1
|
Chen TC, Lo TH, Huang HC, Wang CW, Yang TL, Lou PJ, Ko JY, Wang CP. Outcomes of salvage treatment in patients with recurrent oral squamous cell carcinoma. Head Neck 2021; 43:3764-3774. [PMID: 34510614 DOI: 10.1002/hed.26862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The survival outcomes of different salvage treatments for patients with recurrent oral cancer remain unclear. METHODS A total of 556 patients with recurrent oral cancer between 2010 and 2015 were reviewed. Clinical/pathological risk factors and different salvage treatments were analyzed. RESULTS The 2-year disease-free survival rates after recurrence in patients not receiving salvage operation (305 patients), receiving salvage operation with (121 patients), and without (130 patients) major pathological risk factors (margin or extranodal extension) were 5.3%, 32.4%, and 77.2%, respectively (p < 0.001). The 2-year overall survival rates were 20.3%, 58.4%, and 89.2%, respectively (p < 0.001). A late-onset recurrence, salvage radiation, and salvage operation were independent factors for good disease-free and overall survival. Salvage radiation showed survival benefits among patients not indicated for salvage operations. CONCLUSIONS Salvage operation was the first choice for recurrent oral cancer. Patients who received the salvage operation without major risk factors had the best survival.
Collapse
Affiliation(s)
- Tseng-Cheng Chen
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ta-Hsuan Lo
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Huai-Cheng Huang
- Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Wei Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Sooby P, Tarmal A, Townsley R. Management of catastrophic haemorrhage in palliative head and neck cancer: creation of a new protocol using simulation. BMJ Open Qual 2020; 9:bmjoq-2020-001003. [PMID: 33139295 PMCID: PMC7607599 DOI: 10.1136/bmjoq-2020-001003] [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: 04/27/2020] [Revised: 08/15/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022] Open
Abstract
Catastrophic haemorrhage or carotid blowout a rare but devastating consequence of head and neck cancer. In most cases, this represents a terminal event, and the patient is prescribed pre-emptive analgesia and anxiolytics. There is anecdotal evidence that due to the time taken to prepare the medications that patients do not receive these drugs prior to death. We aimed to identify the drug to patient time using simulated catastrophic haemorrhage simulations. We used the current protocol for this and also proposed a new grab-bag with preprepared anxiolytic and anagelsic medications. Each scenario was repeated 16 times. The mean time for drug administration using the current policy was 124 s compared with 48 s when the grab-bag was used (p<0.01). The new protocol also reduced the variability in the drug to patient time. We aim to implement this new protocol on the head and neck ward.
Collapse
Affiliation(s)
- Paul Sooby
- ENT, NHS Ayrshire and Arran, Ayr, UK .,ENT, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | |
Collapse
|
4
|
Hanks JE, Yalamanchi P, Kovatch KJ, Ali SA, Smith JD, Durham AB, Bradford CR, Malloy KM, McLean SA. Cranial nerve outcomes in regionally recurrent head & neck melanoma after sentinel lymph node biopsy. Laryngoscope 2020; 130:1707-1714. [PMID: 31441955 DOI: 10.1002/lary.28243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/28/2019] [Accepted: 07/31/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Characterize long-term cranial nerve (CN) outcomes following sentinel lymph node biopsy (SLNB) based management for head and neck cutaneous melanoma (HNCM). METHODS Longitudinal review of HNCM patients undergoing SLNB from 1997-2007. RESULTS Three hundred fifty-six patients were identified, with mean age 53.5 ± 19.0 years, mean Breslow depth 2.52 ± 1.87 mm, and 4.9 years median follow-up. One hundred five (29.4%) patients had SLNB mapping to the parotid basin. Eighteen patients had positive parotid SLNs and underwent immediate parotidectomy / immediate completion lymph node dissection (iCLND), with six possessing positive parotid non-sentinel lymph nodes (NSLNs). Fifty-two of 356 (14.6%) patients developed delayed regional recurrences, including 20 total intraparotid recurrences: five following false negative (FN) parotid SLNB, three following prior immediate superficial parotidectomy, two following iCLND without parotidectomy, and the remaining 12 parotid recurrences had negative extraparotid SLNBs. Parotid recurrences were multiple (4.9 mean recurrent nodes) and advanced (n = 4 extracapsular extension), and all required salvage dissection including parotidectomy. Immediate parotidectomy/iCLND led to no permanent CN injuries. Delayed regional HNCM macrometastasis precipitated 16 total permanent CN injuries in 13 patients: 10 CN VII, five CN XI, and one CN XII deficits. Fifty percent (n = 10) of parotid recurrences caused ≥1 permanent CN deficits. CONCLUSIONS Regional HNCM macrometastases and salvage dissection confer marked CN injury risk, whereas early surgical intervention via SLNB ± iCLND ± immediate parotidectomy yielded no CN injuries. Further, superficial parotidectomy performed in parotid-mapping HNCM does not obviate delayed intraparotid recurrences, which increase risk of CN VII injury. Despite lack of a published disease-specific survival advantage in melanoma, early disease control in cervical and parotid basins is paramount to minimize CN complications. LEVEL OF EVIDENCE 4 (retrospective case series) Laryngoscope, 130:1707-1714, 2020.
Collapse
Affiliation(s)
- John E Hanks
- Department of Otolaryngology-Head & Neck Surgery, University of California-Davis Medical center, Ann Arbor, Michigan, U.S.A
| | - Pratyusha Yalamanchi
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Kevin J Kovatch
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - S Ahmed Ali
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Joshua D Smith
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Alison B Durham
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Carol R Bradford
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
- University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | - Kelly M Malloy
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Scott A McLean
- Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, U.S.A
| |
Collapse
|
5
|
McCammon SD. Concurrent palliative care in the surgical management of head and neck cancer. J Surg Oncol 2019; 120:78-84. [DOI: 10.1002/jso.25452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Susan D. McCammon
- Department of Otolaryngology, Department of Internal Medicine, Division of Gerontology, Geriatrics and Palliative CareThe University of AlabamaBirmingham Alabama
| |
Collapse
|
6
|
Rawl J, Conner G, Gillenwater A, McCammon S. The Role of Palliative Care in Oral Cavity Carcinoma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0203-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Yerramilli D, Kovatch KJ, Chan AW, Swiecicki P, Margalit DN, Shuman AG. Palliative Head and Neck Cancer Treatment for Asymptomatic Disease. Otolaryngol Head Neck Surg 2018; 159:25-28. [PMID: 29484923 DOI: 10.1177/0194599818761861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Divya Yerramilli
- 1 Department of Radiation Oncology Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,2 Department of Radiation Oncology, Brigham and Women's/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kevin J Kovatch
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan, USA
| | - Annie W Chan
- 1 Department of Radiation Oncology Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Swiecicki
- 4 Department of Medical Oncology, University of Michigan Health Center, Ann Arbor, Michigan, USA
| | - Danielle N Margalit
- 2 Department of Radiation Oncology, Brigham and Women's/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrew G Shuman
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Center, Ann Arbor, Michigan, USA
| |
Collapse
|
8
|
Lu-Myers Y. Training Otolaryngologists in Palliative Care Delivery: An Underutilized Opportunity. Otolaryngol Head Neck Surg 2017; 158:24-26. [PMID: 28971721 DOI: 10.1177/0194599817735314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Palliative care is an underutilized and often misunderstood discipline in the treatment of patients with head and neck cancer. The key components of palliative care include symptoms management, psychosocial support, and enhanced communications. Abundant evidence has demonstrated the beneficial effect for the early incorporation of palliative care in the treatment paradigm for patients with chronic diseases and malignancies, with findings supporting its positive effect on patients' quality of life as well their survival. Particularly for otolaryngologists, the unique morbidities of head and neck cancer make our patients especially vulnerable and even more in need of the support and benefits that can come from palliative care. While increased consultation with palliative care providers for patients with head and neck cancer is a good first step, training otolaryngologists to develop their own "primary palliative care competencies" is key for improving our patients' outcomes.
Collapse
Affiliation(s)
- Yemeng Lu-Myers
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| |
Collapse
|
9
|
CT-guided 125I brachytherapy in the treatment of distant metastases in the oral cavity and maxillofacial region. Transl Oncol 2016; 10:90-98. [PMID: 27992832 PMCID: PMC5175989 DOI: 10.1016/j.tranon.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We aimed to evaluate the feasibility and clinical effectiveness of CT-guided 125I brachytherapy for distant oral and maxillofacial metastases. MATERIALS AND METHODS We retrospectively analyzed 65 patients with 84 distant oral and maxillofacial metastases. Thirty-one patients with 38 lesions received 125I brachytherapy (group A) and 34 with 46 lesions received external beam radiotherapy (EBRT; group B). RESULTS Median follow-up time was 16 months. The 3-, 6-, 12-, 18-, and 24-month local control rates for group A were 83.9%, 75.9%, 66.7%, 38.4%, and 25.0%, respectively; for group B they were 76.5%, 62.5%, 43.8%, 25.0%, and 0.0%, respectively (P<.05); the median local tumor progression-free survival times were 14 and 9 months, respectively. Group A had a better local tumor progression-free survival (LTPFS) relative to group B (P<.001; HR, 6.961 [95%CI, 2.109, 9.356]). Cox proportional hazards regression analysis indicated that 125I brachytherapy, tumor size, and primary pathological type were the independent factors affecting LTPFS. Additionally, 125I brachytherapy showed better performance in relieving patient clinical symptoms relative to EBRT (P<.05). Group A also had fewer complications than group B, especially regarding grade 3/4 complications according to Radiation Therapy Oncology Group grading criteria. Mean overall survival times in groups A and B were 17.1 and 14.8 months, respectively. CONCLUSION CT-guided 125I brachytherapy is feasible and safe for distant oral and maxillofacial metastases; it achieved a better local control rate, longer LTPFS and fewer complications without compromising overall survival compared with EBRT.
Collapse
|
10
|
Halpern MT, Urato MP, Kent EE. The health care experience of patients with cancer during the last year of life: Analysis of the SEER-CAHPS data set. Cancer 2016; 123:336-344. [PMID: 27654842 DOI: 10.1002/cncr.30319] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/02/2016] [Accepted: 08/05/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Providing high-quality medical care for individuals with cancer during their last year of life involves a range of challenges. An important component of high-quality care during this critical period is ensuring optimal patient satisfaction. The objective of the current study was to assess factors influencing health care ratings among individuals with cancer within 1 year before death. METHODS The current study used the Surveillance, Epidemiology, and End Results (SEER)-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data set, a new data resource linking patient-reported information from the CAHPS Medicare Survey with clinical information from the National Cancer Institute's SEER program. The study included 5102 Medicare beneficiaries diagnosed with cancer who completed CAHPS between 1998 and 2011 within 1 year before their death. Multivariable logistic regression analyses examined associations between patient demographic and insurance characteristics with 9 measures of health care experience. RESULTS Patients with higher general or mental health status were significantly more likely to indicate excellent experience with nearly all measures examined. Sex, race/ethnicity, and education also were found to be significant predictors for certain ratings. Greater time before death predicted an increased likelihood of higher ratings for health plan and specialist physician. Clinical characteristics were found to have few significant associations with experience of care. Individuals in fee-for-service Medicare plans (vs Medicare Advantage) had a greater likelihood of excellent experience with health plans, getting care quickly, and getting needed care. CONCLUSIONS Among patients with cancer within 1 year before death, experience with health plans, physicians, and medical care were found to be associated with sociodemographic, insurance, and clinical characteristics. These findings provide guidance for the development of programs to improve the experience of care among individuals with cancer. Cancer 2017;123:336-344. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Michael T Halpern
- RTI International, Research Triangle Park, North Carolina.,Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, Pennsylvania
| | | | - Erin E Kent
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| |
Collapse
|
11
|
Patel TD, Marchiano E, Chin OY, Kilic S, Eloy JA, Baredes S, Park RCW. Utility of Surgery/Radiotherapy in Distant Metastatic Head and Neck Squamous Cell Carcinoma: A Population-Based Approach. Otolaryngol Head Neck Surg 2016; 154:868-74. [PMID: 26884368 DOI: 10.1177/0194599815627637] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study is to analyze the survival benefits of surgery and/or radiation therapy over no therapy in patients with metastatic (M1) squamous cell carcinoma of the head and neck region (HN-SCC). STUDY DESIGN Retrospective administrative database analysis. SUBJECTS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried for M1 HN-SCC cases from 1988 to 2012 (6663 patients). Patient demographics, initial treatment, and survival outcomes were analyzed. Survival was analyzed with the Kaplan-Meier model. RESULTS Of the 6663 patients identified with M1 HN-SCC in the SEER database, 1669 patients received no therapy; 2459 patients, radiotherapy; 570 patients, surgery; and 1100 patients, surgery with adjuvant radiotherapy. The mean survival was 8.44 months for patients who did not undergo any therapy. In comparison, patients who underwent radiotherapy alone, surgery alone, or surgery with radiotherapy had mean survivals of 18.03 (P < .0001), 31.07 (P < .0001), and 39.93 (P < .0001) months, respectively. The 5-year disease-specific survival rates were 6.35% for no therapy, 17.51% for radiotherapy alone, 30.50% for surgery alone, and 33.75% for surgery with radiotherapy (P < .0001). Site-specific analysis revealed that surgery and/or radiation provides disease-specific survival benefit as compared with no therapy at all subsites within the head and neck region. CONCLUSIONS Surgery and/or radiation-which has been shown to improve quality of life in patients with advanced cancer-is associated with an increased survival when utilized in patients with distant metastatic disease.
Collapse
Affiliation(s)
- Tapan D Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Emily Marchiano
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Oliver Y Chin
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Suat Kilic
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| |
Collapse
|
12
|
Analysis of deaths between 2007 and 2012 of patients with cancer of the head and neck on a surgical ward at a regional centre and in an independent hospice. Br J Oral Maxillofac Surg 2015; 54:62-7. [PMID: 26611828 DOI: 10.1016/j.bjoms.2015.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/13/2015] [Indexed: 11/23/2022]
Abstract
Providing the best care for patients dying from cancer of the head and neck is crucial, and their complex, unpredictable needs, particularly at the end of life, mean that they are likely to die in institutional care. To evaluate the care given at the end of life we retrospectively reviewed the case notes of patients who died between 2007 and 2012 in a regional head and neck unit and a specialist palliative care unit (hospice). Deaths were categorised as sudden (rapid or unanticipated) or expected (gradual or anticipated). A total of 105 patients died, of whom 29 were excluded from analysis because records were missing. Of the remaining 76, 63 died in the head and neck unit and 13 in the hospice. Patients who died the hospice were younger (mean (SD) age 63.7 (11.0) years) than those who died in hospital (mean (SD) age 70.6 (11.9) years). Most had stage III or IV disease (head and neck unit 45/57, 79%, hospice 9/13, 69%). Death was sudden in 33 (43%) and expected in 43 (57%). Haemorrhage was the commonest cause of sudden death (n=13) and carcinomatosis (n=17) the commonest cause of expected death. Specialists in palliative care had been involved in the care of 13 patients who died suddenly (39%) and 34 whose deaths were expected (79%). The family was present at the time of death (or was aware of it) in 30 who died suddenly (91%) and in 40 (93%) whose deaths were expected. In patients with cancer of the head and neck death can be sudden because of unpredictable complications, and everyone should be aware of this.
Collapse
|
13
|
Shuman AG. Clinical Ethics in Otolaryngology: At the Bedside. EAR, NOSE & THROAT JOURNAL 2013. [DOI: 10.1177/014556131309200601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrew G. Shuman
- Head and Neck Service, Department of Surgery Memorial
Sloan-Kettering Cancer Center, and Division of Medical Ethics Weill Cornell Medical
College New York, New York
| |
Collapse
|
14
|
Shuman AG, McCabe MS, Fins JJ, Kraus DH, Shah JP, Patel SG. Clinical ethics consultation in patients with head and neck cancer. Head Neck 2012; 35:1647-51. [PMID: 23161591 DOI: 10.1002/hed.23204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2012] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe the impact of clinical ethics consultations among patients with head and neck cancer in order to better anticipate and manage clinical challenges. METHODS A database was queried to identify patients with head and neck cancer for whom ethics consultation was performed at a comprehensive cancer center (n = 14). Information from the database was verified via data abstraction and analyzed qualitatively and quantitatively. RESULTS Common requests for ethics consultation involved code status (6 of 14) and withdrawal/withholding life-sustaining treatments (6 of 14). Common contextual features were interpersonal conflicts (6 of 14) and communication barriers (5 of 14). Airway management concerns were frequent (5 of 14). Whereas 21% of patients had do not resuscitate (DNR) orders before ethics consultation, 79% were DNR subsequently. CONCLUSION Ethics consultations among patients with head and neck cancer reflect distinctive complexities inherent to their disease, but are entirely consistent with global clinical ethical themes. Consideration of communication barriers, social isolation/stigma, symptom control, and airway management are critical.
Collapse
Affiliation(s)
- Andrew G Shuman
- Head and Neck Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Ethics Committee, Memorial Sloan-Kettering Cancer Center, New York, New York; Division of Medical Ethics, Weill Cornell Medical College, New York, New York
| | | | | | | | | | | |
Collapse
|