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Bekkers S, Stewart L, Panizza BJ. Time is function and survival. ANZ J Surg 2023; 93:2281-2282. [PMID: 37849061 DOI: 10.1111/ans.18680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/19/2023]
Affiliation(s)
- Stijn Bekkers
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Otolaryngology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Linda Stewart
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Benedict J Panizza
- Queensland Skull Base Unit and Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Shah HP, Cohen O, Sukys J, Dibble J, Mehra S. The impact of frailty on adjuvant treatment in patients with head and neck free flap reconstruction-A retrospective study using two independent frailty scores. Oral Oncol 2022; 132:106006. [PMID: 35835056 DOI: 10.1016/j.oraloncology.2022.106006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Reconstructive surgery may result in prolonged postoperative recovery, especially in frail patients, which in turn may impact delivery of adjuvant therapy. To date, no studies have investigated potential associations between frailty and adjuvant treatment delivery after reconstructive surgery. We examine the impact of frailty on time to initiation, duration, and completion of adjuvant treatment after reconstructive surgery for head and neck cancers (HNCs). METHODS A retrospective review of patients who underwent free flap reconstruction for HNC at a single institution from 2015 to 2021 and received adjuvant radiation was performed. Frailty was assessed using two independent scales: the 11-item modified frailty index (mFI) score and binary Johns Hopkins Adjusted Clinical Groups (ACG) frailty indicator. Timely adjuvant initiation (within six weeks of surgery), duration of adjuvant treatment, and completion were compared between frail and non-frail patients. RESULTS Of the 163 patients included for analysis, 52 (31.9%) were identified as frail by the ACG indicator and 24 (14.7%) were identified as frail with an mFI score ≥ 3. Frail patients (mFI score ≥ 3) were significantly less likely than non-frail patients to initiate adjuvant treatment within six weeks (OR:0.21, CI:0.04-0.85, p = 0.046). Frailty designated by either frailty scale was not significantly associated with adjuvant treatment duration. Likelihood of adjuvant treatment completion was significantly lower for frail compared to non-frail patients by both scales: ACG indicator (OR 0.02, CI:9.05 × 10-4-0.25, p = 0.007) and mFI score ≥ 3 (OR:0.01, CI:6.85 × 10-4-0.13, p = 0.007). CONCLUSIONS Frailty is associated with decreased likelihood of timely adjuvant treatment initiation and completion in patients with HNCs after free flap reconstruction.
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Affiliation(s)
- Hemali P Shah
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Oded Cohen
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Jordan Sukys
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Jacqueline Dibble
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA
| | - Saral Mehra
- Yale University School of Medicine, Department of Surgery, Division of Otolaryngology, Section of Head and Neck Surgery, New Haven, CT, USA; Yale Cancer Center, New Haven, CT, USA.
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The effect of delayed treatment initiation on adverse events and recurrence in older head and neck cancer patients. Radiother Oncol 2022; 173:154-162. [DOI: 10.1016/j.radonc.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
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Schoonbeek RC, de Vries J, Bras L, Sidorenkov G, Plaat BEC, Witjes MJH, van der Laan BFAM, van den Hoek JGM, van Dijk BAC, Langendijk JA, Halmos GB. The effect of treatment delay on quality of life and overall survival in head and neck cancer patients. Eur J Cancer Care (Engl) 2022; 31:e13589. [PMID: 35438210 PMCID: PMC9541370 DOI: 10.1111/ecc.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/21/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
Objective Head and neck squamous cell carcinomas (HNSCC) are rapidly developing tumours, and substantial delay in treatment initiation is associated with decreased overall survival. The effect of delay on health‐related quality of life (HRQOL) is unknown. The aim of this study was to assess the impact of delay on QOL and overall survival. Methods Patients with mucosal HNSCC were prospectively included. HRQOL and 2‐year overall survival were analysed using linear mixed‐model analyses and cox regression, respectively. Delay was defined as care pathway interval (CPI) of ≥30 days between first consultation and treatment initiation. Results Median CPI was 39 days for the 173 patients included. A trend towards higher HRQOL‐scores (indicating better HRQOL) during 2‐year follow‐up for patients with delay in treatment initiation was visible in the adjusted models (HRQOL summary score—β: 2.62, 95% CI: 0.57–4.67, p = 0.012). Factors associated with decreased overall survival were moderate comorbidities (HR: 5.10, 95% CI: 1.65–15.76, p = 0.005) and stage‐IV tumours (HR: 12.37, 95% CI: 2.81–54.39, p = 0.001). Delay was not associated with worse overall survival. Conclusion Timely treatment initiation is challenging, especially for patients with advanced tumours and initial radiotherapy treatment. Encountering delay in treatment initiation did not result in clinically relevant differences in HRQOL‐scores or decreased overall survival during 2‐year follow‐up.
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Affiliation(s)
- Rosanne C Schoonbeek
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Julius de Vries
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Linda Bras
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Grigory Sidorenkov
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johanna G M van den Hoek
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boukje A C van Dijk
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - György B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Schoonbeek RC, Festen S, Rashid R, van Dijk BAC, Halmos GB, van der Velden LA. Impact of Delay on Hospitalization in Older Patients With Head and Neck Cancer: A Multicenter Study. Otolaryngol Head Neck Surg 2022; 167:678-687. [PMID: 35043734 PMCID: PMC9527368 DOI: 10.1177/01945998211072828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the impact of delay in treatment initiation on hospitalization, overall survival, and recurrence in older patients with head and neck cancer (HNC). STUDY DESIGN Retrospective multicenter study. SETTING Two tertiary referral centers. METHODS All patients with newly diagnosed HNC (≥60 years) treated between 2015 and 2017 were retrospectively included. Time-to-treatment intervals were assessed (ie, calendar days between first visit and start of treatment). Multiple multivariable models were performed with hospital admission days (>14 days), survival, and recurrence as dependent outcome variables. RESULTS In total, 525 patients were enrolled. The mean age was 70.7 years and 70.7% were male. Median time to treatment was 34.0 days, and 36.3% started treatment within 30 days (P = .576 between centers). Patients with radiotherapy had longer time to treatment than surgical patients (39.0 vs 29.0 days, P < .001). Current smoking status, stage IV tumors, and definitive radiotherapy were significantly associated with delay in the multivariable analysis. Time-to-treatment interval ≥30 days was a significant predictor of longer hospital admission (>14 days) in the first year after treatment in an adjusted model (odds ratio, 4.66 [95% CI, 2.59-8.37]; P < .001). Delay in treatment initiation was not associated with overall survival or tumor recurrence. CONCLUSION This study highlights the importance and challenges of ensuring timely treatment initiation in older patients with HNC, as treatment delay was an independent predictor of hospitalization. During oncologic workup, taking time to consider patient-centered outcomes (including minimizing time spent in hospital) while ensuring timely start of treatment requires well-structured, fast-track care pathways.
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Affiliation(s)
- Rosanne C Schoonbeek
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Suzanne Festen
- University Center for Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Roza Rashid
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Boukje A C van Dijk
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - György B Halmos
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lilly-Ann van der Velden
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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Schoonbeek RC, de Jel DVC, van Dijk BAC, Willems SM, Bloemena E, Hoebers FJP, van Meerten E, Verbist BM, Smeele LE, Halmos GB, Merkx MAW, Siesling S, De Bree R, Takes RP. Fewer head and neck cancer diagnoses and faster treatment initiation during COVID-19 in 2020: A nationwide population-based analysis. Radiother Oncol 2021; 167:42-48. [PMID: 34915063 PMCID: PMC8667560 DOI: 10.1016/j.radonc.2021.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
Background Inevitably, the emergence of COVID-19 has impacted non-COVID care. Because timely diagnosis and treatment are essential, especially for patients with head and neck cancer (HNC) with fast-growing tumours in a functionally and aesthetically important area, we wished to quantify the impact of the COVID-19 pandemic on HNC care in the Netherlands. Material and Methods This population-based study covered all, in total 8468, newly diagnosed primary HNC cases in the Netherlands in 2018, 2019 and 2020. We compared incidence, patient and tumour characteristics, primary treatment characteristics, and time-to-treatment in the first COVID-19 year 2020 with corresponding periods in 2018 and 2019 (i.e. pre-COVID). Results The incidence of HNC was nearly 25% less during the first wave (n = 433) than in 2019 (n = 595) and 2018 (n = 598). In April and May 2020, the incidence of oral cavity and laryngeal carcinomas was significantly lower than in pre-COVID years. There were no shifts in tumour stage or alterations in initial treatment modalities. Regardless of the first treatment modality and specific period, the median number of days between first visit to a HNC centre and start of treatment was significantly shorter during the COVID-19 year (26–28 days) than pre-COVID (31–32 days, p < 0.001). Conclusion The incidence of HNC during the Netherlands’ first COVID-19 wave was significantly lower than expected. The expected increase in incidence during the remainder of 2020 was not observed. Despite the overloaded healthcare system, the standard treatment for HNC patients could be delivered within a shorter time interval.
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Affiliation(s)
- Rosanne C Schoonbeek
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology and Head and Neck Surgery, Groningen, The Netherlands.
| | - Dominique V C de Jel
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, The Netherlands; Netherlands Cancer Institute/Antoni van Leeuwenhoek, Department of Head and Neck Oncology and Surgery, Amsterdam, The Netherlands
| | - Boukje A C van Dijk
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Stefan M Willems
- University of Groningen, University Medical Center Groningen, Department of Pathology, Groningen, The Netherlands
| | - Elisabeth Bloemena
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Pathology, The Netherlands
| | - Frank J P Hoebers
- Maastricht University Medical Centre Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, The Netherlands
| | - Esther van Meerten
- Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam, The Netherlands
| | - Berit M Verbist
- Leiden University Medical Center, Department of Radiology, The Netherlands
| | - Ludi E Smeele
- Netherlands Cancer Institute/Antoni van Leeuwenhoek, Department of Head and Neck Oncology and Surgery, Amsterdam, The Netherlands; Amsterdam University Medical Center, University of Amsterdam, Department of Oral and Maxillofacial Surgery, The Netherlands
| | - György B Halmos
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology and Head and Neck Surgery, Groningen, The Netherlands
| | - Matthias A W Merkx
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research, Utrecht, The Netherlands; Radboud University Medical Center, Department of Oral and Maxillofacial Surgery, Nijmegen, The Netherlands
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research, Utrecht, The Netherlands; University of Twente, Department of Health Technology and Services Research, Technical Medical Centre, Enschede, The Netherlands
| | - Remco De Bree
- University Medical Center Utrecht, Department of Head and Neck Surgical Oncology, The Netherlands
| | - Robert P Takes
- Radboud University Medical Center, Department of Otolaryngology/Head and Neck Surgery, Nijmegen, the Netherlands
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Schoonbeek RC, Bult FFS, Plaat BEC, Witjes MJH, van der Hoorn A, van Dijk BAC, Halmos GB. Incidental findings during the diagnostic work-up in the head and neck cancer pathway: Effects on treatment delay and survival. Oral Oncol 2021; 118:105350. [PMID: 34030108 DOI: 10.1016/j.oraloncology.2021.105350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES As a result of the increasing number of diagnostic scans, incidental findings (IFs) are more frequently encountered during oncological work-up in patients with head and neck squamous cell carcinomas (HNSCC). IFs are unintentional discoveries found on diagnostic imaging. Relevant IFs implicate clinical consequences, resulting in delay in oncologic treatment initiation, which is associated with unfavorable outcomes. This study is the first to investigate the incidence and nature of IFs over the years and establish the effect of relevant IFs on delay. MATERIAL AND METHODS This retrospective study compared two time periods (2010-2011 and 2016-2017), described associations between relevant IFs and delay in carepathway interval (days between first visit and treatment initiation) and assessed the effect of relevant IFs on overall two-year survival. RESULTS In total, 592 patients were included. At least one IF was found in 61.5% of the patients, most frequently on chest-CT. In 128 patients (21.6%) a relevant IF was identified, resulting for the majority in radiologist recommendations (e.g. additional scanning). Presence of a relevant IF was an independent significant factor associated with delay in treatment initiation. The risk of dying was higher for patients with a relevant IF, although not significant in the multivariable model (HR: 1.46, p = 0.079). CONCLUSION In diagnostic work-up for HNSCC patients, relevant IFs are frequently encountered. As the frequency of additional imaging rises over the years, the number of IFs increased simultaneously. These relevant IFs yield clinical implications and this study described that relevant IFs result in significant delay in treatment initiation.
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Affiliation(s)
- R C Schoonbeek
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Groningen, the Netherlands.
| | - F F S Bult
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Groningen, the Netherlands
| | - B E C Plaat
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Groningen, the Netherlands
| | - M J H Witjes
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, the Netherlands
| | - A van der Hoorn
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - B A C van Dijk
- Netherlands Comprehensive Cancer Organization (IKNL), Department of Research, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - G B Halmos
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Groningen, the Netherlands
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Schoonbeek RC, de Vries J, Bras L, Plaat BEC, van Dijk BAC, Halmos GB. Determinants of delay in the head and neck oncology care pathway: The next step in value-based health care. Eur J Cancer Care (Engl) 2021; 30:e13419. [PMID: 33555121 PMCID: PMC8365688 DOI: 10.1111/ecc.13419] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/30/2020] [Accepted: 01/15/2021] [Indexed: 12/13/2022]
Abstract
Objective Head and neck squamous cell carcinomas (HNSCC) are relatively fast‐growing tumours, and delay of treatment is associated with tumour progression and adverse outcomes. The aim of this study is to identify determinants of delay in a head and neck oncology centre. Methods This cohort study with prospectively collected data investigated associations between patient (including geriatric assessment at first consultation), tumour and treatment characteristics and treatment delay. Two quality indicator intervals assessing value‐based healthcare were studied: care pathway interval (CPI, interval between first visit in an HNOC and treatment initiation) and time‐to‐treatment initiation (TTI, interval between histopathological confirmation of HNSCC and treatment initiation), using regression analyses. Results Stage‐IV tumours and initial radiotherapy were independent predictors of delay in CPI. Initial radiotherapy was associated with delay in TTI. Overall, 37% of the patients started treatment within 30 days after first consultation (67% in case of initial surgical treatment and 11.5% if treated with (chemo)radiation, p < 0.001). Geriatric assessment outcomes were not associated with delay. Indicators for delay in initial surgery patients were stage‐IV tumours (CPI). Conclusion The majority of HNSCC patients encounter delay in treatment initiation, specifically in patients with advanced‐stage tumours or when radiotherapy is indicated.
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Affiliation(s)
- Rosanne C Schoonbeek
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Julius de Vries
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Linda Bras
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boukje A C van Dijk
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL, Utrecht, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - György B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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