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Sriram S, Xie D, Gersten RA, Gourin CG. Palliative care outcome measures used in head and neck cancer: A scoping review. Head Neck 2024. [PMID: 39152535 DOI: 10.1002/hed.27920] [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: 04/09/2024] [Revised: 07/21/2024] [Accepted: 08/05/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND The palliative care (PC) needs of patients with head and neck cancer (HNC) are complex, due to high and unique symptom burdens. Uniform outcome measures are critical to assessing the impact of PC interventions in HNC. METHODS A scoping review of outcome measures used in patients with HNC receiving PC was performed using PubMed, Embase, and Web of Science from 1980 to 2022. RESULTS Of 20 eligible studies, 19 unique instruments were identified which assessed 22 physical, 5 mental, 4 social, 7 related quality of life, and 9 advanced care planning outcomes. Instruments were underutilized, with a larger number of outcomes measurable for instruments used than were reported. The average instrument assessed three domains whereas the average study only reported outcomes from two domains. CONCLUSIONS Comparison across studies is limited due to heterogeneity in outcome measures. Future work is needed to develop core PC outcome measures for use in HNC care.
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Affiliation(s)
- Shreya Sriram
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Deborah Xie
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Rebecca A Gersten
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Christine G Gourin
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Talani C, Högmo A, Laurell G, Mäkitie A, Farnebo L. Six-month mortality has decreased for patients with curative treatment intent for head and neck cancer in Sweden. PLoS One 2024; 19:e0296534. [PMID: 38625920 PMCID: PMC11020944 DOI: 10.1371/journal.pone.0296534] [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: 12/21/2023] [Accepted: 02/25/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND In general, survival outcomes for patients with Head and Neck Cancer (HNC) has improved over recent decades. However, mortality within six months after diagnosis for curative patients remains at approximately 5%. The aim of this study was to identify risk factors for early death among patients with curative treatment, and furthermore, to analyze whether the risk of early death changed over recent years. MATERIAL AND METHOD This real-world, population-based, nationwide study from the Swedish Head and Neck Cancer Register (SweHNCR) included all patients ≥18 years diagnosed with HNC with a curative treatment intent at the multidisciplinary tumor board from 2008 to 2020. A total of 16,786 patients were included. RESULTS During the study period a total of 618 (3.7%) patients with curative-intended treatment died within six months of diagnosis. Patients diagnosed between 2008 and 2012 had a six-month mortality rate of 4.7% compared to 2.5% for patients diagnosed between 2017 and 2020, indicating a risk reduction of 53% (p <0.001) for death within six months. The mean time to radiation therapy from diagnosis in the 2008-2012 cohort was 38 days, compared to 22 days for the 2017-2020 cohort, (p <0.001). The mean time to surgery from diagnosis was 22 days in 2008-2012, compared to 15 days for the 2017-2020 cohort, (p <0.001). Females had a 20% lower risk of dying within six months compared to males (p = 0.013). For every year older the patient was at diagnosis, a 4.8% (p <0.001) higher risk of dying within six months was observed. Patients with a WHO score of 1 had approximately 2.4-times greater risk of early death compared to WHO 0 patients (p <0.001). The risk of early death among WHO 4 patients was almost 28 times higher than for WHO 0 patients (p <0.001). Patients with a hypopharyngeal tumor site had a 2.5-fold higher risk of dying within six months from diagnosis compared to oropharyngeal tumor patients (p <0.001). CONCLUSIONS We found that the risk of early death decreased significantly from 2008 to 2020. During this period, the mean time to the start of treatment was significantly reduced both for surgery and oncological treatment regimes. Among patients with a curative treatment intention, increased risk of early death was associated with male sex, older age, advanced disease, increased WHO score, and a hypopharyngeal tumor site.
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Affiliation(s)
- Charbél Talani
- Division of Sensory Organs and Communication, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Otorhinolaryngology, Region Östergötland Anesthetics, Operations, and Specialty Surgery Center, Linköping, Sweden
| | - Anders Högmo
- Regional Cancer Center Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Laurell
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Antti Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lovisa Farnebo
- Division of Sensory Organs and Communication, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
- Department of Otorhinolaryngology, Region Östergötland Anesthetics, Operations, and Specialty Surgery Center, Linköping, Sweden
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Ratnasekera N, Fazelzad R, Bagnarol R, Cunha V, Zimmermann C, Lau J. Palliative care interventions for patients with head and neck cancer: protocol for a scoping review. BMJ Open 2023; 13:e078980. [PMID: 38011979 PMCID: PMC10685954 DOI: 10.1136/bmjopen-2023-078980] [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: 08/18/2023] [Accepted: 10/24/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION A head and neck cancer (HNC) diagnosis significantly impacts a patient's quality of life (QOL). Palliative care potentially improves their QOL. We will conduct a scoping review to identify existing knowledge about palliative care interventions for patients with HNC. METHODS AND ANALYSIS This scoping review was designed in accordance with the JBI Manual for Evidence Synthesis: Scoping Reviews and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Our eligibility criteria follow the Population, Intervention, Comparison or Control, Outcomes and Study characteristics framework. The population is adult patients with locally advanced, metastatic, unresectable and/or recurrent HNC. We include peer-reviewed journal articles and articles in the press, in English, reporting on palliative care interventions with at least two of the eight National Consensus Project on Clinical Practice Guidelines for Quality Palliative Care domains; studies with and without comparators will be included. The outcomes are patient QOL (primary) and symptom severity, patients' satisfaction with care, patients' mood, advance care planning and place of death (secondary). We developed a search strategy across ten databases, to be searched from the inception to 11 September 2023: Medline ALL (Medline and EPub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase Classic+Embase, Emcare and PsycINFO all from the OvidSP platform; CINAHL from EBSCOhost, Scopus from Elsevier, Web of Science from Clarivate and Global Index Medicus from WHO. We will extract data using a piloted data form and analyse the data through descriptive statistics and thematic analysis. ETHICS AND DISSEMINATION Ethics approval is not needed for a scoping review. We will disseminate the findings to healthcare providers and policy-makers by publishing the results in a scientific journal.
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Affiliation(s)
- Nadisha Ratnasekera
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Rebecca Bagnarol
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Vanessa Cunha
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre Research Institute, University Health Network, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Palliative Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Lau
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre Research Institute, University Health Network, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Kim H, Kim HR, Kang SH, Koh KN, Im HJ, Park YR. Comorbidity Differences by Trajectory Groups as a Reference for Identifying Patients at Risk for Late Mortality in Childhood Cancer Survivors: Longitudinal National Cohort Study. JMIR Public Health Surveill 2023; 9:e41203. [PMID: 36754630 PMCID: PMC10131914 DOI: 10.2196/41203] [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: 07/19/2022] [Revised: 11/30/2022] [Accepted: 01/06/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Childhood cancer has a high long-term morbidity and mortality rate. Five years after the initial cancer diagnosis, approximately two-thirds of childhood cancer survivors experience at least one late complication, with one-quarter experiencing severe, life-threatening complications. Chronic health conditions can impact survivors' life planning and daily activities, reducing their health-related quality of life. Comprehensive and longitudinal data are required for investigations of national claims data. OBJECTIVE This study aimed to address clinical and health policy interventions and improved survival rates. A comprehensive categorization of the long-term morbidities associated with childhood cancer survivorship is required. We analyzed the trajectory groups associated with long-term mortality among childhood cancer survivors. METHODS We collected data from a nationwide claims database of the entire Korean population. Between 2003 and 2007, patients diagnosed with and treated for cancer before the age of 20 years were included. With 8119 patients who survived >10 years, 3 trajectory groups were classified according to yearly changes in the number of diagnoses (the lowest in group 1 and the highest in group 3). RESULTS The patterns of most comorbidities and survival rates differed significantly between the trajectory groups. Group 3 had a higher rate of mental and behavioral disorders, neoplasms, and blood organ diseases than the other two groups. Furthermore, there was a difference in the number of diagnoses by trajectory groups over the entire decade, and the disparity increased as the survival period increased. If a patient received more than four diagnoses, especially after the fourth year, the patient was likely to be assigned to group 3, which had the worst prognosis. Group 1 had the highest overall survival rate, and group 3 had the lowest (P<.001). Group 3 had the highest hazard ratio of 4.37 (95% CI 2.57-7.42; P<.001) in a multivariate analysis of late mortality. CONCLUSIONS Our findings show that the pattern of comorbidities differed significantly among trajectory groups for late death, which could help physicians identify childhood cancer survivors at risk for late mortality. Patients with neoplasms, blood organ diseases, or mental and behavioral disorders should be identified as having an increased risk of late mortality. Furthermore, vigilance and prompt action are essential to mitigate the potential consequences of a child cancer survivor receiving four or more diagnoses within a year.
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Affiliation(s)
- Hyery Kim
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hae Reong Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Han Kang
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung-Nam Koh
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Joon Im
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
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de Brito RV, Mancini MW, Palumbo MDN, de Moraes LHO, Rodrigues GJ, Cervantes O, Sercarz JA, Paiva MB. The Rationale for "Laser-Induced Thermal Therapy (LITT) and Intratumoral Cisplatin" Approach for Cancer Treatment. Int J Mol Sci 2022; 23:5934. [PMID: 35682611 PMCID: PMC9180481 DOI: 10.3390/ijms23115934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 01/27/2023] Open
Abstract
Cisplatin is one of the most widely used anticancer drugs in the treatment of various types of solid human cancers, as well as germ cell tumors, sarcomas, and lymphomas. Strong evidence from research has demonstrated higher efficacy of a combination of cisplatin and derivatives, together with hyperthermia and light, in overcoming drug resistance and improving tumoricidal efficacy. It is well known that the antioncogenic potential of CDDP is markedly enhanced by hyperthermia compared to drug treatment alone. However, more recently, accelerators of high energy particles, such as synchrotrons, have been used to produce powerful and monochromatizable radiation to induce an Auger electron cascade in cis-platinum molecules. This is the concept that makes photoactivation of cis-platinum theoretically possible. Both heat and light increase cisplatin anticancer activity via multiple mechanisms, generating DNA lesions by interacting with purine bases in DNA followed by activation of several signal transduction pathways which finally lead to apoptosis. For the past twenty-seven years, our group has developed infrared photo-thermal activation of cisplatin for cancer treatment from bench to bedside. The future development of photoactivatable prodrugs of platinum-based agents injected intratumorally will increase selectivity, lower toxicity and increase efficacy of this important class of antitumor drugs, particularly when treating tumors accessible to laser-based fiber-optic devices, as in head and neck cancer. In this article, the mechanistic rationale of combined intratumor injections of cisplatin and laser-induced thermal therapy (CDDP-LITT) and the clinical application of such minimally invasive treatment for cancer are reviewed.
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Affiliation(s)
- Renan Vieira de Brito
- Department of Otolaryngology and Head and Neck Surgery, Federal University of São Paulo (UNIFESP), Sao Paulo 04023-062, SP, Brazil; (R.V.d.B.); (M.d.N.P.); (O.C.)
| | - Marília Wellichan Mancini
- Biophotonics Department, Institute of Research and Education in the Health Area (NUPEN), Sao Carlos 13562-030, SP, Brazil;
| | - Marcel das Neves Palumbo
- Department of Otolaryngology and Head and Neck Surgery, Federal University of São Paulo (UNIFESP), Sao Paulo 04023-062, SP, Brazil; (R.V.d.B.); (M.d.N.P.); (O.C.)
| | - Luis Henrique Oliveira de Moraes
- Department of Physiological Sciences, Federal University of Sao Carlos (UFSCar), Sao Carlos 13565-905, SP, Brazil; (L.H.O.d.M.); (G.J.R.)
| | - Gerson Jhonatan Rodrigues
- Department of Physiological Sciences, Federal University of Sao Carlos (UFSCar), Sao Carlos 13565-905, SP, Brazil; (L.H.O.d.M.); (G.J.R.)
| | - Onivaldo Cervantes
- Department of Otolaryngology and Head and Neck Surgery, Federal University of São Paulo (UNIFESP), Sao Paulo 04023-062, SP, Brazil; (R.V.d.B.); (M.d.N.P.); (O.C.)
| | - Joel Avram Sercarz
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Marcos Bandiera Paiva
- Department of Otolaryngology and Head and Neck Surgery, Federal University of São Paulo (UNIFESP), Sao Paulo 04023-062, SP, Brazil; (R.V.d.B.); (M.d.N.P.); (O.C.)
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
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Taylor N, Christie J, Wakefield D. Head and neck cancer end of life care: complex challenges. BMJ Support Palliat Care 2022:bmjspcare-2022-003644. [PMID: 35383046 DOI: 10.1136/bmjspcare-2022-003644] [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: 03/17/2022] [Accepted: 03/26/2022] [Indexed: 11/04/2022]
Abstract
Head and neck cancers frequently carry a poor prognosis and are commonly associated with complex medical needs and symptoms. Timing of referral to specialist palliative care teams (SPCTs) is challenging. We present the case of a 57-year-old woman with locally highly advanced head and neck cancer. The patient had highly complex medical needs including a tracheostomy to maintain airway patency, artificial feeds via jejunostomy and impaired communication due to hearing loss, tracheostomy and fatigue. She required support with advance care planning and complex symptom management of pain related to abdominal skin excoriation due to leakage of gastric contents; bleeding of necrotic tumour; anxiety and discomfort due to displacement of tracheostomy. Care by an integrated SPCT allowed smooth transition from hospital to community settings with smooth ongoing management despite highly complex needs. This complex symptom management included tracheostomy removal in the home towards the end of life.
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Affiliation(s)
- Naomi Taylor
- Palliative Medicine, North Tees and Hartlepool NHS Foundation Trust, Stockton-upon-Tees, UK
| | - Julie Christie
- Palliative Medicine, North Tees and Hartlepool NHS Foundation Trust, Stockton-upon-Tees, UK
| | - Donna Wakefield
- Palliative Medicine, North Tees and Hartlepool NHS Foundation Trust, Stockton-upon-Tees, UK
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Psychological variables associated with quality of life in patients with head and neck cancer: the role of body image distress. Support Care Cancer 2022; 30:9127-9139. [PMID: 35997811 PMCID: PMC9633472 DOI: 10.1007/s00520-022-07334-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 08/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of this cross-sectional study was to explore the relationship between quality of life (QoL) and body image distress in patients with head and neck cancer (HNC), considering relevant psychological variables (i.e., coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress). We also aimed to explore gender differences in patients with HNC in terms of relevant psychological variables in HNC. METHODS Fifty-one HNC patients (37 males and 14 females) completed self-report questionnaires to assess body image distress, physical and mental QoL, and relevant psychological variables in HNC (coping strategies, social anxiety symptoms, self-esteem, intolerance of uncertainty, pain, and distress) before undergoing treatment. Pearson's correlations and four-step hierarchical regressions were performed to assess the relationship between body image distress, QoL, and the abovementioned psychological variables, while one-way analyses of variance and one-way analysis of covariance were employed to assess gender differences. RESULTS Physical QoL was associated with body image distress above and beyond disease duration, distress, coping strategies, pain, mental QoL, and self-esteem, while mental QoL was associated with pain above and beyond distress, coping strategies, physical QoL, self-esteem, and body image distress. Concerning gender differences, females scored higher than males on most of the explored psychological variables, except for physical QoL and intolerance of uncertainty, and showed lower mental QoL and self-esteem than males. CONCLUSION Body image distress and pain emerged as negatively associated with QoL, and almost all the explored psychological variables differed among genders. Psychological interventions targeting body image distress and pain should be promoted in patients with HNC to increase their QoL, while keeping gender differences in mind.
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Fabian A, Domschikowski J, Hoffmann M, Weiner O, Schmalz C, Dunst J, Krug D. Patient-Reported Outcomes Assessing the Impact of Palliative Radiotherapy on Quality of Life and Symptom Burden in Head and Neck Cancer Patients: A Systematic Review. Front Oncol 2021; 11:683042. [PMID: 34150646 PMCID: PMC8213366 DOI: 10.3389/fonc.2021.683042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 01/02/2023] Open
Abstract
Incurable head and neck cancer has a poor prognosis and impairs a patient's health-related quality of life. Palliative radiotherapy may improve or stabilize health-related quality of life and symptoms, best measured by patient-reported outcomes. There is no systematic analysis if palliative radiotherapy for head and neck cancer improves or stabilizes health-related quality of life or symptoms as validly measured by patient-reported outcomes. Therefore, the primary objective of this systematic review (PROSPERO-ID: CRD42020166434) was to assess the effect of palliative radiotherapy for head and neck cancer on patient-reported outcomes. The secondary objective was to assess the rate and quality of use of patient-reported outcomes in relevant studies claiming a "palliative effect" of radiotherapy. The databases MEDLINE/PubMed, EMBASE, Cochrane CENTRAL, "ClinicalTrials.gov" were searched. Concerning the primary objective, four studies were eligible to assess the effectiveness of palliative radiotherapy as measured by patient-reported outcomes. A narrative synthesis suggests a favorable impact of palliative radiotherapy on health-related quality of life and symptom burden. The risk of bias, however, is considerable and the overall quality of evidence low. Concerning the secondary objective, over 90% of studies claiming a "palliative effect" of palliative radiotherapy did either not use patient-reported outcomes or did so by limited quality. In conclusion, implementation of patient-reported outcomes in studies assessing palliative radiotherapy for head and neck cancer should be fostered. Palliative radiotherapy remains an option for head and neck cancer patients, although more studies focusing on patient-reported outcomes are needed. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier CRD42020166434.
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Affiliation(s)
- Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Oliver Weiner
- University Library Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Claudia Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
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Best Practices: Application of NI-RADS for Posttreatment Surveillance Imaging of Head and Neck Cancer. AJR Am J Roentgenol 2021; 216:1438-1451. [PMID: 32876470 DOI: 10.2214/ajr.20.23841] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Imaging surveillance is an important component of posttreatment management of head and neck cancers. There is variability in the surveillance regimen used by various practitioners and institutions, with no official National Comprehensive Cancer Network guidelines for patients showing no symptoms beyond 6 months posttreatment. Moreover, imaging of the neck after treatment is a complex examination with significant interreader heterogeneity, particularly in terms of the manner in which degree of suspicion for disease recurrence is expressed. The Neck Imaging Reporting and Data System (NI-RADS) was introduced by the American College of Radiology (ACR) in 2018 as a practical guide for the interpreting radiologist. NI-RADS is a proposed interpretive framework that can be applied to any standardized or institutional surveillance imaging protocol. NI-RADS simplifies communication between radiologists and referring clinicians and provides management guidance linked to specific levels of suspicion. The ACR NI-RADS Committee also provided general best practice recommendations for imaging surveillance modality and timing in the 2018 white paper. This article will review existing literature regarding choice of modality and timeline for surveillance in treated cancer of the head and neck. NI-RADS will then be presented as an approach to imaging reporting, interpretation, and design of next steps in management.
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Mayland CR, Doughty HC, Rogers SN, Gola A, Mason S, Hubbert C, Macareavy D, Jack BA. A Qualitative Study Exploring Patient, Family Carer and Healthcare Professionals' Direct Experiences and Barriers to Providing and Integrating Palliative Care for Advanced Head and Neck Cancer. J Palliat Care 2021; 36:121-129. [PMID: 32928058 PMCID: PMC7961626 DOI: 10.1177/0825859720957817] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To report on direct experiences from advanced head and neck cancer patients, family carers and healthcare professionals, and the barriers to integrating specialist palliative care. METHODS Using a naturalistic, interpretative approach, within Northwest England, a purposive sample of adult head and neck cancer patients was selected. Their family carers were invited to participate. Healthcare professionals (representing head and neck surgery and specialist nursing; oncology; specialist palliative care; general practice and community nursing) were recruited. All participants underwent face-to-face or telephone interviews. A thematic approach, using a modified version of Colazzi's framework, was used to analyze the data. RESULTS Seventeen interviews were conducted (9 patients, 4 joint with family carers and 8 healthcare professionals). Two main barriers were identified by healthcare professionals: "lack of consensus about timing of Specialist Palliative Care engagement" and "high stake decisions with uncertainty about treatment outcome." The main barrier identified by patients and family carers was "lack of preparedness when transitioning from curable to incurable disease." There were 2 overlapping themes from both groups: "uncertainty about meeting psychological needs" and "misconceptions of palliative care." CONCLUSIONS Head and neck cancer has a less predictable disease trajectory, where complex decisions are made and treatment outcomes are less certain. Specific focus is needed to define the optimal way to initiate Specialist Palliative Care referrals which may differ from those used for the wider cancer population. Clearer ways to effectively communicate goals of care are required potentially involving collaboration between Specialist Palliative Care and the wider head and neck cancer team.
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Affiliation(s)
- Catriona Rachel Mayland
- Department of Oncology and Metabolism, 7315University of Sheffield, United Kingdom
- Palliative Care Institute, 4591University of Liverpool, United Kingdom
| | - Hannah C Doughty
- Palliative Care Institute, 4591University of Liverpool, United Kingdom
- Department of Primary Care and Mental Health, 4591University of Liverpool, United Kingdom
| | - Simon N Rogers
- Faculty of Health and Social Care, 6249Edge Hill University, Ormskirk, United Kingdom
- 89542Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Anna Gola
- Marie Curie Palliative Care Research Department, 4919University College London, United Kingdom
| | - Stephen Mason
- Palliative Care Institute, 4591University of Liverpool, United Kingdom
| | - Cathy Hubbert
- 429822Aintree Park General Practice, Liverpool, United Kingdom
| | - Dominic Macareavy
- 89542Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Barbara A Jack
- Faculty of Health and Social Care, 6249Edge Hill University, Ormskirk, United Kingdom
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Mayland CR, Ho QM, Doughty HC, Rogers SN, Peddinti P, Chada P, Mason S, Cooper M, Dey P. The palliative care needs and experiences of people with advanced head and neck cancer: A scoping review. Palliat Med 2021; 35:27-44. [PMID: 33084497 PMCID: PMC7797618 DOI: 10.1177/0269216320963892] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The palliative care needs of people with advanced head and neck cancer pose unique complexities due to the impact the illness has on eating, speaking, appearance and breathing. Examining these needs would help provide guidance about developing relevant models of care and identify gaps in research knowledge. AIM To identify and map out the palliative care needs and experiences for people with advanced head and neck cancer. DESIGN A scoping literature review following the methods described by the Joanna Briggs Institute. DATA SOURCES An electronic search of the literature was undertaken in MEDLINE (Ovid), EMBASE and CINAHL covering the years January 1996 to January 2019. RESULTS People with advanced head and neck cancer often had palliative care needs but there was variability in the timing and access to relevant services. A high prevalence of interventions, for example hospital admissions were needed even during the last month of life. This was not necessarily negated with early engagement of palliative care. Dissonance between patients and family carers about information needs and decision-making was an additional complexity. Studies tended to be descriptive in nature, and often involved a single centre. CONCLUSION This scoping review demonstrates the complexity of care for people with advanced head and neck cancer and the issues related to the current healthcare systems. Focus on appropriate referral criteria, increased integration and coordination of care and robust evaluation of specific care components seems key. Linkage between research and service design delivery across teams, disciplines and care settings seems pertinent.
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Affiliation(s)
- Catriona R Mayland
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Palliative Care Institute, University of Liverpool, Liverpool, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Qiaoling Marilyn Ho
- Palliative Care Institute, University of Liverpool, Liverpool, UK
- Nanyang Technology University, Singapore
| | - Hannah C Doughty
- Palliative Care Institute, University of Liverpool, Liverpool, UK
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Simon N Rogers
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Prithvi Peddinti
- University of Liverpool Medical School, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Praytush Chada
- University of Liverpool Medical School, Liverpool, UK
- Luton and Dunstable University Hospital, Luton, UK
| | - Stephen Mason
- Palliative Care Institute, University of Liverpool, Liverpool, UK
| | - Matthew Cooper
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paola Dey
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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12
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Oliveira TB, Mesía R, Falco A, Hsieh JCH, Yokota T, Saada-Bouzid E, Schmitz S, Elicin O, Giacomelli L, Bossi P. Defining the needs of patients with recurrent and/or metastatic head and neck cancer: An expert opinion. Crit Rev Oncol Hematol 2020; 157:103200. [PMID: 33321152 DOI: 10.1016/j.critrevonc.2020.103200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 02/08/2023] Open
Abstract
The clinical and biological heterogeneity of head and neck cancer (HNC) is paralleled by a plethora of different symptoms that affect the patient's quality of life. These symptoms include, for instance, pain, fatigue, nutritional issues, airways obstruction, voice alterations and psychological distress. In addition, patients with HNC are prone to a high risk of infection, and may also suffer from acute complications, such as hypercalcemia, spine compression by bone metastasis or bleeding. Prolonging survival is also an inherent expectation for all patients. Addressing the above needs is crucial in all patients with HNC, and especially in those with recurrent and/or metastatic (RM) disease. However, research on how to address patients' needs in RM-HNC remains scarce. This paper defines patients' needs for RM HNC and presents an Expert Opinion on how to address them, proposing also some lines of research.
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Affiliation(s)
| | - Ricard Mesía
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Barcelona, Spain
| | - Agustin Falco
- Medical Oncology Department, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Jason Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, 333, Taiwan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Esma Saada-Bouzid
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | - Sandra Schmitz
- Departments of Medical Oncology and Head and Neck Surgery, Institut Roi Albert II, Institut de Recherche Clinique et Expérimentale (Pole MIRO), Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Woluwe-Saint-Lambert, Belgium
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Luca Giacomelli
- Polistudium srl, Milan, Italy; Department of Surgical Sciences and Integrated Diangostics, University of Genoa, Genoa, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, 25123, Brescia, Italy.
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13
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Fabian A, Krug D, Dunst J. Randomisierte, kontrollierte Studie zur palliativen Radiotherapie von Kopf-Hals-Tumoren – Herausforderungen bleiben bestehen. Strahlenther Onkol 2020; 196:1062-1064. [PMID: 32821954 PMCID: PMC7581577 DOI: 10.1007/s00066-020-01672-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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