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Zuo X, Chen Y, Zhu Y, Pan D, Rong X, Shen Q, Li H, Xu Y, Tang Y. Radiation-induced Chronic Pain Plagues Head and Neck Cancer Survivors: A Cross-sectional Analysis From the Cohort in Radiotherapy-related Nervous System Complications. THE JOURNAL OF PAIN 2024; 25:104612. [PMID: 38908498 DOI: 10.1016/j.jpain.2024.104612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 05/03/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
The epidemiology and prognosis of radiation-induced chronic pain, especially chronic neuropathic pain (CNP), are the understudied domain among head and neck cancer (HNC) survivors after radiotherapy (RT). This study aimed to estimate the prevalence of such chronic pain, and explore its correlations with mental health, sleep disorders, cognitive function, and quality of life (QOL) within these patients. This research encompassed HNC survivors post RT. The determination of radiation-induced chronic pain and CNP adhered to the guidelines outlined by the International Association for the Study of Pain. Multivariable regression analyses were employed to explore the relationship between pain and anxiety, depression, sleep disturbances, cognitive function, and QOL. A total of 1,071 HNC survivors post RT were included in this study. The prevalence of radiation-induced chronic pain was 67.1%, and the prevalence of RT-associated CNP was 38.3%. Compared with those reporting no pain, patients with radiation-induced chronic pain had a significantly increased risk of anxiety, depression, and sleep disorders (all P < .001). And there was a significantly negative association between chronic pain and QOL across physiological (P < .001), psychological (P < .001), social relationships (P = .001), and environmental (P = .009) domains. Compared with non-CNP, patients with RT-related CNP had a higher risk of anxiety (P = .027) and sleep disorders (P = .013). The significantly negative associations were found between CNP and the physiological (P = .001), psychological (P = .012), and social score (P = .035) in World Health Organisation Quality of Life Assessment-Bref. This study underscores the substantial prevalence of chronic pain, particularly CNP, and its potential impact on the mental health, sleep, and QOL among HNC survivors post RT. PERSPECTIVE: This study highlights the high prevalence of radiation-induced chronic pain and CNP, and their potential impacts on anxiety, depression, sleep, and QOL among the HNC survivors. Clinically, these findings have important implications for improving the care and outcomes of HNC survivors.
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Affiliation(s)
- Xuzheng Zuo
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanting Chen
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yingying Zhu
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Division of Clinical Research Design, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dong Pan
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qingyu Shen
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Honghong Li
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yongteng Xu
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yamei Tang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Division of Clinical Research Design, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.
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Ouadghiri F, Salles C, Passemard L, Lapeyre M, Mulliez A, Devoize L, Pham Dang N. After 4 years of survival, patients treated for an oral or oropharyngeal cancer have more neurosensorial disorders than chronic pain and a better quality of life. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101924. [PMID: 38802061 DOI: 10.1016/j.jormas.2024.101924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE During follow-up, patients in remission after oral or oropharyngeal cancer are few to express pain, depression or anxiety, their chief complain are dry mouth and difficulties to chewing. The aim of the study is to estimate prevalence of pain, quality of life and their evolution over four years. METHODS This prospective observational study included 21 patients between June and September 2017. Clinical examination, neurosensory examination and questionnaires (using visual analogic scale DN4, PCS-CF, HADS EORTC QLQ30 and H&N 35) were performed and a second time 4 years later. RESULTS After 4 years, 17 patients could be reviewed. In 2017 as in 2021, two patients (11.8 %) experience neuropathic pain. In 2017, 14 (82.3 %) reported paresthesia or dysesthesia or hypo/anesthesia, none of them have provoked pain to a mechanical or thermal stimulus. In 2021, only 9 (53 %) still report those symptoms. Global analysis of the questionnaire QLQC30 reveals a significant increase quality of life of all 17 patients (p = 0.0003). For the two questionnaires QLQC30 and QLQ-H&N 35, dry mouth, sticky saliva, difficulties for eating and relation with food, are strong grievances which an absence of amelioration or a degradation. CONCLUSIONS Neurosensory disturbance is a frequent symptom but pain concerns only 11.8 % of patients. Quality of life increase globally, yet difficulties concerning oral cavity functions endure. IMPLICATIONS FOR CANCER SURVIVORS For remission patients, pain is an unfrequent situation unlike neurosensory disturbance. Support care improve life quality. In case of onset of pain, recurrence and osteoradionecrosis should be mentioned immediately.
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Affiliation(s)
- Fannie Ouadghiri
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, 63000, Clermont-Ferrand, France
| | - Cléa Salles
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, 63000, Clermont-Ferrand, France
| | - Léa Passemard
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, 63000, Clermont-Ferrand, France
| | - Michel Lapeyre
- Department of Radiation Oncology, Jean Perrin Cancer Center, 63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Biostatistics Unit, Clinical Research and Innovation Direction, 63000, Clermont-Ferrand, France
| | - Laurent Devoize
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Odontology, 63000, Clermont-Ferrand, France; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, 63003, Clermont-Ferrand, France
| | - Nathalie Pham Dang
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Department of Oral and Maxillofacial surgery, 63000, Clermont-Ferrand, France; UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, 63003, Clermont-Ferrand, France.
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Salz T, Meza AM, Bradshaw PT, Jinna S, Moryl N, Kriplani A, R Tringale K, Flory J, Korenstein D, Lipitz-Snyderman A. Role of primary care in opioid prescribing for older head and neck cancer survivors. Cancer 2024. [PMID: 39072710 DOI: 10.1002/cncr.35478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Older head and neck cancer (HNC) survivors have concerning rates of potentially unsafe opioid prescribing. Identifying the specialties of opioid prescribers for HNC survivors is critical for targeting the settings for opioid safety interventions. This study hypothesized that oncology and surgery providers are primarily responsible for opioid prescriptions in the year after treatment but that primary care providers (PCPs) are increasingly involved in prescribing over time. METHODS Using linked Surveillance, Epidemiology, and End Results-Medicare data, a retrospective analysis was conducted of adults aged >65 years diagnosed between 2014 and 2017 with stage I-III HNC and who had ≥6 months of treatment-free follow-up through 2019. Starting at treatment completion, opioid fills were assigned to a prescriber specialty: oncology, surgery, primary care, pain management, or other. Prescriber patterns were summarized for each year of follow-up. Multinomial logistic regression models captured the likelihood of opioids being prescribed by each specialty. RESULTS Among 5135 HNC survivors, 2547 (50%) had ≥1 opioid fill (median, 2.1-year follow-up). PCPs prescribed 47% of all fills (42%-55% each year). PCPs prescribed opioids to 45% of survivors with ≥1 opioid fill, which was a greater share than other specialties. PCPs prescribed longer supplies of opioids (median, 20 days/fill; median, 30 days/year) than oncologists or surgeons. The likelihood of an opioid being prescribed by an oncology provider was four times lower than that of it being prescribed by a PCP. CONCLUSIONS PCP involvement in opioid prescribing remains high throughout HNC survivorship. Interventions to improve the safety of opioid prescribing should target primary care, as is typical for opioid reduction efforts in the noncancer population.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Sankeerth Jinna
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Natalie Moryl
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kathryn R Tringale
- University of California San Diego School of Medicine, San Diego, California, USA
| | - James Flory
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Howren MB, Christensen AJ, Pagedar NA. Prevalence of pain in a sample of long-term survivors of head and neck cancer. Am J Otolaryngol 2024; 45:104300. [PMID: 38640810 PMCID: PMC11168893 DOI: 10.1016/j.amjoto.2024.104300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE The experience of long-term pain in head and neck cancer (HNC) survivors is important but has received less attention in the HNC literature. The present study sought to examine the prevalence of pain from 2 to 5 years postdiagnosis and its association with HNC-specific health-related quality of life. MATERIALS & METHODS Prospective observational study at a single-institution tertiary care center. Pain was measured using a single item ranging from 0 to 10 with 0 representing no pain and 10 representing worst pain possible at 2 through 5 years postdiagnosis. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). RESULTS Pain reports were consistent across time. At 2 years postdiagnosis (N = 581), 27.6 % experienced at least some pain with 14.3 % reporting moderate or severe pain. At 3 years postdiagnosis (N = 417), 21.4 % experienced at least some pain with 14.2 % indicating moderate or severe pain. At 4 years postdiagnosis (N = 334), 26.7 % experienced at least some pain with 15.9 % reporting moderate or severe pain. At 5 years postdiagnosis (N = 399), 30.5 % experienced at least some pain with 17.5 % indicating moderate or severe pain. In general, across all four HNCI domains, those in the moderate and severe pain categories largely failed to reach 70 which is indicative of high functioning on the HNCI. CONCLUSIONS Pain is a considerable issue in long-term HNC survivors up to 5 years postdiagnosis. More research is needed to understand correlates of pain after treatment, including opportunities for screening and intervention, to improve outcomes and optimize recovery in HNC.
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Affiliation(s)
- M Bryant Howren
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, United States of America; Department of Internal Medicine, The University of Iowa, Iowa City, IA, United States of America; Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America.
| | - Alan J Christensen
- Department of Psychology, East Carolina University, Greenville, NC, United States of America
| | - Nitin A Pagedar
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America; Department of Otolaryngology, Head and Neck Surgery, The University of Iowa, Iowa City, IA, United States of America
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Gemmiti A, Audlin J, Debick N, Proper H, Yeturu P, Walsh R, Ryan J, Samudre S. Effects of popliteal nerve blocks on postoperative pain management in fibula-free flap patients for head and neck cancer reconstruction. Laryngoscope Investig Otolaryngol 2024; 9:e1290. [PMID: 38867853 PMCID: PMC11168061 DOI: 10.1002/lio2.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/26/2024] [Accepted: 05/22/2024] [Indexed: 06/14/2024] Open
Abstract
Objective To determine if performing popliteal nerve blocks preoperatively in patients undergoing fibula-free flap surgery for head and neck cancer reconstruction decreases subjective pain scores decreases narcotic usage, and improves mobility in the acute postoperative time period when compared to alternative pain control regimens. Methods A retrospective review of the medical records of patients who underwent fibula-free flap reconstruction for head and neck malignancy at SUNY Upstate Medical University during the time period from 2015 to 2022 was performed. Collected data consisted of patient demographics and clinical characteristics, postoperative pain management modalities, reported pain scores, postoperative narcotic usage, length of hospital stay, and days until out of bed without personal assistance. Results A total of 40 patients were included in the study. The average reported pain score was reduced in the nerve block group compared to the control group (1.7 vs. 4.0, p-value = .003). Similarly, the average maximum reported pain score was also lower in patients who received a nerve block (3.4 vs. 6.9, p-value = .002). None of the patients who received popliteal nerve blocks required pain control with parenteral narcotics postoperatively, whereas 82.9% of patients without a nerve block did. Patients who received a popliteal nerve block consumed an average of 103.5 MME, whereas those who did not receive a block consumed an average of 523.0 MME. No statistically significant difference was found between the groups regarding time from surgery until transfer without personal assistance or length of hospital stay. Conclusion Popliteal nerve blocks can reduce postoperative pain in patients undergoing fibula-free flap reconstruction for head and neck cancer.
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Affiliation(s)
- Amanda Gemmiti
- Department of OtolaryngologySUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Jason Audlin
- Department of OtolaryngologySUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | | | | | - Prabhat Yeturu
- Department of AnesthesiologySUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | | | - Jesse Ryan
- Department of OtolaryngologySUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Susan Samudre
- Department of AnesthesiologySUNY Upstate Medical UniversitySyracuseNew YorkUSA
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Schoenberg P, Wulff-Burchfield E, Schlundt D, Bonnet K, Dietrich M, Murphy B. Qualitative Classification of Late Systemic Symptoms in Head and Neck Cancer Survivors. Cancers (Basel) 2024; 16:2106. [PMID: 38893225 PMCID: PMC11172150 DOI: 10.3390/cancers16112106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Improved rates of cancer control have increased the head and neck cancer survivor population. Cancer survivorship clinics are not widely available in the USA, and longitudinal supportive care for patients undergoing multimodal therapy has not advanced at a pace commensurate with improvements in cancer control. Consequently, a large head and neck cancer survivor population whose quality of life may be chronically and/or permanently diminished presently exists. This lack of awareness perpetuates under-recognition and under-investigation, leaving survivors' (mostly detrimental) experiences largely uncharted. We conducted a qualitative exploration of survivors' experiences, aiming to unpack the profound impact of late systemic symptoms on daily life, encompassing work, relationships, and self-identity in the head and neck cancer survivor community. The study included 15 remitted head and neck survivors, ≥12 months from their final treatment, who participated in semi-structured interviews conducted by a medical oncologist. Data analysis comprised qualitative thematic analysis, specifically inductive hierarchical linear modeling, enriched by a deductive approach of anecdotal clinical reporting. Results highlighted that 43.36% of all quotation material discussed in the interviews pertained to chronic emotion disturbance with significant implications for other domains of life. A central symptom cluster comprised impairments in mood/emotions, daily activity, and significant fatigue. Dysfunction in sleep, other medical conditions, and cognitive deficits comprised a secondary cluster. Physical dysfunctionality, encompassing pain, appetite, and eating, and alterations in experienced body temperature, constituted a tertiary cluster, and perhaps were surprisingly the least discussed symptom burden among head and neck cancer survivors. Symptoms causing heightened long-term survivor burden may be considered epiphenomenal to central physical dysfunctionality, albeit being presently the least represented in cancer survivor care programs. Moving forward, the development of targeted and multi-dimensional treatment programs that encompass physical, psychosocial, and spiritual domains are needed to increase clinical specificity and effective holistic long-term solutions that will foster a more compassionate and informed future of care for the cancer survivorship community.
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Affiliation(s)
- Poppy Schoenberg
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | | | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN 37212, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN 37212, USA
| | - Mary Dietrich
- Department of Biostatistics, School of Nursing, Vanderbilt University, Nashville, TN 37240, USA
| | - Barbara Murphy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA
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Arranz-Martín B, Del-Castillo-Pardo-de-Vera JL, Cebrián-Carretero JL, Rouco-García D, Fernández-Oliva C, Gil-Martínez A. Quality of life, craniomandibular function, and psychosocial factors related to pain and movement in patients with head and neck cancer. Support Care Cancer 2024; 32:334. [PMID: 38722345 DOI: 10.1007/s00520-024-08518-y] [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: 11/09/2023] [Accepted: 04/21/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE To describe the characteristics of and the associations between health-related quality of life, pain, craniomandibular function, and psychosocial factors related to pain and fear of movement in patients with head and neck cancer. METHODS Seventy-eight patients diagnosed with HNC were recruited. Measurements of the maximum mouth opening range and pressure pain thresholds on the masseter muscle and the distal phalanx of the thumb were conducted, as well as a battery of self-report questionnaires were administrated, including the QoL Questionnaire (EORT QLQ-H&N35), Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), the Spanish translation of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD), and the short version of the Craniofacial Pain and Disability Inventory (CF-PDI-11). RESULTS The study sample (66.7% men, mean age 60.12 [11.95] years) experienced a moderate impact on their QoL levels (57.68 [18.25] EORT QLQ-H&N35) and high kinesiophobia values (20.49 [9.11] TSK-TMD). Pain was present in 41% of the patients, but only 3.8% reported severe pain. 26.4% had a restricted mouth opening range, and 34.62% showed significant catastrophism levels. There were strong positive correlations between EORT QLQ-H&N35 and CF-PDI-11 (r = 0.81), between NRS and CF-PDI-11 (r = 0.74), and between PCS and CF-PDI-11 (r = 0.66). CONCLUSION Patients with HNC experience negative effects in their QoL, related to their impairment in craniomandibular function. Fear of movement, pain intensity, and catastrophism are associated with poorer functionality; relationships that should be considered when attempting to improve health care.
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Affiliation(s)
- Beatriz Arranz-Martín
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Calle La Salle, 10, 28023, Madrid, Spain.
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, 28023, Madrid, Spain.
| | | | | | - David Rouco-García
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Calle La Salle, 10, 28023, Madrid, Spain
| | - Carlos Fernández-Oliva
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Calle La Salle, 10, 28023, Madrid, Spain
| | - Alfonso Gil-Martínez
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, 28023, Madrid, Spain
- Physiotherapy Unit, La Paz-Carlos III University Hospital (IdiPAZ), 28046, Madrid, Spain
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Inchingolo AM, Dipalma G, Inchingolo AD, Palumbo I, Guglielmo M, Morolla R, Mancini A, Inchingolo F. Advancing Postoperative Pain Management in Oral Cancer Patients: A Systematic Review. Pharmaceuticals (Basel) 2024; 17:542. [PMID: 38675500 PMCID: PMC11054702 DOI: 10.3390/ph17040542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
The goal of this review is to shed light on the management of orofacial discomfort after a cancer diagnosis in the head and neck region. A search was conducted on PubMed, Scopus, and Web of Science to identify studies on postoperative pain control in oral cancer. The review included open-access research, investigations into pain management, randomized clinical trials, retrospective studies, case-control studies, prospective studies, English-written studies, and full-text publications. Exclusion criteria included animal studies; in vitro studies; off-topic studies; reviews, case reports, letters, or comments; and non-English language. Three reviewers independently accessed databases and assigned a quality rating to the chosen articles. The review explores postoperative pain management in oral cancer patients; highlighting persistent opioid use; the efficacy of adjuvant drugs, such as gabapentin; and a multimodal approach. It emphasizes the need for personalized pain management, recognizing individual pain perception and tailoring interventions. Integrating pharmacological and non-pharmacological strategies is crucial for comprehensive pain management. The review also serves as a guide for future research, emphasizing the need for standardized methodologies and diverse participant populations.
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Affiliation(s)
| | - Gianna Dipalma
- Correspondence: (G.D.); (F.I.); Tel.: +39-339-698-9939 (G.D.); +39-331-211-1104 (F.I.)
| | | | | | | | | | | | - Francesco Inchingolo
- Correspondence: (G.D.); (F.I.); Tel.: +39-339-698-9939 (G.D.); +39-331-211-1104 (F.I.)
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Jiao J, Fan J, Zhang Y, Chen L. Efficacy and Safety of Ketamine to Treat Cancer Pain in Adult Patients: A Systematic Review. J Pain Symptom Manage 2024; 67:e185-e210. [PMID: 37972720 DOI: 10.1016/j.jpainsymman.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
CONTEXT Ketamine is a well-characterized anesthetic agent, and subanesthetic ketamine possesses analgesic effects in both acute and chronic pain. OBJECTIVES A systematic review was performed to ascertain the efficacy and safety of ketamine in treating pain for cancer patients. METHODS Eight databases were searched from the inception to March 20th, 2023 to obtain randomized controlled trials (RCTs) on ketamine for treating pain in cancer patients. Two reviewers independently screened studies, extracted the data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Revman 5.3 software and Stata 14.0 software. RESULTS Thirty-five studies were included, involving 2279 patients with cancer pain. The results of meta-analysis showed that ketamine could significantly reduce pain intensity. Subgroup analysis revealed that, when compared with control group, ketamine decreased markedly visual analogue scale (VAS) scores in two days after the end of treatment with ketamine, and ketamine administrated by patient controlled epidural analgesia (PCEA) was effective. Meanwhile, ketamine could significantly reduce the number of patient-controlled analgesia (PCA) compressions within 24 hours and morphine dosage. Ketamine could not decrease Ramsay sedation score. Additionally, the adverse events significantly decreased in the ketamine group, including nausea and vomiting, constipation, pruritus, lethargy, uroschesis, hallucination, and respiratory depression. In addition, compared with the control group, ketamine could reduce Hamilton depression scale (HAMD) score and relieve depressive symptoms. CONCLUSION Ketamine may be used as an effective therapy to relieve cancer pain. However, more rigorously designed RCTs with larger sample sizes are required to verify the above conclusions.
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Affiliation(s)
- Jiao Jiao
- Department of Anesthesiology (J.J., L.C.), West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China-Chinese Academy of Medical Sciences (J.J., L.C.), West China Hospital, Sichuan University, Chengdu, China
| | - Jin Fan
- School of Acupuncture-Moxibustion and Tuina (J.F.), Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yonggang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics (Y.Z.), West China Hospital, Sichuan University, Chengdu, China; Chinese Evidence-based Medicine Center (Y.Z.), West China Hospital, Sichuan University, Chengdu, China; Nursing Key Laboratory of Sichuan Province (Y.Z.), Chengdu, China
| | - Lingmin Chen
- Department of Anesthesiology (J.J., L.C.), West China Hospital, Sichuan University, Chengdu, China; The Research Units of West China-Chinese Academy of Medical Sciences (J.J., L.C.), West China Hospital, Sichuan University, Chengdu, China.
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10
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Bolnykh I, Patterson JM, Harding S, Watson LJ, Lu L, Hurley K, Thomas SJ, Sharp L. Cancer-related pain in head and neck cancer survivors: longitudinal findings from the Head and Neck 5000 clinical cohort. J Cancer Surviv 2024:10.1007/s11764-024-01554-x. [PMID: 38421499 DOI: 10.1007/s11764-024-01554-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Reports suggest pain is common in head and neck cancer (HNC). However, past studies are limited by small sample sizes and design and measurement heterogeneity. Using data from the Head and Neck 5000 longitudinal cohort, we investigated pain over a year post-diagnosis. We assessed: temporal trends; compared pain across HNC treatments, stages, sites and by HPV status; and identified subgroups of patients at increased risk of pain. METHODS Sociodemographic and clinical data and patient-reported pain (measured by EORTC QLQ-C30 and QLQ-H&N35) were collected at baseline (pre-treatment), 4- and 12- months. Using mixed effects multivariable regression, we investigated time trends and identified associations between (i) clinically-important general pain and (ii) HN-specific pain and clinical, socio-economic, and demographic variables. RESULTS 2,870 patients were included. At baseline, 40.9% had clinically-important general pain, rising to 47.6% at 4-months and declining to 35.5% at 12-months. HN-specific pain followed a similar pattern (mean score (sd): baseline 26.4 (25.10); 4-months. 28.9 (26.55); 12-months, 17.2 (19.83)). Across time, general and HN-specific pain levels were increased in: younger patients, smokers, and those with depression and comorbidities at baseline, and more advanced, oral cavity and HPV negative cancers. CONCLUSIONS There is high prevalence of general pain in people living with HNC. We identified subgroups more often reporting general and HN-specific pain towards whom interventions could be targeted. IMPLICATIONS FOR CANCER SURVIVORS Greater emphasis should be placed on identifying and treating pain in HNC. Systematic pain screening could help identify those who could benefit from an early pain management plan.
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Affiliation(s)
- Iakov Bolnykh
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK
| | - Joanne M Patterson
- Liverpool Head and Neck Centre, School of Health Science, University of Liverpool, Liverpool, UK
| | - Sam Harding
- Speech and Language Therapy Research Unit, Southmead Hospital North Bristol NHS Hospital Trust, Bristol, UK
| | - Laura-Jayne Watson
- Speech & Language Therapy, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK
- NHS Forth Valley, Stirling, Scotland, UK
| | - Katrina Hurley
- Head & Neck 5000 Study, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Steve J Thomas
- Head & Neck 5000 Study, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle, UK.
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11
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Salama V, Humbert-Vidan L, Godinich B, Wahid KA, ElHabashy DM, Naser MA, He R, Mohamed ASR, Sahli AJ, Hutcheson KA, Gunn GB, Rosenthal DI, Fuller CD, Moreno AC. Comparison of Machine Leaning Models for Prediction of Acute Pain Severity and On-Treatment Opioid Utilization in Oral Cavity and Oropharyngeal Cancer Patients Receiving Radiation Therapy: Exploratory Analysis from a Large-Scale Retrospective Cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.06.24302341. [PMID: 38370746 PMCID: PMC10871386 DOI: 10.1101/2024.02.06.24302341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Background Acute pain is a common and debilitating symptom experienced by oral cavity and oropharyngeal cancer (OC/OPC) patients undergoing radiation therapy (RT). Uncontrolled pain can result in opioid overuse and increased risks of long-term opioid dependence. The specific aim of this exploratory analysis was the prediction of severe acute pain and opioid use in the acute on-treatment setting, to develop risk-stratification models for pragmatic clinical trials. Materials and Methods A retrospective study was conducted on 900 OC/OPC patients treated with RT during 2017 to 2023. Clinical data including demographics, tumor data, pain scores and medication data were extracted from patient records. On-treatment pain intensity scores were assessed using a numeric rating scale (0-none, 10-worst) and total opioid doses were calculated using morphine equivalent daily dose (MEDD) conversion factors. Analgesics efficacy was assessed based on the combined pain intensity and the total required MEDD. ML models, including Logistic Regression (LR), Support Vector Machine (SVM), Random Forest (RF), and Gradient Boosting Model (GBM) were developed and validated using ten-fold cross-validation. Performance of models were evaluated using discrimination and calibration metrics. Feature importance was investigated using bootstrap and permutation techniques. Results For predicting acute pain intensity, the GBM demonstrated superior area under the receiver operating curve (AUC) (0.71), recall (0.39), and F1 score (0.48). For predicting the total MEDD, LR outperformed other models in the AUC (0.67). For predicting the analgesics efficacy, SVM achieved the highest specificity (0.97), and best calibration (ECE of 0.06), while RF and GBM achieved the same highest AUC, 0.68. RF model emerged as the best calibrated model with ECE of 0.02 for pain intensity prediction and 0.05 for MEDD prediction. Baseline pain scores and vital signs demonstrated the most contributed features for the different predictive models. Conclusion These ML models are promising in predicting end-of-treatment acute pain and opioid requirements and analgesics efficacy in OC/OPC patients undergoing RT. Baseline pain score, vital sign changes were identified as crucial predictors. Implementation of these models in clinical practice could facilitate early risk stratification and personalized pain management. Prospective multicentric studies and external validation are essential for further refinement and generalizability.
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12
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Salz T, Chimonas S, Jinna S, Brens J, Kriplani A, Salner A, Rabinowits G, Currier B, Daly B, Korenstein D. Pain management for post-treatment survivors of complex cancers: a qualitative study of opioids and cannabis. Pain Manag 2024; 14:87-99. [PMID: 38318666 PMCID: PMC10918509 DOI: 10.2217/pmt-2023-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024] Open
Abstract
Aim: We aimed to understand experiences with opioids and cannabis for post-treatment cancer survivors. Patients & methods: We conducted seven focus groups among head and neck and lung cancer survivors, using standard qualitative methodology to explore themes around 1) post-treatment pain and 2) utilization, perceived benefits and perceived harms of cannabis and opioids. Results & conclusion: Survivors (N = 25) experienced addiction fears, stigma and access challenges for both products. Opioids were often perceived as critical for severe pain. Cannabis reduced pain and anxiety for many survivors, suggesting that anxiety screening, as recommended in guidelines, would improve traditional pain assessment. Opioids and cannabis present complex harms and benefits for post-treatment survivors who must balance pain management and minimizing side effects.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Susan Chimonas
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Sankeerth Jinna
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology & Biostatistics, New York, NY 10017, USA
| | - Jessica Brens
- Memorial Sloan Kettering Cancer Center, Department of Advanced Practice Providers, New York, NY 10065, USA
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY 10065, USA
| | - Andrew Salner
- Hartford Hospital, Department of Radiation Oncology, Hartford, CT 06106, USA
| | - Guilherme Rabinowits
- Moffit Cancer Center, Department of Head and Neck-Endocrine Oncology, Tampa, FL 33612, USA
| | - Beatriz Currier
- Miami Cancer Institute, Department of Medicine, Miami, FL 33176, USA
| | - Bobby Daly
- Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY 10065, USA
| | - Deborah Korenstein
- Mount Sinai Hospital, Department of Internal Medicine, New York, NY 10001, USA
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13
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Boguszewicz Ł, Heyda A, Ciszek M, Bieleń A, Skorupa A, Mrochem-Kwarciak J, Składowski K, Sokół M. Metabolite Biomarkers of Prolonged and Intensified Pain and Distress in Head and Neck Cancer Patients Undergoing Radio- or Chemoradiotherapy by Means of NMR-Based Metabolomics-A Preliminary Study. Metabolites 2024; 14:60. [PMID: 38248863 PMCID: PMC10819132 DOI: 10.3390/metabo14010060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Treatment of head and neck squamous cell carcinoma (HNSCC) has a detrimental impact on patient quality of life. The rate of recognized distress/depression among HNSCC patients ranges from 9.8% to 83.8%, and the estimated prevalence of depression among patients receiving radiotherapy is 63%. Shorter overall survival also occurs in preexisting depression or depressive conditions. The present study analyzes the nuclear magnetic resonance (NMR) blood serum metabolic profiles during radio-/chemoradiotherapy and correlates the detected alterations with pain and/or distress accumulated with the disease and its treatment. NMR spectra were acquired on a Bruker 400 MHz spectrometer and analyzed using multivariate methods. The results indicate that distress and/or pain primarily affect the serum lipids and metabolites of energy (glutamine, glucose, lactate, acetate) and one-carbon (glycine, choline, betaine, methanol, threonine, serine, histidine, formate) metabolism. Sparse disturbances in the branched-chain amino acids (BCAA) and in the metabolites involved in protein metabolism (lysine, tyrosine, phenylalanine) are also observed. Depending on the treatment modality-radiotherapy or concurrent chemoradiotherapy-there are some differences in the altered metabolites.
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Affiliation(s)
- Łukasz Boguszewicz
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.C.); (A.S.); (M.S.)
| | - Alicja Heyda
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (A.H.); (A.B.)
| | - Mateusz Ciszek
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.C.); (A.S.); (M.S.)
| | - Agata Bieleń
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (A.H.); (A.B.)
| | - Agnieszka Skorupa
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.C.); (A.S.); (M.S.)
| | - Jolanta Mrochem-Kwarciak
- Analytics and Clinical Biochemistry Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Krzysztof Składowski
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (A.H.); (A.B.)
| | - Maria Sokół
- Department of Medical Physics, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (M.C.); (A.S.); (M.S.)
- 1st Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland; (A.H.); (A.B.)
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14
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Zhu A, O'Byrne TJ, Haller TJ, Martin E, Moore EJ. The Effects of Gross Cranial Nerve Invasion on Oncologic Outcomes in Patients with HPV(+)OPSCC. Laryngoscope 2024; 134:170-177. [PMID: 37254916 DOI: 10.1002/lary.30798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES This study examines oncologic outcomes in patients with HPV-related oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) who had evidence of gross cranial nerve invasion (CNI) identified at the time of surgery. STUDY DESIGN Retrospective cohort study comparing demographics, clinical features, and outcomes of HPV(+)OPSCC patients with and without gross CNI. METHODS Patients with biopsy proven HPV(+)OPSCC involving the base of tongue, tonsil, or unknown primary site, who underwent surgery as a part of their treatment between 1/1/2006-12/31/2020 (n = 874), were included in this study. Gross CNI was identified during operative intervention (n = 36). Statistical analyses were performed using SAS version 9.4 and R version 3.6.2. P-values <0.05 were considered statistically significant. RESULTS HPV(+)OPSCC patients with gross CNI were nearly 5 times as likely to suffer death by cancer (HR = 5.41, 95% CI 2.51 to 11.67, p < 0.0001), over 4 times as likely to see disease progression (HR = 4.25, 95% CI 2.31 to 7.84, p < 0.0001), and nearly 5 times as likely to experience metastasis (HR = 4.46, 95% CI 2.20 to 9.06, p < 0.0001) when compared to patients without CNI. Patients with gross CNI had significantly lower overall survival, cancer-specific survival, progression-free survival, and distant-metastasis free survival (p < 0.0001). Patients with gross CNI were significantly more likely to present with higher clinical N stage, higher pathological N stage and extracapsular spread than patients without gross CNI. CONCLUSIONS Our findings indicate that the presence of CNI is associated with significantly poorer oncologic outcomes in HPV(+)OPSCC patients. LEVEL OF EVIDENCE 3 Laryngoscope, 134:170-177, 2024.
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Affiliation(s)
- Agnes Zhu
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, U.S.A
| | - Thomas J O'Byrne
- Mayo Clinic Department of Quantitative Health Sciences, Rochester, Minnesota, U.S.A
| | - Travis J Haller
- Mayo Clinic Department of Otolaryngology-Head and Neck Surgery, Rochester, Minnesota, U.S.A
| | - Eliot Martin
- Mayo Clinic Department of Otolaryngology-Head and Neck Surgery, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Mayo Clinic Department of Otolaryngology-Head and Neck Surgery, Rochester, Minnesota, U.S.A
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15
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Howren MB, Seaman A, Super GL, Christensen AJ, Pagedar NA. Examination of Predictors of Pain at 12 Months Postdiagnosis in Head and Neck Cancer Survivors. Otolaryngol Head Neck Surg 2023; 169:1506-1512. [PMID: 37403789 PMCID: PMC10766866 DOI: 10.1002/ohn.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Pain following the completion of treatment is important but has received less attention in the head and neck cancer (HNC) literature. The present study sought to examine the prevalence and predictors of pain measured 12 months postdiagnosis and its impact on HNC-specific health-related quality of life (HRQOL) in 1038 HNC survivors. STUDY DESIGN Prospective observational study. SETTING Single-institution tertiary care center. METHODS Pain was measured using a single item ranging from 0 to 10 with 0 representing no pain and 10 representing the worst pain possible. Self-reported depressive symptomatology was measured using the Beck Depression Inventory and self-reported problem alcohol use was measured by the Short Michigan Alcoholism Screening Test. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). RESULTS Hierarchical multivariable linear regression analyses indicated that in addition to pain at 3 months postdiagnosis (β = .145, t = 3.18, sr2 = .019, p = .002), both depressive symptomatology (β = .110, t = 2.49, sr2 = .011, p = .015) and problem alcohol use (β = .092, t = 2.07, sr2 = .008, p = .039) were significant predictors of pain at 12 months postdiagnosis. Subgroup analyses suggest that across all 4 HNCI domains, those in the moderate and severe pain groups at 12 months postdiagnosis failed to reach 70 which is indicative of high functioning. CONCLUSION Pain in patients with HNC is a considerable issue at 12 months postdiagnosis, deserving further attention. Behavioral factors such as depression and problem alcohol use may be associated with pain and require systematic screening over time to identify and treat issues that impact optimal long-term recovery from HNC, including disease-specific HRQOL.
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Affiliation(s)
- M. Bryant Howren
- Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University; Tallahassee, FL
- Florida Blue Center for Rural Health Research & Policy, College of Medicine, Florida State University; Tallahassee, FL
| | - Aaron Seaman
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System; Iowa City, IA
- Department of Internal Medicine, The University of Iowa; Iowa City, IA
| | - Grace L. Super
- College of Medicine, Florida State University; Tallahassee, FL
| | | | - Nitin A. Pagedar
- Department of Otolaryngology—Head and Neck Surgery, Carver College of Medicine, The University of Iowa; Iowa City, IA
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16
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Aghajanzadeh S, Karlsson T, Tuomi L, Engström M, Finizia C. Facial pain, health-related quality of life and trismus-related symptoms up to 5 years post-radiotherapy for head and neck cancer. Support Care Cancer 2023; 31:699. [PMID: 37966497 PMCID: PMC10651533 DOI: 10.1007/s00520-023-08162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE Pain is a frequent symptom of head and neck cancer (HNC) but longitudinal studies investigating facial pain are scarce. We aimed to investigate prevalence of facial pain, its effect on health-related quality of life (HRQL) and trismus-related symptoms in a HNC cohort. METHODS Patients (n = 194) were prospectively followed post completion of radiotherapy (RT). Outcome measures included facial pain, HRQL, trismus-specific symptoms, and maximal interincisal opening (MIO). RESULTS Facial pain was reported by 50% at baseline. Corresponding figures for 3-, 12-, and 60 months post-RT were 70%, 54% and 41%. Moderate to severe pain was reported in 29-44% of patients reporting pain during the study period. Patients reporting pain scored significantly worse on more HRQL variables and trismus symptoms, as well as had significantly smaller MIO at all follow-up time points. CONCLUSIONS Facial pain was common in HNC patients pre- and post-RT and remained prevalent up to 5 years after completion of RT. Reductions in MIO were associated with more facial pain. Pain was also associated with worse HRQL.
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Affiliation(s)
- Susan Aghajanzadeh
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
- Region Västra Götaland, Department of Otorhinolaryngology- Head & Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Therese Karlsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
- Region Västra Götaland, Department of Otorhinolaryngology- Head & Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - My Engström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery Gothenburg, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
- Region Västra Götaland, Department of Otorhinolaryngology- Head & Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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17
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Patel B, Eskander MA, Fang-Mei Chang P, Chapa B, Ruparel SB, Lai Z, Chen Y, Akopian A, Ruparel NB. Understanding painful versus non-painful dental pain in female and male patients: A transcriptomic analysis of human biopsies. PLoS One 2023; 18:e0291724. [PMID: 37733728 PMCID: PMC10513205 DOI: 10.1371/journal.pone.0291724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
Dental pain from apical periodontitis is an infection induced-orofacial pain condition that presents with diversity in pain phenotypes among patients. While 60% of patients with a full-blown disease present with the hallmark symptom of mechanical allodynia, nearly 40% of patients experience no pain. Furthermore, a sexual dichotomy exists, with females exhibiting lower mechanical thresholds under basal and diseased states. Finally, the prevalence of post-treatment pain refractory to commonly used analgesics ranges from 7-19% (∼2 million patients), which warrants a thorough investigation of the cellular changes occurring in different patient cohorts. We, therefore, conducted a transcriptomic assessment of periapical biopsies (peripheral diseased tissue) from patients with persistent apical periodontitis. Surgical biopsies from symptomatic male (SM), asymptomatic male (AM), symptomatic female (SF), and asymptomatic female (AF) patients were collected and processed for bulk RNA sequencing. Using strict selection criteria, our study found several unique differentially regulated genes (DEGs) between symptomatic and asymptomatic patients, as well as novel candidate genes between sexes within the same pain group. Specifically, we found the role of cells of the innate and adaptive immune system in mediating nociception in symptomatic patients and the role of genes involved in tissue homeostasis in potentially inhibiting nociception in asymptomatic patients. Furthermore, sex-related differences appear to be tightly regulated by macrophage activity, its secretome, and/or migration. Collectively, we present, for the first time, a comprehensive assessment of peripherally diseased human tissue after a microbial insult and shed important insights into the regulation of the trigeminal system in female and male patients.
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Affiliation(s)
- Biraj Patel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Michael A. Eskander
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Phoebe Fang-Mei Chang
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Brett Chapa
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Shivani B. Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Zhao Lai
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
- Department of Molecular Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Yidong Chen
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
- Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Armen Akopian
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Nikita B. Ruparel
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
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18
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Zuo X, Li Y, Rong X, Yang X, Zhu Y, Pan D, Li H, Shen QY, Tang Y. Efficacy of transcutaneous auricular vagus nerve stimulation on radiotherapy-related neuropathic pain in patients with head and neck cancers (RELAX): protocol for a multicentre, randomised, double-blind, sham-controlled trial. BMJ Open 2023; 13:e072724. [PMID: 37730386 PMCID: PMC10514600 DOI: 10.1136/bmjopen-2023-072724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/20/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Radiotherapy-related neuropathic pain (RRNP) is one of the most distressing complications after radiotherapy for head and neck cancers. Drug therapy is not sufficiently effective and has limitations in terms of dose titration period and side effects. Transcutaneous auricular vagus nerve stimulation (taVNS), which stimulates the auricular branches of the vagus nerve through electrical impulses, has been proven to have analgesic effects in certain diseases. However, it is unknown whether taVNS can relieve RRNP. METHODS AND ANALYSIS This is a multicentre, randomised, double-blind, parallel, sham-controlled trial. We will include adult patients newly diagnosed with neuropathic pain after radiotherapy for head and neck cancers. One hundred and sixteen individuals will be recruited and randomly assigned in a 1:1 ratio to receive taVNS or sham stimulation. The interventions will last for 7 days, twice daily for 30 min each. The primary efficacy outcome is pain reduction on day 7. The secondary outcomes are changes in functional interference, psychological distress, fatigue, quality of life and serum inflammatory factors. The study may provide a new early intervention strategy for RRNP among patients with head and neck cancers. ETHICS AND DISSEMINATION This study has been approved by the Medical Research Ethics Committee of Sun Yat-sen University (SYSKY-2022-109-01) and will be conducted in strict accordance with the Declaration of Helsinki. Ethical approvals will be obtained separately for all centres involved in the study. Study results will be published in peer-reviewed academic journals. The database of the study will be available from the corresponding author on reasonable request. TRIAL REGISTRATION NUMBER NCT05543239.
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Affiliation(s)
- Xuzheng Zuo
- Department of Neurology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Yi Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Xinguang Yang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Yingying Zhu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Guangzhou, China
- Division of Clinical Research Design, Sun Yat-sen University, Guangzhou, China
| | - Dong Pan
- Department of Neurology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Honghong Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Qing-Yu Shen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Yamei Tang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Guangzhou, China
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19
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Yin M, Gu K, Cai H, Shu XO. Association between chronic pain and quality of life in long-term breast cancer survivors: a prospective analysis. Breast Cancer 2023; 30:785-795. [PMID: 37329439 DOI: 10.1007/s12282-023-01472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Pain is a leading cause of disability worldwide and is highly prevalent among breast cancer survivors. Pain and quality of life (QOL) are associated in breast cancer patients undergoing active treatment, but little is known about the relationship between the two in long-term survivors. METHODS We evaluated associations between pain information collected during a 5-year post-diagnosis follow-up survey and QOL assessed by the SF-36 during a 10-year post-diagnosis survey for 2828 participants in the Shanghai Breast Cancer Survival Study. RESULTS The mean overall QOL score was 78.7 for the entire study population and decreased as pain severity and frequency measured at the 5-year timepoint increased (none: 81.9, mild: 75.9, moderate/severe: 70.4, infrequent: 76.7, frequent: 72.3; P < 0.001). Significant inverse associations were found between pain and all QOL domains, including pain at 10-years post-diagnosis after multivariate adjustments. Concurrent pain was significantly and strongly associated with QOL. Most of the associations between 5-years post-diagnosis pain and QOL at 10-years post-diagnosis persisted after further adjustment for concurrent pain. CONCLUSIONS Pain is associated prospectively and concurrently with poor QOL among long-term breast cancer survivors. Programs to manage pain are needed to improve QOL among breast cancer survivors.
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Affiliation(s)
- Michelle Yin
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Vanderbilt University Institute of Medicine and Public Health, 2525 West End Avenue, Suite 600, Nashville, TN, 37203-1738, USA
| | - Kai Gu
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Vanderbilt University Institute of Medicine and Public Health, 2525 West End Avenue, Suite 600, Nashville, TN, 37203-1738, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Vanderbilt University Institute of Medicine and Public Health, 2525 West End Avenue, Suite 600, Nashville, TN, 37203-1738, USA.
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20
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Ibrahim T, Wu P, Wang LJ, Fang-Mei C, Murillo J, Merlo J, Shein SS, Tumanov AV, Lai Z, Weldon K, Chen Y, Ruparel S. Sex-dependent differences in the genomic profile of lingual sensory neurons in naïve and tongue-tumor bearing mice. Sci Rep 2023; 13:13117. [PMID: 37573456 PMCID: PMC10423281 DOI: 10.1038/s41598-023-40380-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023] Open
Abstract
Mechanisms of sex-dependent orofacial pain are widely understudied. A significant gap in knowledge exists about comprehensive regulation of tissue-specific trigeminal sensory neurons in diseased state of both sexes. Using RNA sequencing of FACS sorted retro-labeled sensory neurons innervating tongue tissue, we determined changes in transcriptomic profiles in males and female mice under naïve as well as tongue-tumor bearing conditions Our data revealed the following interesting findings: (1) FACS sorting obtained higher number of neurons from female trigeminal ganglia (TG) compared to males; (2) Naïve female neurons innervating the tongue expressed immune cell markers such as Csf1R, C1qa and others, that weren't expressed in males. This was validated by Immunohistochemistry. (3) Accordingly, immune cell markers such as Csf1 exclusively sensitized TRPV1 responses in female TG neurons. (4) Male neurons were more tightly regulated than female neurons upon tumor growth and very few differentially expressed genes (DEGs) overlapped between the sexes, (5) Male DEGs contained higher number of transcription factors whereas female DEGs contained higher number of enzymes, cytokines and chemokines. Collectively, this is the first study to characterize the effect of sex as well as of tongue-tumor on global gene expression, pathways and molecular function of tongue-innervating sensory neurons.
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Affiliation(s)
- Tarek Ibrahim
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Ping Wu
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Li-Ju Wang
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, San Antonio, USA
| | - Chang Fang-Mei
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Josue Murillo
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Jaclyn Merlo
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Sergey S Shein
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health San Antonio, San Antonio, USA
| | - Alexei V Tumanov
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health San Antonio, San Antonio, USA
| | - Zhao Lai
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Korri Weldon
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Yidong Chen
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, San Antonio, USA
| | - Shivani Ruparel
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
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21
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Gerhart J, Ramos K, Porter LS, Ravyts S, Malhotra S, Mossman B, Eaton England A, Alonzi S, Peyser T, Kim S, O'Mahony S, Burns JW, Hoerger M. Top Ten Tips Palliative Care Clinicians Should Know About Behavioral Pain Management for Persistent Pain. J Palliat Med 2023; 26:992-998. [PMID: 36706441 PMCID: PMC10398738 DOI: 10.1089/jpm.2022.0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/28/2023] Open
Abstract
Seriously ill patients often experience persistent pain. As a part of a comprehensive repertoire of pain interventions, palliative care clinicians can help by using behavioral pain management. Behavioral pain management refers to evidence-based psychosocial interventions to reduce pain intensity and enhance functional outcomes and quality of life. Conceptualized using the biopsychosocial model, techniques involve promoting helpful behaviors (e.g., activity pacing, stretching, and relaxation exercises) and modifying underlying patterns of thinking, feeling, and communicating that can exacerbate pain. The authors have expertise in pain management, clinical health psychology, geropsychology, behavioral science, and palliative medicine. The article reviews the current evidence for behavioral interventions for persistent pain and provides 10 recommendations for behavioral pain management.
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Affiliation(s)
- James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura S. Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Scott Ravyts
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonia Malhotra
- Department of Palliative and Supportive Medicine, University Medical Center, New Orleans, Louisiana, USA
| | - Brenna Mossman
- Department of Psychology and Tulane University, New Orleans, Louisiana, USA
| | - Ashley Eaton England
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Sarah Alonzi
- Department of Psychology, University of California—Los Angeles, Los Angeles, California, USA
| | - Tristen Peyser
- Department of Psychology and Tulane University, New Orleans, Louisiana, USA
| | - Seowoo Kim
- Department of Psychology and Tulane University, New Orleans, Louisiana, USA
| | - Sean O'Mahony
- Department of Internal Medicine and Rush University Medical Center, Chicago, Illinois, USA
| | - John W. Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Hoerger
- Department of Palliative and Supportive Medicine, University Medical Center, New Orleans, Louisiana, USA
- Department of Psychology and Tulane University, New Orleans, Louisiana, USA
- Department of Psychiatry and Medicine, Tulane University, New Orleans, Louisiana, USA
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22
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Ibrahim T, Wu P, Wang LJ, Fang-Mei C, Murillo J, Merlo J, Tumanov A, Lai Z, Weldon K, Chen Y, Ruparel S. Sex-dependent Differences in the Genomic Profile of Lingual Sensory Neurons in Naïve and Tongue-Tumor Bearing Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.14.524011. [PMID: 36711730 PMCID: PMC9882171 DOI: 10.1101/2023.01.14.524011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mechanisms of sex-dependent orofacial pain are widely understudied. A significant gap in knowledge exists about comprehensive regulation of tissue-specific trigeminal sensory neurons in diseased state of both sexes. Using RNA sequencing of FACS sorted retro-labeled sensory neurons innervating tongue tissue, we determined changes in transcriptomic profiles in males and female mice under naïve as well as tongue-tumor bearing conditions Our data revealed the following interesting findings: 1) Tongue tissue of female mice was innervated with higher number of trigeminal neurons compared to males; 2) Naïve female neurons innervating the tongue exclusively expressed immune cell markers such as Csf1R, C1qa and others, that weren't expressed in males. This was validated by Immunohistochemistry. 4) Accordingly, immune cell markers such as Csf1 exclusively sensitized TRPV1 responses in female TG neurons. 3) Male neurons were more tightly regulated than female neurons upon tumor growth and very few differentially expressed genes (DEGs) overlapped between the sexes, 5) Male DEGs contained higher number of transcription factors whereas female DEGs contained higher number of enzymes, cytokines and chemokines. Collectively, this is the first study to characterize the effect of sex as well as of tongue-tumor on global gene expression, pathways and molecular function of tongue-innervating sensory neurons.
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Affiliation(s)
- Tarek Ibrahim
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Ping Wu
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Li-Ju Wang
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, USA
| | - Chang Fang-Mei
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Josue Murillo
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Jaclyn Merlo
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Alexei Tumanov
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health San Antonio, USA
| | - Zhao Lai
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Korri Weldon
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Yidong Chen
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, USA
| | - Shivani Ruparel
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
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23
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Scheff NN, Nilsen ML, Li J, Harris AL, Acharya R, Swartz A, Hsieh RW, Anderson JL, Ferris RL, Menk AV, Delgoffe GM, Zandberg DP. The effect of opioids on the efficacy of immunotherapy in recurrent/metastatic squamous cell carcinoma of the head and neck. Oral Oncol 2023; 140:106363. [PMID: 36963232 PMCID: PMC10450941 DOI: 10.1016/j.oraloncology.2023.106363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES Head and neck squamous cell carcinoma (HNSCC) causes severe pain and opioids, the mainstay of pain management, may have immunomodulatory effects. We evaluated the effect of opioids on immunotherapy efficacy in recurrent/metastatic (R/M) HNSCC patients. MATERIALS AND METHODS In a retrospective study of 66 R/M HNSCC patients from 2015 to 2020, opioid dosage, calculated as mean morphine milligram equivalent per day, was assessed on the day of anti-PD-1 monoclonal antibody (mAb) treatment and most recent prior visit. Intratumoral T cells were evaluated by single cell RNAseq and immunohistochemistry prior to treatment. Univariable and multivariable Cox proportional hazards and logistic regression models were used to estimate the association between opioid usage, progression-free survival (PFS), overall survival (OS), disease control rate. RESULTS Patients were 79% male, 35% oropharynx, 35% oral cavity, 40% locoregional recurrence, and 56% platinum failure. Higher opioid dosage by continuous variable was significantly associated with lower PFS (p = 0.016) and OS (p < 0.001). In multivariable analysis, including platinum failure status and PD-L1, higher opioids were associated with lower OS. Opioid usage by categorical variable was associated with significantly lower intratumoral CD8+ T cells. Opioid receptor, OPRM1, expression was identified in intratumoral and circulating T cells. CONCLUSIONS In our study cohort of anti-PD-1 mAb treatment in R/M HNSCC patients, higher opioids were associated with significantly lower PFS and OS and lower CD8+ T cells in the tumor microenvironment. To our knowledge, this is the first analysis in R/M HNSCC patients and further research into the clinical and biologic effect of opioids is warranted.
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Affiliation(s)
- Nicole N Scheff
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States; Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Marci L Nilsen
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States; Department of Acute and Tertiary Care, University of Pittsburgh, School of Nursing, Pittsburgh, PA, United States; Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Jinhong Li
- Department of Biostatistics, University of Pittsburgh, School of Public Health, Pittsburgh, PA, United States
| | - Alexandria L Harris
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Rajesh Acharya
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Andrew Swartz
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Ronan W Hsieh
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Jennifer L Anderson
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Robert L Ferris
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States; Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Ashley V Menk
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Greg M Delgoffe
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States
| | - Dan P Zandberg
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh PA, United States.
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24
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Skarf LM, Jones KF, Meyerson JL, Abrahm JL. Pharmacologic Pain Management: What Radiation Oncologists Should Know. Semin Radiat Oncol 2023; 33:93-103. [PMID: 36990640 DOI: 10.1016/j.semradonc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Individuals with cancer experience a host of symptoms, especially when the malignancy is advanced. Pain occurs from the cancer itself or related treatments. Undertreated pain contributes to patient suffering and lack of engagement in cancer-directed therapies. Adequate pain management includes thorough assessment; treatment by radiotherapists or anesthesia pain specialists; anti-inflammatory medications, oral or intravenous opioid analgesics, and topical agents; and attention to the emotional and functional effects of pain, which may involve social workers, psychologists, speech therapists, nutritionists, physiatrists and palliative medicine providers. This review discusses typical pain syndromes arising in cancer patients undergoing radiotherapy and provides concrete recommendations for pain assessment and pharmacologic treatment.
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Affiliation(s)
- Lara Michal Skarf
- Section of Palliative Care, VA Boston Healthcare System, Harvard Medical School, Boston, MA.
| | - Katie Fitzgerald Jones
- Boston College William F. Connell School of Nursing and VA Boston Health Care System, Boston, MA
| | - Jordana L Meyerson
- Section of Palliative Care, VA Boston Healthcare System, Harvard Medical School, Boston, MA
| | - Janet L Abrahm
- Department of Psychosocial Oncology and Palliative Care, Division of Adult Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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25
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Yin M, Wang C, Gu K, Bao P, Shu XO. Chronic pain and its correlates among long-term breast cancer survivors. J Cancer Surviv 2023; 17:460-467. [PMID: 35963975 DOI: 10.1007/s11764-022-01241-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/22/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Chronic pain is a common symptom affecting quality of life for breast cancer survivors. However, its prevalence and correlate factors in long-term breast cancer survivors, particularly Asian women, are understudied. The reported study is to address these knowledge gaps. METHODS We evaluated pain severity and frequency, and their associations with clinical features and lifestyle factors among 3640 5-year breast cancer survivors who participated in the Shanghai Breast Cancer Survival Study. Demographic, clinical, and lifestyle information was collected at study enrollment, which occurred 6 months post-diagnosis, and pain was assessed at the 5-year post-diagnosis follow-up survey. RESULTS In total, 42% of participants reported experiencing pain. Pain is more prevalent among survivors with low educational attainment or low income. Multivariable polytomous regression analyses showed that pain was positively associated with metastasis or recurrence (moderate pain OR: 2.17, 95% CI: 1.45, 3.26, frequent pain OR: 1.92, 95% CI: 1.37, 2.70), triple negative status (infrequent pain OR: 1.36, 95% CI: 1.04, 1.78), obesity (frequent pain OR: 1.80, 95% CI: 1.41, 2.31), and multiple comorbidities. Exercise (OR: 0.65, 95%: 0.49, 0.88), chemotherapy (OR: 0.59, 95% CI: 0.41, 0.849), and HER2-positive and ER/PR-negative status (OR: 0.64, 95% CI: 0.43, 0.97) were inversely associated with moderate pain. CONCLUSIONS Chronic pain is highly prevalent among long-term breast cancer survivors in China and was associated with obesity, physical inactivity, and several clinical factors. IMPLICATIONS FOR CANCER SURVIVORS This study highlights the importance of promoting weight control and exercise to alleviate chronic pain.
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Affiliation(s)
- Michelle Yin
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cong Wang
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kai Gu
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Pingping Bao
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Epidemiology Center, Vanderbilt University Institute of Medicine and Public Health, 2525 West End Avenue, Suite 600, Nashville, TN, 37203-1738, USA.
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26
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Leonard JA, Hayden JA, Tripuraneni PS, Maxwell JH, Giurintano JP. Malnutrition universal screening tool predicts postoperative complications following major head and neck cancer surgery. Head Neck 2023; 45:604-611. [PMID: 36541597 DOI: 10.1002/hed.27273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/22/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Head and neck cancer patients are at risk for malnutrition, which can impact postoperative outcomes. This study evaluates the Malnutrition Universal Screening Tool (MUST) to predict outcomes in major head and neck surgeries. METHODS A retrospective chart review included 275 major surgical procedures performed on 242 patients over the age of 18 years between May 2015 and May 2020. RESULTS The majority of patients had a MUST score of zero (68.7%). Just under 17% scored 2 or greater indicating malnourishment. Having a MUST score of 2 or higher was associated with occurrence of a postoperative complication (p < 0.001). Patients with alcohol use disorder or depression were 5.2 (CI: 2.0-13.7, p = 0.001) and 2.75 (CI 1.1-7.0; p = 0.033) times more likely to develop a postoperative complication, respectively. CONCLUSIONS Malnutrition and comorbidities were associated with complications in our surgical cohort. MUST is a novel tool to identify patients who may benefit from nutritional interventions.
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Affiliation(s)
- James A Leonard
- Department of Otolaryngology - Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Jamil A Hayden
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | | | - Jessica H Maxwell
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Jonathan P Giurintano
- Department of Otolaryngology - Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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27
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Canick JE, Bhardwaj A, Patel A, Kuziez D, Larsen R, Misra S, Pearson B, Smith BD, Rohde RL, Adjei Boakye E, Kahmke RR, Osazuwa-Peters N. Sociodemographic Differences in Patient-Reported Pain and Pain Management of Patients With Head and Neck Cancer in a Community Oncology Setting. JCO Oncol Pract 2023; 19:e397-e406. [PMID: 36480772 PMCID: PMC10022872 DOI: 10.1200/op.22.00132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE While pain is prevalent among survivors of head and neck cancer (HNC), there is a lack of data on pain management in the community oncology setting. We described sociodemographic correlates and disparities associated with patient-reported pain among patients with HNC. METHODS We used the 2017-2021 nationwide community oncology data set from Navigating Cancer, which included electronic patient-reported outcomes. We identified a retrospective cohort of patients diagnosed with HNC (N = 25,572), with ≥ 1 patient-reported pain event. We adjusted for demographic (sex, age, smoking history, marital status) and clinical (cancer site) factors associated with pain reporting and pain resolution by new pain prescription on the basis of race (White v non-White patients), using multivariate logistic regression models. RESULTS Our analytic cohort included 2,331 patients, 90.58% White, 58.62% married, with an average age of 66.47 years. Of these, 857 patients (36.76%) reported ≥ 1 pain event during study period. Mean resolution time (in minutes) for pain incidents was significantly longer for White patients than non-White patients (99.6 ± 3.2 v 74.9 ± 7.2, P < .05). After adjusting for covariates, smoking was associated with a 25% increased odds of reporting pain incidents (adjusted odds ratio [aOR], 1.25; 95% CI, 1.03 to 1.52). There was no statistically significant difference in odds of pain reporting between White versus non-White patients (aOR, 0.97; 95% CI, 0.73 to 1.30). However, White patients were significantly more likely to receive new prescription for pain than non-White patients (aOR, 2.52; 95% CI, 1.09 to 5.86). CONCLUSION We found racial differences in patient-reported pain management, with White patients significantly more likely to receive new pain prescriptions. As pain management is a mainstay in cancer care, equity in pain management is critical to optimize quality of life for patients with HNC.
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Affiliation(s)
- Julia E. Canick
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC
| | | | | | - Duaa Kuziez
- Wake Forest School of Medicine, Department of Surgery, Winston-Salem, NC
| | | | | | | | - Blaine D. Smith
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC
| | - Rebecca L. Rohde
- Medical College of Wisconsin, Department of Otolaryngology & Communication Sciences, Milwaukee, WI
| | - Eric Adjei Boakye
- Henry Ford Health System, Department of Otolaryngology-Head & Neck Surgery, Detroit, MI
- Henry Ford Health System, Department of Population Health Sciences, Detroit, MI
| | - Russel R. Kahmke
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC
- Duke Cancer Institute, Durham, NC
| | - Nosayaba Osazuwa-Peters
- Duke University School of Medicine, Department of Head and Neck Surgery & Communication Sciences, Durham, NC
- Duke Cancer Institute, Durham, NC
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC
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28
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Duggar WN, Vengaloor Thomas T, Wang Y, Rahman A, Wang H, Roberts PR, Bian L, Gatewood RT, Vijayakumar S. Preoperative Prediction and Identification of Extracapsular Extension in Head and Neck Cancer Patients: Progress and Potential. Cureus 2023; 15:e34769. [PMID: 36909098 PMCID: PMC10001423 DOI: 10.7759/cureus.34769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Background This study aimed to demonstrate both the potential and development progress in the identification of extracapsular nodal extension in head and neck cancer patients prior to surgery. Methodology A deep learning model has been developed utilizing multilayer gradient mapping-guided explainable network architecture involving a volume extractor. In addition, the gradient-weighted class activation mapping approach has been appropriated to generate a heatmap of anatomic regions indicating why the algorithm predicted extension or not. Results The prediction model shows excellent performance on the testing dataset with high values of accuracy, the area under the curve, sensitivity, and specificity of 0.926, 0.945, 0.924, and 0.930, respectively. The heatmap results show potential usefulness for some select patients but indicate the need for further training as the results may be misleading for other patients. Conclusions This work demonstrates continued progress in the identification of extracapsular nodal extension in diagnostic computed tomography prior to surgery. Continued progress stands to see the obvious potential realized where not only can unnecessary multimodality therapy be avoided but necessary therapy can be guided on a patient-specific level with information that currently is not available until postoperative pathology is complete.
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Affiliation(s)
- William N Duggar
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | | - Yibin Wang
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Abdur Rahman
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Haifeng Wang
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Paul R Roberts
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Linkan Bian
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Ronald T Gatewood
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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29
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Shen WC, Hou MM, Huang TL, Wang CH, Huang YM, Chen JS, Chen ML. Transdermal buprenorphine improves overall quality of life and symptom severity in cancer patients with pain. J Clin Nurs 2023; 32:539-547. [PMID: 35362192 DOI: 10.1111/jocn.16303] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 01/17/2023]
Abstract
AIM AND OBJECTIVES This study explored the effect of transdermal buprenorphine on quality of life and six symptoms in cancer patients with pain. BACKGROUND Transdermal opioids offer advantages over traditional routes of administration. The impact of transdermal buprenorphine on quality of life for patients with cancer in Asian populations is unknown. DESIGN This study employed a single-arm observational repeated measures design. Cancer patients with pain were evaluated prior to treatment (baseline). Over a 4-week treatment period, quality of life and symptoms were assessed at 2 and 4 weeks. This study adhered to the recommendations of STROBE guidelines. METHODS This multi-site study was conducted in six hospitals located across northern, middle and southern Taiwan. Adult cancer patients whose pain was previously stable with opioid analgesics and, based on clinical judgement, were able to convert to transdermal buprenorphine treatment were invited to participate. Quality of life was measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30). RESULTS Generalised estimating equations showed participants who completed at least one follow-up measurement (N = 80) over 4-weeks had a significant improvement in overall quality of life. Functional status only improved for social functioning. However, symptom severity decreased significantly for nausea/vomiting, pain, insomnia and constipation. CONCLUSIONS The study provides initial evidence supporting transdermal buprenorphine for providing beneficial effects of improving quality of life and reducing severity of symptoms in Asian patients with cancer. RELEVANCE TO CLINICAL PRACTICE The findings of this study can inform the clinical practice that the use of transdermal buprenorphine in cancer patients with pain may also reduce the severity of other symptoms and improve overall quality of life. TRIAL REGISTRATION DETAILS This study was registered in ClinicalTrials.gov. Identifier: NCT04315831.
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Affiliation(s)
- Wen-Chi Shen
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Chang Gung University, Taoyuan, Taiwan
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Chang Gung University, Taoyuan, Taiwan
| | - Tai-Lin Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Hsu Wang
- Chang Gung University, Taoyuan, Taiwan.,Division of Hematology-Oncology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yen-Min Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Chang Gung University, Taoyuan, Taiwan
| | - Mei-Ling Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Chang Gung University, Taoyuan, Taiwan.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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Snijders RAH, Brom L, Theunissen M, van den Beuken-van Everdingen MHJ. Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2023; 15:591. [PMID: 36765547 PMCID: PMC9913127 DOI: 10.3390/cancers15030591] [Citation(s) in RCA: 74] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Experiencing pain and insufficient relief can be devastating and negatively affect a patient's quality of life. Developments in oncology such as new treatments and adjusted pain management guidelines may have influenced the prevalence of cancer pain and severity in patients. This review aims to provide an overview of the prevalence and severity of pain in cancer patients in the 2014-2021 literature period. A systematic literature search was performed using the databases PubMed, Embase, CINAHL, and Cochrane. Titles and abstracts were screened, and full texts were evaluated and assessed on methodological quality. A meta-analysis was performed on the pooled prevalence and severity rates. A meta-regression analysis was used to explore differences between treatment groups. We identified 10,637 studies, of which 444 studies were included. The overall prevalence of pain was 44.5%. Moderate to severe pain was experienced by 30.6% of the patients, a lower proportion compared to previous research. Pain experienced by cancer survivors was significantly lower compared to most treatment groups. Our results imply that both the prevalence of pain and pain severity declined in the past decade. Increased attention to the assessment and management of pain might have fostered the decline in the prevalence and severity of pain.
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Affiliation(s)
- Rolf A. H. Snijders
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research & Development, 3511 DT Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3511 DT Utrecht, The Netherlands
| | - Linda Brom
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research & Development, 3511 DT Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), 3511 DT Utrecht, The Netherlands
| | - Maurice Theunissen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Marieke H. J. van den Beuken-van Everdingen
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
- Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+ (MUMC+), 6229 HX Maastricht, The Netherlands
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Castellanos CX, Paoletti M, Ulloa R, Kim C, Fong M, Xepoleas M, Sinha U, Kokot N, Swanson MS. Opioid Sparing Multimodal Analgesia for Transoral Robotic Surgery: Improved Analgesia and Narcotic Use Reduction. OTO Open 2023; 7:e17. [PMID: 36998552 PMCID: PMC10046737 DOI: 10.1002/oto2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/23/2022] [Indexed: 03/15/2023] Open
Abstract
Objective To compare postoperative pain scores and opioid consumption in patients after transoral robotic surgery (TORS). Study Design Single institution retrospective cohort study. Setting TORS was performed at a single academic tertiary care center. Methods This study compared traditional opioid-based and opioid-sparing multimodal analgesia (MMA) regimens in patients with oropharyngeal and supraglottic malignancy after TORS. Data were obtained from the electronic health records from August 2016 to December 2021. The average postoperative pain scores and total opioid consumption in morphine milligram equivalents were calculated for postoperative days (PODs) 0 to 3. The secondary objectives were to quantify and characterize opioid prescriptions upon hospital discharge. Results A total of 114 patients were identified for this study, 58 patients in the non-MMA cohort and 56 in the MMA cohort. Postoperative pain levels in the MMA cohort were statistically lower on POD 0 (p = 0.001), POD 1 (p = 0.001), and POD 3 (p = 0.004). Postoperative opioid consumption decreased significantly in the MMA cohort from 37.7 to 10.8 mg on POD 0 (p = 0.002), 65.9 to 19.9 mg on POD 1 (p < 0.001), 36.0 to 19.3 mg on POD 2 (p = 0.02), and 45.4 to 13.8 mg on POD 3 (p = 0.02). The number of patients discharged from the hospital with a prescription for narcotics was significantly lower in the MMA cohort (71.4%) compared with the non-MMA cohort (98.3%) (p < 0.001). Conclusion Implementation of our MMA pain protocol reduced pain levels and narcotic consumption in the immediate postoperative period.
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Affiliation(s)
- Carlos X. Castellanos
- Caruso Department of Otolaryngology‐Head & Neck SurgeryKeck Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Marcus Paoletti
- Caruso Department of Otolaryngology‐Head & Neck SurgeryKeck Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Ruben Ulloa
- Caruso Department of Otolaryngology‐Head & Neck SurgeryKeck Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Celeste Kim
- Caruso Department of Otolaryngology‐Head & Neck SurgeryKeck Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Michelle Fong
- Caruso Department of Otolaryngology‐Head & Neck SurgeryKeck Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Meredith Xepoleas
- Caruso Department of Otolaryngology‐Head & Neck SurgeryKeck Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Uttam Sinha
- Caruso Department of Otolaryngology‐Head & Neck SurgeryKeck Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Niels Kokot
- Caruso Department of Otolaryngology‐Head & Neck SurgeryKeck Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mark S. Swanson
- Caruso Department of Otolaryngology‐Head & Neck SurgeryKeck Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
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Boden A, Lusque A, Lodin S, Bourgouin M, Mauries V, Moreau C, Fabre A, Mounier M, Poublanc M, Caunes-Hilary N, Filleron T. Study protocol of the TEC-ORL clinical trial: a randomized comparative phase II trial investigating the analgesic activity of capsaicin vs Laroxyl in head and neck Cancer survivors presenting with neuropathic pain sequelae. BMC Cancer 2022; 22:1260. [PMID: 36471253 PMCID: PMC9720988 DOI: 10.1186/s12885-022-10348-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/19/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Neuropathic pain is common in cancer survivorship and is one of the most distressing symptoms for patients previously treated for head and neck cancer. Persistent neuropathic pain, when it is ongoing and uncontrolled, has a detrimental effect and erodes patients' quality of life. Patients treated for head and neck cancer are chronic opioid users to manage their post-treatment pain, which may entail an increased risk of addiction and overdose. We propose to evaluate the analgesic activity of high-concentration capsaicin patches for the treatment of head and neck cancer survivors presenting with neuropathic pain sequelae. METHODS TEC-ORL is a parallel, multicenter randomized comparative phase II study evaluating whether Capsaïcin patches (Qutenza®) reduce neuropathic pain when compared to Amitriptyline (Laroxyl®) in head and neck cancer survivors presenting with neuropathic pain sequelae. The primary efficacy outcome is the rate of patients with a pain reduction of at least two points at 9 months compared to baseline. Assuming that 5% of patients become lost to follow-up, 130 patients will need to be randomized to detect a 25% improvement (i.e., standard: 25%, experimental: 50%) using a one-sided chi-square test with an alpha of 0.05%. According to the recommendations for comparative phase II trials, the target differences and type I error rates are relaxed. Randomized patients will either be treated with a capsaicin 8% (Qutenza®) patch applied at three time intervals in the experimental arm or with Amitriptyline (Laroxyl®) (oral solution 40 mg/ml) taken for 9 months at the recommended daily dose of 25 mg to 75 mg in the control arm. DISCUSSION TEC-ORL is a randomized comparative phase II trial designed to comprehensively evaluate the analgesic activity of capsaicin compared to Laroxyl in Head and Neck Cancer survivors presenting with neuropathic pain sequelae. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04704453 Date of registration: 2021/01/13.
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Affiliation(s)
- Antoine Boden
- Support Care Department, Institut Claudius Regaud IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Amélie Lusque
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Sabrina Lodin
- Clinical Trials Office, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Marie Bourgouin
- Support Care Department, Institut Claudius Regaud IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Valérie Mauries
- Support Care Department, Institut Claudius Regaud IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Christelle Moreau
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Amandine Fabre
- Clinical Trials Office, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Muriel Mounier
- Clinical Trials Office, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Muriel Poublanc
- Clinical Trials Office, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
| | - Nathalie Caunes-Hilary
- Support Care Department, Institut Claudius Regaud IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse Cedex, France
| | - Thomas Filleron
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud, IUCT-Oncopole, 1 avenue Irène Joliot Curie, 31059 Toulouse, France
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Massa ST, Chidambaram S, Luong P, Graboyes EM, Mazul AL. Quantifying Total and Out-of-Pocket Costs Associated With Head and Neck Cancer Survivorship. JAMA Otolaryngol Head Neck Surg 2022; 148:1111-1119. [PMID: 36264567 PMCID: PMC9585466 DOI: 10.1001/jamaoto.2022.3269] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/28/2022] [Indexed: 01/10/2023]
Abstract
Importance Oncologic treatment is costly to the health care system and to individuals, but patients with head and neck cancer (HNC) also have long-term care needs after treatment. Survivors of HNC require specific consideration given their rapidly growing numbers. This subpopulation of cancer survivors often experiences long-term treatment-associated morbidity. Objective To describe the total and out-of-pocket (OOP) costs associated with HNC survivorship and the risk factors for financial toxicity among this population. Design, Setting, and Participants This was a retrospective review and economic evaluation of a cohort of US adults with a diagnosis of HNC from 2006 to 2018. The study used data the from IBM MarketScan Commercial Claims Database. Data were analyzed from November 2020 to June 2022. Exposures Treatment for HNC. Main Outcomes and Measures Total and OOP medical costs were assessed monthly and reported relative to the date of HNC diagnosis. The primary outcome was the difference between a patient's mean monthly survivorship costs (13-60 months after diagnosis) and mean monthly baseline costs (7-12 months before diagnosis). Univariate and multivariable linear regression models were created for total and OOP costs to generate coefficient estimates with 95% CIs. Results The study cohort of this economic evaluation included 19 098 patients with HNC (median [range] age, 56 [18-64] years; 14 144 [74.1%] men and 4954 [25.9%] women; race and ethnicity were not considered). Throughout the survivorship period, median total and OOP costs were $372 per month and $31 per month higher than baseline costs, respectively, with variation in expenses by demographic information, health plan type, and oncologic variables. In the multivariable model, greater total and OOP excess survivorship costs were associated with female sex ($343/mo; 95% CI, $126 to $560 and $9/mo; 95% CI, $4 to $14). Highest and lowest total excess survivorship costs associated with cancer site were seen for hypopharyngeal ($1908/mo; 95% CI, $1102 to $2714) and oropharyngeal cancers (-$703/mo; 95% CI, -$967 to -$439) vs oral cavity cancers. Compared with surgery or radiation therapy alone, multimodal treatment was generally associated with excess OOP survivorship costs. Conclusions and Relevance The findings of this retrospective economic evaluation review suggest that the costs of HNC survivorship remain persistently elevated above baseline costs for at least 5 years after diagnosis. High survivorship costs were associated with female sex, hypopharyngeal tumors, and treatment with multimodal therapy. Practitioners should seek to minimize costs for these patients at higher-risk of financial toxicity after treatment and work to provide directed supportive services.
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Affiliation(s)
- Sean T. Massa
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
| | - Smrithi Chidambaram
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
- Department of Otolaryngology−Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Peter Luong
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
| | - Evan M. Graboyes
- Department of Otolaryngology−Head and Neck Surgery, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Angela L. Mazul
- Department of Otolaryngology−Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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Verdonck-de Leeuw I, Dawson C, Licitra L, Eriksen JG, Hosal S, Singer S, Laverty DP, Golusinski W, Machczynski P, Varges Gomes A, Girvalaki C, Simon C, Leemans CR. European Head and Neck Society recommendations for head and neck cancer survivorship care. Oral Oncol 2022; 133:106047. [PMID: 35932637 DOI: 10.1016/j.oraloncology.2022.106047] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Survivors of head and neck cancer can experience long-term consequences of the cancer and subsequent treatments even after the cancer has resolved. Increasingly clinicians are aware of the social, psychological, financial, and emotional impacts of these cancers, in addition to the support required for the physical symptoms. This review provides recommendations on the long-term management and support required for survivors of head and neck cancer in the European healthcare setting.
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Affiliation(s)
- Irma Verdonck-de Leeuw
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department Otolaryngology-Head and Neck Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department Clinical, Neuro and Developmental Psychology, Van der Boechorststraat 7-9, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands.
| | - Camilla Dawson
- Speech and Language Therapist-Dysphagia and Altered Airways University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Lisa Licitra
- Head and Neck Cancer Medical Oncology Unit and Head & Neck Research Program at the Istituto Nazionale Tumori in Milan, Italy.
| | - Jesper Grau Eriksen
- Experimental Clinical Oncology, Aarhus University Hospital, Entrance C, Level 1, C108, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark.
| | - Sefik Hosal
- Department of Otolaryngology-Head & Neck Surgery, Atılım University Faculty of Medicine, Ankara, Turkey.
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Hospital of Johannes Gutenberg University Mainz, Germany.
| | - Dominic P Laverty
- Restorative Dentistry, Birmingham Dental Hospital, 5 Mill Pool Way, Birmingham B5 7EG, UK.
| | - Wojciech Golusinski
- Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznan, Poland.
| | - Piotr Machczynski
- Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznan, Poland.
| | - Ana Varges Gomes
- Centro Hospitalar e Universitario do Algarve, Chair of Administration Council, MD Medical Oncologist, Portugal.
| | - Charis Girvalaki
- European Cancer Patient Coalition, Avenue des Arts 6, 1210 Brussels, Belgium.
| | - Christian Simon
- Chef-de-service, Service d'Oto-rhino-laryngologie et chirurgie cervico-faciale CHUV, UNIL, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - C René Leemans
- Department of Otolaryngology - Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC - Vumc, P.O. Box 7057, 1007MB Amsterdam, the Netherlands.
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35
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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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36
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Oral pain in the cancer patient. Curr Opin Support Palliat Care 2022; 16:174-179. [DOI: 10.1097/spc.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Riggauer J, Blaser D, Elicin O, Gahl B, Giger R, Mueller SA. Risk Factors for Fear of Recurrence in Head and Neck Cancer Patients. Laryngoscope 2022. [DOI: 10.1002/lary.30340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 07/06/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Julia Riggauer
- Inselspital Head and Neck Anticancer Center Bern University Hospital Bern Switzerland
- Department of ENT, Head and Neck Surgery, Inselspital Bern University Hospital, University of Bern Bern Switzerland
| | - Daniela Blaser
- Inselspital Head and Neck Anticancer Center Bern University Hospital Bern Switzerland
- Department of ENT, Head and Neck Surgery, Inselspital Bern University Hospital, University of Bern Bern Switzerland
| | - Olgun Elicin
- Inselspital Head and Neck Anticancer Center Bern University Hospital Bern Switzerland
- Department of Radiation Oncology, Inselspital Bern University Hospital Bern Switzerland
| | - Brigitta Gahl
- Clinical Trials Unit University of Bern Bern Switzerland
| | - Roland Giger
- Inselspital Head and Neck Anticancer Center Bern University Hospital Bern Switzerland
- Department of ENT, Head and Neck Surgery, Inselspital Bern University Hospital, University of Bern Bern Switzerland
| | - Simon Andreas Mueller
- Inselspital Head and Neck Anticancer Center Bern University Hospital Bern Switzerland
- Department of ENT, Head and Neck Surgery, Inselspital Bern University Hospital, University of Bern Bern Switzerland
- Department of Otolaryngology, Head & Neck Surgery University Hospital Zurich, University of Zurich Zurich Switzerland
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Gascon B, Panjwani AA, Mazzurco O, Li M. Screening for Distress and Health Outcomes in Head and Neck Cancer. Curr Oncol 2022; 29:3793-3806. [PMID: 35735413 PMCID: PMC9221700 DOI: 10.3390/curroncol29060304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/21/2022] Open
Abstract
Head and neck cancers (HNC) have higher rates of emotional distress than other cancer types and the general population. This paper compares the prevalence of emotional distress in HNC across various distress screening measures and examines whether significant distress or distress screening are associated with cancer-related survival. A retrospective observational cohort design was employed, with data collected from the Distress Assessment and Response Tool (DART) and linkages to administrative databases from 2010 to 2016. Descriptive and prevalence data were reported using multiple concurrently administered distress tools, including the Patient Health Questionaire-9 (PHQ-9), Generalized Anxiety Disorders-7 (GAD-7), Edmonton Symptom Assessment Scale-revised (ESAS-r), and MD Anderson Symptom Index-Head and Neck module (MDASI-HN). Across measures, 7.8 to 28.1% of the sample reported clinically significant emotional distress, with PHQ-9 and GAD-7 identifying lowest prevalence of moderate/severe distress, and the ultrashort distress screens within ESAS-r and MDASI-HN performing equivalently. Cox hazards models were used in univariate and multivariate survival analyses. ESAS depression (≥4), but not anxiety, was associated with increased risk of cancer-related mortality and patient completion of DART was associated with greater cancer-related survival. The findings underscore the importance of implementing routine distress screening for HNC populations and the utility of ultra-brief screening measures.
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Affiliation(s)
- Bryan Gascon
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (A.A.P.); (O.M.)
| | - Aliza A. Panjwani
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (A.A.P.); (O.M.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Olivia Mazzurco
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (A.A.P.); (O.M.)
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Madeline Li
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada; (A.A.P.); (O.M.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence: ; Tel.: +1-416-946-4501 (ext. 7505); Fax: +1-416-946-2047
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DeGuzman PB, Vogel DL, Bernacchi V, Scudder MA, Jameson MJ. Self-reliance, Social Norms, and Self-stigma as Barriers to Psychosocial Help-Seeking Among Rural Cancer Survivors With Cancer-Related Distress: Qualitative Interview Study. JMIR Form Res 2022; 6:e33262. [PMID: 35588367 PMCID: PMC9164097 DOI: 10.2196/33262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/04/2022] [Accepted: 03/28/2022] [Indexed: 01/19/2023] Open
Abstract
Background Even when technology allows rural cancer survivors to connect with supportive care providers from a distance, uptake of psychosocial referrals is low. Fewer than one-third of participants in a telemedicine intervention for identifying rural survivors with high distress and connecting them with care accepted psychosocial referral. Objective The purpose of this research was to examine the reasons for which rural cancer survivors did not accept a psychosocial referral. Methods We utilized a qualitative design to address the research purpose. We interviewed participants who had been offered psychosocial referral. Semistructured interviews were conducted 6 weeks later (n=14), and structured interviews were conducted 9 months later (n=6). Data were analyzed descriptively using an inductive approach. Results Ultimately, none of the rural cancer survivors (0/14, 0%) engaged with a psychosocial care provider, including those who had originally accepted referrals (0/4, 0%) for further psychosocial care. When explaining their decisions, survivors minimized their distress, emphasizing their self-reliance and the need to handle distress on their own. They expressed a preference for dealing with distress via informal support networks, which was often limited to close family members. No survivors endorsed public stigma as a barrier to accepting psychosocial help, but several suggested that self-stigma associated with not being able to handle their own distress was a reason for not seeking care. Conclusions Rural cancer survivors’ willingness to accept a psychosocial referral may be mediated by the rural cultural norm of self-reliance and by self-stigma. Interventions to address referral uptake may benefit from further illumination of these relationships as well as a strength-based approach that emphasizes positive aspects of the rural community and individual self-affirmation.
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Affiliation(s)
| | - David L Vogel
- Department of Pyschology, Iowa State University, Ames, IA, United States
| | - Veronica Bernacchi
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Margaret A Scudder
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Mark J Jameson
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Virginia, Charlottesville, VA, United States
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Lenze NR, Bensen JT, Yarbrough WG, Shuman AG. Characteristics and outcomes associated with anxiety and depression in a head and neck cancer survivorship cohort. Am J Otolaryngol 2022; 43:103442. [PMID: 35405498 DOI: 10.1016/j.amjoto.2022.103442] [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: 03/03/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the prevalence and predictors of mental health disorders (MDHs) among head and neck squamous cell carcinoma (HNSCC) survivors, and the association with health-related quality of life (HRQOL), pain, and survival outcomes. MATERIALS AND METHODS This was a retrospective, cross-sectional study of HNSCC survivors surveyed at an outpatient oncology clinic from May 2012 through July 2016. RESULTS Among 198 HNSCC survivors, 21% reported a MHD. Female sex (OR 6.60, 95% CI 2.08 to 20.98; p = 0.001) and Medicare insurance status (OR 4.95, 95% CI 1.52 to 16.11; p = 0.008) were significant predictors of reporting a MHD in the fully adjusted model. Patients reporting a MHD reported significantly worse pain (p < 0001) and worse HRQOL on the PROMIS Physical (p < 0.001), PROMIS Mental (p < 0.001), and FACT-GP (p < 0.026) questionnaires. Diagnosis of a MHD was not correlated with 5-year OS (74% vs. 84%; p = 0.087). CONCLUSION Initiatives for early identification and intervention of MHDs as part of survivorship initiatives may engender clinically meaningful outcomes in head and neck cancer.
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Affiliation(s)
- Nicholas R Lenze
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, MI, United States.
| | - Jeannette T Bensen
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Wendell G Yarbrough
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Andrew G Shuman
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, MI, United States
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Riechelmann H, Dejaco D, Steinbichler TB, Lettenbichler-Haug A, Anegg M, Ganswindt U, Gamerith G, Riedl D. Functional Outcomes in Head and Neck Cancer Patients. Cancers (Basel) 2022; 14:cancers14092135. [PMID: 35565265 PMCID: PMC9099625 DOI: 10.3390/cancers14092135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary With increasing long-term survivorship of head and neck cancer (HNC), the functional outcomes are gaining importance. Recently, a tool for the rapid clinical assessment of the functional status in HNC-patients based on observable clinical criteria, termed “HNC-Functional InTegrity (FIT) Scales, was validated. Here, the functional outcomes of 681 newly diagnosed HNC-patients were reported using the HNC-FIT Scales. A normal/near-normal outcome in all six functional domains was observed in 61% of patients, with individual scores of 79% for food intake, 89% for breathing, 84% for speech, 89% for pain, 92% for mood, and 88% for neck and shoulder mobility. Clinically relevant impairment in at least one functional domain was observed in 30% of patients, and 9% had loss of function in at least one functional domain. Thus, clinically relevant persistent functional deficits in at least one functional domain must be expected in 40% of HNC-patients. The treatment of these functional deficits is an essential task of oncologic follow-up. Abstract With the increase in long-term survivorship of head and neck cancer (HNC), the functional outcomes are gaining importance. We reported the functional outcomes of HNC patients using the HNC-Functional InTegrity (FIT) Scales, which is a validated tool for the rapid clinical assessment of functional status based on observable clinical criteria. Patients with newly diagnosed HNC treated at the Medical University of Innsbruck between 2008 and 2020 were consecutively included, and their status in the six functional domains of food-intake, breathing, speech, pain, mood, and neck and shoulder mobility was scored by the treating physician at oncological follow-up visits on a scale from 0 (loss of function) to 4 (full function). HNC-FIT scales were available for 681 HNC patients at a median of 35 months after diagnosis. The response status was complete remission in 79.5%, 18.1% had recurrent or persistent disease, and 2.4% had a second primary HNC. Normal or near-normal scores (3 and 4) were seen in 78.6% for food intake, 88.7% for breathing, 83.7% for speech, 89% for pain, 91.8% for mood, and 87.5% for neck and shoulder mobility. A normal or near-normal outcome in all six functional domains was observed in 61% of patients. Clinically relevant impairment (score 1–2) in at least one functional domain was observed in 30%, and 9% had loss of function (score 0) in at least one functional domain. The main factors associated with poor functional outcome in a multivariable analysis were recurrence or persistent disease, poor general health (ASA III and IV), and higher T stage. Particularly, laryngeal and hypopharyngeal tumors impaired breathing and speech function, and primary radiation therapy or concomitant systemic therapy and radiotherapy worsened food intake. Clinically relevant persistent functional deficits in at least one functional domain must be expected in 40% of the patients with HNC. The treatment of these functional deficits is an essential task of oncologic follow-up.
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Affiliation(s)
- Herbert Riechelmann
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Daniel Dejaco
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
- Correspondence: ; Tel.: +43-512-504-23142
| | - Teresa Bernadette Steinbichler
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Anna Lettenbichler-Haug
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Maria Anegg
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Ute Ganswindt
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Gabriele Gamerith
- Internal Medicine V, Department of Hematology & Oncology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - David Riedl
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
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Persson K, Sjövall J, Kander T, Walther-Sturesson L. Pain management with popliteal block for fibular graft harvesting in head and neck reconstruction; a randomised double-blind placebo-controlled study. Oral Oncol 2022; 128:105833. [PMID: 35421821 DOI: 10.1016/j.oraloncology.2022.105833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Curative treatment for locally advanced head and neck tumours often includes reconstructive surgery using a microvascular free flap. Effective recuperation is essential but may be impeded by postoperative donor site pain. The aim of this study was to evaluate the effects of a continuous popliteal block on postoperative pain after fibular graft harvesting. MATERIAL AND METHODS In this randomized double-blind placebo-controlled study adult patients scheduled for reconstructive head and neck surgery with a microvascular free fibular graft received an indwelling popliteal nerve block catheter and were randomized to receive continuous levobupivacaine/ropivacaine or placebo during the first postoperative week. Primary outcome was postoperative extremity pain assessed using the numerated rating scale (NRS). Secondary outcomes included opioid consumption. RESULTS In total 24 patients were included. The median (median, IQR [range]) postoperative extremity NRS scores was lower in the local anaesthetic (LA) group (2, 0-3 [0-10]) compared to the placebo group (2, 1-4 [0-10]), p = 0.008. The LA group also experienced fewer episodes of breakthrough pain, defined as NRS ≥ 4 (17% vs 33% of observations), p = 0.009. Furthermore, median (median, IQR [range]) opioid consumption the first postoperative week was lower in the LA group (109 mg, 74-134 [19-611]) compared to the placebo group (202 mg, 135-241 [78-749]), p = 0.010. No complications attributed to the blocks were observed. CONCLUSION Continuous popliteal block significantly reduced postoperative extremity pain and opioid consumption in patients undergoing fibular graft harvesting for head and neck reconstructive surgery.
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Affiliation(s)
- Karolina Persson
- Department of Intensive and Perioperative Care, Skåne University Hospital, Entrégatan 7, 222 42 Lund, Sweden; Department of Clinical Sciences, Lund University, Box 117, 221 00 Lund, Sweden.
| | - Johanna Sjövall
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Entrégatan 7, 222 42 Lund, Sweden; Department of Clinical Sciences, Lund University, Box 117, 221 00 Lund, Sweden.
| | - Thomas Kander
- Department of Intensive and Perioperative Care, Skåne University Hospital, Entrégatan 7, 222 42 Lund, Sweden; Department of Clinical Sciences, Lund University, Box 117, 221 00 Lund, Sweden.
| | - Louise Walther-Sturesson
- Department of Intensive and Perioperative Care, Skåne University Hospital, Entrégatan 7, 222 42 Lund, Sweden; Department of Clinical Sciences, Lund University, Box 117, 221 00 Lund, Sweden.
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Bates N, Bello JK, Osazuwa-Peters N, Sullivan MD, Scherrer JF. Depression and Long-Term Prescription Opioid Use and Opioid Use Disorder: Implications for Pain Management in Cancer. Curr Treat Options Oncol 2022; 23:348-358. [PMID: 35254595 PMCID: PMC8899439 DOI: 10.1007/s11864-022-00954-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 01/22/2023]
Abstract
OPINION STATEMENT Preventing depression in cancer patients on long-term opioid therapy should begin with depression screening before opioid initiation and repeated screening during treatment. In weighing the high morbidity of depression and opioid use disorder in patients with chronic cancer pain against a dearth of evidence-based therapies studied in this population, patients and clinicians are left to choose among imperfect but necessary treatment options. When possible, we advise engaging psychiatric and pain/palliative specialists through collaborative care models and recommending mindfulness and psychotherapy to all patients with significant depression alongside cancer pain. Medications for depression should be reserved for moderate to severe symptoms. We recommend escitalopram/citalopram or sertraline among selective serotonin reuptake inhibitors (SSRIs), or the serotonin and norepinephrine reuptake inhibitors (SNRIs) duloxetine, venlafaxine, or desvenlafaxine if patients have a significant component of neuropathic pain or fibromyalgia. Tricyclic antidepressants (TCAs) (consider nortriptyline or desipramine, which have better anticholinergic profiles) should be considered for patients who do not respond to or tolerate SSRI/SNRIs. Existing evidence is inadequate to definitively recommend methylphenidate or novel agents, such as ketamine or psilocybin, as adjunctive treatments for cancer-related depression and pain. Physicians who treat patients with cancer pain should utilize universal precautions to limit the risk of non-medical opioid use (non-medical opioid use). Patients should be screened for non-medical opioid use behaviors at initial consultation and at regular intervals during treatment using a non-judgmental approach that reduces stigma. Co-management with an addiction specialist may be indicated for patients at high risk of non-medical opioid use and opioid use disorder. Buprenorphine and methadone are indicated for the treatment of opioid use disorder, and while they have not been systematically studied for treatment of opioid use disorder in patients with cancer pain, they do provide analgesia for cancer pain. While an interdisciplinary team approach to manage psychological stress may be beneficial, this may not be possible for patients treated outside of comprehensive cancer centers.
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Affiliation(s)
- Nicole Bates
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA. .,Department of Psychosocial Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave E, MS K2-231, PO Box 19023, Seattle, WA, 98109-1023, USA.
| | - Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, St. Louis, MO, 63110, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, 27710-4000, USA.,Duke Cancer Institute, Durham, NC, 27710, USA
| | - Mark D Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, St. Louis, MO, 63110, USA.,The Advanced HEAlth Data (AHEAD) Research Institute at Saint Louis University, Saint Louis University School of Medicine, 3545 Lafayette Ave., St. Louis, MO, 63104, USA
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Cancer Survivors’ Disability Experiences and Identities: A Qualitative Exploration to Advance the Cancer Equity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053112. [PMID: 35270802 PMCID: PMC8910238 DOI: 10.3390/ijerph19053112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/10/2022]
Abstract
Eliminating cancer-related disparities is a global public health priority. Approximately 40% of cancer survivors experience long-term effects of cancer which can lead to activity limitations and participation restrictions; yet discussions of disability are largely absent from clinical and research cancer health equity agendas. The purpose of this study was to explore how cancer survivors experience and make sense of the long-term disabling effects of cancer and its treatments. In this qualitative study, data were collected via in-depth semi-structured interviews with survivors of breast cancer, head and neck cancer, and sarcoma (n = 30). Data were analyzed thematically using a 2-phase iterative process proceeding from descriptive to conceptual coding. Survivors experienced a wide range of long-term physical, sensory, cognitive, and emotional effects, that intertwined to restrict their participation in self-care, work, leisure, and social roles. While the interaction between impairments and participation restrictions meets the definition of disability; participants articulated a range of responses when asked about their disability identity, including (1) rejecting, (2) othering, (3) acknowledging, and (4) affirming. Findings may be indicative of structural and internalized ableism which can impede cancer care and survivorship. To support cancer survivors’ transition to post-treatment life, cancer care providers should implement anti-ableist practices and engage in frank discussions about cancer’s long-term impacts.
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McDowell L, Rischin D, Gough K, Henson C. Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer. Front Oncol 2022; 12:834068. [PMID: 35242716 PMCID: PMC8885992 DOI: 10.3389/fonc.2022.834068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the most common cancer involving the mucosal surfaces of the head and neck and is associated with a number of etiological factors, including cigarette smoking, alcohol and betel nut consumption and exposure to high-risk human papillomavirus. The risk of HNSCC increases with age, peaking in the seventh and eighth decade, but this varies by anatomical and histological subtype. While several advancements have been made in the treatment of head and neck cancer (HNC) in recent decades, undertaking curative treatment still subjects the majority of HNSCC patients to substantial treatment-related toxicity requiring patients to tolerate a gamut of physical, psychological, and emotional demands on their reserves. In conjunction with other patient-related factors, clinicians involved in treating patients with HNSCC may incorporate advancing chronological age into their decision-making process when determining treatment recommendations. While advancing chronological age may be associated with increased concerns regarding physical treatment tolerability, clinicians may also be concerned about heightened vulnerability in various health and wellbeing outcomes. The available literature, however, does not provide evidence of this vulnerability in patients with advancing age, and, in many instances, older patients self-report greater resilience compared to their younger counterparts. While this data is reassuring it is limited by selection bias and heterogeneity in trial and study design and the absence of a consistent definition of the elderly patient with HNSCC. This narrative review article also includes a review of the measures used to assess HRQL, psychosocial outcomes and unmet needs in elderly or older patients with HNSCC.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
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Salz T, Mishra A, Gennarelli RL, Lipitz-Snyderman A, Moryl N, Tringale KR, Boudreau DM, Kriplani A, Jinna S, Korenstein D. Safety of opioid prescribing among older cancer survivors. Cancer 2022; 128:570-578. [PMID: 34633662 PMCID: PMC9377378 DOI: 10.1002/cncr.33963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cancer survivors receive more long-term opioid therapy (LTOT) than people without cancer, but the safety of LTOT prescribing is unknown. METHODS Opioid-naive adults aged ≥66 years who had been diagnosed in 2008-2015 with breast, lung, head and neck, or colorectal cancer were identified with data from Surveillance, Epidemiology, and End Results cancer registries linked with Medicare claims. Survivors with 1 or more LTOT episodes (≥90 consecutive days) occurring ≥1 year after their cancer diagnosis and before censoring at hospice entry, another cancer diagnosis, 6 months before death, or December 2016 were included. The safety of prescribing during the first 90 days of the first LTOT episode was measured during follow-up. As a positive safety indicator, the proportion of survivors with concurrent nonopioid pain management was measured. Indicators of less safe prescribing were the proportion of survivors with a high average daily opioid dose (≥90 morphine milligram equivalents) and the proportion of survivors with concurrent benzodiazepine dispensing. Multivariable logistic regression analyses were conducted to identify clinical predictors of each safety outcome. RESULTS In all, 3628 cancer survivors received LTOT during follow-up (median duration, 4.9 months; interquartile range, 3.5-8.0 months). Seventy-two percent of the survivors received multimodal pain management concurrently with LTOT. Eight percent of the survivors had high-dose opioid prescriptions; 25% of the survivors received benzodiazepines during LTOT. Multivariable analyses identified variations in safety measures by multiple clinical factors, although none were consistently significant across outcomes. CONCLUSIONS To improve safe LTOT prescribing for survivors, efforts should focus on increasing multimodal pain management and reducing inappropriate benzodiazepine prescribing. Different clinical predictors of each outcome suggest different drivers of safe prescribing.
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Affiliation(s)
- Talya Salz
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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Chou YH, Yeh ML, Huang TS, Hsu H. Acupoint stimulation improves pain and quality of life in head and neck cancer patients with chemoradiotherapy: A randomized controlled trial. Asia Pac J Oncol Nurs 2022; 9:61-68. [PMID: 35528798 PMCID: PMC9072178 DOI: 10.1016/j.apjon.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to evaluate the effect of acupoint stimulation on pain, negative moods, and quality of life for head and neck cancer (HNC) patients who underwent concurrent chemoradiotherapy (CCRT). Methods This randomized controlled trial recruited participants from a medical center and randomly assigned using a permuted block randomization list with computer-generated random serial numbers into the AcuCare group (n = 46) receiving acupoint stimulation with transcutaneous acupoint electrical stimulation (TAES) and auricular acupressure (AA) or the control group (n = 46) without any acupoint stimulation. Outcomes were repeatedly assessed pain intensity using the visual analogue scale, negative moods using the hospital anxiety and depression scale, and quality of life (QoL) using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35. Results After adjusting varying mucositis grades and time-dependent growth effects, the generalized estimating equations showed a significantly increase in pain intensity at weeks 1, 2, 3, and 6 (P < 0.05), but not in negative moods (P > 0.05), compared to baseline and control group. Analysis of covariance showed a significant group-difference in the senses problems of QoL (F = 7.33, P = 0.01) at Week 6. Conclusions This study supports that acupoint stimulation could effectively reduce pain and improve senses problem of QoL for patients with HNC. Trial registration This study was registered at https://clinicaltrials.gov/NCT03640195.
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Affiliation(s)
- Ya-Hui Chou
- Department of Nursing, Taoyuan Chang Gung Memorial Hospital; School of Nursing, National Taipei University of Nursing and Health Sciences, Taoyuan, Taiwan
| | - Mei-Ling Yeh
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Tzu-Shin Huang
- Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hedi Hsu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Ren JL, Rojo RD, Perez JVD, Yeung SCJ, Hanna EY, Reyes-Gibby CC. Variations in pain prevalence, severity, and analgesic use by duration of survivorship: a cross-sectional study of 505 post-treatment head and neck cancer survivors. BMC Cancer 2021; 21:1304. [PMID: 34872526 PMCID: PMC8650364 DOI: 10.1186/s12885-021-09024-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/10/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Studies suggest a high prevalence of pain in head and neck cancer (HNC) patients at diagnosis, during and after treatment; however, these studies had small sample sizes and did not comprehensively assess factors known to influence pain. We surveyed a large cohort of HNC survivors to determine variations in the prevalence of pain, its treatment and management by duration of survivorship, and assessed a comprehensive list of risk factors. METHODS A cross sectional survey of post-treatment survivors of HNC during routine follow-up clinic visits. RESULTS A total of 505 HNC survivors with a median follow up of 3 years from cancer diagnosis were included in the study. Overall, 45% (n = 224) reported pain and 14.5, 22 and 7% reported use of prescribed pain medication, over-the-counter pain medication and alternative pain therapies, respectively. Prevalence of severe pain was 7.3% and did not vary significantly by years of survivorship (< 1 year = 5.7%; 1 to < 3 years = 7.1%; 3 to < 8 years = 7.6%; 8 years or more =9.7%; P = 0.392). However, use of prescribed pain medication significantly varied by years of survivorship (< 1 year = 45.7%; 1 to < 3 years = 24.6%; 3 to < 8 years = 18.9; 8 years or more = 18.3%; p < 0.001). Of note, a significant proportion of survivors reported moderate to severe pain (moderate to severe = 55.7% versus none to mild = 44.3%) despite step 3 analgesic use (p < 0.001). Multivariable regression shows that recurrent disease (OR 6.77, 95% CI [1.44, 31.80]), history of chemotherapy (OR 6.00, 95% CI [2.10, 17.14]), and depression (Mild-moderate OR 5.30, 95% CI [2.20, 12.78]; Major OR 8.00, 95% CI [2.67, 23.96]) were significant risk factors for severe pain. CONCLUSIONS We identified a high prevalence of pain among HNC survivors and determined that analgesic use varied by the duration of survivorship. Therefore, routine surveillance for pain must be consistent throughout the course of survivorship.
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Affiliation(s)
- Jenny L. Ren
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
- Baylor College of Medicine, Houston, TX 77030 USA
| | - Raniv D. Rojo
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
- College of Medicine, University of the Philippines Manila, 1000 Manila, Philippines
| | - Joy Vanessa D. Perez
- College of Medicine, University of the Philippines Manila, 1000 Manila, Philippines
| | - Sai-Ching J. Yeung
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Cielito C. Reyes-Gibby
- Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Room Z9.3018, Zayed Building for Personalized Cancer Care, 6565 MD Anderson Blvd., Houston, TX 77030 USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
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Gubler-Gut BE, Pöhlmann J, Flatz A, Schwenkglenks M, Rohrmann S. Cost-effectiveness of physical activity interventions in cancer survivors of developed countries: a systematic review. J Cancer Surviv 2021; 15:961-975. [PMID: 33624172 PMCID: PMC8521580 DOI: 10.1007/s11764-021-01002-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/06/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Physical activity has been shown to improve survival and quality of life of cancer patients. Due to differences in patient populations, healthcare settings, and types of intervention, cost-effectiveness analyses of physical activity interventions in cancer survivors are difficult to compare. Available evidence from breast cancer survivor research has shown inconsistent results, and transfer of results to other types of cancer is not straightforward. This paper systematically reviewed current evidence on the cost-effectiveness of physical activity interventions in cancer survivors independent of cancer type compared to usual care or another experimental intervention. METHODS The literature search was conducted in seven databases and enhanced by a search for gray literature. Eligible studies were restricted to developed countries and assessed using the CHEERS, CHEC, and PHILIPS checklists. The study protocol was pre-published in PROSPERO. RESULTS Seven studies, five cost-utility, and two combined cost-utility/cost-effectiveness analyses fully met the inclusion criteria. They covered eight different types of cancer and various interventions. The cost-effectiveness analyses were of moderate to high methodological quality. A high probability of cost-effectiveness was reported in two analyses. One intervention appeared to be not cost-effective, and one to be cost-effective only from an organizational perspective. Three other analyses reported a cost-effectiveness better than US$ 101,195 (€ 80,000) per QALY gained. CONCLUSIONS Physical activity interventions in cancer survivors of developed countries were cost-effective in some but not all clinical trials reviewed. IMPLICATIONS FOR CANCER SURVIVORS Cost-effectiveness of physical activity interventions appear to depend upon the intensity of the activity.
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Affiliation(s)
- Barbara E. Gubler-Gut
- Institute of Physiotherapy, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland
| | - Johannes Pöhlmann
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse15, 8401 Winterthur, Switzerland
| | - Aline Flatz
- Swiss Cancer League, Effingerstrasse 40, 3001 Berne, Switzerland
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine, University of Basel, Klingenbergstrasse 61, 4056 Basel, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Sabine Rohrmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
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