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Pérez IMM, Pérez SEM, García RP, Lupgens DDZ, Martínez GB, González CR, Yán NK, Hernández FR. Exercise-based rehabilitation on functionality and quality of life in head and neck cancer survivors. A systematic review and meta-analysis. Sci Rep 2023; 13:8523. [PMID: 37237097 DOI: 10.1038/s41598-023-35503-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Head and Neck Cancer (HNC) is a globally rare cancer that includes a variety of tumors affecting the upper aerodigestive tract. It presents with difficulty breathing or swallowing and is mainly treated with radiation therapy, chemotherapy, or surgery for tumors that have spread locally or throughout the body. Alternatively, exercise can be used during cancer treatment to improve function, including pain relief, increase range of motion and muscle strength, and reduce cancer-related fatigue, thereby enhancing quality of life. Although existing evidence suggests the adjunctive use of exercise in other cancer types, no previous studies have examined the effects on HNC survivors. The aim of this meta-analysis was to quantify the effect of exercise-based rehabilitation on functionality and quality of life in HNC survivors who underwent surgery and/or chemoradiotherapy. A systematic review and meta-analysis were carried out following PRISMA statement and registered in PROSPERO (CRD42023390300). The search was performed in MEDLINE (PubMED), Cochrane Library, CINAHL and Web of Science (WOS) databases from inception to 31st December 2022 using the terms "cancer", "head and neck neoplasms", "exercise", "rehabilitation", "complications", "muscle contraction", "muscle stretching exercises" combining with booleans "AND"/"OR". PEDro scale, Cochrane Risk of Bias Tool and GRADE were used to assess methodological quality, risk of bias and grade of recommendation of included studies respectively. 18 studies (n = 1322) were finally included which 1039 (78.6%) were men and 283 (21.4%) were women. In patients who underwent radio-chemotherapy, overall pain [SMD = - 0.62 [- 4.07, 2.83] CI 95%, Z = 0.35, p = 0.72] and OP [SMD = - 0.07 [- 0.62, 0.48] CI 95%, Z = 0.25, p = 0.81] were slightly reduced with exercise in comparison to controls. Besides, lower limb muscle strength [SMD = - 0.10 [- 1.52, 1.32] CI 95%, Z = 0.14, p = 0.89] and fatigue [SMD = - 0.51 [- 0.97, - 0.057] CI 95%, Z = 2.15, p < 0.01] were also improved in those who receive radio-chemoradiation. In HNC survivors treated with neck dissection surgery, exercise was superior to controls in overall pain [SMD = - 1.04 [- 3.31, 1.23] CI 95%, Z = 0.90, p = 0.37] and, in mid-term, on shoulder pain SMD = - 2.81 [- 7.06, 1.43] CI 95%, Z = 1.76, p = 0.08]. No differences in quality of life were found at any of the follow-up periods. There is evidence of fair to good methodological quality, low to moderate risk of bias, and weak recommendations supporting the use of exercise-based rehabilitation to increase functionality. However, no evidence was found in favor of the use of this modality for improving the quality of life of HNC survivors who underwent chemoradiotherapy or surgery.
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Affiliation(s)
- Isidro Miguel Martín Pérez
- Departamento de Medicina Física y Farmacología, Área de Radiología y Medicina Física, Facultad de Ciencias de la Salud, Universidad de la Laguna, 38200, Santa Cruz de Tenerife, Spain
- Escuela de Doctorado y Estudios de Posgrado, Universidad de la Laguna, 38203, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Sebastián Eustaquio Martín Pérez
- Departamento de Medicina Física y Farmacología, Área de Radiología y Medicina Física, Facultad de Ciencias de la Salud, Universidad de la Laguna, 38200, Santa Cruz de Tenerife, Spain.
- Escuela de Doctorado y Estudios de Posgrado, Universidad de la Laguna, 38203, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain.
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300, La Orotava, Santa Cruz de Tenerife, Spain.
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670, Villaviciosa de Odón, Madrid, Spain.
| | - Raquel Pérez García
- Departamento de Medicina Física y Farmacología, Área de Radiología y Medicina Física, Facultad de Ciencias de la Salud, Universidad de la Laguna, 38200, Santa Cruz de Tenerife, Spain
| | - Diego de Zárate Lupgens
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300, La Orotava, Santa Cruz de Tenerife, Spain
| | - Germán Barrachina Martínez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300, La Orotava, Santa Cruz de Tenerife, Spain
| | - Carolina Rodríguez González
- Departamento de Medicina Física y Farmacología, Área de Radiología y Medicina Física, Facultad de Ciencias de la Salud, Universidad de la Laguna, 38200, Santa Cruz de Tenerife, Spain
- Hospital Universitario de Canarias, 38320, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Nart Keituqwa Yán
- Departamento de Medicina Física y Farmacología, Área de Radiología y Medicina Física, Facultad de Ciencias de la Salud, Universidad de la Laguna, 38200, Santa Cruz de Tenerife, Spain
- Hospital Universitario de Canarias, 38320, San Cristóbal de la Laguna, Santa Cruz de Tenerife, Spain
| | - Fidel Rodríguez Hernández
- Departamento de Medicina Física y Farmacología, Área de Radiología y Medicina Física, Facultad de Ciencias de la Salud, Universidad de la Laguna, 38200, Santa Cruz de Tenerife, Spain
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Rojo RD, Ren JL, Lipe DN, Badr H, Shete S, Hanna EY, Reyes-Gibby CC. Neuropathic pain prevalence and risk factors in head and neck cancer survivors. Head Neck 2022; 44:2820-2833. [PMID: 36129114 DOI: 10.1002/hed.27199] [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: 04/25/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Neuropathic pain (NP) is a debilitating symptom among head and neck cancer (HNC) survivors although few large studies report its prevalence and associated risk factors. METHODS A cross-sectional survey assessing demographic, behavioral, and clinical risk factors for NP. NP was assessed using the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS). RESULTS Forty-five percent (227/505) reported having pain including 13.7% (69/505) who were positive for S-LANSS. Reported pain sites were in the regions of the head and oral cavity (46.2%) and neck and throat (41.5%). Despite a higher self-reported use of analgesic medication (NP+ = 41.2%; NP- = 27.4%; p = 0.020) and alternative pain therapies (NP+ = 19.1%; NP- = 8.4%; p = 0.009), severe pain was more prevalent among those with NP (N+ = 23.2%; NP- = 13.3%; p = 0.004). Adjusted for opioid medications, ethnicity/race, age, surgery, depression, and comorbidities were risk factors for NP. CONCLUSION NP remains prevalent in HNC survivors highlighting the importance of routine pain surveillance.
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Affiliation(s)
- Raniv D Rojo
- Department of Emergency Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Jenny L Ren
- Department of Emergency Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
| | - Demis N Lipe
- Department of Emergency Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Hoda Badr
- Baylor College of Medicine, Houston, Texas, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Cielito C Reyes-Gibby
- Department of Emergency Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.,Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Farlow JL, McLean SA, Peddireddy N, Bradford CR, Malloy KM, Stucken CL, VanKoevering KK, Spector ME, Rosko AJ. Impact of Completion Lymphadenectomy on Quality of Life for Head and Neck Cutaneous Melanoma. Otolaryngol Head Neck Surg 2021; 166:313-320. [PMID: 33874791 DOI: 10.1177/01945998211007442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Recent randomized data suggest that completion lymph node dissection after a positive sentinel lymph node biopsy (SLNB) improves locoregional control but does not improve survival for melanoma patients. Locoregional recurrences of head and neck cutaneous melanoma (HNCM) may result in significant morbidity. A better understanding of morbidity is thus important to inform decisions about whether to pursue completion neck dissection (ND). STUDY DESIGN Cross-sectional study. SETTING Academic tertiary care hospital. METHODS Clinical data were collected for patients with HNCM seen between 2016 and 2019 who were at least 1-year disease free. Each patient completed the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (SLANSS), Neck Dissection Impairment Index, and SF-36 (Short Form-36). Scores were compared by surgical treatment: wide local excision (WLE) only, SLNB, and ND. Univariate and multivariable regression was performed. RESULTS Of 474 patients, 140 returned questionnaires (29.5% response rate; WLE, n = 49; SLNB, n = 76; ND, n = 15). No significant differences in SLANSS or Neck Dissection Impairment Index scores were found between the WLE and SLNB groups. SLANSS scores differed by 2 SD (P = .001) in the ND cohort, which had a 36% rate of neuropathy. Neck impairment was worse by 1 SD (P = .01) in the ND cohort. No differences were found in SF-36 domains. CONCLUSION Neuropathy and neck impairment are components of morbidity after ND. These risks must be balanced with potential morbidity of locoregional recurrence in HNCM.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Scott A McLean
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Nithin Peddireddy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Course of Self-Reported Dysphagia, Voice Impairment and Pain in Head and Neck Cancer Survivors. BIOLOGY 2021; 10:biology10020144. [PMID: 33670412 PMCID: PMC7918686 DOI: 10.3390/biology10020144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Head and neck cancer (HNC)-specific symptoms have a substantial impact on health-related quality of life. The aim of this study was to determine whether self-reported dysphagia, voice problems and pain of HNC patients changed over time and whether specific clinical or sociodemographic variables were associated with these symptoms. METHODS HNC patients (n = 299) in an outpatient setting answered questionnaires (Eating Assessment Tool-10; questions from the EORTC QLQ-C30 and EORTC H&N35) on dysphagia, voice problems and pain, collected with the software "OncoFunction" at three different timepoints (t1-t3) after diagnosis. The mean score changes from t1 to t3 were expressed in terms of effect sizes d. The impact of sociodemographic and clinical factors on the course of the variables was tested with multivariate analyses of variance. RESULTS Dysphagia, voice impairment and pain in HNC survivors significantly improved over a period of approximately 14 months after diagnosis. Tumor site, stage, treatment modality, occupational state and ECOG state were significantly correlated with self-reported functional outcome. The pain level of the HNC patients was rather low. CONCLUSIONS Patients suffer from functional impairments after HNC treatment, but an improvement in self-reported symptoms could be demonstrated within this time period.
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Dysphagia, voice problems, and pain in head and neck cancer patients. Eur Arch Otorhinolaryngol 2021; 278:3985-3994. [PMID: 33452920 PMCID: PMC8382612 DOI: 10.1007/s00405-020-06584-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/22/2020] [Indexed: 11/12/2022]
Abstract
PURPOSE Head and neck cancer (HNC) and its treatment can leave devastating side effects with a relevant impact on physical and emotional quality of life (QoL) of HNC patients. The objectives were to examine the amount of dysphagia, voice problems, and pain in HNC patients, the impact of sociodemographic, behavioral, and clinical factors on these symptoms, the psychometric properties of the EAT-10, and the relationship between these symptoms and QoL variables. METHODS HNC patients attending for regular follow-up from 07/2013 to 09/2019 completed questionnaires (Eating Assessment Tool-10 (EAT-10); questions from the EORTC QLQ-C30 and EORTC H&N35) on dysphagia, voice problems, pain, fatigue, and QoL collected with the software OncoFunction. Associations between prognostic factors and symptoms were tested with analyses of variance (ANOVAs). Associations between the symptom scales and QoL variables were expressed with Pearson correlations. RESULTS Of 689 patients, 54.9% suffered from dysphagia, the EAT-10 proved to be a reliable measure. The mean voice score was 37.6 (± 33.9) [range 0-100], the mean pain score 1.98 (± 2.24) [range 0-10]. Trimodality treatment was associated with the highest dysphagia scores. Dysphagia, voice problems, and pain significantly correlated with each other, the highest association was found for dysphagia and pain (r = 0.51). QoL was strongly correlated with dysphagia and pain (r = - 0.39 and r = - 0.40, respectively), while the association with voice problems was weaker (r = - 0.28). CONCLUSION Dysphagia is an important symptom in HNC patients greatly affecting patients' QoL and significantly correlating with voice problems and pain.
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Starr N, Oyler DR, Schadler A, Aouad RK. Chronic opioid use after laryngeal cancer treatment. Head Neck 2020; 43:1242-1251. [PMID: 33368718 DOI: 10.1002/hed.26591] [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] [Received: 02/01/2020] [Revised: 11/14/2020] [Accepted: 12/17/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Survivors of head and neck cancer may be at increased risk for chronic opioid use and questions remain about risk factors. METHODS Retrospective study of patients with laryngeal cancer prescribed opioids utilizing the Truven Health Marketscan database. Patients had laryngeal cancer, underwent treatment, filled an opioid prescription, and were enrolled in this private insurance plan 1 year prior to and after treatment. RESULTS In this study, 7484 patients were included; 17.2% developed chronic opioid use, defined as consecutive opioid fills at least 90 days after treatment cessation. Early opioid use (OR = 3.607, 95% CI [3.125-4.163]), tobacco use (OR = 1.28, 95% CI [1.117-1.467]), median morphine milligram equivalent (MME; OR = 1.001, 95% CI [1.000-1.0001]), and radiation alone (OR = 1.435, 95% CI [1.199-1.717]) were predictive of chronic opioid use. CONCLUSIONS Nearly one in five patients prescribed opioids during treatment developed chronic use. Providers should discuss the risk of chronic opioid use, set expectations for opioid weaning, and consider adjunct pain regimens to develop effective pain management strategies.
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Affiliation(s)
- Nicole Starr
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Douglas R Oyler
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Aric Schadler
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Rony K Aouad
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, Kentucky, USA
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Kiong KL, Vu CN, Yao CMKL, Kruse B, Zheng G, Yu P, Weber RS, Lewis CM. Enhanced Recovery After Surgery (ERAS) in Head and Neck Oncologic Surgery: A Case-Matched Analysis of Perioperative and Pain Outcomes. Ann Surg Oncol 2020; 28:867-876. [PMID: 32964371 DOI: 10.1245/s10434-020-09174-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) pathways are well established in certain surgical specialties because findings have shown significant improvements in outcomes. Convincing literature in head and neck cancer (HNC) surgery is lacking. This study aimed to assess the effect of an ERAS pathway on National Surgical Quality Improvement Program (NSQIP)-based occurrences and pain-related outcomes in HNC surgery. METHODS The study matched 200 patients undergoing head and neck oncologic surgery on an ERAS pathway between 1 March 2016 and 31 March 2019 with control subjects (1:1 ratio) during the same period. Demographic and perioperative data collected from the NSQIP database were extracted. Pain scores and medication usage were electronically extracted from our electronic medical record system and compared. Risk factors for high opioid usage also were assessed. RESULTS Both groups were statistically similar in baseline characteristics. The ERAS group had fewer planned intensive care unit (ICU) admissions (4% vs. 14%; p < 0.001), a shorter mean hospital stay (7.2 ± 2.3 vs. 8.7 ± 4.2 days; p < 0.001), and fewer overall complications (18.6% vs. 27.0%; p = 0.045). Morphine milligram equivalent requirements over 72 h were significantly reduced during 72 h in the ERAS group (138.8 ± 181.5 vs. 207.9 ± 205.5; p < 0.001). In the multivariate analysis, the risk factors for high opioid analgesic usage included preoperative opioid usage, age younger than 65 years, race, patient-controlled analgesia use, and ICU admission. CONCLUSION The study findings showed that ERAS in HNC surgery can result in improved outcomes and resource use, and that these results are sustainable. The outcomes described in this report can be further used to optimize ERAS pathways.
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Affiliation(s)
- Kimberley L Kiong
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Catherine N Vu
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher M K L Yao
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brittany Kruse
- Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gang Zheng
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peirong Yu
- Department of Plastics and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carol M Lewis
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ozsoy-Unubol T, Bulgurcu S, Erkul BE. Longitudinal perioperative pain, neuromusculoskeletal complications and quality-of-life assessment in partial parotidectomy. Eur Arch Otorhinolaryngol 2020; 278:239-245. [PMID: 32728846 DOI: 10.1007/s00405-020-06241-y] [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] [Received: 06/21/2020] [Accepted: 07/22/2020] [Indexed: 01/27/2023]
Abstract
AIM The aim of this study was to evaluate the pain, neuromusculoskeletal complications, and quality of life (QoL) in patients who had undergone partial parotidectomy (PP) for benign parotid tumors. PATIENTS AND METHODS All patients were evaluated before (T0) and at 1 week (T1) and 1 month (T2) after surgery. The patients were assessed for cervical range of motion (ROM), neck pain (NRS), neuropathic pain (DN4), neck disability (NDI), facial disability (FDI), and the presence of facial neuropathy, and QoL. RESULTS Twenty patients were included. A slight decrease was noted in cervical ROM, mild neck pain and disability were seen in T1. The DN4 score markedly increased at T1 (4.25) compared to T0 (0.1). Then it declined to 1.95 at T2. While there was no neuropathy in any of the patients at T0, it was present in 3 patients at T1. However, all improved at T2. QoL was negatively affected at T1 but showed improvement at T2. There was a significant correlation between NRS and NDI, FDI. CONCLUSION Neuromusculoskeletal problems and impaired QoL may develop in patients who have undergone PP. It would be beneficial to evaluate these patients using a multidisciplinary approach and inform them before surgery.
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Affiliation(s)
- Tugba Ozsoy-Unubol
- Department of Physical Medicine and Rehabilitation, Sultan II. Abdulhamid Han Training and Research Hospital, Selimiye Mahallesi, Tıbbiye Cd, Üsküdar, 34668, Istanbul, Turkey.
| | - Suphi Bulgurcu
- Department of Otorhinolaryngology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Bulent Evren Erkul
- Department of Otorhinolaryngology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Cata JP, Patino M, Gorur A, Du KN, Uhelski ML, Myers J, Lai S, Rubin ML, Dougherty PM, Owusu-Agyemang P. Persistent and Chronic Postoperative Opioid Use in a Cohort of Patients with Oral Tongue Squamous Cell Carcinoma. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:1061-1067. [PMID: 31609416 PMCID: PMC8453604 DOI: 10.1093/pm/pnz242] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recently, the concept of persistent postsurgical opioid use has been described for patients undergoing cancer surgery. Our hypothesis was based on the premise that patients with oral tongue cancer require high dosages of opioids before, during, and after surgery, and thus a large percentage of patients might develop persistent postsurgical opioid use. METHODS After institutional review board approval, we conducted a retrospective study that included a cohort of patients with oral tongue cancers who underwent curative-intent surgery in our institution. Multivariable logistic regression models were fit to study the association of the characteristics of several patients with persistent (six months after surgery) and chronic (12 months after surgery) postoperative opioid use. RESULTS A total of 362 patients with oral tongue malignancies were included in the study. The rate of persistent use of opioids after surgery was 31%. Multivariate analysis showed that patients taking opioids before surgery and those receiving adjuvant therapy were 2.9 and 1.78 times more likely to use opioids six months after surgery. Fifteen percent of the patients were taking opioids 12 months after surgery. After adjusting for clinically relevant covariates, patients complaining of moderate tongue pain before surgery and those taking opioids preoperatively had at least three times higher risk of still using these analgesics one year after surgery. CONCLUSIONS Patients with oral tongue cancers have a high risk of developing persistent and chronic postsurgical opioid use.
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Affiliation(s)
- Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas
| | - Miguel Patino
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas
- Department of Anesthesiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Aysegul Gorur
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas
| | - Kim N Du
- University of Texas McGovern Medical School, Houston, Texas, USA
| | - Megan L Uhelski
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - M Laura Rubin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patrick M Dougherty
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pascal Owusu-Agyemang
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas
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Craker NC, Gal TJ, Wells L, Schadler A, Pruden S, Aouad RK. Chronic Opioid Use after Laryngeal Cancer Treatment: A VA Study. Otolaryngol Head Neck Surg 2020; 162:492-497. [PMID: 32093569 DOI: 10.1177/0194599820904693] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate opioid utilization in veterans undergoing laryngeal cancer treatment and describe the risk of chronic use after treatment cessation. STUDY DESIGN A retrospective cohort study. SETTING A single Veterans Health Administration site. SUBJECTS AND METHODS Veterans with newly diagnosed and treated laryngeal cancer with attributable opioid use from 2005 to 2015. Milligram morphine equivalents (MMEs) were calculated from 90 days prior to diagnosis for up to 1 year. Adjuvant pain medications filled 30 days prior to and up to a year from the date of diagnosis were assessed. RESULTS Of 74 veterans with biopsy-proven laryngeal carcinoma, 73 (98.6%) were male and 71 (96%) were white. Forty-three (58%) patients were stage 0/I/II; 31 (42%) were III/IV. Eleven (14.9%) were treated with surgery alone, 35 (47.3%) with radiation alone, and 28 (38%) with multimodal therapy. Twenty-four (32.4%) patients had preexisting opioid use prior to cancer diagnosis. Patients who used opioids more than 30 days prior to date of diagnosis were found to be 10 times more likely to have persistent opioid use at 90 days (P = .0024) and 8 times more likely to have chronic use at 360 days (P = .0041). Maximum MMEs within 1 year of diagnosis were significantly associated with chronic use at 90 days (P = .00045) and chronic use at 360 days (P = .0006). CONCLUSION Preexisting opioid use and maximum MMEs are strongly associated with chronic opioid use among veterans treated for laryngeal carcinoma independent of stage and treatment type.
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Affiliation(s)
- Nicole C Craker
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Thomas J Gal
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Lindsay Wells
- Veterans Health Administration Health Care System, Lexington, Kentucky, USA
| | - Aric Schadler
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Samuel Pruden
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Rony K Aouad
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, Kentucky, USA
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Thibouw F, Duvillard C, Thibouw D, Bertaut A, Blanc J, Vulquin N, Chevalier C, Guigou C, Folia M. Evaluation of the quality of the information received during head and neck cancer announcement: Prospective two-center study. Head Neck 2020; 42:1800-1810. [PMID: 32091638 DOI: 10.1002/hed.26109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/14/2019] [Accepted: 01/28/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Providing patient with cancer with appropriate information following the disclosure of a cancer diagnosis has multiple benefits. The objective was to evaluate the quality of the information received during an announcement for head and neck cancer and to determine predictive factors. METHODS We conducted a prospective two-center study using self-questionnaires to assess the patient's perception of the quality of the announcement. RESULTS Satisfaction scores on the information provided about the overall disease were 7.7/10. The main positive predictors of quality were a satisfactory consultation setting (P = .004), assessment of pain by a physician (P = .04), physician availability (P = .003), accurate information about tumor stage, quality of information regarding the type (P < .0001) and purpose (P = .001) of treatment and its side effects (P = .006), and the interview with the oncology nurse coordinator (P < .05). CONCLUSIONS Patients who received the announcement of head and neck cancer perceived the information received during the pretherapeutic period as satisfactory.
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Affiliation(s)
- François Thibouw
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Center François-Mitterrand, Dijon, France
| | - Christian Duvillard
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Center François-Mitterrand, Dijon, France
| | - David Thibouw
- Department of Radiotherapy, Centre Georges-François Leclerc, Dijon, France
| | - Aurélie Bertaut
- Clinical research center of Methodology and Biostatistics Unit, Centre Georges-François Leclerc, Dijon, France
| | - Julie Blanc
- Clinical research center of Methodology and Biostatistics Unit, Centre Georges-François Leclerc, Dijon, France
| | - Noémie Vulquin
- Department of Radiation Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Cédric Chevalier
- Department of Radiotherapy, Centre Georges-François Leclerc, Dijon, France
| | - Caroline Guigou
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Center François-Mitterrand, Dijon, France
| | - Mireille Folia
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Center François-Mitterrand, Dijon, France
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Stephenson ED, Farzal Z, Jowza M, Hackman T, Zanation A, Du E. Postoperative Analgesic Requirement and Pain Perceptions after Nonaerodigestive Head and Neck Surgery. Otolaryngol Head Neck Surg 2019; 161:970-977. [PMID: 31476960 DOI: 10.1177/0194599819871699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Little data exist on associations between patient factors and postoperative analgesic requirement after head and neck (H&N) surgeries. Such information is important for optimizing postoperative care considering concerns regarding opioid misuse. We analyzed factors associated with narcotic use and pain perception following H&N surgery sparing the upper aerodigestive tract. STUDY DESIGN Prospective cohort. SETTING Tertiary referral center. SUBJECTS AND METHODS From May to October 2017, data were collected for patients undergoing nonaerodigestive H&N procedures requiring hospitalization. Patients completed a preoperative survey querying chronic pain history, narcotic usage, and postoperative pain expectation. Demographics, surgical data, postoperative narcotic use defined by morphine milligram equivalents (MME), pain scores, and Overall Benefit of Analgesia Score (OBAS) were analyzed. RESULTS Seventy-six patients, 44 (57.9%) females and 32 (42.1%) males with a mean age of 54.0 years, met inclusion criteria. The most common procedures were parotidectomy (27.6%) and total thyroidectomy (19.7%). Average cumulative 24-hour postoperative MME and calculated MME per hospital day (MME/HD, cumulative MME for hospitalization divided by length of stay) were 40.5 ± 30.6 and 60.8 ± 60.1, respectively. Average pain score throughout the initial 24 hours after surgery was 3.7/10 ± 2.0. Female sex and prior chronic pain diagnosis were associated with higher OBAS after multivariate linear adjustments. CONCLUSION Postoperative narcotic requirement in nonaerodigestive H&N surgery is overall low. Female sex and prior chronic pain diagnosis may be associated with higher postoperative OBAS, a validated assessment of pain and opioid-related side effects. This study may serve as a comparison for future studies evaluating narcotic-sparing analgesia and pain perception in nonaerodigestive H&N surgery.
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Affiliation(s)
- Elizabeth D Stephenson
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zainab Farzal
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Maryam Jowza
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Trevor Hackman
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam Zanation
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eugenie Du
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Cata JP, Corrales G, Speer B, Owusu-Agyemang P. Postoperative acute pain challenges in patients with cancer. Best Pract Res Clin Anaesthesiol 2019; 33:361-371. [DOI: 10.1016/j.bpa.2019.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022]
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McDermott JD, Eguchi M, Stokes WA, Amini A, Hararah M, Ding D, Valentine A, Bradley CJ, Karam SD. Short- and Long-term Opioid Use in Patients with Oral and Oropharynx Cancer. Otolaryngol Head Neck Surg 2019; 160:409-419. [PMID: 30396321 PMCID: PMC6886698 DOI: 10.1177/0194599818808513] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Opioid use and abuse is a national health care crisis, yet opioids remain the cornerstone of pain management in cancer. We sought to determine the risk of acute and chronic opioid use with head and neck squamous cell cancer (HNSCC) treatment. STUDY DESIGN Retrospective population-based study. SETTING Surveillance, Epidemiology and End Results (SEER)-Medicare database from 2008 to 2011. SUBJECTS AND METHODS In total, 976 nondistant metastatic oral cavity and oropharynx patients undergoing cancer-directed treatment enrolled in Medicare were included. Opiate use was the primary end point. Univariate and multivariable logistic analyses were completed to determine risk factors. RESULTS Of the patients, 811 (83.1%) received an opioid prescription during the treatment period, and 150 patients (15.4%) had continued opioid prescriptions at 3 months and 68 (7.0%) at 6 months. Opioid use during treatment was associated with prescriptions prior to treatment (odds ratio [OR], 3.28; 95% confidence interval [CI], 2.11-5.12) and was least likely to be associated with radiation treatment alone (OR, 0.35; 95% CI, 0.18-0.68). Risk factors for continued opioid use at both 3 and 6 months included tobacco use (OR, 2.23; 95% CI, 1.05-4.71 and OR, 3.84; 95% CI, 1.44-10.24) and opioids prescribed prior to treatment (OR, 3.84; 95% CI, 2.45-5.91 and OR, 3.56; 95% CI, 1.95-6.50). Oxycodone prescribed as the first opioid was the least likely to lead to ongoing use at 3 and 6 months (OR, 0.33; 95% CI, 0.17-0.62 and OR, 0.26; 95% CI, 0.10-0.67). CONCLUSION Patients with oral/oropharyngeal cancer are at a very high risk for receiving opioids as part of symptom management during treatment, and a significant portion continues use at 3 and 6 months after treatment completion.
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Affiliation(s)
- Jessica D. McDermott
- Department of Medical Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Megan Eguchi
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William A. Stokes
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | - Mohammad Hararah
- Department of Otolaryngology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Ding Ding
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Allison Valentine
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cathy J. Bradley
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
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