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Chepeha DB, Barbon CEA, Esemezie AO, Al Mardini M, Philteos J, Spector ME, Bressmann T, Martino R, Bratman SV, Cho JBC, Hope AJ, Hosni AA, Kim JJH, Ringash JG, Waldron JN, Brown DH, de Almeida JR, Gilbert RW, Goldstein DP, Gullane PJ, Irish JC, Monteiro EA, Yao CMKL. Telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER): A pilot study for patients treated with surgery for oral cavity carcinoma. Head Neck 2024; 46:1737-1751. [PMID: 38561946 DOI: 10.1002/hed.27721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/22/2024] [Accepted: 02/24/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND To address the rehabilitative barriers to frequency and precision of care, we conducted a pilot study of a biofeedback electropalatography (EPG) device paired with telemedicine for patients who underwent primary surgery +/- adjuvant radiation for oral cavity carcinoma. We hypothesized that lingual optimization followed by telemedicine-enabled biofeedback electropalatography rehabilitation (TEBER) would further improve speech and swallowing outcomes after "standard-of-care" SOC rehabilitation. METHOD Pilot prospective 8-week (TEBER) program following 8 weeks of (SOC) rehabilitation. RESULTS Twenty-seven patients were included and 11 completed the protocol. When examining the benefit of TEBER independent of standard of care, "range-of-liquids" improved by +0.36 [95% CI, 0.02-0.70, p = 0.05] and "range-of-solids" improved by +0.73 [95% CI, 0.12-1.34, p = 0.03]. There was a positive trend toward better oral cavity obliteration; residual volume decreased by -1.2 [95% CI, -2.45 to 0.053, p = 0.06], and "nutritional-mode" increased by +0.55 [95% CI, -0.15 to 1.24, p = 0.08]. CONCLUSION This pilot suggests that TEBER bolsters oral rehabilitation after 8 weeks of SOC lingual range of motion.
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Affiliation(s)
- Douglas B Chepeha
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Carly E A Barbon
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alex O Esemezie
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Majd Al Mardini
- Department of Dentistry, Maxillofacial and Ocular Prosthetics, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Matthew E Spector
- Department of Otolaryngogy-Head & Neck Surgery, University of Pittsburgh, Pittsburgh, Pensylvania, USA
| | - Tim Bressmann
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - John B C Cho
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Andrew J Hope
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Ali Abdalati Hosni
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - John J H Kim
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Jolie G Ringash
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - John N Waldron
- Department of Radiation Oncology, University Health Network-Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Dale H Brown
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eric A Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head & Neck surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Lawrence AC, King S, Renslo B, Sawaf T, Karadaghy O, Kraft S. Functional Oral Intake in Primary Versus Salvage Laryngectomy. Otolaryngol Head Neck Surg 2024. [PMID: 38769874 DOI: 10.1002/ohn.813] [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: 09/30/2023] [Revised: 03/04/2024] [Accepted: 04/06/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Advanced-stage laryngeal squamous cell carcinoma is treated with primary surgery or chemoradiation. We aim to determine if there are differences in postoperative functional oral intake in primary (PL) versus salvage laryngectomees (SL). STUDY DESIGN Retrospective cohort study. SETTING Patients who underwent laryngectomy between 2011 and 2021. METHODS We examined demographic, diagnostic, treatment, and swallow function data pre- and postoperatively. A follow-up survey was distributed to assess current swallow status. RESULTS One hundred twenty-five patients were included. Preoperatively, 68.8% of patients reported dysphagia. Median functional oral intake score (FOIS) was 4.0 [interquartile range, IQR: 1.0-6.75]. The SL group had lower preop FOIS [2.0; IQR: 1.0-4.75] that did not reach significance compared to the PL group [4.5; IQR: 1.0-7.0] (P = .052). 73.4% of patients had a feeding tube. The PL group was more likely to have the tube removed [odds ratio, OR: 2.4; confidence interval, CI: 1.0-5.7]. The SL group was more likely to require feeding tube placement more than 6 months postop [OR: 6.9; CI: 1.65-32.6]. SL FOIS scores improved by 3 months postop to 5 (SL ΔFOIS = 3, P = .0150). PL scores improved to 7 [PL ΔFOIS = 2, P = .0005] at 12 to 15 months. Sixty-nine patients were contacted for a follow-up survey and 16 completed this survey. 30.4% patients reported dietary restrictions (mean 4.4 years postop). CONCLUSION Patients undergoing SL appear to obtain similar swallow outcomes compared to PL at 3 to 6 months postlaryngectomy, but plateau. The PL group continues to improve up to 1 year postoperatively. Fifty percent of patients report on-going dysphagia after 5 years.
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Affiliation(s)
- Anna C Lawrence
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Sarah King
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Bryan Renslo
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Tuleen Sawaf
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Omar Karadaghy
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Shannon Kraft
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Chepeha DB, Esemezie AO, Philteos J, Brown DH, de Almeida JR, Gilbert RW, Goldstein DP, Gullane PJ, Irish JC, Yao CM, Barbon CEA. Glossectomy for the treatment of oral cavity carcinoma: Quantitative, functional and patient-reported quality of life outcomes differ by four glossectomy defects. Oral Oncol 2023; 142:106431. [PMID: 37263070 DOI: 10.1016/j.oraloncology.2023.106431] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The goal was to characterize four clinically distinct glossectomy defects to establish significant quantitative cut points using functional metrics, the MD Anderson Dysphagia Index (MDADI) and speech intelligibility. METHODS Population included 101 patients treated with surgery, adjuvant radiation per NCCN guidelines, and ≥ 12 months follow-up. RESULTS Defect groups: subtotal hemiglossectomy (1), hemiglossectomy (2), extended hemiglossectomy (3) and oral glossectomy (4) were compared: All outcomes supported a four defect model. Intergroup comparison of outcomes with subtotal hemiglossectomy as reference (p value): Tongue Protrusion <0.001,<0.001,<0.001; Elevation <0.001,<0.001,<0.001; Open Mouth Premaxillary Contact Elevation <0.001,<0.001,<0.001; Obliteration 0.6,<0.001,<0.001; Normalcy of Diet, <0.3,<0.001,<0.001; Nutritional Mode, <0.9,<0.8,<0.001; Range of Liquids, <0.4,<0.016,<0.02; Range of Solids, <0.5,<0.004,<0.001; Eating in Public, <0.2,<0.002,<0.03; Understandability of Speech, <0.9,<0.001,<0.001; Speaking in Public, <0.4,<0.03,<0.001; MDADI, <0.4,<0.005,<0.01; Single Word Intelligibility, <0.4,<0.1,<0.001; Sentence Intelligibility, <0.5,<0.08,<0.001; Words Per Minute Intelligibility, <0.6,<0.04,<0.001; Sentence Efficiency Ratio, <0.4,<0.03,<0.002. Proportion of patients by 4 defect groups who underwent: tissue transplantation, 51%,93.9%,100%,100%.Radiation,24%,67%,88%,80%.Between hemiglossectomy and extended hemiglossectomy, the defect extends into the contralateral floor of the mouth and/or the anterior tonsillar pillar; resection of these subunits limits tongue mobility with an impact on functional outcome and MDADI. Between extended hemiglossectomy and oral glossectomy, the defect extends to include the tip of the tongue and appears to impact functional outcome and MDADI. CONCLUSIONS Subtotal hemiglossectomy, hemiglossectomy, extended glossectomy and oral glossectomy are associated with quantitative (elevation, protrusion, open mouth premaxillary contact and obliteration), qualitative (speech and swallowing) and MDADI differences, suggesting that these 4 ordinal defect groups are distinct.
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Affiliation(s)
- Douglas B Chepeha
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Otolaryngology-Head & Neck Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
| | - Alex O Esemezie
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dale H Brown
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Patrick J Gullane
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Christopher Mkl Yao
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Carly E A Barbon
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Association between trismus and dysphagia-related quality of life in survivors of head and neck cancer in Brazil. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:235-242. [DOI: 10.1016/j.oooo.2019.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 02/07/2023]
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5
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Han AY, Kuan EC, Mallen-St Clair J, Badran KW, Palma Diaz MF, Blackwell KE, St John MA. Total Glossectomy With Free Flap Reconstruction: Twenty-Year Experience at a Tertiary Medical Center. Laryngoscope 2019; 129:1087-1092. [PMID: 30667056 DOI: 10.1002/lary.27579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To characterize the demographics, clinicopathologic characteristics, and treatment and reconstructive outcomes of patients who underwent total glossectomy STUDY DESIGN: Retrospective chart review at an academic tertiary-care medical center. METHODS All patients who had undergone total glossectomy (as an individual procedure or as part of a more extensive resection) between January 1, 1995 and December 31, 2014 were included in the analysis. Patient characteristics and clinical outcomes were reviewed. RESULTS Forty-eight patients underwent total glossectomy for oral tongue and base of tongue cancer. The mean age of the patients was 56 (range, 29-92 years). History of tobacco and heavy alcohol use was found in 76% and 11% of patients, respectively. The majority of patients had advanced cancer (91.7% at stage IV), and 60.4% had salvage therapy for recurrent disease. T4 disease comprised 81% of patients. Sixty percent had clinical or radiographic evidence of nodal metastasis. Reconstruction of the defect was performed with free flaps from the rectus abdominus (40%), fibula (25%), anterolateral thigh (23%), and other donor tissues. One- and 5-year survival rates were 42% and 26%, with locoregional and distant recurrence reported at 36% and 25%, respectively. CONCLUSIONS Total glossectomy for oncologic control is most commonly performed in patients who have stage IV cancers. Despite high reconstructive success rates, the likelihood of locoregional and distance recurrence was high. Most patients can communicate intelligibly and achieve decannulation, but swallowing outcomes remain guarded, especially considering previous irradiation and resection of the base of tongue. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1087-1092, 2019.
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Affiliation(s)
- Albert Y Han
- Department of Head and Neck Surgery, Los Angeles, California
| | - Edward C Kuan
- Department of Head and Neck Surgery, Los Angeles, California
| | - Jon Mallen-St Clair
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco Medical Center, San Francisco, California, U.S.A
| | - Karam W Badran
- Department of Head and Neck Surgery, Los Angeles, California
| | | | - Keith E Blackwell
- Department of Head and Neck Surgery, Los Angeles, California.,University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California
| | - Maie A St John
- Department of Head and Neck Surgery, Los Angeles, California.,Jonsson Comprehensive Cancer Center, Los Angeles, California.,University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California
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6
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Structured review of papers reporting specific functions in patients with cancer of the head and neck: 2006 - 2013. Br J Oral Maxillofac Surg 2016; 54:e45-51. [PMID: 26923873 DOI: 10.1016/j.bjoms.2016.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 02/09/2016] [Indexed: 11/21/2022]
Abstract
Health-related quality of life (HRQoL) focuses on 4 core domains: physical and psychological function, social interaction, disease, and treatment-related symptoms, and is a key outcome in patients with cancer of the head and neck. We reviewed papers published between 2006 and 2013 that used validated questionnaires to report functional outcome in this group. A total of 572 papers were identified and 118 of them concerned function. Specific outcomes included anxiety, chewing, maxillectomy, mucositis, pain, shoulder function, and trismus. The specific functions most often identified were xerostomia, speech or voice, and swallowing or dysphagia. A considerable body of evidence has now accumulated on HRQoL and functional outomes although the precise role of HRQoL during the planning of treatment remains controversial. Over time, the emphasis of the studies included has tended to move away from the reporting of outcomes in general to more hypothesis-driven and group-specific work.
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7
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Zhang L, Huang Z, Wu H, Chen W, Huang Z. Effect of swallowing training on dysphagia and depression in postoperative tongue cancer patients. Eur J Oncol Nurs 2014; 18:626-9. [DOI: 10.1016/j.ejon.2014.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/31/2014] [Accepted: 06/03/2014] [Indexed: 12/27/2022]
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Zheng Y, Liu M, Li M, Zhang J, Ge J, Sun Y, Tian L. The Influence of the ‘Patient-to-Patient Model' on Swallowing Problems in Patients with Supraglottic Laryngeal Cancer. ORL J Otorhinolaryngol Relat Spec 2014; 76:171-7. [DOI: 10.1159/000365092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/03/2014] [Indexed: 11/19/2022]
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9
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Lee DY, Ryu YJ, Hah JH, Kwon TK, Sung MW, Kim KH. Long-term subjective tongue function after partial glossectomy. J Oral Rehabil 2014; 41:754-8. [DOI: 10.1111/joor.12193] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- D. Y. Lee
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Y.-J. Ryu
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
| | - J. H. Hah
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
| | - T.-K. Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
| | - M.-W. Sung
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
| | - K. H. Kim
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Korea
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The superficial circumflex iliac artery perforator flap in intra-oral reconstruction. J Plast Reconstr Aesthet Surg 2013; 66:1683-7. [DOI: 10.1016/j.bjps.2013.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/05/2013] [Accepted: 07/09/2013] [Indexed: 11/18/2022]
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Barrios R, Montero J, González-Moles MA, Baca P, Bravo M. Levels of scientific evidence of the quality of life in patients treated for oral cancer. Med Oral Patol Oral Cir Bucal 2013; 18:e578-84. [PMID: 23722141 PMCID: PMC3731084 DOI: 10.4317/medoral.19052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 02/10/2013] [Indexed: 12/24/2022] Open
Abstract
Treatments used in cancer of the oral cavity have great impact on the physical, psychological and functional state of patients. There has been increasingly interest in evaluating the health-related quality of life using questionnaires among patients treated with oral cancer. Up to our knowledge no review on this theme has incorporated the level of evidence of the single identified studies. The objective of the present study is to determinate results and conclusions about the health-related quality of life of these patients, in view of scientific evidence. In general, the diversity of designs, level of evidence and questionnaires used for their assessment does not affect results, which indicate a decline in the health related quality of life after treatment. This decline is greater when the tumor is large in size, and when radiotherapy is used, though the situation is seen to improve over the span of a year. Questionnaires on health-related quality of life provide concrete information regarding the impact of cancer treatment on patients.
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Affiliation(s)
- Rocío Barrios
- School of Dentistry, University of Granada, Granada, Spain
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12
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Speech and swallowing following tongue cancer surgery and free flap reconstruction – A systematic review. Oral Oncol 2013; 49:507-24. [DOI: 10.1016/j.oraloncology.2013.03.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 02/04/2013] [Accepted: 03/04/2013] [Indexed: 11/20/2022]
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Tschiesner U. Preservation of organ function in head and neck cancer. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 11:Doc07. [PMID: 23320059 PMCID: PMC3544204 DOI: 10.3205/cto000089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Preservation of function is a crucial aspect for the evaluation of therapies applied in the field of head and neck cancer. However, preservation of anatomic structures cannot automatically be equated with preservation of function. Functional outcome becomes increasingly important particularly for the evaluation of alternative treatment options with equivalent oncological outcomes.AS A RESULT, PRESENT STUDIES TAKE INTO ACCOUNT THREE TOPIC AREAS WITH VARYING EMPHASIS: (1) the effects of cancer therapy on essential physiological functions, (2) additional therapy-induced side-effects and complications, and (3) health-related quality of life. The present article summarizes vital aspects of clinical research from recent years. Functional outcomes after surgical and non-surgical treatment approaches are presented according to tumor localization and staging criteria. Additional methodological aspects relating to data gathering and documentation as well as challenges in implementing the results in clinical practice are also discussed.
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Affiliation(s)
- Uta Tschiesner
- Clinic for Otorhinolaryngology, Ludwig Maximilians University (LMU) Munich, Munich, Germany
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14
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Thomas L, Moore EJ, Olsen KD, Kasperbauer JL. Long-term quality of life in young adults treated for oral cavity squamous cell cancer. Ann Otol Rhinol Laryngol 2012; 121:395-401. [PMID: 22737962 DOI: 10.1177/000348941212100606] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES We assessed the long-term quality of life (QOL) in patients who survived oral cavity squamous cell cancer when they were young and looked for any clinical factors that might adversely affect function and QOL. METHODS We performed a retrospective case series and questionnaire survey in a tertiary care center. The subjects were consecutive patients treated for oral cancers during a 25-year period, when they were 40 years of age or less. The patients completed the University of Washington Quality of Life questionnaire and the M. D. Anderson Dysphagia Inventory (MDADI). We made an overall descriptive report of swallowing and QOL measures in the study population and looked for any clinical factors associated with functional outcomes. RESULTS Among the 62 patients treated over the course of 25 years, 46 were alive and disease-free. Twenty-six participated. The median follow-up duration was 14.7 years (range, 3 to 27 years). Age at diagnosis and duration of follow-up did not correlate with overall QOL or health-related QOL. Seventy-seven percent rated their overall QOL as outstanding, very good, or good. The key domains affected by cancer were appearance, mood, saliva, and shoulder function. Radiotherapy significantly adversely affected the QOL. The median MDADI scores on all 4 subscales were at least 85%. Higher T-stage and radiotherapy were significantly associated with lower scores on all subscales. CONCLUSIONS The long-term health-related QOL in this cohort was quite good. Radiotherapy and tumor stage correlated with swallowing outcomes, and only radiotherapy seemed to adversely affect the overall QOL.
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Affiliation(s)
- Ligy Thomas
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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15
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Zuydam AC, Ghazali N, Lowe D, Skelly R, Rogers SN. Evaluation of the limitations of using the University of Washington Quality of Life swallowing domain alone to screen patients in the routine clinical setting. Br J Oral Maxillofac Surg 2012; 51:e148-54. [PMID: 22721809 DOI: 10.1016/j.bjoms.2012.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/23/2012] [Indexed: 11/18/2022]
Abstract
A broad patient-completed screening tool in routine clinical practice in head and neck oncology has merit, but clinicians should be aware that its simplicity could lead to some patients and the detail of their problems being missed. The purpose of this study was to compare the University of Washington Quality of Life (UWQoL) swallowing domain with the MD Anderson Dysphagia Inventory (MDADI) in relation to the need for interventions for swallowing around one year after treatment. The group comprised 112 consecutively referred patients to speech and language therapy between January 2007 and August 2009 after primary operation for previously untreated oral and oropharyngeal squamous cell carcinoma (SCC). A total of 78 patients completed questionnaires (median time of assessment 11.7 months, IQR 6.1-12.2). There were significant (p<0.001) and moderately strong correlations (rs=0.51-0.62) between the UWQoL swallowing domain score and MDADI subscales and total scores, and also with individual MDADI questions: taking a great deal of effort (rs=0.71); being upset (rs=0.61); and not going out (rs=0.62) were the strongest in regard to swallowing. Use of a gastrostomy tube was associated with worse UWQoL and MDADI scores. In conclusion, patients who score 100 on the UWQoL do not require swallowing to be evaluated further. Those who score 70 could benefit from the detailed MDADI to help to clarify the specific problem and the impact it has before being referred to speech and language therapy. Those who score less than 70 should be brought to the attention of speech and language therapists to confirm that appropriate support and intervention are in place.
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Affiliation(s)
- A C Zuydam
- University Hospital Aintree, Lower Lane, Liverpool L9 7AL, United Kingdom.
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Guedes RLV, Angelis ECD, Chen AY, Kowalski LP, Vartanian JG. Validation and Application of the M.D. Anderson Dysphagia Inventory in Patients Treated for Head and Neck Cancer in Brazil. Dysphagia 2012; 28:24-32. [DOI: 10.1007/s00455-012-9409-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
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17
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Shin YS, Koh YW, Kim SH, Jeong JH, Ahn S, Hong HJ, Choi EC. Radiotherapy Deteriorates Postoperative Functional Outcome After Partial Glossectomy With Free Flap Reconstruction. J Oral Maxillofac Surg 2012; 70:216-20. [DOI: 10.1016/j.joms.2011.04.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 04/11/2011] [Indexed: 10/17/2022]
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18
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The impact of enteral feeding route on patient-reported long term swallowing outcome after chemoradiation for head and neck cancer. Oral Oncol 2011; 47:980-3. [DOI: 10.1016/j.oraloncology.2011.07.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 07/13/2011] [Indexed: 11/19/2022]
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19
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An exploratory study of the influence of clinico-demographic variables on swallowing and swallowing-related quality of life in a cohort of oral and oropharyngeal cancer patients treated with primary surgery. Eur Arch Otorhinolaryngol 2011; 269:1233-9. [DOI: 10.1007/s00405-011-1756-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
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20
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