 11:cells11121960. [PMID: 35741089 PMCID: PMC9221945 DOI: 10.3390/cells11121960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 12/04/2022] Open
Abstract
Tumor-infiltrating CD45RO+ memory T cells have unanimously been described as a positive prognostic factor in head and neck squamous cell carcinomas (HNSCCs). Here, we investigated the long-term prognostic relevance of CD45RO+ memory T cells in HNSCC with special regard to the influence of clinical characteristics. Pre-treatment biopsy samples from 306 patients with predominantly advanced HNSCC were analyzed. Immunohistochemistry was used to stain tissue microarrays for CD45RO+ memory T cells. CD45RO cell densities were semi-automatically registered and used for survival analysis. High CD45RO+ cell densities were clearly associated with prolonged overall survival (OS) and recurrence-free survival as well as no evidence of disease status after 10 years (p < 0.05). In contrast, the prognostic significance of tumor-infiltrating memory T cells was completely reversed in high-risk groups: in poorly differentiated tumors (G3, G4) and in cases with lymph node involvement (N+), high memory T cell densities correlated with reduced 10-year OS (p < 0.05). In conclusion, an increased density of tumor-infiltrating CD45RO+ cells in HNSCC can be a positive as well as a negative prognostic factor, depending on disease stage and histological grade. Therefore, if CD45RO+ cell density is to be used as a prognostic biomarker, further clinical characteristics must be considered.
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13
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Aggarwal P, Nader M, Gidley PW, Pratihar R, Jivani S, Garden AS, Mott FE, Goepfert RP, Ogboe CW, Charles C, Fuller CD, Lai SY, Gunn GB, Sturgis EM, Hanna EY, Hutcheson KA, Shete S. Association of hearing loss and tinnitus symptoms with health-related quality of life among long-term oropharyngeal cancer survivors. Cancer Med 2022; 12:569-583. [PMID: 35695117 PMCID: PMC9844619 DOI: 10.1002/cam4.4931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study investigated the association of hearing loss and tinnitus with overall health-related quality of life (HRQoL) among long-term oropharyngeal cancer (OPC) survivors. METHODS This study included OPC survivors treated between 2000 and 2013 and surveyed from September 2015 to July 2016. Hearing loss and tinnitus were measured by asking survivors to rate their "difficulty with hearing loss and/or ringing in the ears" from 0 (not present) to 10 (as bad as you can imagine). Hearing loss and tinnitus scores were categorized as follows: 0 for none, 1-4 for mild, and 5-10 for moderate to severe. The primary outcome was the mean score of MD nderson Symptom Inventory Head & Neck module interference component as a HRQoL surrogate dichotomized as follows: 0 to 4 for none to mild and 5 to 10 for moderate to severe interference. RESULTS Among 880 OPC survivors, 35.6% (314), reported none, 39.3% (347) reported mild, and 25.1% (221) reported moderate to severe hearing loss and tinnitus. On multivariable analysis, mild (OR, 5.83; 95% CI; 1.48-22.88; p = 0.012) and moderate (OR, 30.01; 95% CI; 7.96-113.10; p < 0.001) hearing loss and tinnitus were associated with higher odds of reporting moderate to severe symptom interference scores in comparison to no hearing loss and tinnitus. This association of hearing dysfunction was consistent with all domains of HRQoL. CONCLUSIONS Our findings provide preliminary evidence to support the need for continued audiological evaluations and surveillance to detect hearing dysfunction, to allow for early management and to alleviate the long-term impact on QoL.
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Affiliation(s)
- Puja Aggarwal
- Department of EpidemiologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Marc‐Elie Nader
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Paul W. Gidley
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Raj Pratihar
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Shirin Jivani
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Adam S. Garden
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Frank E. Mott
- Department of Thoracic Head and Neck Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ryan P. Goepfert
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Camille Charles
- Department of EpidemiologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Clifton D. Fuller
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Stephen Y. Lai
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA,Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - G. Brandon Gunn
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Erich M. Sturgis
- Department of Otolaryngology‐Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Ehab Y. Hanna
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Katherine A. Hutcheson
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA,Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sanjay Shete
- Department of EpidemiologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA,Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUnited States,Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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14
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Schar MS, Omari TI, Woods CM, Footner LR, Marshall N, Cock C, Thompson A, Nguyen T, Athanasiadis T, Ooi EH. Pharyngeal tongue base augmentation for dysphagia therapy: A prospective case series in patients post head and neck cancer treatment. Head Neck 2022; 44:1871-1884. [PMID: 35665556 DOI: 10.1002/hed.27104] [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: 12/25/2021] [Revised: 03/03/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dysphagia post head and neck cancer (HNC) multimodality treatment is attributed to reduced pharyngeal strength. We hypothesized that pharyngeal tongue base augmentation for dysphagia (PAD therapy) would increase pharyngeal pressures during swallowing thereby improving swallow symptoms. METHODS Adults with moderate-severe dysphagia post-HNC treatment had PAD therapy using a temporary filler (hyaluronic acid [HA]), with follow-up long-lasting lipofilling. Swallowing preprocedure and postprocedure was assessed with the Sydney Swallow Questionnaire (SSQ), High-Resolution Pharyngeal Manometry (HRPM), and Videofluoroscopic Swallowing Study (VFSS). Statistical comparison utilized paired tests. RESULTS Six participants (all male; median age 64 years [IQR 56, 71]) underwent PAD therapy at a median of 47 [IQR 8, 95] months post-treatment. SSQ scores reduced from baseline (mean 1069 [95%CI 703, 1434]) to post-HA (mean 579 [76, 1081], p > 0.05), and post-lipofilling (491 [95%CI 913, 789], p = 0.003, n = 4). Individual participants demonstrated reduced Swallow Risk Index, Bolus Presence Time, and increased Upper Esophageal Sphincter opening, but mesopharyngeal contractile pressures were unchanged. VFSS measures of aspiration, residue, and severity were unchanged. CONCLUSIONS Novel PAD therapy is safe and improves dysphagia symptoms. Biomechanical swallowing changes are suggestive of more efficacious bolus propulsion with conservative filler volume, but this was unable to resolve residue or aspiration measures.
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Affiliation(s)
- Mistyka S Schar
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Taher I Omari
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Charmaine M Woods
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lauren R Footner
- Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nicholas Marshall
- Department of Plastics & Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Charles Cock
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Alison Thompson
- Department of Gastroenterology & Hepatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Thi Nguyen
- South Australian Medical Imaging, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Theodore Athanasiadis
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Eng H Ooi
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia.,Otolaryngology Head & Neck Surgery Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
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15
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Verduijn GM, Capala ME, Sijtsema ND, Lauwers I, Hernandez Tamames JA, Heemsbergen WD, Sewnaik A, Hardillo JA, Mast H, van Norden Y, Jansen MPHM, van der Lugt A, van Gent DC, Hoogeman MS, Mostert B, Petit SF. The COMPLETE trial: HolistiC early respOnse assessMent for oroPharyngeaL cancEr paTiEnts; Protocol for an observational study. BMJ Open 2022; 12:e059345. [PMID: 35584883 PMCID: PMC9119182 DOI: 10.1136/bmjopen-2021-059345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The locoregional failure (LRF) rate in human papilloma virus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC) remains disappointingly high and toxicity is substantial. Response prediction prior to or early during treatment would provide opportunities for personalised treatment. Currently, there are no accurate predictive models available for correct OPSCC patient selection. Apparently, the pivotal driving forces that determine how a OPSCC responds to treatment, have yet to be elucidated. Therefore, the holistiC early respOnse assessMent for oroPharyngeaL cancer paTiEnts study focuses on a holistic approach to gain insight in novel potential prognostic biomarkers, acquired before and early during treatment, to predict response to treatment in HPV-negative patients with OPSCC. METHODS AND ANALYSIS This single-centre prospective observational study investigates 60 HPV-negative patients with OPSCC scheduled for primary radiotherapy (RT) with cisplatin or cetuximab, according to current clinical practice. A holistic approach will be used that aims to map the macroscopic (with Intra Voxel Incoherent Motion Diffusion Kurtosis Imaging (IVIM-DKI); before, during, and 3 months after RT), microscopic (with biopsies of the primary tumour acquired before treatment and irradiated ex vivo to assess radiosensitivity), and molecular landscape (with circulating tumour DNA (ctDNA) analysed before, during and 3 months after treatment). The main end point is locoregional control (LRC) 2 years after treatment. The primary objective is to determine whether a relative change in the mean of the diffusion coefficient D (an IVIM-DKI parameter) in the primary tumour early during treatment, improves the performance of a predictive model consisting of tumour volume only, for 2 years LRC after treatment. The secondary objectives investigate the potential of other IVIM-DKI parameters, ex vivo sensitivity characteristics, ctDNA, and combinations thereof as potential novel prognostic markers. ETHICS AND DISSEMINATION The study was approved by the Medical Ethical Committee of Erasmus Medical Center. The main results of the trial will be presented in international meetings and medical journals. TRIAL REGISTRATION NUMBER NL8458.
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Affiliation(s)
- Gerda M Verduijn
- Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marta E Capala
- Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nienke D Sijtsema
- Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
- Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Iris Lauwers
- Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Aniel Sewnaik
- Otorhinolaryngology and Head and Neck surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jose A Hardillo
- Otorhinolaryngology and Head and Neck surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hetty Mast
- Oral and Maxillofacial surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Aad van der Lugt
- Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dik C van Gent
- Molecular Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Bianca Mostert
- Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Steven F Petit
- Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
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16
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Granström B, Holmlund T, Laurell G, Fransson P, Tiblom Ehrsson Y. Addressing symptoms that affect patients' eating according to the Head and Neck Patient Symptom Checklist ©. Support Care Cancer 2022; 30:6163-6173. [PMID: 35426524 PMCID: PMC9135877 DOI: 10.1007/s00520-022-07038-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this prospective study was to assess which nutritional impact symptoms (NIS) interfere with oral intake in patients with head and neck cancer (HNC) and how the symptoms interfere with body weight loss, up to 1 year after treatment. METHODS This was a prospective study of 197 patients with HNC planned for treatment with curative intention. Body weight was measured before the start of treatment, at 7 weeks after the start of treatment, and at 6 and 12 months after completion of treatment. NIS and NIS interfering with oral intake at each follow-up were examined with the Head and Neck Patient Symptom Checklist© (HNSC©). RESULTS At 7 weeks of follow-up, patients experienced the greatest symptom and interference burden, and 12 months after treatment the NIS scorings had not returned to baseline. One year after treatment, the highest scored NIS to interfere with oral intake was swallowing problems, chewing difficulties, and loss of appetite. At all 3 follow-ups, the total cumulative NIS and NIS interfering with oral intake were associated with body weight loss. Factors increasing the risk for a body weight loss of ≥ 10% at 12 months after treatment were pain, loss of appetite, feeling full, sore mouth, difficulty swallowing, taste changes, and dry mouth. Women scored higher than men in NIS and NIS interfering with oral intake. Furthermore, during the study period about half of the population had a body weight loss > 5%. CONCLUSION Because both nutritional and clinical factors may affect body weight, this study highlights the importance of a holistic approach when addressing the patients' nutritional issues. TRIAL REGISTRATION ClinicalTrials.gov NCT03343236, date of registration: November 17, 2017.
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Affiliation(s)
- Brith Granström
- Department of Clinical Science, Otorhinolaryngology, Umeå University, 901 87, Umeå, Sweden.
| | - Thorbjörn Holmlund
- Department of Clinical Science, Otorhinolaryngology, Umeå University, 901 87, Umeå, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, 751 85, Uppsala, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, 901 87, Umeå, Sweden
| | - Ylva Tiblom Ehrsson
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, 751 85, Uppsala, Sweden
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17
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Factors Influencing Quality of Life in Survivors of Head and Neck Cancer: A Preliminary Study. Semin Oncol Nurs 2022; 38:151256. [DOI: 10.1016/j.soncn.2022.151256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
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18
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Kao NH, Iyer NG, Chua A, Nagadia RH. Early quality of life outcomes after surgery in head and neck cancer survivors with EORTC QLQ-C30 and EORTC QLQ-HN35 in an Asian tertiary centre. Support Care Cancer 2022; 30:4537-4546. [PMID: 35119518 DOI: 10.1007/s00520-022-06871-4] [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: 06/20/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of the study was to evaluate the quality of life (QOL) of head and neck cancer survivors after surgical treatment and to identify patients' main concerns. The study also aims to establish pre-treatment reference values particularly for the Asian patient. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and Head and Neck module (EORTC QLQ-HN35) were used for objective evaluation. METHODS Patients planned for elective surgery for head and neck cancers were enrolled in the study. The questionnaires were completed at pre-treatment and at 6 months after surgery. Results were compared with previously published reference values. RESULTS One hundred forty patients completed both questionnaires. Locally advanced tumour and extent of surgery (tracheostomy (p<0.01), surgical flap (p<0.01)) were associated with lower global health scores. Adjuvant treatment was also a contributory factor (p<0.01). Dysphagia and social eating was a primary concern within our population. CONCLUSION Surgical treatment of head and neck cancers is safe, but there is poor QOL in the early post-treatment period especially with eating. Previously published data suggested improvement after a year.
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Affiliation(s)
- Nern Hoong Kao
- Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
| | - N Gopalakrishna Iyer
- Department of Head and Neck Surgery, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Alice Chua
- Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Rahul Harshad Nagadia
- Department of Head and Neck Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.,Department of Oral and Maxillofacial Surgery, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore, 168938, Singapore.,Department of Dental Medicine, Karolinska Institute, 17177, Stockholm, Sweden
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19
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Kutz LM, Abel J, Schweizer D, Tribius S, Krüll A, Petersen C, Löser A. Quality of life, HPV-status and phase angle predict survival in head and neck cancer patients under (chemo)radiotherapy undergoing nutritional intervention: Results from the prospective randomized HEADNUT-trial. Radiother Oncol 2021; 166:145-153. [PMID: 34838889 DOI: 10.1016/j.radonc.2021.11.011] [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] [Received: 07/23/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To analyze the impact of quality of life (QoL), nutritional and clinical indicators on overall survival in patients with head and neck squamous cell cancer (HNSCC) undergoing (chemo)radiotherapy. MATERIALS AND METHODS At the beginning, at the end of (chemo)radiotherapy and during follow-up, QoL was prospectively assessed using the EORTC-QLQ-C30 and -QLQ-H&N35 questionnaires. Data were analyzed in 58 out of 220 screened patients, who were randomized into a control and intervention group. All patients received a nutritional assessment including bioelectrical impedance analysis (BIA), laboratory testing, and a screening for malnutrition based on the questionnaires MUST, NRS-2002 and Nutriscore at baseline and at the end of therapy. The intervention consisted of an individualized nutritional counseling every 2 weeks. RESULTS Except for emotional functioning, dyspnea, financial difficulties, dental problems and weight gain, all other scales from the EORTC-QLQ-C30 and -H&N35 deteriorated during (chemo)radiotherapy. At first follow-up, patients of the control group experienced more nausea and vomiting compared to those of the intervention group (p = 0.02). After performing a multivariable model, dental problems at the end of therapy (HR: 1.03; 95% CI: 1-1.06; p = 0.03), HPV negativity (HR: 18.19, 95% CI: 1.61-204.17; p = 0.02), and baseline phase angle (HR: 0.09; 95% CI: 0.01-0.82; p = 0.03) were identified as predictors for overall survival. CONCLUSIONS Factors influencing overall survival in patients with HNSCC undergoing (chemo)radiotherapy are complex and multifactorial. We were able to identify QoL-related (dental problems), clinical (HPV status) and nutritional (phase angle) factors as negative predictors for survival. This study was registered within the German Clinical Trials Register (DRKS00016862).
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Affiliation(s)
- Laura Magdalena Kutz
- University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, Hamburg, Germany
| | - Jakob Abel
- University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, Hamburg, Germany
| | - Diana Schweizer
- University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Germany
| | - Silke Tribius
- Asklepios Hospital St. Georg, Hermann Holthusen Institute for Radiation Oncology, Hamburg, Germany
| | - Andreas Krüll
- University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Department of Radiotherapy and Radiation Oncology, Germany
| | - Cordula Petersen
- University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Department of Radiotherapy and Radiation Oncology, Germany
| | - Anastassia Löser
- University Medical Center Hamburg-Eppendorf, Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, Hamburg, Germany.
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20
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de Vries J, Bras L, Sidorenkov G, Festen S, Steenbakkers RJHM, Langendijk JA, Witjes MJH, van der Laan BFAM, de Bock GH, Halmos GB. Association of Deficits Identified by Geriatric Assessment With Deterioration of Health-Related Quality of Life in Patients Treated for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 147:1089-1099. [PMID: 34673914 DOI: 10.1001/jamaoto.2021.2837] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Accumulation of geriatric deficits, leading to an increased frailty state, makes patients susceptible for decline in health-related quality of life (HRQOL) after treatment for head and neck cancer (HNC). Objective To assess the association of single and accumulated geriatric deficits with HRQOL decline in patients after treatment for HNC. Design, Setting, and Participants Between October 2014 and May 2016, patients at a tertiary referral center were included in the Oncological Life Study (OncoLifeS), a prospective data biobank, and followed up for 2 years. A consecutive series of 369 patients with HNC underwent geriatric assessment at baseline; a cohort of 283 patients remained eligible for analysis, and after 2 years, 189 patients remained in the study. Analysis was performed between March and November 2020. Interventions or Exposures Geriatric assessment included scoring of the Adult Comorbidity Evaluation 27, polypharmacy, Malnutrition Universal Screening Tool, Activities of Daily Living, Instrumental Activities of Daily Living (IADL), Timed Up & Go, Mini-Mental State Examination, 15-item Geriatric Depression Scale, marital status, and living situation. Main Outcomes and Measures The primary outcome measure was the Global Health Status/Quality of Life (GHS/QOL) scale of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Differences between patients were evaluated using linear mixed models at 3 months after treatment (main effects, β [95% CI]) and declining course per year during follow-up (interaction × time, β [95% CI]), adjusted for baseline GHS/QOL scores, and age, sex, stage, and treatment modality. Results Among the 283 patients eligible for analysis, the mean (SD) age was 68.3 (10.9) years, and 193 (68.2%) were male. Severe comorbidity (β = -7.00 [-12.43 to 1.56]), risk of malnutrition (β = -6.18 [-11.55 to -0.81]), and IADL restrictions (β = -10.48 [-16.39 to -4.57]) were associated with increased GHS/QOL decline at 3 months after treatment. Severe comorbidity (β = -4.90 [-9.70 to -0.10]), IADL restrictions (β = -5.36 [-10.50 to -0.22]), restricted mobility (β = -6.78 [-12.81 to -0.75]), signs of depression (β = -7.08 [-13.10 to -1.06]), and living with assistance or in a nursing home (β = -8.74 [-15.75 to -1.73]) were associated with further GHS/QOL decline during follow-up. Accumulation of domains with geriatric deficits was a major significant factor for GHS/QOL decline at 3 months after treatment (per deficient domain β = -3.17 [-5.04 to -1.30]) and deterioration during follow-up (per domain per year β = -2.74 [-4.28 to -1.20]). Conclusions and Relevance In this prospective cohort study, geriatric deficits were significantly associated with HRQOL decline after treatment for HNC. Therefore, geriatric assessment may aid decision-making, indicate interventions, and reduce loss of HRQOL. Trial Registration trialregister.nl Identifier: NL7839.
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Affiliation(s)
- Julius de Vries
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Linda Bras
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Grigory Sidorenkov
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Suzanne Festen
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Otorhinolaryngology-Head and Neck Surgery, Haaglanden Medical Center, The Hague, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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21
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De Cicco D, Tartaro G, Ciardiello F, Fasano M, Rauso R, Fiore F, Spuntarelli C, Troiano A, Lo Giudice G, Colella G. Health-Related Quality of Life in Oral Cancer Patients: Scoping Review and Critical Appraisal of Investigated Determinants. Cancers (Basel) 2021; 13:cancers13174398. [PMID: 34503208 PMCID: PMC8431462 DOI: 10.3390/cancers13174398] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Oral cancer may strongly impair patients’ quality of life. Huge efforts have been made during recent decades in trying to improve the treatment outcomes in terms of patients’ survival, self-perception, and satisfaction. Consequently, the investigation into health-related quality of life (HRQOL) became an established and worldwide practice. Hundreds of studies tried to clarify which could be the most important variables that impact HRQOL in head and neck cancer patients. However, such a complex topic may be influenced by a multitude of interconnected aspects and several controversies were reported. In this study the current literature was reviewed to identify all those possible sources of bias that may be encountered in trying to correlate HRQOL to patient-specific or disease/treatment-specific aspects. As a result, a list of recommendations was reported to enhance the evidence of future studies. Abstract Background: health-related quality of life (HRQOL) represents a secondary endpoint of medical interventions in oncological patients. Our aim was to highlight potential sources of bias that could be encountered when evaluating HRQOL in oral cancer patients. Methods: this review followed PRISMA-ScR recommendations. Participants: patients treated for oral cancer. Concept: HRQOL assessed by EORTC QLQ-C30 and QLQ-H&N35/QLQ-H&N43. A critical appraisal of included studies was performed to evaluate the accuracy of data stratification with respect to HRQOL determinants. Results: overall, 30 studies met the inclusion criteria, totaling 1833 patients. In total, 8 sociodemographic (SDG) and 15 disease/treatment-specific (DT) HRQOL determinants (independent variables) were identified. The mean number of the independent variables was 6.1 (SD, 4.3)—5.0 (SD, 4.0) DT-related and 1.1 (SD, 1.8) SDG-related variables per article. None of the included papers considered all the identified determinants simultaneously. Conclusions: a substantial lack of evidence regarding HRQOL determinants was demonstrated. This strongly weakens the reliability of the reported findings due to the challenging presence of baseline confounding, selection, and omitted variable biases. The proposed approach recommends the use of further evaluation tools that gather more variables in a single score together with a selection of more homogeneous, reproducible, and comparable cohorts based on the identified baseline confounding.
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Affiliation(s)
- Davide De Cicco
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
| | - Gianpaolo Tartaro
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (R.R.); (G.C.)
| | - Fortunato Ciardiello
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.C.); (M.F.)
| | - Morena Fasano
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.C.); (M.F.)
| | - Raffaele Rauso
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (R.R.); (G.C.)
| | - Francesca Fiore
- Department of Internal and Polyspecialist Medicine, A.O.U. “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Chiara Spuntarelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
| | - Antonio Troiano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
- Correspondence:
| | - Giorgio Lo Giudice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy; (D.D.C.); (C.S.); (G.L.G.)
| | - Giuseppe Colella
- Department of Multidisciplinary Medical, Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.T.); (R.R.); (G.C.)
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22
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Thompson LMA, Donovan KA. Discussions About Sexual Health: An Unmet Need Among Patients With Human Papillomavirus-Related Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2021; 110:394-395. [PMID: 33989575 DOI: 10.1016/j.ijrobp.2020.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Lora M A Thompson
- Supportive Care Medicine Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | - Kristine A Donovan
- Supportive Care Medicine Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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23
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Billa O, Bonnetain F, Chamois J, Ligey A, Ganansia V, Noel G, Renard S, Maillard S, Quivrin M, Vulquin N, Truntzer P, Dabakuyo-Yonli TS, Maingon P. Randomized Trial Assessing the Impact of Routine Assessment of Health-Related Quality of Life in Patients with Head and Neck Cancer. Cancers (Basel) 2021; 13:cancers13153826. [PMID: 34359726 PMCID: PMC8345055 DOI: 10.3390/cancers13153826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The purpose of this research was to investigate the impact of routine assessment of health-related quality of life (HRQoL) on quality of life and satisfaction with care in patients with head and neck cancer (HNC). A randomized controlled open-label clinical trial with 200 patients with HNC managed in four cancer centers in Eastern France was performed. In the intervention arm (regularly completed HRQoL questionnaires), HRQoL mean change was significantly improved at 2 years from baseline. Compared with the control arm, differences were not statistically significant, but minimal clinically important differences in favor of the intervention arm were found for HRQoL, satisfaction with waiting times, and satisfaction with accessibility. In patients with head and neck cancer undergoing treatments, routine assessment of HRQoL is a simple practice and may have HRQoL and satisfaction benefits. Abstract The impact of routine assessment of health-related quality of life (HRQoL) on satisfaction with care and the HRQoL of patients with head and neck cancer (HNC) treated with radiotherapy was assessed. Patients with HNC were randomly assigned to two arms, with stratification on sex, cancer localization, and stage of the disease. In the intervention arm, the patients completed the EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires first before randomization, then before each medical appointment during radiotherapy (7 weeks), and then every 3 months until 1 year and at 2 years thereafter. In the control arm, the EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires were completed before randomization and at 1 year and 2 years thereafter. The primary endpoint was mean change in HRQoL at score at 2 years from baseline assessed by EQ VAS from the EuroQol questionnaire. The secondary endpoint was mean change in satisfaction with care at 2 years from baseline assessed by QLQ-SAT32. Two hundred patients with head and neck cancers were involved in this study (mean age, 58.83 years (range, 36.56–87.89)), of whom 100 were assigned to the intervention arm and 100 to the control arm. Patients in the intervention arm were reported to have a statistically significant increase in EQ VAS at 2 years (p < 0.0001) and exceeded the minimal clinically important difference (mean change at 2 years from baseline = 10.46). In the two arms, mean differences between arms were not statistically significant, but minimal clinically important differences in favor of the intervention arm were found for EQ VAS (mean change difference (MD) = 5.84), satisfaction with care, in particular waiting times (MD = 10.85) and satisfaction with accessibility (MD = 6.52). Routine assessment of HRQoL improves HRQoL and satisfaction with care for patients with HNC treated with radiotherapy.
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Affiliation(s)
- Oumar Billa
- Georges-François Leclerc Cancer Centre-UNICANCER, Epidemiology and Quality of Life Unit, 21000 Dijon, France;
- Lipids, Nutrition, Cancer Research Center, U1231 INSERM, 21000 Dijon, France
- National Quality of Life and Cancer Clinical Research Platform, 21000 Dijon, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, Inserm UMR 1098, University Hospital of Besancon, 25000 Besancon, France;
| | - Jérôme Chamois
- Georges-François Leclerc Cancer Centre-UNICANCER, Radiotherapy Department, 1 Rue Professeur Marion, 21000 Dijon, France; (J.C.); (M.Q.); (N.V.); (P.M.)
- Centre Hospitalier Saint Gregoire, 35760 Saint-Grégoire, France
| | - Angeline Ligey
- Centre Hospitalier Fleriat, 01012 Bourg-en-Bresse, France;
| | - Valérie Ganansia
- Paul Strauss Cancer Centre-Unicancer, 67000 Strasbourg, France; (V.G.); (G.N.); (P.T.)
| | - Georges Noel
- Paul Strauss Cancer Centre-Unicancer, 67000 Strasbourg, France; (V.G.); (G.N.); (P.T.)
| | - Sophie Renard
- Institut de cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France;
| | | | - Magali Quivrin
- Georges-François Leclerc Cancer Centre-UNICANCER, Radiotherapy Department, 1 Rue Professeur Marion, 21000 Dijon, France; (J.C.); (M.Q.); (N.V.); (P.M.)
| | - Noémie Vulquin
- Georges-François Leclerc Cancer Centre-UNICANCER, Radiotherapy Department, 1 Rue Professeur Marion, 21000 Dijon, France; (J.C.); (M.Q.); (N.V.); (P.M.)
| | - Pierre Truntzer
- Paul Strauss Cancer Centre-Unicancer, 67000 Strasbourg, France; (V.G.); (G.N.); (P.T.)
| | - Tienhan Sandrine Dabakuyo-Yonli
- Georges-François Leclerc Cancer Centre-UNICANCER, Epidemiology and Quality of Life Unit, 21000 Dijon, France;
- Lipids, Nutrition, Cancer Research Center, U1231 INSERM, 21000 Dijon, France
- National Quality of Life and Cancer Clinical Research Platform, 21000 Dijon, France
- Correspondence: ; Tel.: +33-345-348-067
| | - Philippe Maingon
- Georges-François Leclerc Cancer Centre-UNICANCER, Radiotherapy Department, 1 Rue Professeur Marion, 21000 Dijon, France; (J.C.); (M.Q.); (N.V.); (P.M.)
- Radiotherapy Unit, Hôpital de la Pitié-Salpêtrière-APHP, 75013 Paris, France
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24
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Van den Bosch L, van der Laan HP, van der Schaaf A, Oosting SF, Halmos GB, Witjes MJH, Oldehinkel E, Meijer TWH, van den Hoek JGM, Steenbakkers RJHM, Langendijk JA. Patient-Reported Toxicity and Quality-of-Life Profiles in Patients With Head and Neck Cancer Treated With Definitive Radiation Therapy or Chemoradiation. Int J Radiat Oncol Biol Phys 2021; 111:456-467. [PMID: 34048816 DOI: 10.1016/j.ijrobp.2021.05.114] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE Radiation therapy is an effective but burdensome treatment for head and neck cancer (HNC). We aimed to characterize the severity and time pattern of patient-reported symptoms and quality of life in a large cohort of patients with HNC treated with definitive radiation therapy, with or without systemic treatment. METHODS AND MATERIALS A total of 859 patients with HNC treated between 2007 and 2017 prospectively completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Head and Neck Cancer module (QLQ-HN35) and Core Quality of Life Questionnaire (QLQ-C30) at regular intervals during and after treatment for up to 5 years. Patients were classified into 3 subgroups: early larynx cancer, infrahyoideal cancer, and suprahyoideal cancer. Outcome scales of both questionnaires were quantified per subgroup and time point by means of average scores and the frequency distribution of categorized severity (none, mild, moderate, and severe). Time patterns and symptom severity were characterized. Toxicity profiles were compared using linear mixed model analysis. Additional toxicity profiles based on age, human papillomavirus status, treatment modality, smoking status, tumor site, and treatment period were characterized as well. RESULTS The study population consisted of 157 patients with early larynx cancer, 304 with infrahyoideal cancer, and 398 with suprahyoideal cancer. The overall questionnaire response rate was 83%. Generally, the EORTC QLQ-HN35 symptoms reported showed a clear time pattern, with increasing scores during treatment followed by a gradual recovery in the first 2 years. Distinct toxicity profiles were seen across subgroups (P < .001), with generally less severe symptom scores in the early larynx subgroup. The EORTC QLQ-C30 functioning, quality-of-life, and general symptoms reported showed a less evident time pattern and less pronounced differences in mean scores between subgroups, although differences were still significant (P < .001). Differences in mean scores were most pronounced for role functioning, appetite loss, fatigue, and pain. CONCLUSIONS We established patient-reported toxicity and quality-of-life profiles that showed different patterns for 3 subgroups of patients with HNC. These profiles provide detailed information on the severity and persistence of various symptoms as experienced by patients during and after definitive radiation therapy. These profiles can be used to inform treatment of future patients and may serve as a benchmark for future studies.
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Affiliation(s)
- Lisa Van den Bosch
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Hans Paul van der Laan
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edwin Oldehinkel
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tineke W H Meijer
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna G M van den Hoek
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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25
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Lee HJ, Han DH, Kim JH, Wu HG. The effect of comprehensive oral care program on oral health and quality of life in patients undergoing radiotherapy for head and neck cancer: A quasi-experimental case-control study. Medicine (Baltimore) 2021; 100:e25540. [PMID: 33879699 PMCID: PMC8078395 DOI: 10.1097/md.0000000000025540] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES The purpose of this study is to investigate the effect of the comprehensive oral care program on oral health status and symptoms in head and neck cancer (HNC) patients undergoing radiotherapy. METHODS This was a quasi-experimental study using a non-equivalent control group in non-synchronized design. All participants including control and experimental group were asked for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire H&N35 (EORTC QLQ-H&N35) and given an oral health education 4 times at baseline, immediate postradiotherapy, 3 months after radiotherapy, and 6 months after radiotherapy. In each visit except for final, the experimental group was given fluoride varnish application and fluoride mouth rinsing solution for daily use. Oral health examination for dental caries, plaque score (PS), bleeding on probing (BOP), and salivary flow rate was performed in baseline and 6 months after radiotherapy. Statistical analyses were done by paired t-tests and mixed ANCOVA repeated-measures analysis. RESULTS From November 1, 2013 to October 31, 2015, a total 61 patients undergoing radiotherapy for HNC cancer were enrolled (30 in control and 31 in experimental groups). Decrease in salivary flow rate was comparable between 2 groups. Dental caries increased in control group (P = .006); PS and BOP were decreased in experimental group (P < .001 and .004, respectively). Experimental group showed lower swallowing, speech problems, and less sexuality scores in EORTC QLQ-H&N35 than control group. CONCLUSION We found improvement in oral health and the quality of life in HNC patients with comprehensive oral care intervention by dental professionals. Communicating and cooperating between the healthcare and dental professionals is needed to raise the quality of health care services for HNC patients receiving radiotherapy.
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Affiliation(s)
- Hye-Ju Lee
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry
- Dental Research Institute, Seoul National University
| | - Dong-Hun Han
- Department of Preventive and Social Dentistry, Seoul National University School of Dentistry
- Dental Research Institute, Seoul National University
| | - Jin-Ho Kim
- Department of Radiation Oncology and Cancer Research Institute, Seoul National University College of Medicine
| | - Hong-Gyun Wu
- Department of Radiation Oncology and Cancer Research Institute, Seoul National University College of Medicine
- Institute of Radiation Medicine, Medical Research Center
- Cancer Research Institute, Seoul National University, Seoul, Korea
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26
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Loh KP, Lam V, Webber K, Padam S, Sedrak MS, Musinipally V, Grogan M, Presley CJ, Grandi J, Sanapala C, Castillo DA, DiGiovanni G, Mohile SG, Walter LC, Wong ML. Characteristics Associated With Functional Changes During Systemic Cancer Treatments: A Systematic Review Focused on Older Adults. J Natl Compr Canc Netw 2021; 19:1055-1062. [PMID: 33857918 DOI: 10.6004/jnccn.2020.7684] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Maintaining functional status is important to older adults with cancer, but data are limited on how systemic treatments affect functional status. We systematically reviewed changes in functional status during systemic cancer treatments and identified characteristics associated with functional decline and improvement. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Register of Controlled Trials for articles examining characteristics associated with functional changes in older adults during systemic cancer treatment published in English between database inception and January 11, 2019 (PROSPERO CRD42019123125). Findings were summarized with descriptive statistics. Study characteristics between older adult-specific and non-older adult-specific studies were compared using the Fisher exact test. RESULTS We screened 15,244 titles/abstracts and 519 full texts. The final analysis included 44 studies, which enrolled >8,400 patients; 39% of studies focused on older adults (1 study enrolled adults aged ≥60 years, 10 enrolled adults aged ≥65 years, and 6 enrolled adults aged ≥70 years). Almost all studies (98%) used patient-reported outcomes to measure functional status; only 20% used physical performance tests. Reporting of functional change was heterogeneous, with 48% reporting change scores. Older adult-specific studies were more likely to analyze functional change dichotomously (29% vs 4%; P=.008). Functional decline ranged widely, from 6% to 90%. The most common patient characteristics associated with functional decline were older age (n=7 studies), worse performance status (n=4), progressive disease status (n=4), pain (n=4), anemia (n=4), and worse nutritional status (n=4). Twelve studies examined functional improvement and identified 11 unique associated characteristics. CONCLUSIONS Functional decline is increasingly recognized as an important outcome in older adults with cancer, but definitions and analyses are heterogeneous, leading to a wide range of prevalence. To identify patients at highest risk of functional decline during systemic cancer treatments, trials need to routinely analyze functional outcomes and measure characteristics associated with decline (eg, nutrition).
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Affiliation(s)
- Kah Poh Loh
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Vivian Lam
- 2Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Katey Webber
- 3School of Public Health, University of California, Berkeley, Berkeley, California
| | - Simran Padam
- 4Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Mina S Sedrak
- 4Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Vivek Musinipally
- 5Department of Adult and Family Medicine, Kaiser Permanente, San Francisco, California
| | - Madison Grogan
- 6Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Carolyn J Presley
- 6Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Janice Grandi
- 2Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Chandrika Sanapala
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Daniel A Castillo
- 7Edward G. Miner Library, University of Rochester School of Medicine and Dentistry, Rochester, New York; and
| | - Grace DiGiovanni
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Supriya G Mohile
- 1Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Louise C Walter
- 8Division of Geriatrics, University of California, San Francisco, and.,9San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Melisa L Wong
- 2Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California.,8Division of Geriatrics, University of California, San Francisco, and.,9San Francisco Veterans Affairs Medical Center, San Francisco, California
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27
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Farrugia M, Erickson K, Wendel E, Platek ME, Ji W, Attwood K, Ma SJ, Gu F, Singh AK, Ray AD. Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy. Cancers (Basel) 2021; 13:cancers13071638. [PMID: 33915867 PMCID: PMC8037640 DOI: 10.3390/cancers13071638] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Quality of life (QoL) scores and frailty status are becoming increasingly important criterion with implications on both how patients are treated and survival in head and neck cancer (HNC). Despite this, physicians lack tools to identify patients who are at risk of suffering declines in QoL and becoming frail following treatment. Therefore, we investigated whether functional decline, as measured by a series of physical tests called the Short Physical Performance Battery (SPPB), correlated with a reduction in QoL and increased risk of frailty. In the current study, patients who experienced a decline in SPPB scores were significantly more likely to have changes in physical functioning QoL measures as well as transition to frail status following treatment. In conclusion, the SPPB may be a useful tool to identify patients who may benefit from additional rehabilitation in future studies. Abstract Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in HNC and was the focus of this investigation. Methods: Patients who underwent radiation therapy for HNC from 2018 to 2020 were evaluated as a prospective observational cohort. Functional decline, QoL, and the frailty phenotype were measured via the Short Physical Performance Battery (SPPB), European Organization for Research and Treatment of Cancer (EORTC) qlq-C30, and Fried Frailty index, respectively. Results: A total of 106 HNC patients were included, 75 of which received concurrent chemoradiation therapy (CCRT) and 31 received radiation alone, both with and without surgery. There was a decrease in SPPB overall (p < 0.001) from the beginning to the end of treatment in the CCRT group but not the radiation group (p = 0.43). Change in overall SPPB points following treatment correlated with the decline in physical QoL for both groups (p < 0.05) as well as transition frail status in the CCRT group (p < 0.001) with a trend in the radiation group (p = 0.08). Conclusions: Change in SPPB correlates with QoL and transition to frailty status in patients undergoing definitive CCRT for HNC with similar trends in those receiving radiation alone. Decline in SPPB could potentially be useful in identification of those who may benefit from rehabilitation in future studies.
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Affiliation(s)
- Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Kayleigh Erickson
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Elizabeth Wendel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Dietetics, D’Youville College, Buffalo, NY 14203, USA
| | - Wenyan Ji
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Fangyi Gu
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Andrew D. Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Rehabilitation Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
- Correspondence: ; Tel.: +1-716-845-2381; Fax: +1-716-845-8487
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Dugué J, Humbert M, Bendiane MK, Bouhnik AD, Babin E, Licaj I. Head and neck cancer survivors' pain in France: the VICAN study. J Cancer Surviv 2021; 16:119-131. [PMID: 33635450 DOI: 10.1007/s11764-021-01010-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Pain is an increasing concern in the growing number of head and neck cancer survivors. This study aimed to analyze the 5-year prevalence of pain in French survivors of head and neck cancer and to identify associated factors. METHODS Analyses were performed among 296 5-year cancer survivors diagnosed in 2010. Using multivariable logistic regressions, we studied the associations between pain and factors collected in the French representative national "vie après le cancer" (VICAN) survey. Eligible participants were aged from 18 to 82 years; patients' living conditions, socioeconomic characteristics, and medical data were collected. RESULTS Pain was reported by 72.6% of the participants. In the multivariable analyses, decreasing level of physical activity was the only determinant of increased overall pain (OR= 2.77, CI= 1.48-5.17). The chronic pain prevalence was 62.3%. The main risk factors found were tumor localization in the oropharynx (OR= 2.49, CI= 1.27-4.88), education (at least a high school's degree) (OR= 0.33, CI= 0.13-0.9), and decreased physical activity (OR= 2.20, CI= 1.24-3.9). CONCLUSIONS Five years after diagnosis, pain is a very frequent sequelae that has a significant impact on quality of life in head and neck cancer survivors. Reduced physical activity, a low level of education, and tumor localization in the oropharynx are factors associated with pain. IMPLICATIONS FOR CANCER SURVIVORS Pain frequency and its impact on patients' lives imply that an adaptation must be made in terms of both pain diagnosis and management and the training of healthcare professionals. CLINICAL TRIAL REGISTRATION This is not a clinical trial. ISP number: INSERM C11-63.
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Affiliation(s)
- Justin Dugué
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France.
| | - Maxime Humbert
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Marc-Karim Bendiane
- Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM) Marseille, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Anne-Déborah Bouhnik
- Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM) Marseille, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Emmanuel Babin
- Department of Otorhinolaryngology Head and Neck Surgery, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Idlir Licaj
- Clinipace Biostatistics, Morrisville, NC, 27560, USA.,Clinical Research Department, Centre François Baclesse, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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29
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Crowder SL, Najam N, Sarma KP, Fiese BH, Arthur AE. Quality of life, coping strategies, and supportive care needs in head and neck cancer survivors: a qualitative study. Support Care Cancer 2021; 29:4349-4356. [PMID: 33415365 DOI: 10.1007/s00520-020-05981-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/29/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE The purpose of this qualitative study was to better understand the lived experience of head and neck cancer (HNC) survivors between 6 months to 9 years post-radiation. Quality of life, coping strategies, concerns for the future, and preferences for supportive care were explored. METHODS Semi-structured interviews were conducted in 31 HNC survivors from a Midwestern hospital. Interviews were recorded, transcribed verbatim and analyzed using qualitative thematic analysis. RESULTS Survivors described restrictions on daily living, social eating, and financial concerns. Despite these restrictions, survivors reported an overall high mentality and enjoyment of life. Coping considerations included adapting to a new normal and increased involvement in cancer support and faith groups. Preferences for supportive care included receiving more information about and being more involved in the treatment care plan, referrals to therapy and support groups, and more comprehensive follow-up in survivorship. CONCLUSIONS While long-term HNC survivors adapt to daily living restrictions, a high proportion continue to have unmet needs. This data can guide the development of HNC survivorship interventions to inform optimal clinical guidelines based on patients' perceived needs. This qualitative study uncovered distinct perceived needs of HNC survivors which can inform future service development. Incorporating referrals to supportive care services including speech language pathologist, physical therapists, and dietitians into the standard of care before, during, and after treatment would assist survivors in adapting to life after treatment and managing long-term health consequences of their disease.
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Affiliation(s)
- Sylvia L Crowder
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 386 Bevier Hall 905 S Goodwin Ave, Urbana, IL, 61801, USA.,Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave., Tampa, FL, 33617, USA
| | - Natasha Najam
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 386 Bevier Hall 905 S Goodwin Ave, Urbana, IL, 61801, USA
| | - Kalika P Sarma
- Carle Cancer Center, Carle Foundation Hospital, 602 W University Ave., Urbana, IL, 61801, USA
| | - Barbara H Fiese
- Family Resiliency Center and Department of Human Development and Family Studies, University of Illinois at Urbana-Champaign, 1016B Doris Kelley Christopher Hall. 904 West Nevada Street., Urbana, IL, 61801, USA
| | - Anna E Arthur
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 386 Bevier Hall 905 S Goodwin Ave, Urbana, IL, 61801, USA.
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30
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van Nieuwenhuizen AJ, Buffart LM, Langendijk JA, Vergeer MR, Voortman J, Leemans CR, Verdonck-de Leeuw IM. Health-related quality of life and overall survival: a prospective study in patients with head and neck cancer treated with radiotherapy. Qual Life Res 2020; 30:1145-1153. [PMID: 33289866 PMCID: PMC8004520 DOI: 10.1007/s11136-020-02716-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 01/06/2023]
Abstract
Purpose We aimed to examine whether pre-treatment, post-treatment and change in health-related quality of Life (HRQoL) is associated with survival, in patients with head and neck cancer (HNC). Methods We included 948 newly diagnosed HNC patients treated with primary or adjuvant (chemo)radiotherapy with curative intent. The EORTC QLQ-C30 questionnaire was assessed pre-treatment and at 6 weeks, 6 months and 12 months post-treatment. Multivariable Cox regression analyses were performed to examine whether HRQoL at all time points and changes in HRQoL over time were associated with survival, after adjusting for demographic, clinical and lifestyle-related variables. Results Higher HRQoL scores were significantly associated with improved 5-year overall survival at all time points, except for the subscale global QoL at 6 weeks. Changes in HRQoL at 6 weeks post-treatment compared to pre-treatment were not significantly associated with survival. Changes in physical (HR: 0.88 95% CI: 0.82–0.96) and emotional functioning (HR: 0.90 95% CI: 0.85–0.96) from pre-treatment to 6 months post-treatment and changes in global QOL, and physical, emotional, and social functioning from pre-treatment to 12 months post-treatment were significantly associated with survival. Conclusion Higher HRQoL reported pre-treatment and post-treatment (6 weeks, 6 months and 12 months) are significantly associated with improved survival, as well as changes in HRQoL at 6 and 12 months compared to pre-treatment. Our results highlight the value of monitoring HRQoL and to identify those patients that report decreased or deteriorated HRQOL. This may help to further improve cancer care in a timely and efficient manner.
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Affiliation(s)
- A J van Nieuwenhuizen
- Amsterdam University Medical Centers, Department of Otolaryngology-Head and Neck Surgery, Amsterdam, The Netherlands
| | - L M Buffart
- Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam, The Netherlands.,Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J A Langendijk
- University Medical Center Groningen, Department of Radiation Oncology, University of Groningen, Groningen, The Netherlands
| | - M R Vergeer
- Amsterdam University Medical Centers, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - J Voortman
- Amsterdam University Medical Centers, Department of Medical Oncology, Amsterdam, The Netherlands
| | - C R Leemans
- Amsterdam University Medical Centers, Department of Otolaryngology-Head and Neck Surgery, Amsterdam, The Netherlands
| | - I M Verdonck-de Leeuw
- Amsterdam University Medical Centers, Department of Otolaryngology-Head and Neck Surgery, Amsterdam, The Netherlands.
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31
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Johnson DE, Burtness B, Leemans CR, Lui VWY, Bauman JE, Grandis JR. Head and neck squamous cell carcinoma. Nat Rev Dis Primers 2020; 6:92. [PMID: 33243986 PMCID: PMC7944998 DOI: 10.1038/s41572-020-00224-3] [Citation(s) in RCA: 1769] [Impact Index Per Article: 442.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 02/07/2023]
Abstract
Most head and neck cancers are derived from the mucosal epithelium in the oral cavity, pharynx and larynx and are known collectively as head and neck squamous cell carcinoma (HNSCC). Oral cavity and larynx cancers are generally associated with tobacco consumption, alcohol abuse or both, whereas pharynx cancers are increasingly attributed to infection with human papillomavirus (HPV), primarily HPV-16. Thus, HNSCC can be separated into HPV-negative and HPV-positive HNSCC. Despite evidence of histological progression from cellular atypia through various degrees of dysplasia, ultimately leading to invasive HNSCC, most patients are diagnosed with late-stage HNSCC without a clinically evident antecedent pre-malignant lesion. Traditional staging of HNSCC using the tumour-node-metastasis system has been supplemented by the 2017 AJCC/UICC staging system, which incorporates additional information relevant to HPV-positive disease. Treatment is generally multimodal, consisting of surgery followed by chemoradiotherapy (CRT) for oral cavity cancers and primary CRT for pharynx and larynx cancers. The EGFR monoclonal antibody cetuximab is generally used in combination with radiation in HPV-negative HNSCC where comorbidities prevent the use of cytotoxic chemotherapy. The FDA approved the immune checkpoint inhibitors pembrolizumab and nivolumab for treatment of recurrent or metastatic HNSCC and pembrolizumab as primary treatment for unresectable disease. Elucidation of the molecular genetic landscape of HNSCC over the past decade has revealed new opportunities for therapeutic intervention. Ongoing efforts aim to integrate our understanding of HNSCC biology and immunobiology to identify predictive biomarkers that will enable delivery of the most effective, least-toxic therapies.
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Affiliation(s)
- Daniel E. Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Barbara Burtness
- Department of Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - C. René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Vivian Wai Yan Lui
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Julie E. Bauman
- Department of Medicine-Hematology/Oncology, University of Arizona, Tucson, AZ, USA
| | - Jennifer R. Grandis
- Department of Otolaryngology-Head and Neck Surgery, University of California at San Francisco, San Francisco, CA, USA,
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Melissant HC, Jansen F, Eerenstein SE, Cuijpers P, Laan E, Lissenberg-Witte BI, Schuit AS, Sherman KA, Leemans CR, Verdonck-de Leeuw IM. Body image distress in head and neck cancer patients: what are we looking at? Support Care Cancer 2020; 29:2161-2169. [PMID: 32885315 PMCID: PMC7892513 DOI: 10.1007/s00520-020-05725-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/26/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of the present study is to investigate the prevalence of body image distress among head and neck cancer (HNC) patients after treatment and to examine its association with sociodemographic and clinical factors, health-related quality of life (HRQOL), HNC symptoms, sexuality, self-compassion, and psychological distress. Second, we aim to explore daily life experiences of HNC patients regarding body image. METHODS A cross-sectional survey among HNC patients investigated the prevalence of body image distress based on the Body Image Scale. Multivariable logistic regression analysis was applied to study associations with sociodemographic and clinical factors, HRQOL (EORTC QLQ-C30), HNC symptoms (QLQ-HN43), sexuality (FSFI-6; IIEF-5), self-compassion (SCS-SF), and psychological distress (HADS). Qualitative data from a body image writing intervention was used to explore experiences in daily life related to body image. RESULTS Body image distress was prevalent in 13-20% (depending on cut-off scores) of 233 HNC patients. Symptoms of depression (p < 0.001), younger age (p < 0.001), problems with social contact (p = 0.001), problems with wound healing (p = 0.013), and larger extent of surgery (p = 0.014) were associated with having body image distress. This model explained 67% of variance. Writing interventions of 40 HNC patients showed that negative body image experiences were related to appearance and function, with social functioning problems described most often. CONCLUSION Prevalence of body image distress in HNC patients, using different cut-off scores, is 13-20%. Younger patients, patients after extensive surgery, and patients who had wound healing problems are most at risk. There is a significant association between body image distress and depressive symptoms and social functioning.
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Affiliation(s)
- H C Melissant
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands.,Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F Jansen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands. .,Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - S E Eerenstein
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands
| | - P Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - E Laan
- Department of Sexology and Psychosomatic OBGYN, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - B I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A S Schuit
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - K A Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - C R Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands
| | - I M Verdonck-de Leeuw
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, P.O. Box 7057, 1007, Amsterdam, MB, Netherlands.,Cancer Center Amsterdam (CCA), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Bahig H, Lambert L, Filion E, Soulières D, Guertin L, Ayad T, Christopoulos A, Bissada E, Alizadeh M, Bélair M, Nguyen-Tan PF. Phase II study of de-intensified intensity-modulated radiotherapy and concurrent carboplatin/5-fluorouracil in lateralized p16-associated oropharyngeal carcinoma. Head Neck 2020; 42:3479-3489. [PMID: 32866313 DOI: 10.1002/hed.26401] [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] [Received: 11/11/2019] [Revised: 06/16/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess cancer control and patient-reported outcomes (PROs) after de-intensified intensity-modulated radiotherapy (IMRT) in lateralized p16-associated oropharyngeal cancer (p16-OPC). METHODS Lateralized p16-OPC treated with radiotherapy and concurrent Carboplatin/5-fluorouracil between 2011 and 2014 were enrolled. De-intensified IMRT consisted in elective neck dose of 43.2 Gy/24 fractions and omission of contralateral retropharyngeal/level IV nodes. PROs were assessed using the EORTC QLC-C30 and QLQ-HN35 scales. RESULTS Twenty-nine patients were included. Median follow-up was 44 months. As per AJCC 7th Ed, 7%, 83% and 10% of patients had stage III, IVa and IVb. 5-year locoregional control and overall survival rates were 100% and 100%, respectively. Rates of acute were 52% and 35%, respectively. At 2 years post-treatment, 50% and 14% of patients had grade 1 xerostomia and dysgueusia, respectively. Most PROs scores returned to baseline within 8 months post-treatment. CONCLUSION De-intensified IMRT was associated with excellent cancer outcomes, and rapid recovery of PROs in lateralized p16-OPC.
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Affiliation(s)
- Houda Bahig
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Louise Lambert
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Edith Filion
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Denis Soulières
- Medical Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Louis Guertin
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Tareck Ayad
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Apostolos Christopoulos
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Eric Bissada
- Otolaryngology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Moein Alizadeh
- Radiation Oncology Department, Centre Intégré de Cancérologie de la Cité de la Santé à Laval, Montreal, Québec, Canada
| | - Manon Bélair
- Radiology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Phuc Felix Nguyen-Tan
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
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Monteiro AR, Garcia AR, Pereira TC, Macedo F, Soares RF, Pereira K, Serra T, Khouri L, Ribeiro J, Teixeira MM. ACE-27 as a prognostic tool of severe acute toxicities in patients with head and neck cancer treated with chemoradiotherapy: a real-world, prospective, observational study. Support Care Cancer 2020; 29:1863-1871. [PMID: 32789624 DOI: 10.1007/s00520-020-05679-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/08/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the association between comorbidities as assessed by the "Adult Comorbidity Evaluation 27" (ACE-27) and the development of severe acute toxicities in patients with head and neck cancer treated with chemoradiotherapy. METHODS Prospective, single-center cohort of patients with head and neck cancer treated with chemoradiotherapy (cisplatin 100 mg/m2 on days 1, 22, and 43; intensity-modulated radiotherapy 60 to 69.96 gray, in 30 to 33 fractions,) between June 2018 and December 2019. ACE-27 was assessed before the start of treatment. Patients were divided in two groups based on ACE-27 grading (none to mild versus moderate to severe comorbidities). Differences in incidence of severe acute toxicity and change in treatment plan between groups were examined. RESULTS A total of 101 patients were included: 90.1% were male, and median age was 57 years. ACE-27 grading was none in 6.9% of patients, mild in 52.5%, moderate in 29.7%, and severe in 10.9%. Severe acute toxicities occurred more frequently in patients with moderate to severe comorbidities (75.6% versus 48.3%), with a statically significant difference (p = 0.006, OR 3.314, 95%-CI (1.382-7.944)). In the group with moderate to severe comorbidities, omission of at least one cisplatin cycle (75.6% versus 60.0%) and premature ending of radiotherapy (12.2% versus 5.0%) also occurred more frequently (p ≥ 0.05). CONCLUSION In patients with head and neck cancer treated with chemoradiotherapy, the presence of moderate to severe comorbidities seems to correlate with higher incidences of severe acute toxicities. ACE-27 may identify patients at higher risk of major toxicities and assist decisions regarding treatment.
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Affiliation(s)
- Ana Raquel Monteiro
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal.
| | - Ana Rita Garcia
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Tatiana Cunha Pereira
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Filipa Macedo
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Rita Félix Soares
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Kayla Pereira
- Radiation Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Tânia Serra
- Radiation Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Leila Khouri
- Radiation Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - João Ribeiro
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Maria Margarida Teixeira
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
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Wilkie JR, Mierzwa ML, Casper KA, Mayo CS, Schipper MJ, Eisbruch A, Worden FP, El Naqa I, Viglianti BL, Rosen BS. Predicting late radiation-induced xerostomia with parotid gland PET biomarkers and dose metrics. Radiother Oncol 2020; 148:30-37. [DOI: 10.1016/j.radonc.2020.03.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 01/21/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
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van der Geer SJ, van Rijn PV, Roodenburg JLN, Dijkstra PU. Prognostic factors associated with a restricted mouth opening (trismus) in patients with head and neck cancer: Systematic review. Head Neck 2020; 42:2696-2721. [PMID: 32558025 PMCID: PMC7496412 DOI: 10.1002/hed.26327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/24/2020] [Accepted: 05/27/2020] [Indexed: 01/05/2023] Open
Abstract
Background To prescribe early trismus therapy, prognostic factors influencing the restricted mouth opening should be identified first. Our aim is to present an overview of these factors in patients with head and neck cancer. Methods PubMed, Cochrane, EMBASE, and CINAHL were searched using terms related to head and neck cancer and mouth opening. Risk of bias was assessed using the “Quality in Prognosis Studies” tool. A best evidence synthesis was performed. Results Of the identified 1418 studies, 53 were included. Three studies contained a prognostic multivariate model for a restricted mouth opening. Conclusions Patients with head and neck cancer will most likely develop a restricted mouth opening when they have a large tumor near the masticatory muscles that requires extensive cancer treatment. A restricted mouth opening most likely occurs within 6 months after cancer treatment. Further research is necessary on factors related to healing tendency or pain intensity.
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Affiliation(s)
- Sarah J van der Geer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Phillip V van Rijn
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter U Dijkstra
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Tuomi L, Karlsson T. Voice Quality, Function, and Quality of Life for Laryngeal Cancer: A Prospective Longitudinal Study Up to 24 Months Following Radiotherapy. EAR, NOSE & THROAT JOURNAL 2020; 100:913S-920S. [PMID: 32484410 DOI: 10.1177/0145561320929941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To study the potential changes of health-related quality of life (HRQL), voice quality, and communicative function up to 24 months following radiotherapy for patients with laryngeal cancer. METHODS A total of 28 patients with laryngeal cancer, treated by curatively intended radiotherapy were included in this prospective longitudinal descriptive study. Patients were followed pre-radiotherapy, 12 months, and 24 months post-radiotherapy. At each time point, voice recordings and patient-reported outcome instruments (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core30, Head and Neck35, Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer) were completed. Perceptual analysis using the Grade-Roughness-Breathiness-Asthenia-Strain was performed using the voice recordings. RESULTS Voice quality remains inferior to the voices of healthy controls both before and up to 24 months post-radiotherapy, demonstrating no statistically significant changes during the study period. Self-perceived communicative function revealed a trend toward improvement. Health-related quality of life remains mostly at stable levels, however, with statistically significant deterioration regarding dry mouth and sticky saliva. Generally, patients reported inferior scores compared to a normal population. CONCLUSION This study demonstrated no statistically significant changes over time in HRQL and perceptual voice quality at pre-radiotherapy compared to 24 months post-radiotherapy. However, the values remain inferior to the voices of healthy controls or a normal population.
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Affiliation(s)
- Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Therese Karlsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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The course of symptoms of anxiety and depression from time of diagnosis up to 2 years follow-up in head and neck cancer patients treated with primary (chemo)radiation. Oral Oncol 2020; 102:104576. [DOI: 10.1016/j.oraloncology.2020.104576] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 11/17/2022]
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Karimi AM, Gairola M, Ahlawat P, Tandon S, Pal M, Sachdeva N, Sharief MI, Dobriyal K. Health-related quality of life assessment for head-and-neck cancer patients during and at 3 months after radiotherapy - A prospective, analytical questionnaire-based study. Natl J Maxillofac Surg 2019; 10:134-140. [PMID: 31798246 PMCID: PMC6883888 DOI: 10.4103/njms.njms_92_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/18/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Health-related quality of life (HRQoL) is a more specific area of QoL that deals with the evaluation and assessment of the impact of the disease and its treatment-related morbidities on a patient's physical, psychological, and social aspects. The aim of the present study was to assess the HRQoL of patients with head-and-neck cancer (HNCs) during and at 3 months after completion of radiotherapy (RT) by intensity-modulated RT. Materials and Methods This study was a prospective, longitudinal, observational, and self-completed questionnaire-based study that included 120 patients with HNC who underwent intensity-modulated RT. The questionnaire had adequate internal consistency. The questionnaires were given to each patient at the beginning of treatment (pretreatment), weekly visits during the course of RT (at the end of 1st, 2nd, 3rd, 4th, 5th, and 6th week), on the day of completion of RT, and then finally at 3 months after completion of RT. Thus, a total of successive nine time points were assessed. Results and Conclusions One hundred and eleven patients completed the questionnaires at all nine time points. HRQoL usually decreases during treatment and then increases to pretreatment levels by 3 months after treatment. The Quality of Life Questionnaire, Core Module and Quality of Life Questionnaire, Head and Neck Module were found to be both valid and reliable. There was a significant QoL reduction for the patients throughout treatment in relation to functions and symptoms in the treatment of HNC. However, all the functions and most of the symptoms returned to baseline at the 3-month follow-up.
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Affiliation(s)
| | - Munish Gairola
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sarthak Tandon
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Manoj Pal
- Department of Medical Oncology, Millennium Cancer Center, Gurugram, Haryana, India
| | - Nishtha Sachdeva
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Muhammed Ismail Sharief
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Kiran Dobriyal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
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40
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To eat is to practice-managing eating problems after head and neck cancer. J Cancer Surviv 2019; 13:792-803. [PMID: 31446592 DOI: 10.1007/s11764-019-00798-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/12/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this qualitative study was twofold: (1) to explore head and neck cancer (HNC) survivors' experiences of everyday life with eating problems after cancer treatment and (2) to explore their experiences of participating in a multidisciplinary residential rehabilitation program with a primary focus on physical, psychological, and social aspects of eating problems after treatment. METHODS Semi-structured focus group interviews were conducted with 40 Danish HNC survivors who participated in a 5-day residential rehabilitation program with follow-up after 3 months. The transcribed interviews were analyzed through qualitative content analysis. RESULTS Physical nutrition impact symptoms and unmet needs for support were frequent. Participants experienced a feeling of loss due to impaired eating abilities. Eating had become an obligation or a training situation, and the eating problems challenged the relationship with their relatives when well-meaning encouragement was perceived as a pressure. Social eating was a challenge, and this often led to social withdrawal. The residential program was a safe and supportive environment to practice eating skills, and participants benefited from meeting peers. The program provided participants with knowledge and skills that many of them had been missing during and after treatment. CONCLUSIONS Eating problems after treatment have substantial effects on the everyday life of HNC survivors. A multidisciplinary residential rehabilitation program may be beneficial to meet their rehabilitation needs. IMPLICATIONS FOR CANCER SURVIVORS The results are useful for future planning of rehabilitation services and clinical studies that may contribute to improving current clinical practice and benefit HNC survivors.
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Eldridge RC, Pugh SL, Trotti A, Hu K, Spencer S, Yom SS, Rosenthal D, Read N, Desai A, Gore E, Shenouda G, Mishra MV, Bruner D, Xiao C. Changing functional status within 6 months posttreatment is prognostic of overall survival in patients with head and neck cancer: NRG Oncology Study. Head Neck 2019; 41:3924-3932. [PMID: 31435980 DOI: 10.1002/hed.25922] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/26/2019] [Accepted: 08/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Is posttreatment functional status prognostic of overall survival in patients with head and neck cancer (HNC). METHODS In an HNC clinical trial, 495 patients had two posttreatment functional assessments measuring diet, public eating, and speech within 6 months. Patients were grouped by impairment (highly, moderately, modestly, or not impaired) and determined if they improved, declined, or did not change from the first assessment to the second. Multivariable Cox models estimated overall mortality. RESULTS Across all three scales, the change in posttreatment patient function strongly predicted overall survival. In diet, patients who declined to highly impaired had three times the mortality of patients who were not impaired at both assessments (hazard ratio [HR] = 3.60; 95% confidence interval, 2.02-6.42). For patients improving from highly impaired, mortality was statistically similar to patients with no impairment (HR = 1.38; 95% CI, 0.82-2.31). CONCLUSIONS Posttreatment functional status is a strong prognostic marker of survival in patients with HNC.
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Affiliation(s)
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Pittsburgh, Pennsylvania
| | | | - Kenneth Hu
- Laura and Isaac Perlmutter Cancer Center at NYU Langone, New York, New York
| | - Sharon Spencer
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Sue S Yom
- UCSF Medical Center-Mount Zion, San Francisco, California
| | - David Rosenthal
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy Read
- London Regional Cancer Program, London, Ontario, Canada
| | | | - Elizabeth Gore
- Zablocki VA Medical Center (Accruals under Froedtert and the Medical College of Wisconsin), Milwaukee, Wisconsin
| | | | - Mark V Mishra
- University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland
| | - Deborah Bruner
- Emory University/Winship Cancer Center, Atlanta, Georgia
| | - Canhua Xiao
- Emory University/Winship Cancer Center, Atlanta, Georgia
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Liao LJ, Hsu WL, Lo WC, Cheng PW, Shueng PW, Hsieh CH. Health-related quality of life and utility in head and neck cancer survivors. BMC Cancer 2019; 19:425. [PMID: 31064331 PMCID: PMC6505071 DOI: 10.1186/s12885-019-5614-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/15/2019] [Indexed: 11/25/2022] Open
Abstract
Background This study seeks to assess quality of life (QOL) and utility scores of head and neck cancer survivors. Methods We compared QOL as indicated by EORTC QLQ-C30, QLQ-H&N35, utility scores by time trade off (TTO) with previous published reference values and tested series characteristics related to global QOL and utility. Results A total of 127 patients were recruited. Of the patients, 102 (80%) completed the utility assessment. Cancer survivors had lower scores compared with norm values. Patients without a spouse had a lower utility than those with a spouse. Patients with a low annual family income also had lower global QOL and utility scores (p < 0.05). Other factors were not significantly related to QOL and utility scores. Conclusion Disease and treatment of head and neck cancer lead to disability and poor health-related QOL and utility. Economic status may contribute to health-related QOL and utility, while marital status is related to utility for head and neck cancer patients.
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Affiliation(s)
- Li-Jen Liao
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Wan-Lun Hsu
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Hsi Hsieh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Bossi P, Giusti R, Tarsitano A, Airoldi M, De Sanctis V, Caspiani O, Alterio D, Tartaro T, Alfieri S, Siano M. The point of pain in head and neck cancer. Crit Rev Oncol Hematol 2019; 138:51-59. [PMID: 31092385 DOI: 10.1016/j.critrevonc.2019.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/12/2022] Open
Abstract
Head and neck cancer (HNC) can have a devastating impact on patient's lives as both disease and treatment may affect the ability to speak, swallow and breathe. These conditions limit the oral intake of food and drugs, reduce social functioning and impact on patient's quality of life. Up to 80% of patients suffering from HNC have pain due to the spread of the primary tumor, because of consequences of surgery, or by developing oral mucositis, dysphagia or neuropathy as toxic side effects of radiotherapy, chemotherapy or both. All healthcare professionals caring for HNC patients should assess palliative and supportive care needs in initial treatment planning and throughout the disease, with awareness when specialist palliative care expertise is needed. This paper focuses on assessment, characterizations and clinical management of pain in advanced HNC patients undergoing surgery, chemotherapy and radiotherapy, also underlining the importance of symptom assessment in HNC survivors and the need of clinical research in this field.
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Affiliation(s)
- Paolo Bossi
- University of Brescia - Medical Oncology Department, ASST Spedali Civili Brescia, Piazzale Spedali Civili 1, Brescia, Italy.
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant'Andrea, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Achille Tarsitano
- Maxillo-Facial Surgery Unit - Head and Neck Dept., Policlinico S. Orsola, DIBINEM - University of Bologna, Via Massarenti 9, Bologna, Italy
| | - Mario Airoldi
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Cso Bramante 88/90, 10126, Torino, Italy
| | - Vitaliana De Sanctis
- Radiotherapy Oncology, "Sapienza" University of Rome, Department of Medical and Surgical Science and Translational Medicine, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Orietta Caspiani
- Division of Radiation Oncology, Isola Tiberina Hospital, Rome, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Tiziana Tartaro
- Medical Oncology Department, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Salvatore Alfieri
- Head and Neck Medical Oncology Dept., Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, Milan, Italy
| | - Marco Siano
- Cantonal Hospital St. Gallen, Clinic for Oncology and Hematology, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland; Hôpital Riviera-Chablais, Service of Cancerology, Av. De la Prairie 1, CH-1800, Vevey, Switzerland
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Jansen F, Lissenberg-Witte BI, Krebber AMH, Cuijpers P, de Bree R, Becker-Commissaris A, Smit EF, van Straten A, Eeckhout GM, Beekman ATF, Leemans CR, Verdonck-de Leeuw IM. Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: which groups specifically benefit? Secondary analyses of a randomized controlled trial. Support Care Cancer 2019; 27:4543-4553. [PMID: 30915569 PMCID: PMC6825034 DOI: 10.1007/s00520-019-04714-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/22/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Stepped care (SC), consisting of watchful waiting, guided self-help, problem-solving therapy, and psychotherapy/medication is, compared to care-as-usual (CAU), effective in improving psychological distress. This study presents secondary analyses on subgroups of patients who might specifically benefit from watchful waiting, guided self-help, or the entire SC program. METHODS In this randomized controlled trial, head and neck and lung cancer patients with distress (n = 156) were randomized to SC or CAU. Univariate logistic regression analyses were performed to investigate baseline factors associated with recovery after watchful waiting and guided self-help. Potential moderators of the effectiveness of SC compared to CAU were investigated using linear mixed models. RESULTS Patients without a psychiatric disorder, with better psychological outcomes (HADS: all scales) and better health-related quality of life (HRQOL) (EORTC QLQ-C30/H&N35: global QOL, all functioning, and several symptom domains) were more likely to recover after watchful waiting. Patients with better scores on distress, emotional functioning, and dyspnea were more likely to recover after guided self-help. Sex, time since treatment, anxiety or depressive disorder diagnosis, symptoms of anxiety, symptoms of depression, speech problems, and feeling ill at baseline moderated the efficacy of SC compared to CAU. CONCLUSIONS Patients with distress but who are relatively doing well otherwise, benefit most from watchful waiting and guided self-help. The entire SC program is more effective in women, patients in the first year after treatment, patients with a higher level of distress or anxiety or depressive disorder, patients who are feeling ill, and patients with less speech problems. TRIAL NTR1868.
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Affiliation(s)
- Femke Jansen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Anna M H Krebber
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Egbert F Smit
- Department of Pulmonary Diseases, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Guus M Eeckhout
- Department of Psychiatry, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam (CCA), Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands.
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Early Changes in Serial CBCT-Measured Parotid Gland Biomarkers Predict Chronic Xerostomia After Head and Neck Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:1319-1329. [PMID: 30003997 DOI: 10.1016/j.ijrobp.2018.06.048] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/29/2018] [Accepted: 06/27/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine whether serial cone beam computed tomography (CBCT) images taken during head and neck radiation therapy (HNR) can improve chronic xerostomia prediction. METHODS AND MATERIALS In a retrospective analysis, parotid glands (PGs) were delineated on daily kV CBCT images using deformable image registration for 119 HNR patients (60 or 70 Gy in 2 Gy fractions over 6 or 7 weeks). Deformable image registration accuracy for a subset of deformed contours was quantified using the Dice similarity coefficient and mean distance to agreement in comparison with manually drawn contours. Average weekly changes in CBCT-measured mean Hounsfield unit intensity and volume were calculated for each PG relative to week 1. Dose-volume histogram statistics were extracted from each plan, and interactions among dose, volume, and intensity were investigated. Univariable analysis and penalized logistic regression were used to analyze association with observer-rated xerostomia at 1 year after HNR. Models including CBCT delta imaging features were compared with clinical and dose-volume histogram-only models using area under the receiver operating characteristic curve (AUC) for grade ≥1 and grade ≥2 xerostomia prediction. RESULTS All patients experienced end-treatment PG volume reduction with mean (range) ipsilateral and contralateral PG shrinkage of 19.6% (0.9%-58.4%) and 17.7% (4.4%-56.3%), respectively. Midtreatment volume change was highly correlated with mean PG dose (r = -0.318, P < 1e-6). Incidence of grade ≥1 and grade ≥2 xerostomia was 65% and 16%, respectively. For grade ≥1 xerostomia prediction, the delta-imaging model had an AUC of 0.719 (95% confidence interval [CI], 0.603-0.830), compared with 0.709 (95% CI, 0.603-0.815) for the dose/clinical model. For grade ≥2 xerostomia prediction, the dose/clinical model had an AUC of 0.692 (95% CI, 0.615-0.770), and the addition of contralateral PG changes modestly improved predictive performance, with an AUC of 0.776 (0.643-0.912). CONCLUSIONS The rate of CBCT-measured PG image feature changes improves prediction over dose alone for chronic xerostomia prediction. Analysis of CBCT images acquired for treatment positioning may provide an inexpensive monitoring system to support toxicity-reducing adaptive radiation therapy.
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Melissant HC, Jansen F, Schutte LER, Lissenberg-Witte BI, Buter J, Leemans CR, Sprangers MA, Vergeer MR, Laan ETM, Verdonck-de Leeuw IM. The course of sexual interest and enjoyment in head and neck cancer patients treated with primary (chemo)radiotherapy. Oral Oncol 2018; 83:120-126. [PMID: 30098767 DOI: 10.1016/j.oraloncology.2018.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/04/2018] [Accepted: 06/17/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The aim of this prospective study was to investigate the course of sexual interest and enjoyment in relation to sociodemographic and clinical factors, health-related quality of life (HRQOL), and symptoms of psychological distress in head and neck cancer (HNC) patients treated with primary (chemo)radiotherapy. METHODS HNC patients (n = 354) completed patient-reported outcome measures (PROMs) on HRQOL (EORTC QLQ-C30 and QLQ-H&N35, including the sexuality subscale covering less sexual interest and enjoyment), and psychological distress (HADS) pretreatment, at 6-week follow-up and at 3-, 6-, 12-, 18-, and 24-month follow-up (i.e., after treatment). Linear mixed models were used to analyze the course of sexuality from pretreatment to 24-month follow-up, and to investigate its relation to sociodemographic and clinical factors, HRQOL, and psychological distress as measured at baseline, and to investigate the course of sexuality from 6- to 24-month follow-up in relation to these factors measured at 6-month follow-up. RESULTS Before start of treatment, 37% of patients reported having less sexuality, which increased to 60% at 6-week follow-up, and returned to baseline level from 12-month follow-up onwards. Older age (p = 0.037) and trouble with social contact (p < 0.001), weight loss (p = 0.013), and constipation (p = 0.041) before treatment were associated with less sexuality over time. Female gender (p = 0.021) and poor social functioning (p < 0.001) at 6-month follow-up were associated with less sexuality from 6- to 24-month follow-up. DISCUSSION Less sexuality is often reported in HNC patients treated with (chemo)radiotherapy. Using PROMs in clinical practice may help identify patients who might benefit from supportive care targeting sexuality.
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Affiliation(s)
- H C Melissant
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Cancer Center Amsterdam (CCA), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
| | - F Jansen
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Cancer Center Amsterdam (CCA), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
| | - L E R Schutte
- Department of Sexology and Psychosomatic OBGYN, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - B I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands.
| | - J Buter
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - C R Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - M A Sprangers
- Department of Medical Psychology, Academic Medical Center, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands; Cancer Center Amsterdam (CCA), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
| | - M R Vergeer
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - E T M Laan
- Department of Sexology and Psychosomatic OBGYN, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - I M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands; Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Cancer Center Amsterdam (CCA), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
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Ghazizadeh S, Kuan EC, Mallen-St Clair J, Abemayor E, Luu Q, Nabili V, St John MA. It Takes Two: One Resects, One Reconstructs. Otolaryngol Clin North Am 2018; 50:747-753. [PMID: 28755704 DOI: 10.1016/j.otc.2017.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Care of patients with advanced head and neck cancer is a multidisciplinary effort through all phases of care. Head and neck cancer surgery involves balancing oncologic control, functional preservation, and aesthetics. Given the advances in free tissue reconstruction, the majority of defects can be reconstructed using free tissue transfer flaps. A 2-team approach allows for early, continual communication and meticulous operative planning. Operations can be combined into a single effort. This approach maximizes efficiency and enables multidisciplinary collaboration for comprehensive surgical treatment. We present our experience and an outline of how responsibilities between the ablative and reconstructive teams are shared.
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Affiliation(s)
- Shabnam Ghazizadeh
- Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA
| | - Edward C Kuan
- Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA
| | | | - Elliot Abemayor
- UCLA Head and Neck Cancer Program, Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA
| | - Quang Luu
- Division of Facial Plastic and Reconstructive Surgery, Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA
| | - Vishad Nabili
- Division of Facial Plastic and Reconstructive Surgery, Department of Head and Neck Surgery, University of California, Los Angeles Medical Center, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA 90095, USA
| | - Maie A St John
- UCLA Head and Neck Cancer Program, Jonsson Comprehensive Cancer Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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48
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Crowder SL, Douglas KG, Yanina Pepino M, Sarma KP, Arthur AE. Nutrition impact symptoms and associated outcomes in post-chemoradiotherapy head and neck cancer survivors: a systematic review. J Cancer Surviv 2018; 12:479-494. [DOI: 10.1007/s11764-018-0687-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
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Lechien JR, Khalife M, Huet K, Fourneau AF, Delvaux V, Piccaluga M, Harmegnies B, Saussez S. Impact of Chemoradiation After Supra- or Infrahyoid Cancer on Aerodynamic, Subjective, and Objective Voice Assessments: A Multicenter Prospective Study. J Voice 2018; 32:257.e11-257.e19. [DOI: 10.1016/j.jvoice.2017.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 12/13/2022]
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50
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Nevens D, Goeleven A, Duprez F, Braeken R, Decabooter E, De Smet M, Lutters L, Dejaeger E, De Neve W, Nuyts S. Does the total dysphagia risk score correlate with swallowing function examined by videofluoroscopy? Br J Radiol 2017; 91:20170714. [PMID: 29212356 DOI: 10.1259/bjr.20170714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose of this study was to correlate the total dysphagia risk score (TDRS) with swallowing function as measured by videofluoroscopy of swallowing using the swallowing performance scale (SPS) and the penetration aspiration scale (PAS). METHODS 63 patients from two different centres treated with radiotherapy for head and neck cancer were evaluated in the current study. Swallowing videofluoroscopies at baseline, 6 and 12 months following radiotherapy were evaluated by two observers. The TDRS of all patients was calculated and correlated with the consensus PAS and SPS scores of the two observers. RESULTS Regarding the PAS scale, we did not observe a significant correlation with the TDRS. Regarding SPS, we found a significant correlation at 6 months (p = 0.01) and a borderline significant correlation at 12 months (p = 0.05). We observed statistically lower SPS scores for patients in the intermediate-risk category when compared to the high-risk category. When we compared low vs high TDRS risk patients, we did not observe a significant difference regarding SPS scores. When comparing low- vs intermediate-risk patients, we observed higher SPS scores in the low-risk group (p = 0.01). When the low- and intermediate-risk patients were grouped together, we observed less swallowing problems as measured by SPS in the low and intermediate group when compared to the high-risk group (p = 0.05) at 6 months. CONCLUSION Patients with high-risk TDRS scores have higher SPS scores when compared to the intermediate group and the intermediate- and low-risk group together. However, low-risk patients in our patient cohort could not be distinguished from high or intermediate-risk patients. Advances in knowledge: TDRS was never correlated with videofluoroscopies in past studies. The hypothesis of this paper was to see if the TDRS could guide us to see which patients are at risk for high scores on SPS and PAS and might need a videofluoroscopic examination in the follow up. Given the poor correlations in our study, however, we cannot recommend the use of the TDRS to select patients who might benefit from the additional information provided by videofluoroscopies.
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Affiliation(s)
- Daan Nevens
- 1 Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven , Leuven , Belgium
| | - Ann Goeleven
- 2 Department of ENT Head and Neck Surgery, University Hospitals Leuven, Swallowing Clinic , Leuven , Belgium
| | - Fréderic Duprez
- 3 Department of Radiotherapy, Ghent University Hospital , Ghent , Belgium
| | - R Braeken
- 4 Master Program in Speech, Language and Hearing Sciences, Catholic University Leuven , Leuven , Belgium
| | - E Decabooter
- 4 Master Program in Speech, Language and Hearing Sciences, Catholic University Leuven , Leuven , Belgium
| | - M De Smet
- 4 Master Program in Speech, Language and Hearing Sciences, Catholic University Leuven , Leuven , Belgium
| | - L Lutters
- 4 Master Program in Speech, Language and Hearing Sciences, Catholic University Leuven , Leuven , Belgium
| | - Eddy Dejaeger
- 5 Department of Geriatric Medicine, University Hospitals, Leuven Swallowing Clinic , Leuven , Belgium
| | - Wilfried De Neve
- 3 Department of Radiotherapy, Ghent University Hospital , Ghent , Belgium
| | - Sandra Nuyts
- 1 Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven , Leuven , Belgium
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