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Zhang Y, Wang Z, Zheng Y. Chemoradiotherapy vs radiotherapy for non-surgical locally advanced laryngeal squamous cell carcinoma patients: a propensity score-matched study and practical nomogram construction. Eur Arch Otorhinolaryngol 2024; 281:1449-1456. [PMID: 38158418 DOI: 10.1007/s00405-023-08360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To compare the cancer-specific survival (CSS) among patients with locally advanced laryngeal squamous cell carcinoma (LSCC) receiving chemoradiotherapy (CRT) and radiotherapy (RT) treatment, as well as to establish a prognostic nomogram for survival prediction in patients receiving CRT. METHOD Using data from the Surveillance, Epidemiology, and End Results (SEER) database, patients with laryngeal cancer were identified between 2010 and 2015, with follow-up up to 2018. Propensity score matching (PSM) was performed to minimize disproportionate distributions of the potential confounding. Cox regression models were used to evaluate the CSS of two treatment groups. A prognostic nomogram for patients receiving CRT was then developed and evaluated. RESULTS Totally 1085 non-surgical patients with locally advanced LSCC were included in this study (median [IQR] age, 62 [55-69] years; 829 [76.41%] males), of which 913 receiving CRT and 172 receiving RT. After PSM, significantly improved CSS was observed in locally advanced LSCC patients receiving CRT when compared to RT (HR: 0.62 [95% CI 0.42-0.92]; P = 0.014). Then, in the group of 639 locally advanced LSCC patients receiving CRT, a prognostic nomogram based on age, tumor size, N category, and marital status were developed and validated, of which the predictive performance was superior to that of TNM staging system (7th edition). CONCLUSION CSS shows a statistically significant improvement in locally advanced LSCC patients who receipt of CRT when compared with RT. Furthermore, a prognostic nomogram for locally advanced LSCC patients receiving CRT was established, which shows a good calibration and identification accuracy.
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Affiliation(s)
- Yuan Zhang
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
- Department of Audiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Zhipeng Wang
- Department of Audiology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yun Zheng
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China.
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2
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Al-Rashdan A, Grendarova P, Yannitsos D, Quon H, Banerjee R, Barbera L. Feasibility and Acceptability of Implementing Site-Specific Patient-Reported Outcome Measure in Head and Neck Cancer Clinics: A Prospective Institutional Study. Adv Radiat Oncol 2022; 7:101036. [DOI: 10.1016/j.adro.2022.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/16/2022] [Indexed: 11/29/2022] Open
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3
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Li N, Lu J, Xia D, Jiang X, Wen X, Qin X, Chen Y, Wang T. Serum biomarkers predict adjuvant chemotherapy-associated symptom clusters in radical resected colorectal cancer patients. J Gastrointest Oncol 2022; 13:197-209. [PMID: 35284113 PMCID: PMC8899734 DOI: 10.21037/jgo-21-904] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/20/2022] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Due to individual heterogeneity, patients at the same stage of colorectal cancer (CRC) who receive the same chemotherapy may experience different symptom clusters. Identifying the precise factors that predict symptom clusters is of great clinical significance for precision care and for improving the quality of life of patients. The present study investigated the relationship between serum biomarkers and adjuvant chemotherapy-related symptom clusters in radically resected CRC patients. METHODS Serum biomarkers and clinical/pathological characteristics of the radical resected CRC patients were collected before the first cycle of adjuvant chemotherapy. A demographic questionnaire and M.D. Anderson Gastrointestinal Cancer Symptom Scale (MDASI-GI) were performed on the third day after chemotherapy and exploratory factor analysis was performed to determine the symptoms clusters. Multiple linear regression and correlation analysis were also performed to evaluate the correlation between serum biomarkers and chemotherapy-related symptom clusters. RESULTS A total of 4 chemotherapy-related symptom clusters were determined in the enrolled radical resected CRC patients, including a fatigue-psychological symptom cluster, gastrointestinal symptom cluster, neurotoxic symptom cluster, and constipation-abdominal distension symptom cluster. Further analysis showed that the gastrointestinal symptom cluster was significantly associated with age, gender, weight change status, neutrophil to lymphocyte ratio (NLR), and body mass index (BMI). Additionally, the fatigue-psychological symptom cluster was found to be significantly associated with high NLR. The neurotoxic symptom cluster was found to be significantly associated with low hemoglobin level. CONCLUSIONS Serum biomarkers and clinical characteristics of the radical resected CRC patients could be used to predict chemotherapy-related symptoms clusters.
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Affiliation(s)
- Na Li
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China
- Wuxi Medical College, Jiangnan University, Wuxi, China
- Department of Gastrointestinal Surgery, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Jiajia Lu
- Department of Internal Medicine, Wuxi No. 5 People’s Hospital, Wuxi, China
| | - Duanxiang Xia
- Department of Pediatrics, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Xuetong Jiang
- Department of Gastrointestinal Surgery, Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Xiaomeng Wen
- Wuxi Medical College, Jiangnan University, Wuxi, China
| | - Xia Qin
- Wuxi Medical College, Jiangnan University, Wuxi, China
| | - Ying Chen
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China
- Wuxi Medical College, Jiangnan University, Wuxi, China
| | - Teng Wang
- Department of Oncology, Affiliated Hospital of Jiangnan University, Wuxi, China
- Wuxi Medical College, Jiangnan University, Wuxi, China
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4
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Rattay T, Seibold P, Aguado-Barrera ME, Altabas M, Azria D, Barnett GC, Bultijnck R, Chang-Claude J, Choudhury A, Coles CE, Dunning AM, Elliott RM, Farcy Jacquet MP, Gutiérrez-Enríquez S, Johnson K, Müller A, Post G, Rancati T, Reyes V, Rosenstein BS, De Ruysscher D, de Santis MC, Sperk E, Stobart H, Symonds RP, Taboada-Valladares B, Vega A, Veldeman L, Webb AJ, West CM, Valdagni R, Talbot CJ. External Validation of a Predictive Model for Acute Skin Radiation Toxicity in the REQUITE Breast Cohort. Front Oncol 2020; 10:575909. [PMID: 33216838 PMCID: PMC7664984 DOI: 10.3389/fonc.2020.575909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/15/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Acute skin toxicity is a common and usually transient side-effect of breast radiotherapy although, if sufficiently severe, it can affect breast cosmesis, aftercare costs and the patient's quality-of-life. The aim of this study was to develop predictive models for acute skin toxicity using published risk factors and externally validate the models in patients recruited into the prospective multi-center REQUITE (validating pREdictive models and biomarkers of radiotherapy toxicity to reduce side-effects and improve QUalITy of lifE in cancer survivors) study. Methods: Patient and treatment-related risk factors significantly associated with acute breast radiation toxicity on multivariate analysis were identified in the literature. These predictors were used to develop risk models for acute erythema and acute desquamation (skin loss) in three Radiogenomics Consortium cohorts of patients treated by breast-conserving surgery and whole breast external beam radiotherapy (n = 2,031). The models were externally validated in the REQUITE breast cancer cohort (n = 2,057). Results: The final risk model for acute erythema included BMI, breast size, hypo-fractionation, boost, tamoxifen use and smoking status. This model was validated in REQUITE with moderate discrimination (AUC 0.65), calibration and agreement between predicted and observed toxicity (Brier score 0.17). The risk model for acute desquamation, excluding the predictor tamoxifen use, failed to validate in the REQUITE cohort. Conclusions: While most published prediction research in the field has focused on model development, this study reports successful external validation of a predictive model using clinical risk factors for acute erythema following radiotherapy after breast-conserving surgery. This model retained discriminatory power but will benefit from further re-calibration. A similar model to predict acute desquamation failed to validate in the REQUITE cohort. Future improvements and more accurate predictions are expected through the addition of genetic markers and application of other modeling and machine learning techniques.
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Affiliation(s)
- Tim Rattay
- Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Miguel E Aguado-Barrera
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Altabas
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - David Azria
- Fédération Universitaire d'Oncologie Radiothérapie d'Occitanie Méditérranée, Département d'Oncologie Radiothérapie, ICM Montpellier, INSERM U1194 IRCM, University of Montpellier, Montpellier, France
| | - Gillian C Barnett
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ananya Choudhury
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Charlotte E Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, Strangeways Research Laboratory, University of Cambridge, Cambridge, United Kingdom
| | - Rebecca M Elliott
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Marie-Pierre Farcy Jacquet
- Fédération Universitaire d'Oncologie Radiothérapie d'Occitanie Méditérranée, Département d'Oncologie Radiothérapie, CHU Carémeau, Nîmes, France
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Kerstie Johnson
- Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | - Anusha Müller
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Giselle Post
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Victoria Reyes
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Barry S Rosenstein
- Department of Radiation Oncology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Dirk De Ruysscher
- MAASTRO Clinic, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Radiation Oncology, University Hospitals Leuven/KU Leuven, Leuven, Belgium
| | - Maria C de Santis
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsklinikum Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hilary Stobart
- Independent Cancer Patients' Voice, London, United Kingdom
| | - R Paul Symonds
- Cancer Research Centre, University of Leicester, Leicester, United Kingdom
| | - Begoña Taboada-Valladares
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain.,Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
| | - Ana Vega
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Adam J Webb
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Catharine M West
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Riccardo Valdagni
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Hospital Campus, Barcelona, Spain.,Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Hematology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Christopher J Talbot
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
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5
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Bollig CA, Kinealy BP, Gilley DR, Clark AD, Galloway TL, Zitsch RP, Jorgensen JB, Biedermann GB. Implications of Treatment Modality on Chronic Opioid Use Following Treatment for Head and Neck Cancer. Otolaryngol Head Neck Surg 2020; 164:799-806. [DOI: 10.1177/0194599820960137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective To investigate the relationship between treatment modality and chronic opioid use in a large cohort of patients with head and neck cancer. Study Design Retrospective cohort study. Setting Single academic center. Methods There were 388 patients with head and neck cancer treated between January 2011 and December 2017 who met inclusion criteria. Clinical risk factors for opioid use at 3 and 6 months were determined with univariate and multivariate analyses. Results The prevalence of opioid use was 43.0% at 3 months and 33.2% at 6 months. On multivariate analysis, primary chemoradiation (odds ratio [OR], 4.04; 95% CI, 1.91-8.55) and surgery with adjuvant chemoradiation (OR, 2.39; 95% CI, 1.09-5.26) were associated with opioid use at 3 months. Additional risk factors at that time point included pretreatment opioid use (OR, 7.63; 95% CI, 4.09-14.21) and decreasing age (OR, 1.03; 95% CI, 1.01-1.06). At 6 months, primary chemoradiation (OR, 2.40; 95% CI, 1.34-4.28), pretreatment opioid use (OR, 5.86; 95% CI, 3.30-10.38), current tobacco use (OR, 2.00; 95% CI, 1.18-3.40), and psychiatric disorder (OR, 1.79; 95% CI, 1.02-3.14) were associated with opioid use. Conclusion Of the patients who receive different treatment modalities, those receiving primary chemoradiation are independently at highest risk for chronic opioid use. Other risk factors include pretreatment opioid use, tobacco use, and a psychiatric disorder. In an effort to reduce their risk of chronic opioid use, preventative strategies should be especially directed to these patients.
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Affiliation(s)
- Craig A. Bollig
- Department of Otolaryngology–Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Brian P. Kinealy
- School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - David R. Gilley
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Andrew D. Clark
- School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Tabitha L.I. Galloway
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Robert P. Zitsch
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jeffrey B. Jorgensen
- Department of Otolaryngology–Head and Neck Surgery and Communication Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Gregory B. Biedermann
- Department of Radiation Oncology, School of Medicine, University of Missouri, Columbia, Missouri, USA
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6
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Pasalic D, Ludmir EB, Allen PK, Thaker NG, Chapman BV, Hanna EY, Su SY, Ferrarotto R, Glisson BS, Reddy JP, Brandon Gunn G, Fuller CD, Phan J, Rosenthal DI, Morrison WH, Garden AS, Frank SJ. Patient-reported outcomes, physician-reported toxicities, and treatment outcomes in a modern cohort of patients with sinonasal cancer treated using proton beam therapy. Radiother Oncol 2020; 148:258-266. [DOI: 10.1016/j.radonc.2020.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 02/03/2023]
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7
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Vidyasagar N, Manur Gururajachar J. Predicting toxicity for head and neck cancer patients undergoing radiation therapy: an independent and external validation of MDASI-HN based nomogram. Rep Pract Oncol Radiother 2020; 25:355-359. [DOI: 10.1016/j.rpor.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/28/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022] Open
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8
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Chai X, Sun MY, Jia HY, Wang M, Cao L, Li ZW, Wang DW. A prognostic nomogram for overall survival in male breast cancer with histology of infiltrating duct carcinoma after surgery. PeerJ 2019; 7:e7837. [PMID: 31632852 PMCID: PMC6796958 DOI: 10.7717/peerj.7837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/05/2019] [Indexed: 12/19/2022] Open
Abstract
Objective The study was designed to construct and validate a nomogram for predicting overall survival (OS) of male breast cancer (MBC) patients with infiltrating duct carcinoma (IDC). Methods The cohort was selected from the Surveillance, Epidemiology, and End Results (SEER) database between January 1, 2004 and December 31, 2013. Univariate and multivariate Cox proportional hazard (PH) regression models were performed. A nomogram was developed based on the significant prognostic indicators of OS. The discriminatory and predictive capacities of nomogram were assessed by Harrell's concordance index (C-index), calibration plots, area under the curve (AUC) and the decision curve analysis (DCA). Results The median and maximal survival time of 1862 eligible patients were 49 and 131 months, respectively. Multivariate analysis showed that age (P < 0.0001), marital status (P = 0.002), T stage (P < 0.0001), N stage (P = 0.021), M stage (P < 0.0001), progesterone receptor (PR) (P = 0.046), human epidermal growth factor receptor-2 (HER2) (P = 0.009), and chemotherapy (P = 0.003) were independent prognostic indicators of IDC of MBC. The eight variables were then combined to construct a 3-and 5-year nomogram. The C-indexes of the nomogram were0.740 (95% confidence interval [CI] [0.709-0.771]) and 0.718 (95% CI [0.672-0.764]) for the internal validation and external validation, respectively. A better discriminatory capacity was observed in the nomogram compared with the SEER summary stage (P < 0.001) and AJCC TNM staging systems (6th edition; P < 0.001) with respect to OS prediction. Good consistency was detected between the nomogram prediction and actual findings, as indicated by calibration curves. The AUC for 3-and 5-year OS was 0.739 (95% CI [0.693-0.786]) and 0.764 (95% CI [0.725-0.803]) in the training cohort and 0.737 (95% CI [0.671-0.803]) and 0.735 (95% CI [0.678-0.793]) in the validation cohort, respectively. The DCA demonstrated that the survival nomogram was clinically useful. Conclusions The nomogram was able to more accurately predict 3-and 5-year OS of MBC patients with IDC histology than were existing models.
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Affiliation(s)
- Xin Chai
- Breast Surgery Department, Jilin Provincial Cancer Hospital, Changchun, Jilin, China
| | - Mei-Yang Sun
- Breast Surgery Department, Jilin Provincial Cancer Hospital, Changchun, Jilin, China
| | - Hong-Yao Jia
- Breast Surgery Department, First Hospital of Jilin University, Changchun, Jilin, China
| | - Min Wang
- Department of Pathology, Jilin Provincial Cancer Hospital, Changchun, Jilin, China
| | - Ling Cao
- Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, Jilin, China
| | - Zhi-Wen Li
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin, China
| | - Dun-Wei Wang
- Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin, China
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9
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Aggarwal P, Zaveri JS, Goepfert RP, Shi Q, Du XL, Swartz M, Gunn GB, Lai SY, Fuller CD, Hanna EY, Rosenthal DI, Lewin JS, Piller LB, Hutcheson KA. Symptom Burden Associated With Late Lower Cranial Neuropathy in Long-term Oropharyngeal Cancer Survivors. JAMA Otolaryngol Head Neck Surg 2019; 144:1066-1076. [PMID: 30193299 DOI: 10.1001/jamaoto.2018.1791] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Lower cranial neuropathy (LCNP) is a rare but potentially disabling result of radiotherapy and other head and neck cancer therapies. Survivors who develop late LCNP may experience profound functional impairment, with deficits in swallowing, speech, and voice. Objective To investigate the association of late LCNP with severity of cancer treatment-related symptoms and subsequent general functional impairment among oropharyngeal cancer (OPC) survivors. Design, Setting, and Participants This cross-sectional survey study analyzed 889 OPC survivors nested within a retrospective cohort of OPC survivors treated at MD Anderson Cancer Center from January 1, 2000, to December 31, 2013. Eligible survey participants were disease free and completed OPC treatment 1 year or more before the survey. Data analysis was performed from October 10, 2017, to March 15, 2018. Exposures Late LCNP defined by onset 3 months or more after cancer therapy. Main Outcomes and Measures The primary outcome variable was the mean of the top 5 most severely scored symptoms of all 22 core and head and neck cancer-specific symptoms from the MD Anderson Symptom Inventory Head and Neck Cancer Module (MDASI-HN). Secondary outcomes included mean MDASI-HN interference scores and single-item scores of the most severe symptoms. Multivariate models regressed MDASI-HN scores on late LCNP status, adjusting for clinical covariates. Results Overall, 36 of 889 OPC survivors (4.0%) (753 [84.7%] male; 821 [92.4%] white; median [range] age, 56 [32-84] years; median [range] survival time, 7 [1-16] years) developed late LCNP. Late LCNP was significantly associated with worse mean top 5 MDASI-HN symptom scores (coefficient, 1.54; 95% CI, 0.82-2.26), adjusting for age, survival time, sex, therapeutic modality, T stage, subsite, type of radiotherapy, smoking, and normal diet before treatment. Late LCNP was also significantly associated with single-item scores for difficulty swallowing or chewing (coefficient, 2.25; 95% CI, 1.33-3.18), mucus (coefficient, 1.97; 95% CI, 1.03-2.91), fatigue (coefficient, 1.35; 95% CI, 0.40-2.21), choking (coefficient, 1.53; 95% CI, 0.65-2.41), and voice or speech symptoms (coefficient, 2.30; 95% CI, 1.60-3.03) in multivariable models. Late LCNP was not significantly associated with mean interference scores after correction for multiple comparisons (mean interference coefficient, 0.72; 95% CI, 0.09-1.35). Conclusions and Relevance In this large survey study, OPC survivors with late LCNP reported worse cancer treatment-related symptoms, a finding suggesting an association between late LCNP and symptom burden. This research may inform the development and implementation of strategies for LCNP surveillance and management.
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Affiliation(s)
- Puja Aggarwal
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston.,Division of Epidemiology & Disease Control, School of Public Health, The University of Texas, Houston
| | - Jhankruti S Zaveri
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Qiuling Shi
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Xianglin L Du
- Division of Epidemiology & Disease Control, School of Public Health, The University of Texas, Houston
| | - Michael Swartz
- Division of Epidemiology & Disease Control, School of Public Health, The University of Texas, Houston
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Linda B Piller
- Division of Epidemiology & Disease Control, School of Public Health, The University of Texas, Houston
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
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10
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Diao JD, Ma LX, Sun MY, Wu CJ, Wang LJ, Liu YL, Yang YJ. Construction and validation of a nomogram to predict overall survival in patients with inflammatory breast cancer. Cancer Med 2019; 8:5600-5608. [PMID: 31407527 PMCID: PMC6745838 DOI: 10.1002/cam4.2470] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/11/2019] [Accepted: 07/23/2019] [Indexed: 12/27/2022] Open
Abstract
In the present study, we examined the factors affecting survival of women with inflammatory breast cancer (IBC) and constructed and validated a nomogram to predict overall survival (OS) in these patients. The cohort was selected from the Surveillance, Epidemiology, and End Results (SEER) program between 1 January 2004 and 31 December 2013. Univariate and multivariate Cox proportional hazards regression models were constructed. A nomogram was developed based on significant prognostic indicators of OS. The discriminatory and predictive capacities of the nomogram were assessed using Harrell's concordance index (C‐index) and calibration plots. A total of 1651 eligible patients were identified, with a median survival time of 31 months (range 0‐131 months), and the 3‐ and 5‐year OS rates were 52.8% and 39.5%, respectively. Multivariate analysis revealed that race (P < .001), marital status (P = .011), N stage (P = .002), M stage (P < .001), hormone receptor (P < .001), human epidermal growth factor receptor‐2 (HER2) (P = .001), surgery (P < .001), chemotherapy (P < .001), and radiotherapy (P = .010) were independent prognostic indicators of IBC. These nine variables were incorporated to construct a nomogram. The C‐indexes of the nomogram were 0.738 (95% confidence interval [CI]: 0.717, 0.759) and 0.741 (95% CI: 0.717, 0.765) for the internal and external validations, respectively. The nomogram had a better discriminatory capacity for predicting OS than did the SEER summary stage (P < .001) or the American Joint Committee on Cancer tumor‐node metastasis staging systems (8th edition; P < .001). The calibration plot revealed satisfactory agreement between the findings and predicted outcomes in both the internal and external validations. The nomogram‐based 3‐ and 5‐year OS predictions for patients with IBC exhibited superior accuracy over the existing models.
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Affiliation(s)
- Jian-Dong Diao
- Department of Oncology and Hematology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Li-Xia Ma
- Department of Oncology, Jilin Cancer Hospital, Changchun, China
| | - Mei-Yang Sun
- Department of Breast Surgery, Jilin Cancer Hospital, Changchun, China
| | - Chun-Jiao Wu
- Department of Oncology, Jilin Cancer Hospital, Changchun, China
| | - Li-Juan Wang
- Department of Oncology, The People's Hospital of Dehui City, Changchun, China
| | - Yan-Ling Liu
- Department of Oncology, Jilin Cancer Hospital, Changchun, China
| | - Yong-Jing Yang
- Department of Radiation Oncology, Jilin Cancer Hospital, Changchun, China
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11
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Bollig CA, Jorgensen JB. Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer. Head Neck 2019; 41:892-898. [DOI: 10.1002/hed.25482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/05/2018] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Craig A. Bollig
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Missouri School of Medicine Columbia Missouri
| | - Jeffrey B. Jorgensen
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Missouri School of Medicine Columbia Missouri
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12
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Gallo O, Locatello LG, Larotonda G, Napoleone V, Cannavicci A. Nomograms for prediction of postoperative complications in open partial laryngeal surgery. J Surg Oncol 2018; 118:1050-1057. [DOI: 10.1002/jso.25232] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/20/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Oreste Gallo
- Department of Surgery and Translational Medicine; Division of Otolaryngology, University of Florence; Firenze Italy
| | - Luca Giovanni Locatello
- Department of Surgery and Translational Medicine; Division of Otolaryngology, University of Florence; Firenze Italy
| | - Guglielmo Larotonda
- Department of Surgery and Translational Medicine; Division of Otolaryngology, University of Florence; Firenze Italy
| | - Vincenzo Napoleone
- Biodigita - Biostatistical Analysis Section, Gorgia Study Institute; Firenze Italy
| | - Angelo Cannavicci
- Department of Surgery and Translational Medicine; Division of Otolaryngology, University of Florence; Firenze Italy
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13
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Ferris MJ, Zhong J, Switchenko JM, Higgins KA, Cassidy RJ, McDonald MW, Eaton BR, Patel KR, Steuer CE, Baddour HM, Miller AH, Bruner DW, Xiao C, Beitler JJ. Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy. Radiother Oncol 2018; 126:100-106. [PMID: 28826628 PMCID: PMC5841457 DOI: 10.1016/j.radonc.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 07/17/2017] [Accepted: 08/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Radiation (RT) dose to the central nervous system (CNS) has been implicated as a contributor to treatment-related fatigue in head and neck cancer (HNC) patients undergoing radiation therapy (RT). This study evaluates the association of RT dose to CNS structures with patient-reported (PRO) fatigue scores in a population of HNC patients. MATERIALS AND METHODS At pre-RT (baseline), 6th week of RT, and 1-month post-RT time points, Multidimensional Fatigue Inventory (MFI-20) scores were prospectively obtained from 124 patients undergoing definitive treatment for HNC. Medulla, pons, midbrain, total brainstem, cerebellum, posterior fossa, and pituitary dosimetry were evaluated using summary statistics and dose-volume histograms, and associations with MFI-20 scores were analyzed. RESULTS Maximum dose (Dmax) to the brainstem and medulla was significantly associated with MFI-20 scores at 6th week of RT and 1-month post-RT time points, after controlling for baseline scores (p<0.05). Each 1Gy increase in medulla Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p=0.026), and 0.25 (p=0.037), at the 6th week of RT and 1-month post-RT, respectively. Each 1Gy increase in brainstem Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p=0.027), and 0.25 (p=0.037) at the 6th week of RT, 1-month post-RT, respectively. Statistically significant associations were not found between dosimetry for the other CNS structures and MFI-20 scores. CONCLUSIONS In this analysis of PRO fatigue scores from a population of patients undergoing definitive RT for HNC, maximum dose to the brainstem and medulla was associated with a significantly increased risk of acute patient fatigue.
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Affiliation(s)
- Matthew J Ferris
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA.
| | - Jim Zhong
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Jeffrey M Switchenko
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Biostatistics & Bioinformatics, Emory University, Atlanta, USA
| | - Kristin A Higgins
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Richard J Cassidy
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Mark W McDonald
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Bree R Eaton
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Kirtesh R Patel
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
| | - Conor E Steuer
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Hematology and Medical Oncology, Emory University, Atlanta, USA
| | - H Michael Baddour
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, USA
| | - Andrew H Miller
- Winship Cancer Institute of Emory University, Atlanta, USA; Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, USA
| | - Deborah W Bruner
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - Canhua Xiao
- Winship Cancer Institute of Emory University, Atlanta, USA; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology, Emory University, Atlanta, USA; Winship Cancer Institute of Emory University, Atlanta, USA
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14
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Naghavi AO, Echevarria MI, Grass GD, Strom TJ, Abuodeh YA, Ahmed KA, Kim Y, Trotti AM, Harrison LB, Yamoah K, Caudell JJ. Having Medicaid insurance negatively impacts outcomes in patients with head and neck malignancies. Cancer 2016; 122:3529-3537. [PMID: 27479362 DOI: 10.1002/cncr.30212] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients covered by Medicaid insurance appear to have poorer cancer outcomes. Herein, the authors sought to test whether Medicaid was associated with worse outcomes among patients with head and neck cancer (HNC). METHODS The records of 1698 patients with squamous cell HNC without distant metastatic disease were retrospectively reviewed from an institutional database between 1998 and 2011. At the time of diagnosis, insurance status was categorized as Medicaid, Medicare/other government insurance, or private insurance. Outcomes including locoregional control (LRC) and overall survival (OS) were estimated using the Kaplan-Meier method and Cox regression multivariate analysis (MVA). RESULTS The median follow-up for all patients was 35 months. Medicaid patients comprised 11% of the population; the remaining patients were privately insured (56%) or had Medicare/government insurance (34%). On MVA, Medicaid patients were younger, were current smokers, had higher tumor T and N classifications, and experienced a longer time from diagnosis to treatment initiation (all P<.005). Medicaid insurance status was associated with a deficit of 13% in LRC (69% vs 82%) and 26% in OS (46% vs 72%) at 3 years (all with P<.001). A time from diagnosis to treatment initiation of >45 days was found to be associated with worse 3-year LRC (77% vs 83%; P = .009) and OS (68% vs 71%; P = .008). On MVA, Medicaid remained associated with a deficit in LRC (P = .002) and OS (P<.001). CONCLUSIONS Patients with Medicaid insurance more often present with locally advanced HNC and experience a higher rate of treatment delays compared with non-Medicaid patients. Medicaid insurance status appears to be independently associated with deficits in LRC and OS. Improvements in the health care system, such as expediting treatment initiation, may improve the outcomes of patients with HNC. Cancer 2016;122:3529-3537. © 2016 American Cancer Society.
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Affiliation(s)
- Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michelle I Echevarria
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Tobin J Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Yazan A Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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15
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Naghavi AO, Strom TJ, Ahmed KA, Echevarria MI, Abuodeh YA, Venkat PS, Frakes JM, Harrison LB, Trotti AM, Caudell JJ. Management of Oropharyngeal Cancer in the HPV Era. Cancer Control 2016; 23:197-207. [DOI: 10.1177/107327481602300302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Historically, oropharyngeal cancer (OPC) has been attributed to risk factors such as smoking and alcohol use. The increased incidence of OPC has been driven by human papillomavirus (HPV) infection. Methods A search of the literature involving HPV infection and OPC was performed, along with a search of ongoing clinical trials regarding HPV-positive OPC. Results This review summarizes the differences in epidemiology and prognosis of HPV-positive OPC compared with non–HPV-related OPC. It will also discuss use of de-escalating treatment to minimize toxicity while maintaining excellent outcomes. Disease management is also addressed, including prevention and follow-up recommendations for this cohort of patients. Conclusions HPV-positive OPC is a distinct disease, and efforts should be made to personalize its management. Preventive measures and vaccinations, along with de-escalation of treatment, may help optimize outcomes in this population.
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Affiliation(s)
- Arash O. Naghavi
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Tobin J. Strom
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Kamran A. Ahmed
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Michelle I. Echevarria
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Yazan A. Abuodeh
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Puja S. Venkat
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Jessica M. Frakes
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Louis B. Harrison
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Andy M. Trotti
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Jimmy J. Caudell
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
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16
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Gunn GB, Atalar B, Mendoza TR, Cleeland CS, Selek U, Özyar E, Rosenthal DI. Linguistic Validation of the Turkish Version of the M.D. Anderson Symptom Inventory - Head and Neck Cancer Module. Balkan Med J 2016; 33:339-43. [PMID: 27308079 DOI: 10.5152/balkanmedj.2015.150148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The use of patient symptom reports with frequent symptom assessment may be preferred over the more commonly used health-related quality of life questionnaires. AIMS We sought to linguistically validate the Turkish version of the M.D. Anderson Symptom Inventory-Head and Neck module (MDASI-HN) patient reported outcome questionnaire. STUDY DESIGN Validation study. METHODS Following standard forward and backward translation of the original and previously validated English MDASI-HN into a Turkish version (T-MDASI-HN), it was administered to patients with head and neck cancer able to read and understand Turkish. Patients were then cognitively debriefed to evaluate their understanding and comprehension of the T-MDASI-HN. Individual and group responses are presented using descriptive statistics. RESULTS Twenty-six participants with head and neck cancer completed the T-MDASIHN and accompanying cognitive debriefing. Overall, 97 percent of the individual TMDASI-HN items were completed. Average recorded time to complete the 28 item TMDASI-HN questionnaire was 5.4 minutes (range 2-10). Average overall ease of completion, understandability, and acceptability were favorably rated at 1.0, 1.1, and 0.2, respectively, on scales from 0 to 10. Only 5 of the 26 of participants reported trouble completing any single questionnaire items, namely the "difficulty remembering" item for 3 individuals. CONCLUSION The T-MDASI-HN is linguistically valid with ease of completion, relevance, comprehensibility, and applicability and it can be a useful clinical and research tool.
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Affiliation(s)
- G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Banu Atalar
- Department of Radiation Oncology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Uğur Selek
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA; Department of Radiation Oncology, Koç University School of Medicine, İstanbul, Turkey
| | - Enis Özyar
- Department of Radiation Oncology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Texas, USA
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17
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Fromme EK, Holliday EB, Nail LM, Lyons KS, Hribar MR, Thomas CR. Computerized patient-reported symptom assessment in radiotherapy: a pilot randomized, controlled trial. Support Care Cancer 2015; 24:1897-906. [PMID: 26471280 DOI: 10.1007/s00520-015-2983-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/05/2015] [Indexed: 11/12/2022]
Abstract
PURPOSE Computer-based, patient-reported symptom survey tools have been described for patients undergoing chemotherapy. We hypothesized that patients undergoing radiotherapy might also benefit, so we developed a computer application to acquire symptom ratings from patients and generate summaries for use at point of care office visits and conducted a randomized, controlled pilot trial to test its feasibility. METHODS Subjects were randomized prior to beginning radiotherapy. Both control and intervention group subjects completed the computerized symptom assessment, but only for the intervention group were printed symptom summaries made available before each weekly office visit. Metrics compared included the Global Distress Index (GDI), concordance of patient-reported symptoms and symptoms discussed by the physician and numbers of new and/or adjusted symptom management medications prescribed. RESULTS One hundred twelve patients completed the study: 54 in the control and 58 in the intervention arms. There were no differences in GDI over time between the control and intervention groups. In the intervention group, more patient-reported symptoms were actually discussed in radiotherapy office visits: 46/202 vs. 19/230. A sensitivity analysis to account for within-subjects correlation yielded 23.2 vs. 10.3 % (p = 0.03). Medications were started or adjusted at 15.4 % (43/280) of control visits compared to 20.4 % (65/319) of intervention visits (p = 0.07). CONCLUSIONS This computer application is easy to use and makes extensive patient-reported outcome data available at the point of care. Although no differences were seen in symptom trajectory, patients who had printed symptom summaries had improved communication during office visits and a trend towards a more active symptom management during radiotherapy.
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Affiliation(s)
- Erik K Fromme
- Division of Hematology & Medical Oncology, OHSU Knight Cancer Institute, Oregon Health & Science University, Mail Code: L586, Portland, OR, 97239, USA.
| | - Emma B Holliday
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 97, Houston, TX, 78240, USA.
| | - Lillian M Nail
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Karen S Lyons
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Michelle R Hribar
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Charles R Thomas
- Department of Radiation Medicine, OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
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