Evaluation of the quality of life of patients with oral cancer in Brazil

Impact of photobiomodulation for prevention of oral mucositis on the quality of life of patients with head and neck cancer: a systematic review

The aim of this study was to perform a systematic review to evaluate the impact of photobiomodulation therapy (PBMT) for the prevention of oral mucositis (OM) on the quality of life (QoL) of patients with head and neck cancer (HNC) undergoing radiation therapy. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search strategy was performed in five electronic databases (Cochrane, Embase, PubMed, Scopus, and Web of Science). The included studies assessed the QoL of patients undergoing radiation therapy (RT) for HNC and undergoing PBMT for the management of OM. Seven articles met the eligibility criteria. Data extraction was performed in the selected studies including the PBMT parameters (active medium, application procedure, wavelength, fluence, power, irradiance, irradiation time, spot size, energy per point, schedule of irradiation, and total energy). The included studies were qualitatively analyzed, and descriptive analyses were performed. Also, summary results were evaluated for group comparison analysis. All included studies confirmed a decrease in the QoL of the patients that developed OM throughout the RT progress when compared to baseline. Of the informed cases, most of the patients who received PBMT showed grades 1 and 2 OM, while the control group showed more individuals with severe forms of OM (grades 3 and 4). In this sense, patients submitted to PBMT reported better QoL at the end of the treatment compared with the control group. PBMT used for the management of OM preserves the QoL of patients with head and neck cancer.

Quality of life in patients surgically treated for oral carcinoma

Background/Aim: The aim of this study was to examine quality of life in patients who were surgically treated for oral carcinoma. Material and Methods: The study included patients surgically treated over a 3-year period (2014-2016). Data on patients, tumor type and localization, disease status according to the TNM classification, type of surgical intervention and time since surgery were collected from the medical records. Postsurgery functional and aesthetic results were evaluated using the adapted University of Washington Quality of Life questionnaire. Results: Forty patients were included in the study. Male patients were more prevalent (27 vs 13) (ch2=4.225p<0.05). Ratio of planocellular vs adenocarcinoma was 35 vs 5 (ch2=11.404, p=0.0007, a=0.05). Osteotomy was performed in 52.5% of patients, and surgical intervention in the soft tissue was performed in 47.5%. Patients who had recovered >1 year showed better mood (MannWhitney test, p=0.036, a=0.05), functions of speech (Mann-Whitney test p=0.008, a=0.05) and chewing (Mann-Whitney test p=0.04, a=0.05), as well as patients who had soft tissue surgery (chewing: Mann-Whitney test p=0.016, a=0.05; speech: Mann-Whitney test p=0.043, a=0.05). Patients with T1 stage tumors considered their looks less disfigured and had fewer problems in appearing in public, compared with patients with T3 and T4 stage (Dunn's test, CI -95%). Interest in sex was significantly diminished in patients older than 30 years (Kruskal-Wallis testa (p=0.013, a=0.05). Conclusions: The stage of disease, range of resection and success of reconstruction were decisive parameters for postoperative quality of life. Early detection of disease is of utmost importance for both survival and quality of life of patients with carcinoma.

Quality of Life in Oral Cancer Patients in Greek Clinical Practice: A Cohort Study

Cancer of the oral cavity is one of the most common cancers all over the world. Oral cancer and its treatment impacts on patients' Quality of Life (QOL). The purpose of the present study was to assess oral cancer patients' QOL after the completion of surgical therapy, and to investigate factors affecting it. This was a prospective cohort study, conducted at the Department of Oral & Maxillofacial Surgery, of a large general public hospital in Northern Greece. The sample consisted of 135 consecutive eligible cancer patients. Three distinct questionnaires were used. The first one included questions regarding the participants' demographic characteristics and relevant clinical information. The second comprised the European Organization for Research and Treatment core module (EORTC QLQ-C30) and its head and neck module EORTC QLQ-H&N35. The third was the Functional Assessment of Cancer Therapy-General (FACT-G) assessment of quality of life. We also included the physician-completed Karnofsky scale to assess the functional status of the participants. We found that location of the tumor affects QOL and specifically social contact (H = 17.89, p = 0.001), on the first assessment, and nutritional supplements (H = 22.49, p = 0.000), on the fourth assessment. QOL in patients deteriorates immediately after treatment but significantly improves over time. Health care professionals should take into account these results and arrange care plans in order to find ways to increase patients' QOL.

Reabilitação Oral com Prótese Obturadora em Comunicação Buconasal após Ocorrência de Carcinoma de Células Escamosas: Relato de Caso

Introdução: O tratamento de neoplasia maligna pode consistir em ampla excisão cirúrgica. Em alguns casos, em razão do tratamento agressivo na remoção do tumor, há grande comprometimento das estruturas intrabucais. Assim, próteses são utilizadas para a obturação da cavidade maxilar, possibilitando a reconstrução da região afetada, juntamente com a reabilitação oral. Relato do caso: Paciente de 53 anos de idade, sexo feminino, ex-tabagista e ex-etilista, apresentou diagnóstico de carcinoma de células escamosas na região de palato mole, sendo necessária cirurgia de ressecção transoral associada à radioterapia. Após aproximadamente um ano, a paciente retornou com nova lesão em palato, que novamente evidenciou carcinoma de células escamosas, sendo necessária nova cirurgia de ressecção transoral. Após dois anos, a paciente retornou ao Departamento de Odontologia a fim de receber o tratamento reabilitador, pois a prótese parcial removível superior era provisória, não substituía todos os dentes ausentes e não obtinha adaptação adequada à comunicação buconasal. Foi realizado tratamento reabilitador definitivo com prótese parcial removível superior e com prótese total no rebordo residual inferior. Conclusão: A necessidade do acompanhamento odontológico nos casos de ocorrência de carcinoma de células escamosas oral bem como a importância do tratamento reabilitador e suas técnicas contribuem para a autoestima e a qualidade de vida do paciente.

Quality of Life in Patients With Tongue Cancer After Surgical Treatment: A 12-Month Prospective Study

Aim of the study The project assessed the quality of life in post-operative patients with tongue cancer at three-month intervals in the first year after the operation. Material and methods A longitudinal prospective cohort study was conducted in the oral and maxillofacial department of a large public general hospital in northern Greece. Fifty-six patients out of a total of 156 with oral cancer were chosen for the study, who completed distinct quality-of-life surveys (EORTC QLQ-C30, and QLQ Head & Neck Module FACT-G). Results Tumor size correlated negatively with various EORTC QLQ-C30 scores, such as role functioning (p = 0.004) and cognitive functioning (p = 0.007), in the third evaluation. Tumor size correlated positively with subscale problems such as social eating (p = 0.001) and weight loss (p = 0.004) in the QLQ Head & Neck Module. The role functioning subscale (p = 0.003), the pain subscale (p = 0.001), and the speech issues QLQ Head & Neck module subscale (p = 0.003) adversely correlated with cancer stage. Patients who received flap reconstruction significantly differed from those who did not, on the EORTC QLQ-C30 cognitive functioning (U = 139.0, p = 0.006), dyspnea (U = 391.5, p = 0.006), and diarrhea (U = 425.0, p = 0.007) subscales during the third evaluation. Differences were also found in the QLQ-H&N35 subscale of sticky saliva (U = 391.0, p = 0.006). Patients with flap reconstruction did not significantly differ from those with immediate closure after one year. Differences concerned the EORTC QLQ-C30 subscales of cognitive functioning, dyspnea, and diarrhea, and the QLQ Head & Neck Module subscale of sticky saliva on the third assessment. No statistically significant correlations were observed between tumor size and cancer stage in the fourth assessment, but the grade of cancer positively correlated with the EORTC QLQ-C30 subscale of constipation (p = 0.000). Conclusions Our study suggests that quality of life is impaired in patients with tongue cancer who have undergone surgical interventions, particularly within the first month post-operation. However, quality of life is fully restored one year after the surgical excision. Future studies should explore early interventions to help healthcare providers better treat this unique group of patients.

Effectiveness of photodynamic therapy on treatment response and survival of patients with recurrent oral squamous cell carcinoma: a systematic review protocol

OBJECTIVE

This review aims to systematically examine the effectiveness of photodynamic therapy for the treatment of patients with recurrent oral squamous cell carcinoma.

INTRODUCTION

Oral squamous cell carcinoma is a significant public health problem, and is the seventh most common cancer. Its incidence is mainly due to tobacco use, alcohol consumption, and HPV infection. The survival rates are poor due to diagnosis at advanced stages, with high recurrence rates. Although current evidence does not point to photodynamic therapy as a first-line option, this treatment might be suitable for treating recurrent stages of the cancer where conventional treatments were ineffective. Despite the potential of photodynamic therapy, there is a need to verify the scientific evidence to support its indication for the treatment of recurrent oral squamous cell carcinoma.

INCLUSION CRITERIA

This review will consider studies on any stage of recurrent oral squamous cell carcinoma treated with photodynamic therapy after receiving first-line conventional treatments. Patients of any age, gender, and geographic location will be included. The primary outcomes will be to evaluate response to treatment, focusing on remission, recurrence, change in size of the lesion, alleviation of symptoms, and survival. Secondary outcomes will be postoperative complications, presence of necrosis, patient quality of life after treatment, and patient satisfaction.

METHODS

Studies will be searched using a combination of index terms and keywords in MEDLINE, Cochrane Central, Web of Science, Embase, and ClinicalTrials.gov. No date limits will be applied. Articles written in English, French, Spanish, or Portuguese will be considered. Findings will be provided as a narrative synthesis, structured around the photodynamic therapy protocol used. A meta-analysis is planned and subgroup analysis will be conducted if possible. The certainty of findings will be assessed.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020141075.

Quality of life and survival rate after primary surgical treatment of oral squamous cell carcinoma: A retrospective study with 18 years of follow-up

The aim of this study is to evaluate the long-term survival rates and assess the long-term quality of life (QoL) of patients treated for oral squamous cell carcinoma (OSCC). Patients, who underwent primary surgical tumor resection for OSCC at a single hospital center in Germany between 1998 and 2016, were eligible for inclusion in this analysis of survival rates and QoL parameters. The University of Washington-QoL version 4 (UW-QoL v4) questionnaire was administered to the patients in the years 2015 and 2016. The cases of 145 patients with the histological diagnosis of OSCC were included in this study. Despite a common distribution of tumor stage, the 1-year survival rate was 88.0% and the 5-year survival rate was 70.0%. The QoL questionnaire item, 'pain' (84) was selected most frequently. Chewing (50) and swallowing (58) yielded the lowest score. Chewing and swallowing impairment correlated significantly with an increase in tumor size, higher tumor stages, and the use of radio (chemo-)therapy (p < 0.001). In this retrospective study, patients reported significant long-term dysphagia and difficulty chewing. These parameters should be investigated in prospective studies to evaluate methods that could reduce the risk of suffering from these impairments.

The impact of sentinel lymph node biopsy on the quality of life in patients with oral cavity squamous cell carcinoma

INTRODUCTION

Sentinel lymph node biopsy is a proven method for staging the neck in patients with early oral cavity squamous cell carcinoma because it results in less comorbidity than the traditional method of selective neck dissection, with the same oncological results. However, the real effect of that method on the quality of life of such patients remains unknown.

OBJECTIVE

The present study aimed to evaluate the quality of life of patients with oral cavity squamous cell carcinoma T1/T2N0 submitted to sentinel lymph node biopsy compared to those that received selective neck dissection.

METHODS

Cross-sectional study including 24 patients, after a 36 month follow-up, 15 of them submitted to the sentinel lymph node biopsy and 9 to selective neck dissection. All patients answered the University of Washington quality of life questionnaire.

RESULTS

The evaluation of the questionnaires showed a late worsening of the domains appearance (p=0.035) and chewing (p=0.041), as well as a decrease of about 10% of general quality of life (p=0.025) in patients undergoing selective neck dissection ​​in comparison to those undergoing sentinel lymph node biopsy.

CONCLUSION

Patients with early-stage oral cavity squamous cell carcinoma undergoing sentinel lymph node biopsy presented better late results of general quality of life, mainly regarding appearance and chewing, when compared to patients submitted to selective neck dissection.

Quality of life among Oral Potentially Malignant Disorder (OPMD) patients: A prospective study

Objective

The purpose of this study was to evaluate the quality of life among the Oral Potentially Malignant Disorder (OPMD) patients during diagnosis, at one month and 3 months after intervention (surgical or conservative).

Methods

The University of Washington Quality of Life version (4UWQOL v4) and World Health Organization (WHO-BREF) were repeatedly administered on 54 OPMD patients.

Results

The results of Friedman's ANOVA showed a statistically significant change in the mean scores for pain, activity, speech, shoulder, taste, saliva, mood, and anxiety domains of UWQOL with time, (p-value <0.05); while physical health, social relationships, environment domains of WHO- BREF have shown significant changes in their respective mean scores.

Conclusion

The assessment of Quality of Life (QOL) should routinely be done by the clinicians. If the clinicians start considering the QOL as the primary outcome of a treatment protocol, it will enhance patients' identity, well-being, and personality.

Translation and cross-cultural adaptation of the Thyroidectomy-Related Voice Questionnaire (TVQ) to Brazilian Portuguese

PURPOSE

To translate and cross-culturally adapt the Thyroidectomy-Related Voice Questionnaire (TVQ) to Brazilian Portuguese.

METHODS

We divided the process of translation and cross-cultural adaptation into the following stages: two independent translations; synthesis of the translations; analysis by an expert committee; pretest; back-translation; final synthesis; and final version. We performed the pretest with 20 patients before or after thyroidectomy. We characterized the sample by means of descriptive analysis, and calculated the agreement between the experts by the Item Content Validity Index (I-CVI) and the Questionnaire Content Validity Index (Q-CVI).

RESULTS

Throughout the translation and cross-cultural adaptation, the instrument required operational, semantic, idiomatic, and syntactic/grammatical equivalences, especially after the analyses by the experts and the target population. The I-CVI and Q-CVI were mostly acceptable. The back-translation was equivalent to the original version. The comparison between the original, translated, and back-translated versions made possible the final version.

CONCLUSION

We translated and adapted the TVQ to Brazilian Portuguese. The questionnaire is suitable for the next steps of the validation process.

Assessment of Factors Affecting Quality of Life in Oral Squamous Cell Carcinoma Patients Using University of Washington Quality of Life Questionnaire

Introduction

Post-treatment Quality of Life (QOL) is considered an important outcome in cancer patients. A number of questionnaire tools have been designed for its assessment. University of Washington Quality of Life (UW QOL) questionnaire version four is a reliable tool for assessment of post-treatment QOL in oral squamous cell carcinoma (OSCC) patients. Our aim was to identify the post-treatment problems faced by OSCC patients and to assess the impact of clinical factors affecting post-treatment QOL by using UW QOL (version four) questionnaire.

Methods

The study was conducted on 59 patients with OSCC who were treated with curative intent at Patel Hospital, Karachi from August 2015 to September 2015. Patients were asked to fill the UW QOL questionnaire (version four) on their follow-up visit.

Results

Overall mean composite QOL score was 66.59 ± 16.98. Chewing and saliva (dryness of mouth) had the lowest scores (38.98 ± 37.2 and 56.78 ± 41.4, respectively) among all domains while pain and anxiety had the highest scores (80.93 ± 20.4 and 79.66 ± 29.8, respectively). Patients having tumors of the tongue, late stage (III and IV) tumors, and restricted mouth opening had significantly lower mean composite QOL scores. Patients with tongue tumors revealed significantly lower scores for pain, swallowing, mood, and anxiety. Patients with late-stage tumors showed significantly lower scores for chewing, swallowing, taste, saliva, appearance, anxiety, and recreation. Patients with restricted mouth opening had significantly lower scores for pain, speech, appearance, recreation, and anxiety domains.

Conclusion

Different clinical features have different impacts on QOL in terms of problems faced by the patients. Features having a significant effect should be identified, and measures focused on most relevant problems should be employed in order to improve the post-treatment QOL.

Oral health-related quality of life in patients treated for oral malignancy at Kanchipuram district, India: A cross-sectional study

BACKGROUND

The modern-day onco-surgical therapy is now concerned on the overall Quality of Life after treatment of the patient. There is need to evaluate final outcome following the different combination of treatment modalities available to make better therapeutic treatment decisions.

AIM

The aim of this study was to assess Oral health related quality of life (OHRQoL) in patients with oral malignancies who had undergone various treatments.

SETTINGS AND DESIGN

A Cross sectional study was conducted among 90 patients between October 2016 to January 2017 in private hospitals, kanchipuram, India.

MATERIALS AND METHODS

Participants were grouped based on the treatment they had undergone into Group I - Surgery alone, Group II - Surgery and Radiotherapy, Group III- Surgery, chemotherapy and radiotherapy and assessed for OHRQoL using the shorter version of Oral health impact profile -14 (OHIP-14) questionnaire.

STATISTICAL ANALYSIS

Descriptive analysis of socio demographic variables and OHIP 14 was performed using Chi-square test and one way ANOVA.

RESULTS

Among the 90 participants, 43.3% belonged to upper lower class and 38.3% to lower class. Buccal mucosa (58.9%) was found to be the most frequent site. Among the clinical staging, Stage II (33.33%) oral cancer was more prevalent. No statistically significant differences in the OHIP mean score for Groups, I, II, III. Among the domains functional limitation was significantly different in the three groups.

CONCLUSION

Patients with oral malignancies who had been treated surgically alone had better Quality of life when compared to the combined treatment modalities.

Health-related quality of life of patients with squamous cell carcinoma: a comparison according to tumor location

The aim of this study was to evaluate the health-related quality of life (QOL) of patients with squamous cell carcinoma (SCC) according to tumor location. The sample consisted of 27 patients with primary SCC in the oral cavity (n = 15), pharynx (n = 7), and larynx (n = 5) who were undergoing cancer treatment at the Cancer Hospital of Londrina, regardless of age, sex, clinical stage, and type of antineoplastic treatment. Health-related QOL was evaluated using the 30-item Cancer-Quality of Life Questionnaire (QLQ-C30), the 35-item Head and Neck Cancer-Quality of Life Questionnaire (QLQ-HN35), and the University of Washington Quality of Life Questionnaire (UW-QOL). These questionnaires were administered individually to each patient before ambulatory care. Sociodemographic data (age and sex) and clinical data (T stage, tumor location, and type of antineoplastic treatment) were collected from the patients' medical records. Scores were compared according to tumor location using the chi-squared test and one-way analysis of variance (p < 0.05). No score differed significantly according to tumor location. It can be concluded that the health-related QOL of patients with SCC was not influenced by tumor location.

Prospective Evaluation of Quality of Life in Patients Undergoing Primary Surgery for Oral Cancer: Preoperative and Postoperative Analysis

Background:

The purpose of the present study was to compare the preoperative and postoperative health related quality of life (HRQoL) of a sample of patients undergoing primary surgery for oral cancer in 2012-13.

Materials and Methods:

A cross-sectional, prospective study of 54 patients in a Brazilian population was performed. HRQoL was measured preoperatively (after histopathological diagnosis) and postoperatively (2 months after surgery) using the University of Washington Quality of Life Questionnaire (UW-QOL). Clinicopathological, sociodemographic and lifestyle data were collected.

Results:

Surgery had a negative impact on most HRQoL domains, but pain, mood and anxiety scores were significantly improved. Most patients rated their health-related and overall postoperative HRQoL as good or very good.

Conclusions:

The UW-QOL was efficient at measuring HRQoL in our sample of patients with oral cancer. Surgery had a negative impact on HRQoL, especially due to sequelae affecting the stomatognathic system, yet patients classified their postoperative health-related and overall QoL as positive. Qualitative studies are necessary for confirmation of our results and further exploration.

Association between general and oral health-related quality of life in patients treated for oral cancer

Background

Less is known about the association between general health-related quality of life (HRQoL) and oral HRQoL (OHRQoL) among patients with specific diseases. The aim of this study was to assess the association between patient-centered outcome measurements (HRQoL and OHRQoL) of oral cancer patients at least 6 months after treatment.

Material and Methods

HRQoL was measured with the 12-Item Short Form Health Survey (SF-12); OHRQoL was evaluated using the Oral Health Impact Profile (OHIP-14) and the Oral Impacts on Daily Performances (OIDP).

Results

Higher OHRQoL scores were associated with lower SF-12 domains scores. The OHIP-14 explained 16.5 % of the total variance of SF-12 Physical Component Summary (PCS) and the OIDP explained 16.1 %. In the SF-12 Mental Component Summary (MCS), the total variance explained was 23.9 % by the OHIP-14 and 21.8 % by the OIDP.

Conclusions

There was a significant association between long-term OHRQoL and HRQoL in oral and oropharyngeal cancer patients. These results may help to carry out new interventions aiming to improve patient´s life overall.

Key words:Mouth neoplasms, quality of life, health status, oral health.

Translation and cross-cultural adaptation into Brazilian Portuguese of the Vanderbilt Head and Neck Symptom Survey version 2.0 (VHNSS 2.0) for the assessment of oral symptoms in head and neck cancer patients submitted to radiotherapy

Introduction

Patients submitted to radiotherapy for the treatment of head and neck cancer have several symptoms, predominantly oral. The Vanderbilt Head and Neck Symptom Survey version 2.0 is an American tool developed to evaluate oral symptoms in head and neck cancer patients submitted to radiotherapy.

Objective

The aim of the present study was to translate the Vanderbilt Head and Neck Symptom Survey version 2.0 into Brazilian Portuguese and cross-culturally adapt this tool for subsequent validation and application in Brazil.

Methods

A method used for the translation and cultural adaptation of tools, which included independent translations, synthesis of the translations, back-translations, expert committee, and pre-test, was used. The pre-test was performed with 37 head and neck cancer patients, who were divided into four groups, to assess the relevance and understanding of the assessed items. Data were submitted to descriptive statistical analysis.

Results

The overall mean of the content validity index was 0.79 for semantic and idiomatic equivalence, and it was higher than 0.8 for cultural and conceptual equivalence. The cognitive interview showed that patients were able to paraphrase the items, and considered them relevant and easily understood.

Conclusion

The tool was translated and cross-culturally adapted to be used in Brazil. The authors believe this translation is suited for validation.

Greater access to information on how to prevent oral cancer among elderly using primary health care

Educative actions are an important component of health promotion in Brazil's primary healthcare program, the Family Health Strategy (FHS). The efficacy of these actions is evidenced by compliance with healthy behaviors and in the reduction of rates of mortality and morbidity. The objective of this study was to identify whether access to information regarding the prevention of oral cancer is greater among elders whose residences are registered with the FHS. SPSS® was utilized to obtain estimates that were corrected for sample design, considering the magnitude of the associations between access to such information with personal determinants, the use and cost of healthcare, health-related behaviors and health outcomes. 58.9% of the 492 participating elders reported having access to such information. We verified that there was a greater chance for access among residents of houses registered by the FHS; those with greater per capita income (2.01/1.183.43); non-smokers (2.00/1.16-3.46); those that realized oral self-examination (6.35/3.46-11.64); and those that did not perceive discomfort in the mouth, head or neck (2.06/1.02-4.17). Access was greater among residents of homes registered by the FHS. Personal determinants of health, health-related behaviors and health outcomes are influenced or influence access to information regarding the prevention and management of oral diseases.

Quality of life associated factors in head and neck cancer patients in a developing country using the FACT-H&N

Health-related quality of life (HRQoL) associated factors are vital considerations prior to treatment decision-making for head and neck cancer patients. The study aimed to identify potential socio-demographic and clinical prognostic value of HRQoL in head and neck cancer patients in a developing country. The Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N)-V4 in Urdu language was administered among 361 head and neck cancer patients. Data were statistically tested through multivariate analysis of variance (MANOVA) and regression modeling to identify the potentially associated factors. Treatment status, tumor stage and tumor site had the strongest negative impact on patients HRQoL, with a statistically significant decrement in FACT summary scales (effect size >0.15). Moderate associated factors of HRQoL included treatment type, marital status, employment status and age (effect size range 0.06-0.15). Weak associated factors of HRQoL with a small effect size (>0.01-0.06) included tumor size and type, gender, education level and ethnicity. This study reports 12 socio-demographic and clinical variables that have a significant impact on HRQoL of head, and neck cancer patients, and that should be considered during treatment decision-making by multidisciplinary teams and also in future HRQoL studies conducted in other developing countries.

Levels of scientific evidence of the quality of life in patients treated for oral cancer

Treatments used in cancer of the oral cavity have great impact on the physical, psychological and functional state of patients. There has been increasingly interest in evaluating the health-related quality of life using questionnaires among patients treated with oral cancer. Up to our knowledge no review on this theme has incorporated the level of evidence of the single identified studies. The objective of the present study is to determinate results and conclusions about the health-related quality of life of these patients, in view of scientific evidence. In general, the diversity of designs, level of evidence and questionnaires used for their assessment does not affect results, which indicate a decline in the health related quality of life after treatment. This decline is greater when the tumor is large in size, and when radiotherapy is used, though the situation is seen to improve over the span of a year. Questionnaires on health-related quality of life provide concrete information regarding the impact of cancer treatment on patients.

Validade discriminante do questionário de qualidade de vida da Universidade de Washington no contexto brasileiro

OBJETIVO: Avaliar a validade discriminante do questionário de qualidade de vida da Universidade de Washington para pacientes com câncer de cabeça e pescoço e identificar possíveis fatores sociodemográficos que modifiquem seus resultados. MÉTODOS: Foram entrevistados 47 pacientes com câncer de boca e orofaringe em estágio pré-cirúrgico em um hospital no sul do município de São Paulo em 2007, e 141 pacientes sem câncer, pareados por sexo e idade em uma proporção de três para um, que foram atendidos em ambulatórios do mesmo hospital em 2008. Os resultados obtidos para os dois grupos foram comparados pelo teste t de Student. Para os pacientes sem câncer utilizou-se análise de regressão de Poisson para avaliar possíveis fatores de modificação da qualidade de vida. RESULTADOS: O escore geral de qualidade de vida foi significantemente mais elevado (p < 0,001) para os pacientes sem câncer (91,1) do que para os pacientes com câncer (80,6). Observações análogas foram efetuadas para oito dos doze domínios de qualidade de vida compreendidos no questionário (dor, aparência, deglutição, mastigação, fala, ombros, paladar e ansiedade). Como possíveis fatores de modificação dos escores de qualidade de vida foram identificados renda familiar (com impacto nos domínios de recreação, p = 0,017, e função dos ombros, p = 0,049), escolaridade (em ansiedade, p = 0,003), sexo (em função dos ombros, p = 0,038) e dor de dente (em mastigação, p = 0,015). CONCLUSÕES: O questionário tem validade discriminante, pois seus escores são especificamente mais afetados para pacientes com câncer. Reforça-se a indicação do questionário para monitorar o tratamento e recomenda-se avaliar os fatores que podem causar impacto nesses indicadores.

Effect of intraoral low-level laser therapy on quality of life of patients with head and neck cancer undergoing radiotherapy

BACKGROUND

Low-level laser therapy has been used to reduce complications of head and neck cancer treatment. The aim was to assess the impact of laser in the quality of life (QOL) of patients receiving radiotherapy.

METHODS

Sixty outpatients were randomly assigned into 2 groups. The laser group received applications and the placebo group received sham laser. QOL was assessed using the University of Washington QOL questionnaire. A repeated-measures analysis of variance (ANOVA) was used for comparisons of overall QOL scores and Mann-Whitney test compared changes in domain scores.

RESULTS

A decrease in QOL scores was observed in both groups and the reduction in the laser group was significantly lower (p < .01). Changes in QOL scores regarding pain, chewing, and saliva domains were evident in the placebo group. Both health-related QOL and overall QOL were rated higher by patients who received laser therapy.

CONCLUSION

Laser therapy reduces the impact of radiotherapy on the QOL of patients with head and neck cancer.

A structured review of journal articles reporting outcomes using the University of Washington Quality of Life Scale

The University of Washington Quality of Life Scale (UW-QoL) is one of the most frequently reported health-related quality of life (HR-QoL) questionnaires in head and neck cancer, and since its first publication in 1993 has been used in many different cohorts. There is a considerable amount of information to assimilate and, to date, we know of no attempt that has been made to summarise publications specific to its use in a peer review journal. The aim of this review was to systematically search published papers that report its use, identify common themes, and present a tabulated summary. Several search engines were used (PubMed, Medline, Medical-Journals.com, eMedicine), and 222 abstracts were found and hand searched. A total of 66 papers were eligible for inclusion, 21 on functional outcome, 25 on predictors of HR-QoL, 19 on development or validation of the questionnaire, and one clinical trial. The review includes a diversity of studies and a range of HR-QoL outcomes following head and neck cancer. It provides clinicians and their colleagues in multidisciplinary teams with a source of quick reference to relevant papers reporting the UW-QoL, and gives a short summary of the pertinent conclusions drawn from each paper.

Survival and quality of life of patients with oral and oropharyngeal cancer at 1-year follow-up of tumor resection

OBJECTIVE

This study aimed to assess the survival and life quality evolution of patients subjected to surgical excision of oral and oropharyngeal squamous cell carcinoma.

MATERIAL AND METHODS

Forty-seven patients treated at a Brazilian healthcare unit specialized in head and neck surgery between 2006 and 2007 were enrolled in the study. The gathering of data comprised reviewing hospital files and applying the University of Washington Quality of Life (UW-QOL) questionnaire previously and 1 year after the surgery. Comparative analysis used Poisson regression to assess factors associated with survival and a paired t-test to compare preoperative and 1-year postoperative QOL ratings.

RESULTS

1 year after surgery, 7 patients were not found (dropout of the cohort); 15 had died and 25 fulfilled the UW-QOL again. The risk of death was associated with having regional metastasis previously to surgery (relative risk=2.18; 95% confidence interval=1.09-5.17) and tumor size T3 or T4 (RR=2.30; 95%CI=1.05-5.04). Survivors presented significantly (p<0.05) poorer overall and domain-specific ratings of quality of life. Chewing presented the largest reduction: from 74.0 before surgery to 34.0 one year later. Anxiety was the only domain whose average rating increased (from 36.0 to 70.7).

CONCLUSIONS

The prospective assessment of survival and quality of life may contribute to anticipate interventions aimed at reducing the incidence of functional limitations in patients with oral and oropharyngeal cancer.