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McNeely ML, Chan KM, Spychka RA, Nedeljak J, Debenham B, Jha N, Seikaly H. Building a Bridge to Community: A Pragmatic Randomized Trial Examining a Combined Physical Therapy and Resistance Exercise Intervention for People after Head and Neck Cancer. Cancers (Basel) 2024; 16:1758. [PMID: 38730710 PMCID: PMC11083025 DOI: 10.3390/cancers16091758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Established barriers to general exercise and physical activity among individuals with head and neck cancer include dry mouth, difficulty eating, weight loss, fear of injury, comorbidities, and treatment-related symptoms of pain and fatigue. METHODS/DESIGN A 12-week pragmatic randomized controlled trial was conducted followed by an optional supported exercise transition phase. Eligible participants were individuals with head and neck cancers who had undergone surgery and/or radiation therapy to lymph node regions in the neck. Participants were randomized to a comparison group involving a shoulder and neck physiotherapeutic exercise protocol, or to a combined experimental group comprising the shoulder and neck physiotherapeutic exercise protocol and lower-body resistance exercise training. The primary outcome of this study was fatigue-related quality of life. RESULTS Sixty-one participants enrolled, 59 (97%) completed the randomized trial phase, 55 (90%) completed the 24-week follow-up, and 52 (85%) completed the one-year follow-up. Statistically significant between-group differences were found in favor of the combined experimental group for the fatigue-related quality of life, fitness outcomes, and overall physical activity. Paired comparisons confirmed significant within-group improvements for both groups from baseline to one-year follow-up across most outcomes. DISCUSSION A group-based combined physiotherapeutic and lower-body resistance exercise program was feasible and effective. Findings are limited to individuals who had undergone a surgical neck dissection procedure. Given the complexity of head and neck cancer, further pragmatic interdisciplinary research is warranted.
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Affiliation(s)
- Margaret L. McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (R.A.S.); (J.N.)
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1Z2, Canada; (B.D.); (N.J.)
| | - K. Ming Chan
- Department of Physical Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2E1, Canada;
| | - Ryan A. Spychka
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (R.A.S.); (J.N.)
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Joni Nedeljak
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (R.A.S.); (J.N.)
| | - Brock Debenham
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1Z2, Canada; (B.D.); (N.J.)
- Department of Radiation Oncology, Cross Cancer Institute, Alberta Health Services, Edmonton, AB T6G 1Z2, Canada
| | - Naresh Jha
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1Z2, Canada; (B.D.); (N.J.)
- Department of Radiation Oncology, Cross Cancer Institute, Alberta Health Services, Edmonton, AB T6G 1Z2, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada;
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Ou X, Chen H, Qiu T, Yuan Y, Gong X. The impact of multidisciplinary team nutrition management on nutritional and toxicity status in patients with nasopharyngeal carcinoma. Asia Pac J Oncol Nurs 2023; 10:100237. [PMID: 37599990 PMCID: PMC10435935 DOI: 10.1016/j.apjon.2023.100237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/13/2023] [Indexed: 08/22/2023] Open
Abstract
Objective To explore the impact of multidisciplinary team (MDT) nutrition management on the nutritional and toxicity status of patients with nasopharyngeal carcinoma undergoing chemoradiotherapy. Methods A total of 104 patients undergoing chemoradiotherapy for nasopharyngeal carcinoma admitted to our hospital from July 2018 to February 2021 were retrospectively enrolled, including who received conventional nutrition management (the routine group, n = 52) and who received MDT nutrition management (the experimental group, n = 52). Nutritional indicators (dietary intake, body mass index, serum albumin, serum prealbumin, hemoglobin, total lymphocyte count, serum transferrin [TRF]), the Nutrition Risk Screening 2002 (NRS2002) score and acute toxicity level were recorded before, during, and after chemoradiotherapy. Multiple regression analysis was performed to identify nutritional risk indicators. Results During and after chemoradiotherapy, the body mass index, albumin, prealbumin, hemoglobin, total lymphocyte count, TRF, dietary intake, number of patients with an NRS2002 score < 3, and acute toxicity score in the experimental group improved compared to those in the routine group (P < 0.05). Concurrent chemotherapy, the NRS2002 score and a half-diet strategy were independent factors affecting the nutritional status of nasopharyngeal carcinoma patients who underwent chemoradiotherapy. Conclusions Active screening and evaluation of the nutritional status of patients with nasopharyngeal carcinoma during chemoradiotherapy as well as MDT nutrition management can be used to detect nutritional problems, thus improving quality of life and reducing related toxicity.
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Affiliation(s)
- Xueqing Ou
- Department of Cancer Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Hui Chen
- Department of Cancer Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Ting Qiu
- Department of Cancer Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yajun Yuan
- Department of Cancer Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaohua Gong
- Department of Cancer Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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Hagio M, Ishizaki K, Ryu M, Nomura T, Takano N, Sakurai K. Maxillofacial prosthetic treatment factors affecting oral health-related quality of life after surgery for patients with oral cancer. J Prosthet Dent 2017; 119:663-670. [PMID: 28888409 DOI: 10.1016/j.prosdent.2017.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 11/20/2022]
Abstract
STATEMENT OF PROBLEM After oral cancer surgery, tissue defects can cause deformity and limited mobility, complicating many essential functions. For patients with mandibular, tongue, and oral floor defects, evidence regarding the effects of maxillofacial prosthetics on their oral health-related quality of life (OHRQoL) is lacking. Therefore, maxillofacial prosthetic reconstruction has been implemented with no clear treatment goals. PURPOSE The purpose of this clinical study was to identify factors affecting the improvement of OHRQoL by using maxillofacial prosthetic treatment after surgery to repair maxillary, mandibular, tongue, and oral floor defects. MATERIAL AND METHODS All individuals who agreed to maxillofacial prosthetics after surgery for oral cancer were enrolled. Oral function and OHRQoL were evaluated before maxillofacial prosthesis placement and 1 month after final adjustments. The oral functions evaluated included masticatory function, swallowing function, and articulatory function. The Oral Health Impact Profile (OHIP-J54) was used to evaluate OHRQoL. Factors affecting changes in the OHIP-J54 score for participants' background and oral functions before and after treatment were analyzed through logistic regression analysis (stepwise method). RESULTS Participants included 34 men and 16 women with an average age of 72.4 ±8.7 years. "Psychological discomfort" was correlated with the patient's sex and masticatory function. "Physical disability" was related to articulatory function. "Handicap" was related to the swallowing function. "Additional Japanese questions" were related to the patient's sex. CONCLUSIONS Participants' sex and their oral functions, including masticatory, swallowing, and articulatory functions, were associated with improved OHRQoL because of maxillofacial prosthetics after surgery for oral cancer.
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Affiliation(s)
- Miki Hagio
- Graduate student, Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Ken Ishizaki
- Associate Professor, Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan.
| | - Masahiro Ryu
- Senior Assistant professor, Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Takeshi Nomura
- Professor, Department of Oral Medicine and Oral and maxillofacial surgery, Tokyo Dental College, Chiba Japan
| | - Nobuo Takano
- Professor, Oral Cancer Center, Tokyo Dental College, Chiba, Japan
| | - Kaoru Sakurai
- Professor, Department of Removable Prosthodontics & Gerodontology, Tokyo Dental College, Tokyo, Japan
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Bradley PJ. Multidisciplinary clinical approach to the management of head and neck cancer. Eur Arch Otorhinolaryngol 2012; 269:2451-4. [DOI: 10.1007/s00405-012-2209-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 09/19/2012] [Indexed: 12/24/2022]
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de Souza Figueiredo PT, Leite AF, Barra FR, Dos Anjos RF, Freitas AC, Nascimento LA, Melo NS, Guerra ENS. Contrast-enhanced CT and MRI for detecting neck metastasis of oral cancer: comparison between analyses performed by oral and medical radiologists. Dentomaxillofac Radiol 2012; 41:396-404. [PMID: 22241874 DOI: 10.1259/dmfr/57281042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of the study was to verify the concordance of contrast-enhanced CT (CECT) and MRI evaluation among four radiologists in detecting metastatic cervical lymph nodes of oral cancer patients. METHODS Ten patients underwent clinical and imaging examinations (CECT and MRI). Four radiologists, two oral and maxillofacial radiologists (OMRs) and two medical radiologists (MRs), independently analysed the images twice. Cohen's kappa index and Wilcoxon signed-rank test were used to verify the concordance between all analyses. RESULTS Regarding the interobserver agreement, the OMRs presented excellent kappa values for determining the regional lymph nodes (N-stage) in both CECT and MRI. The MRs presented moderate agreement for CECT evaluation at the first reading, but no concordance was found for the other analyses. When each imaging modality was analysed separately, kappa values were higher between all examiners. Greater variability was demonstrated between N-stage evaluation using different examinations. All radiologists were able to identify a greater number of metastatic lymph nodes in CECT than in MRI, except one MR, but no significant difference was found for all readers. The differences between the number of metastatic lymph nodes among all radiologists were not statistically significant. Moderate intraobserver agreement was observed for CECT and MRI evaluation, except for one MR. CONCLUSIONS The differences found between the N-stage performed by OMRs and MRs support the necessity of a multidisciplinary approach in the imaging evaluation of metastatic nodes. Further studies are necessary to confirm which imaging modality should be employed when evaluating neck areas.
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Santa Maria PL, Sader C, Preston NJM, Fisher PH. Neck dissection for squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg 2011; 136:S41-5. [PMID: 17398340 DOI: 10.1016/j.otohns.2006.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 10/17/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the successes and failures of 172 patients receiving neck dissections for squamous cell carcinoma (SCC) managed through a multidisciplinary head and neck clinic and to observe factors in predicting failure (death with head and neck cancer or local regional recurrence) or local regional recurrence alone. STUDY DESIGN A retrospective, 14-year surgical audit. METHODS The information from patient medical records was correlated with that of a database. Multivariate analysis was performed with the use of a logistic regression model. RESULTS The most common site for head and neck SCC was the oral cavity (42%), with 17% of patients having tumors of unknown primary site. The disease-free survival probability was 76.7% at five years. Patients who were older at neck dissection, were nonsmokers, or who did not have radiotherapy to the primary site were more likely to die with head and neck cancer or to have local regional recurrence (P < 0.1). Patients with more radical neck dissections did not have better survival or recurrence outcomes. Lymphatic invasion appears to be the only important factor in predicting local regional recurrence alone (P = 0.1), of which 67% occurred within the first postoperative year. CONCLUSIONS Patients with smoking-related SCC are likely to have a less aggressive disease. Adjuvant radiotherapy plays an important role in the treatment of patients with head and neck SCC. Follow-up, especially within the first postoperative year, is essential in managing head and neck SCC. Head and neck surgeons can confidently continue their practice away from more radical neck dissections.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Squamous Cell/etiology
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Disease-Free Survival
- Female
- Follow-Up Studies
- Head and Neck Neoplasms/etiology
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Logistic Models
- Male
- Medical Records
- Middle Aged
- Mouth Neoplasms/surgery
- Multivariate Analysis
- Neck Dissection
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Radiotherapy, Adjuvant
- Retrospective Studies
- Smoking/adverse effects
- Treatment Outcome
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Affiliation(s)
- Peter L Santa Maria
- Department of Ear, Nose, and Throat Surgery, Fremantle Hospital, Perth, Western Australia, Australia.
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Figueiredo PT, Leite AF, Freitas AC, Nascimento LA, Cavalcanti MG, Melo NS, Guerra EN. Comparison between computed tomography and clinical evaluation in tumour/node stage and follow-up of oral cavity and oropharyngeal cancer. Dentomaxillofac Radiol 2010; 39:140-8. [PMID: 20203275 DOI: 10.1259/dmfr/69910245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim was to verify the concordance of CT evaluation among four radiologists (two oral and maxillofacial and two medical radiologists) at the TN (tumour/node) stage and in the follow-up of oral cavity and oropharyngeal cancer patients. The study also compared differences between clinical and CT examinations in determining the TN stage. METHODS The following clinical and tomographic findings of 15 non-treated oral cavity and oropharyngeal cancer patients were compared: tumour size, bone invasion and lymph node metastases. In another 15 patients, who had previously been treated, a clinical and tomographic analysis comparison for the presence of tumoural recurrence, post-therapeutic changes in muscles and lymph node metastases was performed. The concordances of tomographic evaluation between the radiologists were analysed using the kappa index. RESULTS Significant agreement was verified between all radiologists for the T stage, but not for the N stage. In the group of treated patients, CT disclosed post-therapeutic changes in muscles, tumour recurrence and lymph node metastases, but no concordance for the detection of lymph node metastases was found between radiologists. In the first group, for all radiologists, no concordance was demonstrated between clinical and tomographic staging. CT was effective for delimitating advanced lesions and for detecting lymph node involvement in N0 stage patients. CT revealed two cases of bone invasion not clinically detected. CONCLUSIONS Interprofessional relationships must be stimulated to improve diagnoses, and to promote a multidisciplinary approach to oral cavity and oropharyngeal cancer. Although CT was important in the diagnosis and follow-up of cancer patients, differences between medical and dental analyses should be acknowledged.
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Affiliation(s)
- P T Figueiredo
- Oral Radiology, Department of Dentistry, Faculty of Health Science, University of Brasilia, Brazil.
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Dobbins M, Gunson J, Bale S, Neary M, Ingrams D, Brown M. Improving patient care and quality of life after laryngectomy/glossectomy. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2005; 14:634-40. [PMID: 16010213 DOI: 10.12968/bjon.2005.14.12.18283] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients undergoing total laryngectomy/glossectomy are left without a voice at least temporarily in the early postoperative stage, since their larynx and/or tongue has been removed. Those patients rendered permanently speechless usually acquire a form of mechanical speech through electronic devices. However, the life-changing nature of this surgery should not be underrated as effectively these people have lost their normal voice. It can be argued that this patient group is also without a voice in a political sense - theirs seems to be a forgotten cancer, as other forms of cancer appear to attract greater attention for research priorities and funding. In some ways this research attempts to redress the balance through exploring the patient experience postoperatively, in particular the issues related to communication for this patient group. The results also highlight the emotional trauma experienced by patients and the mechanisms healthcare staff employ to support these patients. This research is multidisciplinary, involving patients and all those health workers that come into contact with them on the ward. The patient experience forms a major part of this article, allowing their stories to form much of the content. The results draw attention to deficiencies in service delivery that, as a direct result of this research, have been and are being addressed so that patients' care is improved and their quality of life is restored. Such change has been driven by patient comment such as: 'But then when you wake up after that operation that's the pits when you are laying there and you think "I'm dead". And then when you wake up properly that's the bit I always say you wish you were dead. That's when you wish you had died.'
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Affiliation(s)
- M Dobbins
- ENT Department, Royal Gwent Hospital, Newport, South Wales
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Abstract
AIMS The aim of this study was to validate a psychometric tool, the team survey, in a health care setting with a range of teams from a Large National Health Service (NHS) Trust. BACKGROUND The team survey was developed by Millward and Ramsay (1998) to measure the team dimensions identified in the cognitive-motivational model of team effectiveness (Millward & Purvis 1998). The team dimensions are team potency, team identification, Shared Mental Models and team meta-cognitions. DESIGN AND METHODS The psychometric properties of the tool as a reliable and valid predictor of team effectiveness was assessed by way of a survey of 10 teams (comprising 124 members in all) located on different premises, within a large NHS Trust. Team size ranged between 5 and 19 members, with average team size being 10 members. Two independent ratings of 'effectiveness' were made for each team. Factor and multiple regression analyses were employed to identify the most powerful predictors of health care team effectiveness from a cognitive and motivational perspective. RESULTS The results suggest that the team survey is psychometrically robust within a health care setting. CONCLUSIONS It is concluded that the tool has a potentially key role in informing and evaluating team development initiatives in support of the work of practice development nurses and nursing team leaders.
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Affiliation(s)
- L J Millward
- Department of Psychology, University of Surrey, Guildford, Surrey, UK.
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