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Buntval K, Dobrovolny HM. Modeling of oncolytic viruses in a heterogeneous cell population to predict spread into non-cancerous cells. Comput Biol Med 2023; 165:107362. [PMID: 37633084 DOI: 10.1016/j.compbiomed.2023.107362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 08/06/2023] [Accepted: 08/12/2023] [Indexed: 08/28/2023]
Abstract
New cancer treatment modalities that limit patient discomfort need to be developed. One possible new therapy is the use of oncolytic (cancer-killing) viruses. It is only recently that our ability to manipulate viral genomes has allowed us to consider deliberately infecting cancer patients with viruses. One key consideration is to ensure that the virus exclusively targets cancer cells and does not harm nearby non-cancerous cells. Here, we use a mathematical model of viral infection to determine the characteristics a virus would need to have in order to eradicate a tumor, but leave non-cancerous cells untouched. We conclude that the virus must differ in its ability to infect the two different cell types, with the infection rate of non-cancerous cells needing to be less than one hundredth of the infection rate of cancer cells. Differences in viral production rate or infectious cell death rate alone are not sufficient to protect non-cancerous cells.
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Affiliation(s)
- Karan Buntval
- SUNY Upstate Medical University, Syracuse, NY, United States of America; Department of Physics and Astronomy, Texas Christian University, Fort Worth, TX, United States of America
| | - Hana M Dobrovolny
- Department of Physics and Astronomy, Texas Christian University, Fort Worth, TX, United States of America.
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2
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Warsame R, Cook J, Fruth B, Hubbard J, Croghan K, Price KA, Jatoi A, Kumar S, Thompson C, Buckner J, Dispenzieri A, Sloan J, Dueck AC. A prospective, randomized trial of patient-reported outcome measures to drive management decisions in hematology and oncology. Contemp Clin Trials Commun 2022; 29:100964. [PMID: 35928285 PMCID: PMC9344350 DOI: 10.1016/j.conctc.2022.100964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Clinicians have limited time during patient encounters which can result in patients' concerns not being addressed. This study's objective was to test whether an electronic patient-reported outcome quality of life tool (PROQOL) in which patients identify their primary concern during clinic visits improves cancer patient quality of life (QOL). Patients and methods This single center non-blinded prospective clinical trial randomized patients (2:1) to PROQOL versus usual care (UC). Two patient cohorts were enrolled: those with hematologic malignancies (multiple myeloma [MM] or light chain amyloidosis [AL]) and solid tumors (head and neck [H/N] or gynecologic [GYN] malignancies). Primary endpoint was patient-reported QOL at 12 months measured by a single-item Linear Analog Self-Assessment. Value to patients and impact on clinician workflow was measured using a "was it worth it" survey. The study was powered to detect a 0.5 standard deviation difference between groups. Results Overall 383 patients were enrolled, 171 with MM, 62 AL, 113 GYN, and 37 H/N between July 2016 and April 2018, with 12-month follow-up. There were 171 (44.6%) male patients and median age was 62 years (range 31-87). The most often selected concern was physical health (30.9%), and second was cancer diagnosis and treatment (29.1%). Mean QOL was 7.12 for PROQOL and 6.98 for UC (0-10 scale) at 12 months, with no between-group difference overall (p = 0.56) or within hematologic or solid tumor cohorts, respectively. Among patients, 74% thought the PROQOL tool was worthwhile, 86% would choose PROQOL again, and 81% would recommend it to others. Among clinicians, 95% responded that PROQOL was worthwhile and did not think that PROQOL negatively impacted their workflow. Conclusions Although we did not demonstrate a QOL difference between PROQOL and UC groups; the PROQOL tool held considerable value in identifying patients' main concerns over time and was worthwhile for patients and clinicians.
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Affiliation(s)
- Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Patricia and Robert Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joselle Cook
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Briant Fruth
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Joleen Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Aminah Jatoi
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Jan Buckner
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Jeff Sloan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Amylou C. Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
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Barker CL, Price GJ, Lee LW, McPartlin A. Baseline MD Anderson Symptom Inventory Score is Strongly Associated With Patient-reported Acute and Late Toxicity Following (Chemo) Radiotherapy for Head and Neck Cancers. Clin Oncol (R Coll Radiol) 2022; 34:683-689. [PMID: 35688777 DOI: 10.1016/j.clon.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/07/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
AIMS Patient-reported outcomes measures (PROMs) are an increasingly recognised end point of radiotherapy studies. We hypothesised that the baseline PROMs score is the strongest predictor for acute and late scores after treatment. We assessed the strength of association of baseline MD Anderson Symptom Inventory (MDASI) scores, alongside other known factors for patient- or clinician-reported toxicity, with acute (6-week) and late (12-month) scores in head and neck cancer (HNC) patients following (chemo)radiotherapy. MATERIALS AND METHODS This was a retrospective analysis of longitudinal MDASI scores for 247 patients receiving (chemo)radiotherapy for HNC via multivariable linear regression. The factors investigated were: baseline symptom score, age, sex, concurrent chemotherapy, disease stage, radiotherapy fractionation, prior definitive surgery and performance status. Patients with a baseline score >4 in any item were defined as symptomatic in that category. RESULTS Patients rated symptomatic for an MDASI item pre-treatment on average reported statistically (P < 0.0005) and clinically (>-1.5) significant reductions in scores 6 weeks and 12 months after (chemo)radiotherapy for all considered sub-items except taste, dryness of mouth and problems with teeth. Conversely patients asymptomatic at baseline reported a worsening of scores at both time points. Other investigated factors showed little association with changes in MDASI scores following treatment. CONCLUSIONS Our data show that baseline MDASI scores are strongly associated with patient-reported toxicity 6 weeks and 12 months after (chemo)radiotherapy for HNC. Patients who are symptomatic at baseline can experience an early and durable benefit from treatment. This finding can inform discussions with patients before therapy and has implications for use of PROMs scores for the assessment of toxicity in randomised trials.
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Affiliation(s)
- C L Barker
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - G J Price
- Manchester Cancer Research Centre, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - L W Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A McPartlin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
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Duan Y, Huang X, Qiao B, Ma R, Li J. Eugenol inhibits the biological activities of an oral squamous cell carcinoma cell line SCC9 via targeting MIF. Anticancer Agents Med Chem 2022; 22:2799-2806. [PMID: 35331101 DOI: 10.2174/1871520622666220324105435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/30/2021] [Accepted: 01/19/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is a rampant cancer type in head and neck cancers with a poor prognosis and a high recurrence rate. Eugenol shows anticancer effect in a variety of cancers, but it has been rarely studied in oral squamous cell carcinoma (OSCC). OBJECTIVE Therefore, the purpose of this study was to explore the role of Eugenol in OSCC and the underlying mechanism. METHODS After different concentrations of Eugenol (0, 200, 400 and 800 μM) treatment, the viability, proliferation, migration and invasion of OSCC cell line SCC9 was measured by CCK-8, colony formation, wound-healing and transwell assays, respectively. TUNEL staining was employed to detect the apoptosis. Western blotting was used to evaluate gene expression at protein level. Molecular docking was used to identify the target of Eugenol. RESULTS Eugenol decreased the proliferation, reduced the abilities of invasion and migration along with the expression of matrix metalloproteinases (MMP) 2 and MMP9 in SCC9 cells. On the contrary, the ratio of apoptotic cells was increased by Eugenol. In addition, Eugenol down-regulated B cell lymphoma-2 (Bcl-2) expression, but up-regulated BCL-2 associated X (Bax), cleaved caspase 3 and cleaved poly-ADP ribose polymerase (PARP) expression. Meanwhile, Eugenol exerted its effect on SCC9 cells in a concentration-dependent manner. Eugenol could bind to macrophage migration inhibitory factor (MIF), the expression of which was down-regulated after Eugenol treatment. Besides, overexpression of MIF reversed all the effects of Eugenol on OSCC cells. CONCLUSION In summary, Eugenol suppressed the malignant processes of OSCC cells by targeting MIF, which could guide the clinical application of Eugenol in OSCC.
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Affiliation(s)
- Yao Duan
- Department of Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, 100101, China
| | - Xiaojin Huang
- Department of Traditional Chinese Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Bo Qiao
- Department of Stomatology, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100101, China
| | - Rui Ma
- Department of Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, 100101, China
| | - Jialin Li
- Department of Traditional Chinese Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
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Nallani R, Smith JB, Penn JP, Bur AM, Kakarala K, Shnayder Y, Villwock MR, Sykes KJ. Decision regret 3 and 6 months after treatment for head and neck cancer: An observational study of associations with clinicodemographics, anxiety, and quality of life. Head Neck 2021; 44:59-70. [PMID: 34704319 DOI: 10.1002/hed.26911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND While quality of life (QOL), psychosocial health, and adverse treatment outcomes have been studied in head and neck cancer (HNC) patients, decision regret is an important and understudied complication that can negatively impact future health care decision making. METHODS Data collected using a HNC patient registry with questionnaires administered at initial consultation visits plus 3 and 6 months after treatment completion was retrospectively analyzed. A visual analog anxiety scale and the University of Washington Quality of Life were given at clinic visits. Decision regret was determined using a validated scale. Demographic and clinical variables were collected retrospectively and at baseline. RESULTS Patients with higher anxiety and lower self-reported QOL had higher concurrent regret at 3-month (n = 140) and at 6-month (n = 82) post-treatment. Later disease stage at presentation, nonprimary surgical treatment, and lower health literacy were associated with greater regret. CONCLUSIONS Decision regret was highest in HNC patients with high anxiety, low QOL, and more advanced disease.
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Affiliation(s)
- Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joshua B Smith
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Joseph P Penn
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andres M Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mark R Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Dreidi M, Alrimawi I, Atout M. Evaluating the relationships between multiple symptoms; altered nutritional status, and their effects on the quality of life of patients diagnosed with cancer in Palestine: an explorative study. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1981566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mutaz Dreidi
- Nursing Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Ramallah, Palestine
| | - Intima Alrimawi
- School of Nursing and Health Professions, Trinity Washington University, Washington, DC 20017, USA
| | - Maha Atout
- Nursing School, Philadelphia University, Amman, Jordan
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Ossowski S, Kammerer A, Stram D, Piazza-DeLap L, Basch E, Katzel JA. Patient-Reported Outcomes Integrated Within an Electronic Medical Record in Patients With Head and Neck Cancer. JCO Clin Cancer Inform 2021; 5:842-848. [PMID: 34406801 DOI: 10.1200/cci.21.00058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patient-reported outcome (PRO) tools lead to clinical benefits, including improved overall survival for patients with cancer. However, routine implementation of PROs in clinical practice within the electronic medical record (EMR) by integrated health care delivery systems remains limited. We studied the use of a PRO tool for patients with head and neck cancer (HNC) integrated in an EMR at Kaiser Permanente in Northern California. METHODS Between August 2017 and December 2019, patients with newly diagnosed HNC were surveyed at baseline, then every 3 months using the Functional Assessment of Cancer Therapy-General 7 and Functional Assessment of Cancer Therapy-Head and Neck (version 4). A medical assistant performed a baseline survey on diagnosis and then notified patients electronically per surveillance protocol. Patients who did not respond to online PRO surveys could complete them via telephone or in-person appointments with medical assistants. Abnormal findings on PRO surveys were referred to appropriate members of the care team or the treating Otolaryngology-Head and Neck Surgery physicians. RESULTS Two hundred ninety patients received baseline surveys. Patients received up to a maximum of eight subsequent surveys. Of a total of 597 electronic surveys, 585 (97.9%) were completed. The percentage of patients completing each interval survey ranged from 92% to 100%. Multivariate Poisson regression analysis showed patients with English as their primary language and an online secure account were the most likely to complete surveys compared with those patients with non-English as a primary language and without an online account. CONCLUSION PRO tools can be effectively used within the EMR for patients with HNC with a high response rate provided there is strong engagement from a dedicated member of the care team. This has important implications for designing clinical trials and symptom monitoring in clinical practices that incorporate EMRs.
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Affiliation(s)
| | | | - Douglas Stram
- Division of Research, Kaiser Permanente, Oakland, CA
| | | | - Ethan Basch
- University of North Carolina, Chapel Hill, NC
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Eskander A, Sahovaler A, Shin J, Deutsch K, Crowson M, Goyal N, Witsell DL, Schulz K, Gross ND, Weber R, Khariwala SS, Cohen S, CyrLee DW, Mehta V. A preliminary assessment of guideline adherence and clinical variation in oral cancer treatment: a MarketScan database study. BMC Oral Health 2021; 21:270. [PMID: 34001080 PMCID: PMC8130137 DOI: 10.1186/s12903-021-01616-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients. METHODS Retrospective study using a U.S. healthcare research database (MarketScan). Index diagnoses were considered from 2010 to 2012 with follow-up from 2013 to 2014. Diagnostic and procedure codes were utilized to identify oral cavity patients with a defined treatment modality. Compliance with guideline-recommended processes of care, which included pre-treatment imaging, thyroid-function testing (TFTs), multidisciplinary consultation and gastrostomy-tube insertion rates, were assessed. RESULTS A total of 2752 patients were identified. Surgery alone was the most common treatment (60.8%), followed by surgery with adjuvant chemoradiotherapy (20.4%) and surgery with adjuvant radiotherapy (18.8%). Head/neck and chest imaging were obtained in 60% and 62.5% of patients respectively. Significant geographical differences in head and neck imaging were observed between North-central (64%), South (58.4%) and West (56.1%) regions (p = 0.026). Differences in chest imaging were also present between North-east (65%) and West (56.8%; p = 0.007). TFTs were obtained in 54.4% of the patients after radiation treatment, and 18.6% of patients had multidisciplinary consultation during the 6 months before and 3 months after initiation of treatment. During the year after treatment initiation, 21.2% of patients underwent G-tube placement, with significantly higher rates in patients receiving triple modality treatment (58%) when compared to surgery plus radiation (27%) and surgery alone (15%; p < 0.01). CONCLUSION Adherence to evidence-based practices was low based on the database coding. These data suggest a potential to improve adherence and increase the routine use of practices delineated in national clinical practice guidelines. CLINICAL RELEVANCE This study reflects a suboptimal adherence to guidelines based on the database employed. This study should be considered by healthcare providers and efforts should be maximized to follow the processes of care which have proven to impact on patient's outcomes.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, University of Toronto, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada.
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, University of Toronto, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada
| | - Jennifer Shin
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Konrado Deutsch
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, University of Toronto, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada
| | - Matthew Crowson
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre and the Odette Cancer Centre, University of Toronto, 2075 Bayview Ave., M1-102, Toronto, ON, M4N 3M5, Canada
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - David L Witsell
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Kristine Schulz
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Neil D Gross
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Randal Weber
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Seth Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Derek Walter CyrLee
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA.,Clinical Research Unit, Duke University, Durham, NC, USA
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, NY, USA
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Kamulegeya A, Nakanjako D, Orem J, Mayanja-Kizza H. Experiences of patients who developed oral mucositis during solid neoplasms treatment: a Ugandan qualitative study. J Patient Rep Outcomes 2021; 5:24. [PMID: 33677726 PMCID: PMC7937001 DOI: 10.1186/s41687-021-00301-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on the management of complications of chemotherapy is important in facilitating the growing approaches to individualized patient management. Hence the need to document patient's perspectives about chemotherapy-induced mucositis and the support they need from cancer care teams. METHODS We carried out a qualitative study using in-depth interviews (IDI) and focus group discussions (FGD). We collected patient's experiences on chemotherapy-induced mucositis by conducting 5 FGD and 13 IDIs. RESULTS One glaring improvement that we need to make is the provision of information and counseling before, during, and after chemotherapy. Additionally, we need to explore inexpensive mucositis preventive strategies to aid our patients as they undergo treatment. CONCLUSION As a country, we must move away from taking cancer patients' needs as those of common tropical diseases. This will allow us to provide that extra help needed outside the usual diagnosis and administration of medication.
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Affiliation(s)
- Adriane Kamulegeya
- Department of Dentistry, Oral maxillofacial unit, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Harriet Mayanja-Kizza
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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10
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Patient-reported outcome measures in patients undergoing radiotherapy for head and neck cancer. Support Care Cancer 2020; 29:2537-2547. [DOI: 10.1007/s00520-020-05778-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
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Symptom clusters in head and neck cancer patients with endotracheal tube: Which symptom clusters are independently associated with health-related quality of life? Eur J Oncol Nurs 2020; 48:101819. [PMID: 32937263 DOI: 10.1016/j.ejon.2020.101819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE The point of view of symptom clusters (SCs) may develop an efficient symptom management strategy to enhance health-related quality of life (HRQoL) in head and neck (HNC) patients with endotracheal tube (ETT). The study aims to investigate the possible SCs in HNC patients with ETT and determine whether there was an independent relationship between one or more SCs and HRQoL. METHODS A cross-sectional study design was adopted, and 203 HNC patients with ETT were recruited. They took measurements of General Information Questionnaire, MD Anderson Symptom Inventory-Head & Neck, and Twelve-Item Short-Form Health Survey (SF-12). Spearman correlations, partial correlations, and hierarchical cluster analysis were performed to determine latent number of SCs, and covariance analyses were used to determine independent associations between SCs and SF-12. This study followed STROBE Statement. RESULTS Pain SCs (pain, distressed, short of breath, and sadness), fatigue SCs (fatigue/weakness, restless, and sleepy), digestive SCs (appetite loss, constipation, and nausea), HNC-specific SCs (dry mouth and mucus), and tracheostomy-related SCs (difficulty swallowing and difficulty with voice and speech) were found. After adjusting covariant variables, this study found independent relationships of pain SCs and fatigue SCs with physical component summary of SF-12, and between fatigue SCs and mental component summary of SF-12. CONCLUSIONS Multiple SCs were found in those HNC patients. Pain SCs and fatigue SCs were independently associated with HRQoL. In process of caring HNC patients with ETT, it is vital to focus on SCs, especially on pain SCs and fatigue SCs, which might effectively improve patients' HRQoL.
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12
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Gutiérrez C, Mayrovitz HN, Naqvi SHS, Karni RJ. Longitudinal effects of a novel advanced pneumatic compression device on patient-reported outcomes in the management of cancer-related head and neck lymphedema: A preliminary report. Head Neck 2020; 42:1791-1799. [PMID: 32187788 PMCID: PMC7496342 DOI: 10.1002/hed.26110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 01/11/2020] [Accepted: 01/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background Head and neck cancer (HNC) survivors experience head and neck lymphedema (HNL), which requires treatment to prevent morbidity. We explore the self‐reported outcomes and satisfaction of patients with HNC receiving treatment for HNL with an advanced pneumatic compression device (APCD). Methods HNC survivors (n = 205) prescribed with an at‐home Flexitouch head and neck APCD completed pretreatment and posttreatment self‐reported assessments addressing efficacy, function, and symptoms. Participant average age was 60 years with 74% male. Pre‐post responses for ≥25 days of use were assessed via the non‐parametric Wilcoxon Signed Rank test. Results Analysis revealed statistically significant improvement in all symptoms and all function items (P < 0.00001). Compliance with prescribed therapy (at least 30 minutes daily) was high with 71% of participants reporting daily use and 87% reporting overall satisfaction. Conclusions The reported improvements in function and symptoms, and high compliance rate, provide a rationale for a subsequent randomized controlled trial.
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Affiliation(s)
- Carolina Gutiérrez
- Department of Physical Medicine & Rehabilitation, The University of Texas Health Science Center / McGovern Medical School, Houston, Texas.,Department of Otorhinolaryngology - Head & Neck Surgery, The University of Texas Health Science Center / McGovern Medical School, Houston, Texas
| | - Harvey N Mayrovitz
- Division of Physiology, Department of Medical Education, Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Syed Hassan Shiraz Naqvi
- Department of Otorhinolaryngology - Head & Neck Surgery, The University of Texas Health Science Center / McGovern Medical School, Houston, Texas
| | - Ron J Karni
- Division of Head & Neck Surgical Oncology, Department of Otorhinolaryngology - Head & Neck Surgery Division of Medical Oncology, The University of Texas Health Science Center / McGovern Medical School, Houston, Texas
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13
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Prevalence of sleep disturbances among head and neck cancer patients: A systematic review and meta-analysis. Sleep Med Rev 2019; 47:62-73. [DOI: 10.1016/j.smrv.2019.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 06/11/2019] [Accepted: 06/14/2019] [Indexed: 01/04/2023]
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14
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Sinha UK, Swanson MS, Villegas BC, Ouyoung LM, Kokot N. Outcomes of Self-Esophageal Dilation for Head and Neck Cancer Patients. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:1060-1066. [PMID: 31112391 DOI: 10.1044/2019_ajslp-18-0190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction Dysphagia is common following treatment for head and neck cancers, and self-esophageal dilation is a safe and effective treatment method. Prior studies on self-dilation have reported only qualitative results and included heterogeneous populations with dysphagia. The objective of this study is to quantitatively assess the safety and efficacy of a self-esophageal dilation program for patients with oropharyngeal squamous cell cancer with treatment-induced dysphagia. Materials and Methods This is a retrospective review of patients with oropharyngeal squamous cell cancer treated at the University of Southern California from 2009 to 2013 with dysphagia following radiation treatment that persisted after swallow therapy. The treatment program consisted of swallow therapy in conjunction with weekly self-esophageal dilation at home with increasing size bougie dilators. Oral intake was monitored using the Functional Oral Intake Scale (Crary, Mann, & Groher, 2005), Modified Barium Swallow Impairment Profile Pharyngoesophageal opening score, and Penetration-Aspiration Scale (Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996) pre- and posttreatment. Results Thirty-three patients met study criteria and completed the program. Twenty-five patients required nutrition via a gastrostomy tube prior to starting therapy, and 84% (21/25) of these patients were able to have the feeding tube removed. Median Functional Oral Intake Scale (Crary et al., 2005) predilation was 1 (range: 1-5), and postdilation was 6 (range: 3-6, p < .05). In addition, there was improvement of the Modified Barium Swallow Impairment Profile Pharyngoesophageal opening score from 2 to 1 after treatment (p < .05). No complications were encountered. Discussion Home self-dilation with concurrent swallowing therapy is a safe and feasible procedure to be used in motivated patients with dysphagia following head and neck cancer treatment.
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Affiliation(s)
- Uttam K Sinha
- Department of Otolaryngology-Head and Neck Surgery, Keck School Medicine of the University of Southern California, Los Angeles
| | - Mark S Swanson
- Department of Otolaryngology-Head and Neck Surgery, Keck School Medicine of the University of Southern California, Los Angeles
| | - Brenda Capobres Villegas
- Department of Otolaryngology-Head and Neck Surgery, Keck School Medicine of the University of Southern California, Los Angeles
| | - Laishyang Melody Ouyoung
- Division of Speech Pathology, Keck Medical Center of the University of Southern California, Los Angeles
| | - Niels Kokot
- Department of Otolaryngology-Head and Neck Surgery, Keck School Medicine of the University of Southern California, Los Angeles
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Fazer C. Checkpoint Inhibitor Immunotherapy for Head and Neck Cancer: Incorporating Care Step Pathways for Effective Side-Effect Management. J Adv Pract Oncol 2019; 10:37-46. [PMID: 33014516 PMCID: PMC7522658 DOI: 10.6004/jadpro.2019.10.2.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The introduction of immunotherapy to treat recurrent/metastatic head and neck squamous cell carcinoma in 2016 has provided new valuable treatment options to many cancer patients. Pembrolizumab and nivolumab, which are classified as immune checkpoint inhibitors of programmed cell death protein 1, have shown clinically significant activity in patients who progressed on or after platinum-based regimens, and these agents are now US Food and Drug Administration approved for this indication. These treatments can result in unique immune-related adverse events (irAEs) that many health-care providers have difficulty identifying and managing. This article addresses the important role advanced practice providers play in a care team. Their experience is vital to managing the irAEs that can occur in patients being treated with immunotherapy agents. Their early experience with these newer therapies allows them to help educate and support not only patients but other health-care providers as well. The Care Step Pathways (CSPs) created as part of the Immuno-Oncology Essentials initiative are excellent tools to help with the diagnosis and management of many irAEs. This article summarizes the CSPs on specific considerations when managing thyroiditis, mucositis/xerostomia, skin toxicities, and hepatotoxicity, and addresses the special concerns of the head and neck squamous cell carcinoma population.
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