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Kabalan S, Papadopoulos-Nydam G, Jeffery CC, Rieger J, Constantinescu G. Temporal Trends in Clinician-Assessed and Patient-Reported Swallowing Outcomes in Oropharyngeal Cancer Patients. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:492-505. [PMID: 36630888 DOI: 10.1044/2022_ajslp-22-00196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Dysphagia is a consequence of oropharyngeal squamous cell carcinoma (OPSCC) treatments and often results in a devastating reduction in quality of life (QoL; Nguyen et al., 2005; Pauloski, 2008). OBJECTIVES This study aimed to report temporal trends in swallowing outcomes using the Modified Barium Swallow Impairment Profile (MBSImP) and the M.D. Anderson Dysphagia Inventory (MDADI) and to study the relationship between these two measures. METHOD This was a retrospective review of clinical data collected in January 2013 to December 2017 from a tertiary care center. MBSImP PI scores and MDADI composite scores were collected pretreatment and 1, 6, and 12 months posttreatment. Data were analyzed in aggregate and stratified by treatment modality. To address the primary objective, descriptive statistics were used. To address the secondary objective, four Spearman tests were run between MBSImP PI and MDADI composite scores. RESULTS A total of 123 OPSCC participants were included. With respect to trends, MBSImP PI scores worsened 1 month posttreatment and remained impaired at 6 and 12 months. For MDADI composite scores, patient reports worsened 1 month posttreatment and subsequently improved at 6 and 12 months. MBSImP PI and MDADI composite scores were weakly negatively correlated (i.e., in agreement) at the pre- and 12-month posttreatment appointments. CONCLUSIONS Swallowing outcomes in OPSCC patients have distinct yet predictable trends for both clinician-assessed and patient-reported swallowing outcomes during the first year following cancer treatment. However, unlike previous findings, these two types of measures were in agreement at the pretreatment and 12 months posttreatment appointments.
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Affiliation(s)
- Sarah Kabalan
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Georgina Papadopoulos-Nydam
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Caroline C Jeffery
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Alberta, Canada
- Faculty of Medicine and Dentistry, Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Canada
| | - Jana Rieger
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Gabriela Constantinescu
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, Alberta, Canada
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Lau F, Tamanini JB, Gazmenga FP, Mercuri G, Oliveira VCD, Araújo Teixeira DN, Couto EV, Chone CT. Prognostic factors in oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil: 10-year follow-up. Braz J Otorhinolaryngol 2022; 88 Suppl 4:S124-S132. [PMID: 36064816 DOI: 10.1016/j.bjorl.2022.07.003] [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: 04/19/2022] [Revised: 06/20/2022] [Accepted: 07/22/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To descriptively analyze the epidemiological data, clinical stage, and outcomes of oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil, and to estimate the influence of clinical stage and treatment type on overall and disease-free survival. METHODS We retrospectively analyzed epidemiological data from the São Paulo Cancer Center Foundation database relative to patients with oropharyngeal squamous cell carcinoma diagnosed between 2004 and 2014 in the state of São Paulo. Univariate and multivariate Cox regression analyses were performed to assess factors associated with the outcomes. A forward stepwise selection procedure was used. Survival curves were estimated by the Kaplan-Meier method and compared by the Gehan-Breslow-Wilcoxon test. RESULTS A total of 8075 individuals with oropharyngeal squamous cell carcinoma were identified. Of these, 86.3% were diagnosed at an advanced stage and 13.7% at an early stage. Only 27.2% of patients were treated surgically, whereas 57.5% were treated medically. Patients undergoing surgery had longer overall survival than those receiving medical treatment in both early- and advanced-stage oropharyngeal squamous cell carcinoma. However, there was no significant difference in disease-free survival between surgical and medical treatment. CONCLUSION No significant difference in disease-free survival between medical and surgical treatment suggests similar complete remission rates with both approaches. Patients receiving medical treatment had shorter overall survival, which may be due to complications from chemotherapy and radiotherapy. However, we cannot confirm this relationship based on the data provided by the São Paulo Cancer Center Foundation. Prospective studies are warranted to assess whether the lower overall survival rate in patients receiving medical treatment is secondary to complications from chemotherapy and radiotherapy. LEVEL OF EVIDENCE 2C.
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Affiliation(s)
- Fabio Lau
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
| | - Jonas Belchior Tamanini
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Fabio Portella Gazmenga
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Gustavo Mercuri
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Vanessa Carvalho de Oliveira
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Daniel Naves Araújo Teixeira
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Eduardo Vieira Couto
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
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Gunjawate DR, Ravi R. Psychosocial Adjustments after Advanced Laryngeal Cancer Treatment - A Systematic Review. Indian J Palliat Care 2021; 27:431-438. [PMID: 34898937 PMCID: PMC8655667 DOI: 10.25259/ijpc_135_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022] Open
Abstract
Psychosocial adjustments are alterations needed by a person after a life-altering event. The present review explored the psychosocial adjustments after advanced laryngeal cancer treatment. Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PubMed and Scopus were searched. Two hundred and three hits, after the three-stage screening, 13 articles were included. Mixed methods appraisal tool was used to perform the quality appraisal. The findings from 1109 laryngeal cancer survivors and 154 spouses of total laryngectomy patients helped to identify the barriers and coping mechanism toward psychosocial adjustments. The barriers included reactions of spouse or family members, effect of voice, communication and speech intelligibility and work and family relationships. The coping was enhanced with a better awareness, motivation and support system. These findings would help in improving the training programs and enhance the pre- and post-treatment counselling based on the priorities and demands of the patient.
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Affiliation(s)
- Dhanshree R Gunjawate
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rohit Ravi
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Melan JB, Philouze P, Pradat P, Benzerdjeb N, Blanc J, Ceruse P, Fuchsmann C. Functional outcomes of soft palate free flap reconstruction following oropharyngeal cancer surgery. Eur J Surg Oncol 2021; 47:2265-2271. [PMID: 33994058 DOI: 10.1016/j.ejso.2021.04.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/25/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The objective of this study was to assess the impact of surgical resection and free flap reconstruction of soft palate cancer on speech, swallowing and quality of life, and to identify the factors influencing functional outcomes and quality of life. MATERIAL AND METHODS Patients treated with surgical resection of squamous cell carcinoma and free-flap reconstruction of the soft palate were reviewed at least 12 months after surgery. Speech was assessed using the Hirose intelligibility scoring system, nasalance scoring, GRBAS scoring and the Voice Handicap Index 30 (VHI30) questionnaire. Swallowing was assessed by fiberoptic endoscopy and the Deglutition Handicap Index (DHI). Quality of life was assessed using EORTC QLQ-C30 and QLQ-H&N35 questionnaires. RESULTS 29 patients were included. Speech outcomes were satisfactory, demonstrating normal or slightly below normal speech intelligibility in 75.9% of the patients, moderate or no rhinolalia in 72.4% of the patients and mean overall VHI30 scores indicative of slight or no handicap in 86.2% of the patients. Swallowing outcomes were satisfactory, with mean overall DHI scores indicative of slight or no handicap in 82.8% of the patients. Patient quality of life was preserved as demonstrated by mean quality of life and functioning scales scores all superior to 80%. CONCLUSION The sequelae arising from surgical resection and free-flap reconstruction of soft palate cancer are tolerable, involving slight handicap in terms of speech and swallowing and relatively little impact on quality of life.
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Affiliation(s)
- Jean-Baptiste Melan
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Philouze
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University, Lyon 1, France
| | - Pierre Pradat
- Claude Bernard University, Lyon 1, France; Clinical Research Center, UMR Inserm U1052, CNRS 5286, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nazim Benzerdjeb
- Claude Bernard University, Lyon 1, France; Department of Pathology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jacques Blanc
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Philippe Ceruse
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Claude Bernard University, Lyon 1, France
| | - Carine Fuchsmann
- Department of Otolaryngology-Head Neck Surgery, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
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Post-operative outcomes of different surgical approaches to oropharyngeal squamous cell cancer: a case-matched study. The Journal of Laryngology & Otology 2021; 135:348-354. [PMID: 33818328 DOI: 10.1017/s0022215121000876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare the post-operative outcomes of transoral laser microsurgery, lateral pharyngotomy and transmandibular surgery in oropharyngeal cancer management. METHODS Records of 162 patients treated with transmandibular surgery, transoral laser microsurgery or lateral pharyngotomy were reviewed. The transoral laser microsurgery cohort was matched with the lateral pharyngotomy and transmandibular surgery cohorts for tumour stage, tumour subsite and human papilloma virus status, and the intra- and post-operative outcomes were compared. RESULTS Duration of surgery and hospital stay were significantly longer for transmandibular surgery. Tracheostomy and nasogastric feeding tube rates were similar, but time to decannulation and to oral feeding were longer in the transmandibular surgery group. Transmandibular surgery more frequently required flap reconstruction and had a greater complication rate. Negative margins were fewer in the lateral pharyngotomy group than in the transoral laser microsurgery and transmandibular surgery groups. CONCLUSION In comparison with transmandibular surgery, transoral laser microsurgery and lateral pharyngotomy were associated with fewer complications and faster functional recovery. Lateral pharyngotomy had a higher rate of positive margins than transoral laser microsurgery, with a consequently greater need for adjuvant therapy. Many patients are nonetheless unsuitable for transoral surgery. All these factors should be considered when deciding on oropharyngeal cancer surgical treatment.
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Patel EJ, Zhu AW, Oliver JR, Cornwell M, Jacobson AS, Hu KS, Tam M, Vaezi A, Morris LGT, Givi B. Treatment of Early Stage Tonsil Cancer in the Age of Human Papillomavirus-Associated Malignancies. Otolaryngol Head Neck Surg 2020; 165:104-112. [PMID: 33290171 DOI: 10.1177/0194599820973256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the patterns of care and outcomes of treatment of early stage tonsil cancers, controlling for human papillomavirus (HPV) status. STUDY DESIGN Historical cohort study. SETTING National Cancer Database (NCDB). METHODS Review of the NCDB between 2010 and 2017 for all T1-2N0M0 tonsillar squamous cell carcinoma (SCC). Demographics, clinical characteristics, HPV status, treatment regimens, and survival were analyzed. RESULTS A total of 4720 patients were identified with early stage SCC of the tonsil. Most were tested for HPV (2759 [58.5%]). Among tested patients, 1758 (63.7%) were positive for HPV and 1001 (36.3%) were negative for HPV. HPV-positive patients had higher 3-year survival compared to HPV-negative patients (93.2% vs 77.8%, P < .001). Among HPV-positive patients, there was no significant difference in survival between treatment cohorts. However, in the HPV-negative cohort, 3-year survival was higher in both bimodality surgical-based settings (tonsillectomy + neck dissection + radiotherapy, 86.0% vs chemoradiotherapy, 69.6%, P = .01) and for all surgical-based treatments when compared to nonsurgical management (84.6% vs 69.3%, P < .001). This difference was maintained in multivariable regression controlling for age, sex, comorbidities, clinical T stage, and treatments. In a subpopulation of HPV-negative patients propensity score matched by all factors significant in multivariable analysis, 3-year survival remained higher in the surgically treated group compared to the nonsurgically treated cohort (84.9% vs 67.1%, P < .001). CONCLUSIONS Surgical- or radiation-based treatment resulted in similar survival in early stage HPV-positive tonsil cancer. Surgical-based treatments were associated with longer survival in HPV-negative cancers. These findings should be further investigated in a randomized prospective trial.
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Affiliation(s)
- Evan J Patel
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, USA
| | - Angela W Zhu
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, USA
| | - Jamie R Oliver
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, USA
| | - MacIntosh Cornwell
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, USA
| | - Adam S Jacobson
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, USA
| | - Kenneth S Hu
- Department of Radiation Oncology, NYU School of Medicine, New York, New York, USA
| | - Moses Tam
- Department of Radiation Oncology, NYU School of Medicine, New York, New York, USA
| | - Alec Vaezi
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, USA
| | - Luc G T Morris
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Babak Givi
- Department of Otolaryngology-Head & Neck Surgery, NYU School of Medicine, New York, New York, USA
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Xia Y, Feng ZC, Li C, Wu H, Tang C, Wang L, Li H. Application of additive manufacturing in customized titanium mandibular implants for patients with oral tumors. Oncol Lett 2020; 20:51. [PMID: 32788938 PMCID: PMC7416405 DOI: 10.3892/ol.2020.11912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 06/18/2020] [Indexed: 01/03/2023] Open
Abstract
The application of additive manufacturing (AM) technology has been widely used in various medical fields, including craniomaxillofacial surgery. The aim of the present study was to examine the surgical efficiency and post-operative outcomes of patient-specific titanium mandibular reconstruction using AM. Major steps in directly designing and manufacturing 3D customized titanium implants are discussed. Furthermore, pre-operative preparations, surgical procedures and post-operative treatment outcomes were compared among patients who received mandibular reconstruction using a customized 3D titanium implant, titanium reconstruction plates or vascularized autologous fibular grafting. Use of a customized titanium implant significantly improved surgical efficiency and precision. When compared with mandibular reconstruction using the two conventional approaches, patients who received the customized implant were significantly more satisfied with their facial appearance, and exhibited minimal post-operative complications in the 12-month follow-up period. Patients who underwent mandibular reconstruction using a customized titanium implant displayed improved mandibular contour symmetry, restored occlusal function, normal range of mouth opening and no temporomandibular joint related pain; all complications frequently experienced by patients who undergo conventional approaches of mandibular reconstruction.
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Affiliation(s)
- Yan Xia
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Zhi Chao Feng
- Rutgers School of Dental Medicine, Rutgers University, Newark, NJ 07103, USA
| | - Changchun Li
- Department of Stomatology, The Second Hospital of Nanjing, Nanjing, Jiangsu 210003, P.R. China
| | - Heming Wu
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Chunbo Tang
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Lihua Wang
- AK Medical Holdings Limited, Beijing 100101, P.R China
| | - Hongwei Li
- Jiangsu Key Laboratory of Oral Disease, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China.,Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Blasco MA, Cordero J, Dundar Y. Chronic Pain Management in Head and Neck Oncology. Otolaryngol Clin North Am 2020; 53:865-875. [PMID: 32684285 DOI: 10.1016/j.otc.2020.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pain is epidemic in patients with head and neck cancer. Providers involved in the care of patients with head and neck cancer should be able to describe the common pain syndromes experienced by these patients, identify patients at risk of pain, and provide multimodal treatment of chronic pain. Treatment of chronic pain encompasses analgesic medications; adjuvant pharmacotherapy, including antidepressants and anticonvulsants; interventional techniques; as well as integrative medicine.
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Affiliation(s)
- Michael A Blasco
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
| | - Joehassin Cordero
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, Stop 8315, Lubbock, TX 79430-8315, USA
| | - Yusuf Dundar
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, Stop 8315, Lubbock, TX 79430-8315, USA.
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Adnan A, Högmo A, Sjödin H, Gebre-Medhin M, Laurell G, Reizenstein J, Farnebo L, Norberg LS, Notstam I, Holmberg E, Cange HH, Hammerlid E. Health-related quality of life among tonsillar carcinoma patients in Sweden in relation to treatment and comparison with quality of life among the population. Head Neck 2020; 42:860-872. [PMID: 32040223 DOI: 10.1002/hed.26064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The health-related quality of life (HRQOL) of tonsillar carcinoma survivors was explored to investigate any HRQOL differences associated with tumor stage and treatment. The survivors' HRQOL was also compared to reference scores from the population. METHODS In this exploratory cross-sectional study patients were invited 15 months after their diagnosis and asked to answer two quality of life questionnaires (EORTC QLQ- C30, EORTC QLQ- HN35), 405 participated. RESULTS HRQOL was associated with gender, with males scoring better than females on a few scales. Patients' HRQOL was more associated with treatment than tumor stage. Patients' HRQOL was worse than that in an age- and sex-matched reference group from the normal population, the largest differences were found for problems with dry mouth followed by problems with sticky saliva, senses, swallowing and appetite loss. CONCLUSIONS The tonsillar carcinoma patients had a worse HRQOL compared to the general population one year after treatment.
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Affiliation(s)
- Ali Adnan
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Högmo
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Hospital, Stockholm, Sweden
| | - Helena Sjödin
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Hospital, Stockholm, Sweden
| | - Maria Gebre-Medhin
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Johan Reizenstein
- Department of Oncology, Örebro University Hospital and Örebro University, Sweden
| | - Lovisa Farnebo
- Division of Otorhinolaryngology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Lena S Norberg
- Department of Clinical Sciences/ENT, Umeå University, Umeå, Sweden
| | - Isak Notstam
- Department of Clinical Sciences/ENT, Umeå University, Umeå, Sweden
| | - Erik Holmberg
- Regional Cancer Center Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hedda H Cange
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Larynx-preserving reconstruction after extended base of the tongue resection. J Plast Reconstr Aesthet Surg 2019; 73:740-748. [PMID: 31864890 DOI: 10.1016/j.bjps.2019.11.018] [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: 05/10/2019] [Revised: 10/03/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND As the base of the tongue (BOT) plays essential roles in speech and swallowing, surgical resection of BOT cancer is typically avoided. Moreover, standard reconstructive procedures for larynx-preserving BOT defects have not yet been established. We performed immediate flap reconstruction after wide resection of BOT cancer with laryngeal preservation. Herein, the functional and oncological results of our strategy were analysed. METHODS We retrospectively evaluated patients who underwent extended BOT resection (including the oral tongue, upper/lateral oropharyngeal wall, epiglottis and false vocal cord) with laryngeal preservation between April 2006 and April 2016. We classified defects involving the oral tongue or upper/lateral oropharyngeal wall as the lateral extension type and those involving the epiglottis or false vocal cord as the laryngeal extension type. Lateral extension-type defects were closed primarily and filled with a deepithelialised skin or muscle flap. Laryngeal extension-type defects were reconstructed using a bulky skin flap plus hyo-thyroid-pexy to create a neo-epiglottis. Postoperative functional and oncologic outcomes were assessed. RESULTS We enrolled 18 patients with extended BOT defects. Of them, 11 had a history of irradiation. The tracheal cannula was removed in all cases, although laryngeal extension defects were associated with a longer duration to removal. All patients achieved complete oral intake and retained intelligible speech, with preservation of laryngeal function. There was no local recurrence, and the 5-year overall survival was 88.9%. CONCLUSIONS Following wide BOT resection, reconstruction with laryngeal preservation is feasible even in cases involving irradiated tumours with laryngeal extension.
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Spiegel JL, Pilavakis Y, Weiss BG, Canis M, Welz C. Quality of life in patients after reconstruction with the supraclavicular artery island flap (SCAIF) versus the radial free forearm flap (RFFF). Eur Arch Otorhinolaryngol 2019; 276:2311-2318. [DOI: 10.1007/s00405-019-05478-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 05/16/2019] [Indexed: 01/22/2023]
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Golusiński W, Golusińska-Kardach E. Current Role of Surgery in the Management of Oropharyngeal Cancer. Front Oncol 2019; 9:388. [PMID: 31179239 PMCID: PMC6542993 DOI: 10.3389/fonc.2019.00388] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
In the last few decades, the surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) has undergone enormous changes. Until the 1990s, open surgery was the primary treatment for OPSCC. However, due to the potentially severe functional morbidity of this approach, open surgery was largely displaced by concurrent chemoradiotherapy (CRT) in the 1990s. At the same time, new, less-invasive surgical approaches such as transoral surgery with monopolar cautery began to emerge, with the potential to reduce functional morbidity and avoid the late-onset toxicity of CRT. More recently, the growing incidence of HPV-positive disease has altered the patient profile of OPSCC, as these patients tend to be younger and have a better long-term prognosis. Consequently, this has further bolstered interest in minimally-invasive techniques to de-intensify treatment to reduce long-term toxicity and treatment-related morbidity. In this context, there has been a renewed interest in the primary surgery, which allows for accurate pathologic staging and thus—potentially—de-intensification of postoperative CRT. The continuous advances in minimally-invasive surgical approaches, including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS), have also altered the surgical landscape. These minimally-invasive approaches offer excellent functional outcomes, without the severe toxicity associated with intensive CRT, thus substantially reducing treatment-related morbidity. In short, given the increasing prevalence of HPV-positive OPSCC, together with the severe long-term sequela of aggressive CRT, surgery appears to be recapturing its previous role as the primary treatment modality for this disease. While a growing body of evidence suggests that TLM and TORS offer oncologic outcomes that are comparable to CRT and open surgery, many questions remain due to the lack of prospective data. In the present review, we explore the emerging range of surgical options and discuss future directions in the treatment of OPSCC, including the most relevant clinical trials currently underway.
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Affiliation(s)
- Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Li H, Yao Q, Huang X, Zhuo X, Lin J, Tang Y. Therapeutic effect of pregabalin on radiotherapy-induced trismus in nasopharyngeal carcinoma patients. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:251-255. [PMID: 30928200 DOI: 10.1016/j.anorl.2018.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/01/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Abstract
AIMS To evaluate the effect of pregabalin on radiotherapy-induced trismus in patients with nasopharyngeal carcinoma, a hospital-based, clinical retrospective cohort study was conducted. MATERIALS AND METHODS Data were collected on patients diagnosed with radiotherapy-induced trismus from March 2014 and March 2016 in the department of neurology in our hospital. Patients in the treatment group were administrated pregabalin for 8 weeks combined with rehabilitation, while the control group only received rehabilitation. The clinical therapeutic effects were observed and evaluated by mandibular motion, severity of trismus measured by late effects of normal tissues/subjective and objective medical analysis (LENT/SOMA) scales, and quality of life (QOL) assessed using the World Health Organization QOL instrument (WHOQOL-BREF) at baseline, week 4 and week 8 during treatment in these two groups, respectively. RESULTS In the treatment group, the number of patients with improvement on maximal vertical dimension (MVD) was significantly more than controls at week 4 and week 8 (P=0.013, P=0.004, respectively). Moreover, at week 4 and week 8, the severity of trismus was both significantly improved on LENT/SOMA grade in treatment group (P=0.047, P=0.032, respectively). And at week 8, the physical health and the whole life domain of the WHOQOL-BREF score were significantly increased (P=0.037, P=0.034, respectively). In the treatment group, 11 patients (36.7%) presented dizziness, and 7 patients (23.3%) presented somnolence. CONCLUSIONS Administration of pregabalin, in adjunct to rehabilitation, might provide a better outcome in patients with radiotherapy-induced trismus.
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Affiliation(s)
- H Li
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 510120 Guangzhou, China
| | - Q Yao
- Department of Neurology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian-Province, China
| | - X Huang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 510120 Guangzhou, China
| | - X Zhuo
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 510120 Guangzhou, China
| | - J Lin
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 510120 Guangzhou, China
| | - Y Tang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 510120 Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
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Quinsan IDCM, Costa GC, Priante AVM, Cardoso CA, Nunes CLS. Functional outcomes and survival of patients with oral and oropharyngeal cancer after total glossectomy. Braz J Otorhinolaryngol 2019; 86:545-551. [PMID: 30956152 PMCID: PMC9422732 DOI: 10.1016/j.bjorl.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/10/2018] [Accepted: 02/11/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Cancer of the oral cavity and oropharynx presents aggressive behavior and its diagnosis is, in most cases, performed in advanced stages. Total glossectomy is a therapeutic option in locally advanced cancer, and the only one in the recurrent or residual disease, after chemoradiotherapy. OBJECTIVE To evaluate the clinical-epidemiological profile, postoperative complications, survival rates and functional aspects of patients with oral cavity and oropharynx cancer after total glossectomy. METHODS It was a retrospective study where 22 patients were included with oral cavity and oropharyngeal cancer after total glossectomy at the Hospital Regional do Vale do Paraíba, em Taubaté, São Paulo. RESULTS All patients were male, with a median age of 57 years, most of tumors are located in the tongue and floor of the mouth and classified as stage IVa. Total glossectomy as initial treatment was performed in 18 and as salvage in four patients. The major pectoralis myocutaneous flap was used for reconstruction in all cases. The main postoperative complication was wound infection and salivary fistula. CONCLUSION Overall survival was 19% and cancer-specific survival was 30.8% in five years. Eight patients were rehabilitated for exclusive oral feeding without the dependence tracheostomy and enteral tube, all with an overall survival greater than 15 months.
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pN status predicts outcomes in surgically treated pT1-pT2 patients of various disease stages with squamous cell carcinoma of the head and neck: a 17-year retrospective single center cohort study. Eur Arch Otorhinolaryngol 2018; 275:2787-2795. [PMID: 30159726 DOI: 10.1007/s00405-018-5108-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/24/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The optimal treatment for a substantial proportion of patients with pT1-pT2 squamous cell carcinomas of the head and neck (SCCHN) remains to be refined. The extent of surgery, role and potential benefit of adjuvant treatment are to be balanced against therapy-induced side effects. We compared the outcomes of surgery with or without adjuvant radiotherapy (RT) or chemotherapy (CRT) and investigated the prognostic value of established clinicopathological parameters. METHODS Data were retrospectively collected for 227 patients who were treated by surgery alone (n = 31), RT (n = 87) and CRT (n = 109) in a single center. RESULTS Patients with stage I/II disease who had received adjuvant RT showed a better disease-free survival (DFS) (P = 0.04) than those who had received adjuvant CRT treatment. Conversely, patients with stage III/IV disease who had received CRT showed a better overall survival (OS) (P = 0.003) and DFS (P = 0.03) than those who had received surgery alone or adjuvant RT without chemotherapy. Survival analysis demonstrated that patients with pN0 to pN1 had better OS (P = 0.02), disease-specific survival (DSS) (P = 0.003), DFS (P = 0.02) and metastases free survival (MFS) (P = 0.002) compared to patients with pN2 to pN3. Multivariate analysis showed that the pN status was an independent factor for OS (P = 0.03), DSS (P = 0.04), relapse-free survival (P = 0.03), DFS (P = 0.03). CONCLUSION The pN status is the most important prognostic factor for pT1 to pT2 SCCHN. Adjuvant CRT was associated with significantly better survival outcomes in patients with pN1 and pN2-3 or more advanced stage, while adjuvant RT showed significantly better outcomes in patients with pN0.
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Doss J, Ghani W, Razak I, Yang Y, Rogers S, Zain R. Changes in health-related quality of life of oral cancer patients treated with curative intent: experience of a developing country. Int J Oral Maxillofac Surg 2017; 46:687-698. [DOI: 10.1016/j.ijom.2017.02.1269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/22/2017] [Indexed: 11/26/2022]
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Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients. Eur J Cancer 2017; 78:91-102. [DOI: 10.1016/j.ejca.2017.03.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/24/2016] [Accepted: 03/06/2017] [Indexed: 01/13/2023]
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Trismus following different treatment modalities for head and neck cancer: a systematic review of subjective measures. Eur Arch Otorhinolaryngol 2017; 274:2695-2707. [PMID: 28343337 PMCID: PMC5486547 DOI: 10.1007/s00405-017-4519-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/21/2017] [Indexed: 11/12/2022]
Abstract
The aim of this review was to compare systematically the subjective measure of trismus between different interventions to treat head and neck cancer, particularly those of the oropharynx. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) Guidelines, Six databases were searched for the text using various terms which include “oropharyngeal/head and neck cancer”, “trismus/mouth opening” and the various treatment modalities. Included in the review were clinical studies (> or =10 patients). Three observers independently assessed the papers identified. Among the six studies reviewed, five showed a significantly worst outcome with regard to the quality-of-life questionnaire scores for a radiotherapy or surgery and radiotherapy (RT) ± chemotherapy or chemoradiotherapy when compared to surgery alone. Only one study showed no significant difference between surgery alone and other treatment modalities. Subjective quality-of-life measures are a concurrent part of modern surgical practice. Although subjective measures were utilised to measure post operative trismus successfully, there was no consensus as to which treatment modality had overall better outcomes, with conflicting studies in keeping with the current debate in this field. Larger and higher quality studies are needed to compare all three treatment modalities.
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Roden DF, Schreiber D, Givi B. Multimodality Treatment of Early-Stage Tonsil Cancer. Otolaryngol Head Neck Surg 2017; 157:62-68. [DOI: 10.1177/0194599817696290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Compare survival outcomes between unimodality and multimodality treatments for early-stage tonsil squamous cell carcinoma (SCC). Study Design and Setting Review of the National Cancer Database. Subjects and Methods Patients were selected if they were <70 years old with clinical stage I-II SCC of the tonsil, as documented in the National Cancer Database from 1998 to 2011. Palliative and nonstandard treatments were excluded. Propensity score matching was performed, controlling for tumor stage, age, race, comorbidity, insurance status, and year of diagnosis. Overall survival (OS) was compared with the Kaplan-Meier method and log-rank test. Results We identified 3247 patients. Radiotherapy (RT) was delivered in 1295 patients (39.9%), surgery in 824 (25.4%), and surgery + RT in 1128 (34.7%). Patients treated with surgery + RT had the highest 5-year OS (81.1%), followed by surgery (67.4%) and RT (63.4%; P < .001). In a propensity score–matched subpopulation of 2378 patients, the 5-year OS was 78.8% for surgery + RT, 66.7% for surgery, and 64.5% for RT ( P < .001). Among patients who underwent surgical tonsillectomy plus elective neck dissection and/or adjuvant RT, the 5-year OS was equal ( P = .29), and all were superior to RT alone ( P < .001). Conclusion Multimodality treatment is associated with the greatest survival in early-stage tonsil cancer. The addition of tonsillectomy to RT confers a 20% increase in survival. The current guidelines might not offer the most effective treatment. An up-front surgical approach, followed by appropriately selected adjuvant therapy, may result in improved survival for early-stage tonsil SCC. These findings merit investigation in a prospective clinical trial.
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Affiliation(s)
- Dylan F. Roden
- Department of Otolaryngology–Head and Neck Surgery, New York University, New York, NY, USA
- Department of Veterans Affairs, New York Harbor Campus, Brooklyn, New York, USA
| | - David Schreiber
- Department of Veterans Affairs, New York Harbor Campus, Brooklyn, New York, USA
- Department of Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Babak Givi
- Department of Otolaryngology–Head and Neck Surgery, New York University, New York, NY, USA
- Department of Veterans Affairs, New York Harbor Campus, Brooklyn, New York, USA
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Prospective evaluation of quality of life in patients with head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:350-357. [DOI: 10.1016/j.oooo.2016.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/15/2016] [Accepted: 11/28/2016] [Indexed: 11/22/2022]
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Abstract
Human papillomavirus-negative head and neck squamous cell carcinoma (HNSCC) carries a poor prognosis, and despite optimal treatment with chemoradiotherapy to the limit of tolerance, many patients will relapse. A number of methods for intensifying treatment of HNSCC have been investigated, leading to the current standards of care. Novel agents targeting tumor cell and stromal signaling, DNA damage response, and immune system are now reaching clinical trials in combination with chemoradiotherapy. In this review, we discuss the evidence for the current treatment of locally advanced human papillomavirus-negative HNSCC, as well as investigational therapies, such as hypoxia modification, molecular targeting of epidermal growth factor receptor family, vascular endothelial growth factor receptor or DNA damage response proteins in combination with radiation therapy.
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Affiliation(s)
- Magnus T Dillon
- All authors: The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Kevin J Harrington
- All authors: The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom.
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Parkar SM, Shah MN. A relationship between quality-of-life and head and neck cancer: A systemic review. South Asian J Cancer 2015; 4:179-82. [PMID: 26981509 PMCID: PMC4772395 DOI: 10.4103/2278-330x.175955] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM The aim was to identify the literature and to assess the association between quality-of-life (QoL) and head and neck cancer (HNC) related outcomes systemically. MATERIALS AND METHODS The full articles published in English language bio-medical journals between 1992 and December 2014 were searched using Medline database. The keywords used for searching the articles include the combination of "health-related of QoL," "QoL," "HNC." The search limited only to the observational studies using questionnaires European Organization for Research and Treatment of Cancer (EORTC) QLQ C 30 and EORTC QLQ H and N 35. Purely psychological studies were excluded. RESULTS A total of 5055 articles were retrieved, and 16 articles were selected for this review. Of 16 observational studies, 13 (81.25%) were prospective cohort studies while remaining 3 (18.75%) were cross-sectional studies. The main findings of the studies revealed that the treatment of HNC had a statistically significant influence on QoL. Others associated factors like age, female sex, duration of treatment, advance tumor, and site of the tumor has also the impact on QoL on patients suffering from HNC. CONCLUSION This review provides evidence for a positive relationship between cancer-related outcomes and QoL. Assessment of QoL in relation to HNC with proper methodology and validated instruments is lacking hence there is a need for further evidence to support the relation between cancer and QoL.
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Affiliation(s)
- Sujal Mitul Parkar
- Department of Public Health Dentistry, Siddhpur Dental College and Hospital, Patan, Gujarat, India
- Correspondence to: Dr. Sujal Mitul Parkar, E-mail:
| | - Mihir N. Shah
- Department of Periodontology, Ahmedabad Dental College and Hospital, Ahmedabad, Gujarat, India
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A systematic review of quality of life in head and neck cancer treated with surgery with or without adjuvant treatment. Oral Oncol 2015. [PMID: 26209066 DOI: 10.1016/j.oraloncology.2015.07.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Quality of life (QoL) is an important consideration in the management of head and neck cancers (HNC). We systematically reviewed the literature to assess the impact of curative surgical resection (+/- adjuvant therapy) of HNC on QoL. Eligible studies (participants>age 18 years, reported fully in English, and prospectively assessed QoL) were filtered using quality criteria, and classified according to the added value, using a published taxonomy. MEDLINE and EMBASE searching yielded 302 distinct reports, 49 met eligibility, and 26 met quality criteria. Among the eligible studies, achievement of certain quality criteria was poor: a priori hypothesis (8%), statistical accounting of missing data (8%), reporting of assessment interval (35%) and rationale for chosen measure (53%). The most frequent ways QoL added value were: understanding of treatment benefit and risk (100%), comparing treatments for QoL effect (92%) and advancing QoL research methodology (50%). QoL (physical/social functioning and various symptom domains) deteriorated with treatment, gradually recovering to baseline (cancer diagnosis) level. Swallowing, chewing, saliva, taste, eating disruption, and aesthetic deficits may persist. Advanced tumors, extensive surgical resection, need for flap reconstruction, neck dissection, and postoperative radiation are associated with worse QoL outcomes. Knowledge of these trends can be applied in shared decision making, identification of commonly faced QoL issues, and to develop and provide survivorship resources. Future research should focus on routinely incorporating QoL in randomized studies, reporting the result according to guidelines, and following knowledge translation principles to maximize the clinician's and patient's ability to use QoL data.
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Gellrich NC, Handschel J, Holtmann H, Krüskemper G. Oral cancer malnutrition impacts weight and quality of life. Nutrients 2015; 7:2145-60. [PMID: 25825828 PMCID: PMC4425137 DOI: 10.3390/nu7042145] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/09/2015] [Accepted: 03/24/2015] [Indexed: 11/16/2022] Open
Abstract
Diet is important for both quality of life (QoL) and survival of patients with oral cancer. Their intake of food is impeded by functional restrictions in chewing and swallowing. In the DÖSAK REHAB STUDY 1652 patients from 38 hospitals within the German-language area of Germany; Austria and Switzerland were examined with regard to functional and psychological variables having an impact on diet. Chewing and swallowing are correlated with mobility of the tongue and the mandible as well as opening of the mouth. Thirty five percent of the patients lost weight; 41% maintained their weight and 24% gained weight. The QoL of patients who were able to maintain their weight and of those who gained weight was significantly better than that of patients who lost weight. A normal diet was important for maintaining weight. Mashed food; liquid food and loss of appetite were closely associated with loss of weight; although it was possible for nutritional counseling and dietary support to be implemented particularly favorably in this respect. Due to problems with eating patients' strength deteriorated; thus restricting activity. Radiotherapy had a negative impact on diet and weight. It influenced sense of taste; dryness of the mouth; swelling and discomfort when ingesting food. Pain and scars in the region of the operation also cause patients to dislike hard; spicy and sour food. Support from a nutritional counselor in implementing a calorie-rich diet remedied this and such support needs to be integrated into patient management. The fact that a poor nutritional status is of such great importance is well-known; but what is often lacking is the systematic implementation of continued professional nutritional counseling over a long period of time; weight control and psycho-social support of the operated patients; particularly those who also have had radiotherapy.
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Affiliation(s)
- Nils-Claudius Gellrich
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Street 1, Hannover D-30625, Germany.
| | - Jörg Handschel
- Department for Oral and Maxillofacial Surgery, Heinrich Heine University of Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany.
| | - Henrik Holtmann
- Department for Oral and Maxillofacial Surgery, Heinrich Heine University of Düsseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany.
| | - Gertrud Krüskemper
- Department of Medical Psychology, Ruhr University of Bochum, Universitätsstr. 150, Building MA 0/145, D-44780 Bochum, Germany.
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Broglie MA, Soltermann A, Haile SR, Huber GF, Stoeckli SJ. Human papilloma virus and survival of oropharyngeal cancer patients treated with surgery and adjuvant radiotherapy. Eur Arch Otorhinolaryngol 2014; 272:1755-62. [PMID: 24880469 DOI: 10.1007/s00405-014-3099-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
Abstract
Impact of p16 protein, a surrogate marker for human papilloma virus induced cancer, p53 and EGFR as well as clinical factors on survival in a patient cohort with oropharyngeal squamous cell carcinoma (OPSCC) treated by surgical resection and adjuvant radiotherapy (RT) ± concomitant chemotherapy (CT). This is a retrospective analysis of patient's charts and tumor tissue. 57 patients were consecutively included and their tumor tissue assembled on a tissue microarray following immunohistochemical analysis. Survival times were estimated by means of Kaplan-Meier analysis. The importance of clinical and immunohistochemical factors for outcome was estimated by cox proportional hazard models. With 88% 5-year overall survival, 91% 5-year disease-specific survival and 91% 5-year disease-free survival, respectively, we found excellent survival rates in this surgically treated patient cohort of mainly advanced OPSCC (93% AJCC stage III or IV). The only factors positively influencing survival were p16 overexpression as well as p53 negativity and even more pronounced the combination of those biomarkers. Survival analysis of patients classified into three risk categories according to an algorithm based on p16, smoking, T- and N-category revealed a low, intermediate and high-risk group with significant survival differences between the low and the high-risk group. Patients with OPSCC can be successfully treated by surgery and adjuvant RT ± CT with a clear survival benefit of p16 positive, p53 negative patients. We recommend considering a combination of immunohistochemical (p16, p53) and clinical factors (smoking, T- and N-category) for risk stratification.
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Affiliation(s)
- Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland,
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Heutte N, Plisson L, Lange M, Prevost V, Babin E. Quality of life tools in head and neck oncology. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:33-47. [DOI: 10.1016/j.anorl.2013.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/15/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
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Dziegielewski PT, Teknos TN, Durmus K, Old M, Agrawal A, Kakarala K, Marcinow A, Ozer E. Transoral robotic surgery for oropharyngeal cancer: long-term quality of life and functional outcomes. JAMA Otolaryngol Head Neck Surg 2014; 139:1099-108. [PMID: 23576186 DOI: 10.1001/jamaoto.2013.2747] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Because treatment for oropharyngeal squamous cell carcinoma (OPSCC), especially in patients of older age, is associated with decreased patient quality of life (QOL) after surgery, demonstration of a less QOL-impairing treatment technique would improve patient satisfaction substantially. OBJECTIVE To determine swallowing, speech, and QOL outcomes following transoral robotic surgery (TORS) for OPSCC. DESIGN, PARTICIPANTS, AND SETTING This prospective cohort study of 81 patients with previously untreated OPSCC was conducted at a tertiary care academic comprehensive cancer center. INTERVENTIONS Primary surgical resection via TORS and neck dissection as indicated. MAIN OUTCOMES AND MEASURES Patients were asked to complete the Head and Neck Cancer Inventory (HNCI) preoperatively and at 3 weeks as well as 3, 6, and 12 months postoperatively. Swallowing ability was assessed by independence from a gastrostomy tube (G-tube). Clinicopathologic and follow-up data were also collected. RESULTS Mean follow-up time was 22.7 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 79%, 60%, 63%, and 67% respectively. There were overall declines in speech, eating, aesthetic, social, and overall QOL domains in the early postoperative periods. However, at 1 year post TORS, scores for aesthetic, social, and overall QOL remained high. Radiation therapy was negatively correlated with multiple QOL domains (P < .05 for all comparisons), while age older than 55 years correlated with lower speech and aesthetic scores (P < .05 for both). Human papillomavirus status did not correlate with any QOL domain. G-tube rates at 6 and 12 months were 24% and 9%, respectively. Greater extent of TORS (>1 oropharyngeal site resected) and age older than 55 years predicted the need for a G-tube at any point after TORS (P < .05 for both). CONCLUSIONS AND RELEVANCE Patients with OPSCC treated with TORS maintain a high QOL at 1 year after surgery. Adjuvant treatment and older age tend to decrease QOL. Patients meeting these criteria should be counseled appropriately.
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Affiliation(s)
- Peter T Dziegielewski
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus2Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
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Bastos de Souza TR, Pinto CAL, da Cunha Mercante AM, Nishimoto IN, Brasilino de Carvalho M, Kowalski LP. Long-term results of surgical treatment for advanced oropharyngeal squamous cell carcinoma. Head Neck 2013; 36:1146-54. [PMID: 23897725 DOI: 10.1002/hed.23427] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 04/29/2013] [Accepted: 06/26/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to review the oncologic and functional outcomes of patients with clinical stage III or IV squamous cell carcinoma (SCC) of the oropharynx submitted to tumor resection and neck dissection with or without postoperative radiotherapy (PORT). METHODS We conducted a retrospective review of medical charts of 256 consecutive patients. RESULTS Fatal postoperative complications were registered in 5 patients (1.9%). During follow-up, there were 74 local recurrences (29%), 27 neck recurrences (10.5%), and 19 distant metastases (7.4%). The 5-year overall survival (OS) was 43.0%. The Cox multivariate model identified pT3 and pT4, pN2 and pN3, and an intense lymphocytic infiltrate as independent prognostic markers for OS. The 5-year disease-free survival (DFS) rate was 54.5%. CONCLUSION Surgical treatment for oropharyngeal carcinoma can be performed with a low-risk of postoperative mortality but with a risk of long-term use of tracheostomy and feeding tubes.
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Affiliation(s)
- Tânia Regina Bastos de Souza
- Head and Neck Surgery and Otorhinolaryngology Department, Hospital A C Camargo, São Paulo, Brazil; Head and Neck Surgery Service, Hospital Heliopolis, São Paulo, Brazil
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Oates J, Davies S, Roydhouse JK, Fethney J, White K. The effect of cancer stage and treatment modality on quality of life in oropharyngeal cancer. Laryngoscope 2013; 124:151-8. [DOI: 10.1002/lary.24136] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Justine Oates
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred HospitalCamperdown Australia
- Cancer Nursing Research UnitSydney Nursing School, University of SydneySydney Australia
| | - Sarah Davies
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred HospitalCamperdown Australia
- Cancer Nursing Research UnitSydney Nursing School, University of SydneySydney Australia
| | - Jessica K. Roydhouse
- Sydney Cancer CentreRoyal Prince Alfred Hospital, Missenden RoadCamperdown Australia
- School of Nursing, Edith Cowan UniversityJoondalup Australia
| | - Judith Fethney
- Cancer Nursing Research UnitSydney Nursing School, University of SydneySydney Australia
| | - Kate White
- Sydney Cancer CentreRoyal Prince Alfred Hospital, Missenden RoadCamperdown Australia
- Cancer Nursing Research UnitSydney Nursing School, University of SydneySydney Australia
- School of Nursing, Edith Cowan UniversityJoondalup Australia
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Pierre CS, Dassonville O, Chamorey E, Poissonnet G, Ettaiche M, Santini J, Peyrade F, Benezery K, Sudaka A, Bozec A. Long-term quality of life and its predictive factors after oncologic surgery and microvascular reconstruction in patients with oral or oropharyngeal cancer. Eur Arch Otorhinolaryngol 2013; 271:801-7. [DOI: 10.1007/s00405-013-2592-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
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Arens C. Transoral treatment strategies for head and neck tumors. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc05. [PMID: 23320057 PMCID: PMC3544208 DOI: 10.3205/cto000087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The introduction of transoral endoscopic surgery has initiated a fundamental change in the treatment of head and neck cancer. The endoscopic approach minimizes the intraoperative trauma. Due to the lower burden for the patient and the savings potential these methods have gained wide acceptance. These transoral accesses routes allow experienced surgeons to reduce the morbidity of surgical resection with no deterioration of oncologic results. This suggests a further extension of the indication spectrum and a high growth potential for these techniques and equipment in the coming years. For selected patients with selected tumors the minimally invasive transoral surgery offers improved oncological and functional results. In the present paper, different surgical access routes are presented and their indications discussed.
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Affiliation(s)
- Christoph Arens
- Clinic for Ear, Nose and Throat Medicine, University Hospital Magdeburg, Germany
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Bücheler B, Ehnes A, Kavsadze M, Langenberg S, Wilhelm-Buchstab T, Zipfel M, Keiner S, Gerstner A. Lebensqualität nach Therapie von Kopf-Hals-Tumoren. HNO 2012. [DOI: 10.1007/s00106-012-2628-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Singer S, Arraras JI, Chie WC, Fisher SE, Galalae R, Hammerlid E, Nicolatou-Galitis O, Schmalz C, Verdonck-de Leeuw I, Gamper E, Keszte J, Hofmeister D. Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQ-H&N35: a methodological review. Qual Life Res 2012. [PMID: 23188134 DOI: 10.1007/s11136-012-0325-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The EORTC QLQ-H&N35 (H&N35) is widely used to measure quality of life in head and neck cancer patients. The aims of this study were to obtain insight into a) the languages in which the H&N35 has been used and the psychometric properties in those languages, b) the study designs, and c) its acceptance by patients and investigators. METHODS A systematic literature review was performed searching for all original papers that had used at least one item of the H&N35. Identified papers were read and the information about methodological issues abstracted statistically analysed. RESULTS A total of 136 papers were identified. The H&N35 was administered in 19 different languages in 27 countries. The study design was cross-sectional in the majority of studies (53 %), prospective cohort studies (31 %), phase-II-trials (7 %), phase-III-trials (6 %) and case-control studies (1 %). The scales with the highest percentages of missing values were Sexuality (11.5 %) and Speech (7 %). The median Cronbach's alpha of the multi-item scales ranged from 0.61 (Senses) to 0.93 (Sexuality). Construct validity was rarely investigated. On average, 12 scales (range 0-18) of the instrument were used by the investigators. The scale most often used was swallowing (in 85 % of studies) and least often used was Weight Gain (39 %). CONCLUSION The H&N35 is widely used throughout the world, mainly in observational studies, and has demonstrated robust psychometric features in different languages. However, some methodological problems reported imply that the instrument can be improved in some areas.
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Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University of Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany,
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Broglie MA, Soltermann A, Haile SR, Röösli C, Huber GF, Schmid S, Stoeckli SJ. Quality of life of oropharyngeal cancer patients with respect to treatment strategy and p16-positivity. Laryngoscope 2012; 123:164-70. [DOI: 10.1002/lary.23622] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2012] [Indexed: 11/12/2022]
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Carrillo JF, Ortiz-Toledo MA, Salido-Noriega Z, Romero-Ventura NB, Ochoa-Carrillo FJ, Oñate-Ocaña LF. Validation of the Mexican Spanish version of the EORTC QLQ-H&N35 instrument to measure health-related quality of life in patients with head and neck cancers. Ann Surg Oncol 2012; 20:1417-26. [PMID: 23108555 DOI: 10.1245/s10434-012-2712-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) is an important outcome measurement in oncology. Our aim was to validate the Mexican Spanish version of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-H&N35 questionnaire to measure HRQL in patients with head and neck cancers. METHODS The QLQ-C30 and QLQ-H&N35 instruments were applied to Mexican patients with head and neck cancer at a cancer referral center. Reliability and validity tests were performed. Test-retest was carried out in selected patients. RESULTS One hundred ninety-three patients were included in this cohort; tumor locations included the following: oral cavity 45 (23.3 %); larynx 35 (18.1 %); thyroid carcinoma invasive to aerodigestive tract 32 (16.6 %); oropharynx 17 (8.8 %); hypopharynx 12 (6.2 %); nasal cavity and paranasal sinuses 11 (5.7 %); salivary glands 11 (5.7 %); nasopharynx 8 (4.1 %); eye and adnexa 7 (3.6 %); cervical metastases of unknown origin 5 (2.6 %); primary sarcoma of the head and neck region 5 (2.6 %); maxillary antrum carcinoma 4 (2.1 %); and retinoblastoma 1 (0.5 %). Questionnaire compliance rates were high, and the instrument was well accepted; the internal consistency tests demonstrated good convergent and divergent validity. Cronbach's α coefficients of 8 of 9 multi-item scales of the QLQ-C30 and 6 of 8 scales of the QLQ-H&N35 instruments were >0.7 (range 0.22-0.89). Scales of the QLQ-C30 and QLQ-H&N35 instruments distinguished among clinically distinct groups of patients; some were highly sensitive to change over time. CONCLUSIONS The Mexican Spanish version of the QLQ-H&N35 questionnaire is reliable and valid for the assessment of HRQL in patients with head and neck cancers and can be used in clinical trials in Mexican communities.
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Affiliation(s)
- José F Carrillo
- Departamento de Tumores de Cabeza y Cuello, Instituto Nacional de Cancerología, Mexico City, Mexico
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Swallowing, speech and quality of life in patients undergoing resection of soft palate. Eur Arch Otorhinolaryngol 2012; 270:305-12. [DOI: 10.1007/s00405-012-2006-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 03/19/2012] [Indexed: 10/28/2022]
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Macfarlane TV, Wirth T, Ranasinghe S, Ah-See KW, Renny N, Hurman D. Head and neck cancer pain: systematic review of prevalence and associated factors. J Oral Maxillofac Res 2012; 3:e1. [PMID: 24422003 PMCID: PMC3886092 DOI: 10.5037/jomr.2012.3101] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 02/23/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC. MATERIAL AND METHODS The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies. RESULTS There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43% - 70%) and after (42%, 95% CI 33% - 50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour- or treatment-related. CONCLUSIONS The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer.
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Affiliation(s)
| | - Tanja Wirth
- School of Medicine and Dentistry, University of Aberdeen, AberdeenUnited Kingdom.
- University of Bremen, BremenGermany.
| | - Sriyani Ranasinghe
- School of Medicine and Dentistry, University of Aberdeen, AberdeenUnited Kingdom.
- Postgraduate Institute of Medicine, University of ColomboSri Lanka.
| | - Kim W. Ah-See
- Department of Otolaryngology, Aberdeen Royal Infirmary, AberdeenUnited Kingdom.
| | - Nick Renny
- Department of Maxillofacial Surgery, Aberdeen Royal Infirmary, AberdeenUnited Kingdom.
| | - David Hurman
- Department of Clinical Oncology, Aberdeen Royal Infirmary, AberdeenUnited Kingdom.
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Lubek JE, Clayman L. An update on squamous carcinoma of the oral cavity, oropharynx, and maxillary sinus. Oral Maxillofac Surg Clin North Am 2012; 24:307-16, x. [PMID: 22341511 DOI: 10.1016/j.coms.2012.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
There are more than 45,000 new cancer cases involving the head and neck diagnosed each year within the United States. Squamous cell carcinoma accounts for the majority of cases, often occurring within the oral cavity and oropharynx. This article reviews current literature and various controversial topics involving the diagnosis and treatment strategies for patients with oral cavity/oropharyngeal cancers. Although not considered cancer within the oral cavity, maxillary sinus squamous cell carcinoma is discussed.
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Affiliation(s)
- Joshua E Lubek
- Maxillofacial Oncology/Microvascular Surgery, Department of Oral & Maxillofacial Surgery, University of Maryland, Baltimore, MD 21201, USA.
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Rich JT, Liu J, Haughey BH. Swallowing function after transoral laser microsurgery (TLM) ± adjuvant therapy for advanced-stage oropharyngeal cancer. Laryngoscope 2011; 121:2381-90. [PMID: 21882203 PMCID: PMC4201117 DOI: 10.1002/lary.21406] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Accepted: 09/27/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To perform a longitudinal description of swallowing function following transoral laser microsurgery (TLM) ± adjuvant therapy for advanced-stage oropharyngeal cancer (OPC) and identify prognostic factors associated with swallowing performance. STUDY DESIGN Retrospective analysis and longitudinal descriptive study of swallowing outcomes. METHODS Patients treated with TLM for AJCC stage III-IV OPC at Washington University from 1996 to 2008 were included. A search of medical records and direct patient contact were performed to obtain swallowing function at multiple time points. Persistently poor swallowing at 2 year after surgery was the primary outcome measure. Two year swallowing outcomes stratified by tumor site and T stage are presented. RESULTS One hundred eighteen patients met criteria for the study (median follow-up 53.9 months). There were 44 T1's, 41 T2's, 23 T3's and 10 T4's. Forty seven percent received radiotherapy and 41% received chemoradiotherapy. Ninety-eight percent underwent neck dissection. Patients tolerated TLM well with 82% enjoying good swallowing at 1 month after surgery. During adjuvant therapy, at 3 months, good swallowing dropped to 55%. At 1 and 2 years after TLM, 89% and 88% of patients had good swallowing function, respectively. At 2 years, 9 patients had persistently poor swallowing function. 93% of patients with T1 through T3 enjoyed good swallowing at 2 years. T4 base of tongue disease was associated with persistently poor swallowing function in multivariate analyses (P = 0.0023), with 40% having good swallowing at 2 years. Preexisting comorbidities and conversion to an open procedure were associated with delayed return of swallowing function, but not with persistently poor swallowing. Seven patients developed late-onset swallowing dysfunction. CONCLUSIONS Treatment of advanced stage OPC with TLM ± adjuvant therapy results in excellent swallowing outcomes for patients with either T1 to T3 tonsil or T1 to T3 base of tongue resections. A detailed, longitudinal swallowing profile is presented to assist in preoperative counseling.
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Affiliation(s)
- Jason T. Rich
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jingxia Liu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bruce H. Haughey
- Department of Otolaryngology – Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Gill S, Frew J, Fry A, Adam J, Paleri V, Dobrowsky W, Chatterjee S, Kelly C. Priorities for the Head and Neck Cancer Patient, their Companion and Members of the Multidisciplinary Team and Decision Regret. Clin Oncol (R Coll Radiol) 2011; 23:518-24. [DOI: 10.1016/j.clon.2011.03.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 01/24/2011] [Accepted: 02/01/2011] [Indexed: 10/18/2022]
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Minimally invasive techniques for head and neck malignancies: current indications, outcomes and future directions. Eur Arch Otorhinolaryngol 2011; 268:1249-57. [PMID: 21562814 DOI: 10.1007/s00405-011-1620-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/12/2011] [Indexed: 01/25/2023]
Abstract
The trend toward minimally invasive surgery, appropriately applied, has evolved over the past three decades to encompass all fields of surgery, including curative intent cancer surgery of the head and neck. Proper patient and tumor selection are fundamental to optimizing oncological and functional outcomes in such a personalized approach to cancer treatment. Training, experience, and appropriate technological equipment are prerequisites for any type of minimally invasive surgery. The aim of this review was to provide an overview of currently available techniques and the evidence justifying their use. Much evidence is in favor of routine use of transoral laser resection, transoral robot-assisted surgery, transnasal endoscopic resection, sentinel node biopsy, and endoscopic neck surgery for selected malignant tumors, by experienced surgical teams. Technological advances will enhance the scope of this type of surgery in the future and physicians need to be aware of the current applications and trends.
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Cartmill B, Cornwell P, Ward E, Davidson W, Porceddu S. A prospective investigation of swallowing, nutrition, and patient-rated functional impact following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer. Dysphagia 2011; 27:32-45. [PMID: 21344190 DOI: 10.1007/s00455-011-9333-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Accepted: 01/22/2011] [Indexed: 11/30/2022]
Abstract
Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition, and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1-T3 oropharyngeal squamous cell carcinoma (SCC) have not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition, and patient-perceived functional impact assessments were conducted pretreatment, at 4-6 weeks post-treatment, and at 6 months post-treatment. Deterioration from pretreatment to 4-6 weeks post-treatment in swallowing, nutrition, and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6 months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing, and overall function, consistent with recovery from acute toxicity. However, weight and patient perception of physical function and side effects remained significantly worse than pretreatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6 months revealed that this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB.
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Affiliation(s)
- Bena Cartmill
- Speech Pathology Department, Princess Alexandra Hospital, Australia.
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Röösli C, Studer G, Stoeckli SJ. Salvage treatment for recurrent oropharyngeal squamous cell carcinoma. Head Neck 2010; 32:989-96. [PMID: 19953618 DOI: 10.1002/hed.21273] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study evaluates the oncological outcome of patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC) after primary radiation therapy +/- chemotherapy, primary surgical therapy, and surgical therapy followed by radiation therapy +/- chemotherapy. METHODS A total of 156 patients (36%) of a cohort of 427 treated for OPSCC between 1990 and 2006 developed recurrent disease. Fifty-one patients (12%) qualified for salvage treatment. Study endpoints were 5-year overall survival (OS) and disease-specific survival (DSS). RESULTS The 5-year OS and DSS rates after salvage treatment were 29% and 40%; after initial primary radiation therapy, 25% and 40%; after initial surgery followed by radiation therapy, 40% and 40%; and after initial surgery alone, 20% and 40%. CONCLUSIONS Patients with an advanced OPSCC have a considerable risk for recurrence. Despite poor ultimate outcome, salvage treatment should be attempted in patients with resectable disease, good performance status, and absence of distant metastases.
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Affiliation(s)
- Christof Röösli
- Clinic of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
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Depprich R, Naujoks C, Lind D, Ommerborn M, Meyer U, Kübler NR, Handschel J. Evaluation of the quality of life of patients with maxillofacial defects after prosthodontic therapy with obturator prostheses. Int J Oral Maxillofac Surg 2010; 40:71-9. [PMID: 20980129 DOI: 10.1016/j.ijom.2010.09.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 05/10/2010] [Accepted: 09/22/2010] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate how patients with maxillofacial defects evaluate their quality of life after maxillectomy and prosthodontic therapy with obturator prostheses. 43 patients were included in the study (25 female, 18 male). 31 (72%) patients completed a standardized questionnaire of 143 items and then answered additional questions in a standardized interview. Global quality of life after prosthodontic therapy with obturator prostheses was 64% (±22.9) on average. Functioning of the obturator prosthesis, impairment of ingestion, speech and appearance, the extent of therapy, and the existence of pain had significant impact on the quality of life (p<0.005). Orofacial rehabilitation of patients with maxillofacial defects using obturator prostheses is an appropriate treatment modality. To improve the situation of patients prior to and after maxillectomy sufficient information about the treatment, adequate psychological care and speech therapy should be provided.
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Affiliation(s)
- R Depprich
- Department of Cranio- and Maxillofacial Surgery, Germany
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Bower WF, Vlantis AC, Chung TML, Van Hasselt CA. Mode of treatment affects quality of life in head and neck cancer survivors: Implications for holistic care. Acta Otolaryngol 2010; 130:1185-92. [PMID: 20331408 DOI: 10.3109/00016481003667366] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION As adverse effects of live-saving treatment are unavoidable surgeons have a duty to address physical changes and quality of life issues that matter to head and neck (H&N) cancer patients. We propose a tailored holistic care package. OBJECTIVES This study compared the quality of life of H&N cancer survivors managed with different approaches in the follow-up phase after initial treatment and identified factors adversely impacting quality of life parameters. METHODS H&N cancer patients studied: 1) surgery only, 2) radiotherapy only, 3) surgery and radiotherapy, and 4) any combination of surgery, chemotherapy or radiotherapy. Patients unable to communicate in Cantonese, with thyroid cancer or end-of-life disease were excluded. EORTC QLQ-H&N35 Cantonese version was administered at least 1 year after initial H&N cancer treatment. RESULTS Quality of life impairment was worse in all of the domains for combination therapy versus monotherapy patients. Scores between surgery or radiotherapy-only patients were not significantly different. Radiotherapy preceding surgery impacted significantly more on speech than surgery before the radiotherapy. Patients with advanced disease had more impairment of quality of life in each domain than patients with early disease. Coughing, eating problems, sticky saliva, and difficulties with social contact were all significant predictors of problems associated with a dry mouth.
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Affiliation(s)
- Wendy Fiona Bower
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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Treatment Outcomes and Quality of Life in Oropharyngeal Cancer after Surgery-based versus Radiation-based Treatment. Clin Exp Otorhinolaryngol 2010; 3:153-60. [PMID: 20978545 PMCID: PMC2958508 DOI: 10.3342/ceo.2010.3.3.153] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 09/05/2010] [Indexed: 12/29/2022] Open
Abstract
Objectives Advances in reconstruction and conservative surgery and the importance of quality of life (QOL) encouraged this reevaluation of surgery-based treatments for oropharyngeal cancer. We tried to compare treatment outcome and QOL after surgery-based versus radiation-based treatment in oropharyngeal cancer. Methods The 133 eligible patients were divided into surgery-based and radiotherapy (RT)-based treatment groups. Medical records were reviewed, and EORTC QLQ-C30 and HN65 questionnaires were completed for survivors. Three-year overall survivals, disease-free survivals, locoregional control rates, and QOL scores were compared between the two groups. Results Demographic data and overall stages were not significantly different between the two groups, and all survival rates were non-significantly different, either. The scores for most QOL items were equivalent, however, for a few items, scores were significantly better in surgery-based group. Conclusion The surgery-based group achieved equivalent treatment outcomes and slightly better QOL scores than the RT-based group. The results of this study suggest that surgery could still be considered as a first-line therapy for oropharyngeal cancer.
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Campos RJDSD, Leite ICG. Qualidade de vida e voz pós-radioterapia: repercussões para a fonoaudiologia. REVISTA CEFAC 2010. [DOI: 10.1590/s1516-18462010005000038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
TEMA: o tratamento radioterápico do câncer de cabeça e pescoço tem mostrado resultados importantes no controle da doença quando neoadjuvante ou mesmo concomitante à quimioterapia. Pesquisas apontam um aumento da sobrevida após 5 anos de tratamento do câncer de laringe, o que torna necessário e justifica os esforços realizados na reabilitação da comunicação dos pacientes, e destaca a presença do profissional de Fonoaudiologia na equipe de radioterapia. OBJETIVO: descrever as seqüelas com repercussão fonoaudiológica, tais como alterações na qualidade vocal e na qualidade de vida, associadas ao tratamento proposto para tumores de cabeça e pescoço, em especial aquelas originadas após a radioterapia. CONCLUSÃO: Várias seqüelas, agudas e crônicas, como rouquidão, odinofagia e afonia, que envolvem dificuldades na comunicação oral e/ou deglutição dos pacientes após o tratamento radioterápico em cabeça e pescoço, interfere de maneira direta na comunicação, deglutição e qualidade de vida dos pacientes. Os profissionais envolvidos no tratamento desse câncer, dentre eles o fonoaudiólogo, através do conhecimento sobre o tratamento e as fragilidades terapêuticas que comprometem a qualidade vocal e qualidade de vida desses pacientes, busca contribuir no processo de recuperação minimizando os danos causados pela doença e melhorando a condição de saúde do indivíduo.
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Jensen SB, Pedersen AML, Vissink A, Andersen E, Brown CG, Davies AN, Dutilh J, Fulton JS, Jankovic L, Lopes NNF, Mello ALS, Muniz LV, Murdoch-Kinch CA, Nair RG, Napeñas JJ, Nogueira-Rodrigues A, Saunders D, Stirling B, von Bültzingslöwen I, Weikel DS, Elting LS, Spijkervet FKL, Brennan MT. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: prevalence, severity and impact on quality of life. Support Care Cancer 2010; 18:1039-60. [PMID: 20237805 DOI: 10.1007/s00520-010-0827-8] [Citation(s) in RCA: 257] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 01/26/2010] [Indexed: 01/09/2023]
Abstract
PURPOSE This systematic review aimed to assess the literature for prevalence, severity, and impact on quality of life of salivary gland hypofunction and xerostomia induced by cancer therapies. METHODS The electronic databases of MEDLINE/PubMed and EMBASE were searched for articles published in English since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies until 2008 inclusive. Two independent reviewers extracted information regarding study design, study population, interventions, outcome measures, results and conclusions for each article. RESULTS The inclusion criteria were met by 184 articles covering salivary gland hypofunction and xerostomia induced by conventional, 3D conformal radiotherapy or intensity-modulated radiotherapy in head and neck cancer patients, cancer chemotherapy, total body irradiation/hematopoietic stem cell transplantation, radioactive iodine treatment, and immunotherapy. CONCLUSIONS Salivary gland hypofunction and xerostomia are induced by radiotherapy in the head and neck region depending on the cumulative radiation dose to the gland tissue. Treatment focus should be on optimized/new approaches to further reduce the dose to the parotids, and particularly submandibular and minor salivary glands, as these glands are major contributors to moistening of oral tissues. Other cancer treatments also induce salivary gland hypofunction, although to a lesser severity, and in the case of chemotherapy and immunotherapy, the adverse effect is temporary. Fields of sparse literature included pediatric cancer populations, cancer chemotherapy, radioactive iodine treatment, total body irradiation/hematopoietic stem cell transplantation, and immunotherapy.
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Affiliation(s)
- S B Jensen
- Department of Oral Medicine, University of Copenhagen, Copenhagen, Denmark.
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Shin HA, Lim YC, Jeong HM, Choi EC. Role of primary surgery for early-stage (T1–2N0) squamous cell carcinoma of the oropharynx. Oral Oncol 2009; 45:1063-6. [DOI: 10.1016/j.oraloncology.2009.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 07/29/2009] [Accepted: 07/29/2009] [Indexed: 10/20/2022]
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Demez PH, Moreau PR. Perception of head and neck cancer quality of life within the medical world: a multicultural study. Head Neck 2009; 31:1056-67. [PMID: 19340871 DOI: 10.1002/hed.21069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physician's perception of quality of life of patients with cancer is unclear. No reports have evaluated its influence on patient management. METHODS Five hundred otolaryngologists completed a questionnaire regarding the quality of life of patients with head and neck cancer. RESULTS Seventy-eight percent of responders thought that quality of life must be considered when choosing treatment, even if this meant decreased survival. Seventy-five percent thought it justified to withhold curative treatment if this would lead to impaired quality of life. Pain and breathing were the most important symptoms to consider. The perception was worse for physicians practicing in Latin culture, working in private practice, or with no personal acquaintance with a head and neck cancer victim and was better after radiotherapy than after surgery and chemotherapy. CONCLUSION Quality of life is important for physicians and is considered as essential as survival by many physicians. The perception of patient's quality of life influences the treatment choice.
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Affiliation(s)
- Pierre H Demez
- Otorhinolaryngology-Head and Neck Surgery Department, C.H.U. Liege, Domaine Universitaire du Sart Tilman, Bâtiment B 35, B-4000 Liège 1, Belgium.
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