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Mäkitie AA, Alabi RO, Pulkki-Råback L, Almangush A, Beitler JJ, Saba NF, Strojan P, Takes R, Guntinas-Lichius O, Ferlito A. Psychological Factors Related to Treatment Outcomes in Head and Neck Cancer. Adv Ther 2024; 41:3489-3519. [PMID: 39110309 DOI: 10.1007/s12325-024-02945-3] [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: 05/28/2024] [Accepted: 07/04/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Patients with head and neck cancer (HNC) often demonstrate stress, distress, anxiety, depression, and are at risk for suicide. These affect their quality of life (QoL) but less attention has been given to psychological variables that may impact response to treatment. OBJECTIVES This study aims to systematically review publications during 2013-2023 to collate evidence on the effects of psychological variables on HNC treatment outcomes. METHODS We searched Ovid Medline, PubMed, Scopus, and Web of Science for articles that examined psychological factors related to treatment outcomes in patients with HNC. RESULTS There were 29 studies (5 before treatment, 2 during, 17 after, and 5 covering the whole management trajectory) including 362,766 patients. The psychological factors were either behavioral (adjustment and coping strategy, unrealistic ideas, self-blame), cognitive (elevated risk of psychiatric co-comorbidity), or emotional (distress, depression, anxiety, nervousness, and fear of disfigurement and complications). It was found that there was a relationship between depression and decreased survival in patients with HNC. Pretreatment pain was an independent predictor of decreased survival in a large sample of patients. The distress level was approximately 54%, emotional problems ranged between 10 and 44%, while financial difficulties were identified in 54% of the patients. Sixty-nine percent of patients were reported to have used at least one cost-coping strategy within 6 months after treatment initiation. During post-treatment period, depression increased from 15% at the baseline to 29%, while the fear of recurrence was found among at least 35% of patients. DISCUSSION AND CONCLUSION Several psychological factors predict QoL and survival among HNC survivors. Distress encompasses depression and anxiety, and physical burden from HNC diagnosis and treatment. Routine screening and early interventions that target distress could improve HNC survivors' QoL. A systematic and standardized measurement approach for QoL is warranted to homogenize these findings and to understand the underlying relationships.
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Affiliation(s)
- Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O.Box 263, 00029 HUS, Helsinki, Finland.
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
| | - Rasheed Omobolaji Alabi
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Department of Industrial Digitalization, School of Technology and Innovations, University of Vaasa, Vaasa, Finland
| | | | - Alhadi Almangush
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Department of Pathology, University of Helsinki, Helsinki, Finland
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
| | - Jonathan J Beitler
- Harold Alfond Center for Cancer Care, Maine General Hospital, Augusta, ME, USA
- Dept of Radiation Oncology, John J. Cochran Veterans Hospital, St. Louis, MO, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, 30322, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Robert Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Bastien AJ, Ng J, Cong I, Garcia J, Walgama ES, Luu M, Jang JK, Mita AC, Scher KS, Moyers JT, Clair JMS, Maghami E, Chen MM, Zumsteg ZS, Ho AS. Patient perceptions underlying ctDNA molecular surveillance for HPV(+) oropharyngeal squamous cell carcinoma. Oral Oncol 2024; 156:106894. [PMID: 38909394 DOI: 10.1016/j.oraloncology.2024.106894] [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: 02/20/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE Circulating tumor DNA assays have robust potential as molecular surveillance tools. They may also exacerbate patient distress without improving outcomes. We investigate patient acceptability of a validated ctHPVDNA assay (NavDx) during cancer surveillance for HPV(+) oropharyngeal cancer (OPC). METHODS Consented HPV(+) OPC participants completed the NCCN Distress Thermometer, the Hospital Anxiety Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-General (FACT-G) scale both (1) before NavDx blood draw, and (2) after results were provided. Patients then completed a series of focused questions related to their perceptions of the assay. RESULTS Overall, 55 patients completed the study, with 98.2 % showing no recurrence. For the NCCN Distress Thermometer, median patient distress decreased (2.0 (IQR 1-5) vs. 1.0 (IQR 0-3)) (p < 0.001) in association with NavDx. Using scores ≥ 4 as a cutoff point to define clinically elevated distress, scores also improved (36.4 % vs. 18.2 %, p = 0.031). For HADS, anxiety significantly improved (5.0 (IQR 2.0-7.0) vs. 3.0 (IQR 1.0-6.5)) (p = 0.037), but not depression (3.0 (IQR 1.0-7.0) vs. 3.0 (IQR 1.0-6.5)) (p = 0.870). FACT-G scores showed no substantial differences. On survey questionnaires, 95.5 % of patients believed the test to be helpful, and 100 % felt "somewhat" or "extremely" confident in the assay as a monitoring tool. While 59.1 % felt that it reduced anxiety, 88.4 % concordantly felt that it did not introduce anxiety. CONCLUSION ctHPVDNA as a molecular surveillance tool reduced distress levels in HPV(+) OPC patients, with notably high patient confidence in the approach. Further investigation is warranted to judiciously incorporate this emerging modality in surveillance guidelines.
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Affiliation(s)
- Amanda J Bastien
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States
| | - Jewel Ng
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States
| | - Iris Cong
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States
| | - Jonathan Garcia
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States
| | - Evan S Walgama
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Biostatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Julie K Jang
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Alain C Mita
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Division of Medical Oncology, Dept. of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Kevin S Scher
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Division of Medical Oncology, Dept. of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Justin T Moyers
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Division of Medical Oncology, Dept. of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; The Angeles Clinic and Research Institute, Cedars-Sinai Medical Center, 1919 Santa Monica Boulevard, Fourth Floor, Los Angeles, CA 90048, United States
| | - Jon Mallen-St Clair
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Ellie Maghami
- Dept. of Surgery, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA 91010, United States
| | - Michelle M Chen
- Dept. of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Stanford, CA 94305, United States
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States; Department of Radiation Oncology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States
| | - Allen S Ho
- Division of Otolaryngology-Head and Neck Surgery, Dept. of Surgery, Cedars-Sinai Medical Center, 8631 West Third St., Suite 915E, Los Angeles, CA 90048, United States; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, United States.
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Raggini E, Mattavelli D, Zigliani G, Bossi P, Piazza C. Measuring financial toxicity in head and neck cancer: a systematic review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:1-12. [PMID: 38420716 PMCID: PMC10914354 DOI: 10.14639/0392-100x-n2762] [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: 09/27/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024]
Abstract
Objective The current study systematically reviews the literature about financial toxicity (FT) in head and neck cancer patients. Three databases were reviewed: PubMed, Scopus and Web of Science. Methods Full text English papers published from 2000 to 2022 reporting on quantitative results about FT in head and neck cancer survivors collected through structured questionnaires or interviews were included. Results Twenty-seven articles were included. Most of the articles were published after 2015 and from United States. There was a slight prevalence of papers dealing with oropharyngeal cancer, squamous-cell carcinoma and locally advanced head and neck cancer. Measures of FT were obtained through validated questionnaires like COST, FIT and FDQ. Collected data were mostly referrable to financial spending, financial resources, psychosocial aspect, support seeking, coping care and coping lifestyle subdomain. FT scores by COST were found to be worse in the COVID era. Financial counseling and adequate information about the costs of treatment were two effective strategies to mitigate FT. Conclusions FT is a relatively new challenge in head and neck cancer treatment, whose expenses are higher than therapies for other cancers. A universal method to assess FT and a unified guideline for the administration of questionnaires are needed to mitigate FT and to improve patient outcomes.
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Affiliation(s)
- Elisa Raggini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Gabriele Zigliani
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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Margalit DN, Salz T, Venchiarutti R, Milley K, McNamara M, Chima S, Wong J, Druce P, Nekhlyudov L. Interventions for head and neck cancer survivors: Systematic review. Head Neck 2022; 44:2579-2599. [PMID: 35848095 PMCID: PMC9796901 DOI: 10.1002/hed.27142] [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: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions for head/neck cancer (HNC) survivors may not address their cancer-related and general health needs. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guided this systematic review of studies from 2000 to 2021 of interventions targeting cancer survivors treated with curative-intent, using MEDLINE, Embase, Emcare, and PsycINFO. Interventions were categorized into domains of the Quality of Cancer Survivorship Care Framework to characterize the scope and quality of interventions. RESULTS We identified 28 studies for inclusion: 13 randomized and 15 non-randomized. Most targeted surveillance/management of physical effects (n = 24) including 13 that also targeted psychosocial effects. Four studies addressed prevention/surveillance for recurrence/new cancers, one addressed health promotion/disease prevention, and one addressed chronic medical conditions. Most studies (n = 27) had medium-high risk of bias. CONCLUSIONS There are few high-quality studies addressing HNC survivorship. Future rigorously designed studies should address broader areas of care, including chronic disease management and health promotion/disease prevention.
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Affiliation(s)
- Danielle N. Margalit
- Department of Radiation Oncology, Head and Neck Oncology ProgramDana‐Farber Cancer Institute/Brigham & Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Talya Salz
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Rebecca Venchiarutti
- Sydney Head and Neck Cancer Institute, Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia,School of Public Health, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - Kristi Milley
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia
| | - Mairead McNamara
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia,Department of Cancer Imaging, Peter MacCallum Cancer CentreMelbourneVICAustralia
| | - Sophie Chima
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia
| | - Jamieson Wong
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia
| | - Paige Druce
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia,Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Larissa Nekhlyudov
- Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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