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Kim EJ, Koo YR, Nam IC. Towards the Improvement of Patient Experience Evaluation Items for Patient-Centered Care in Head and Neck Cancer: A Qualitative Comparative Study. Healthcare (Basel) 2024; 12:1164. [PMID: 38921279 PMCID: PMC11202892 DOI: 10.3390/healthcare12121164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
Owing to long-term treatment, frequent consultations, and complications, the evaluation of patients with head and neck cancer (HNC) must be improved. This study explored an opportunity for improving patient experience (PE) evaluation of patients with HNC to achieve a patient-centered, integrative evaluation model based on patient needs. The study comprised four phases: (1) a systematic literature review of PE factors for patient quality of life (QoL) and establishment of PE factor categories as a framework, (2) a review of current cancer or HNC PE evaluation tools, (3) identification of potential PE evaluation items based on patient needs by conducting user research, and (4) suggestion of integrative HNC PE evaluation items through expert validation. As a result, the 39 potential items were initially identified from the literature review and user research. After conducting two survey rounds with experts, 25 items were suggested as HNC PE evaluation items. These underscore the importance of highlighting the patient's participation, the medical staff's comprehensive information delivery, empathy, and collaborative communication, the hospital's support of communication channels, the medical environment for patient emotional support, the education program, and systematic patient satisfaction data management. PE evaluation items that consider the diverse perspectives of stakeholders involved in HNC treatment and factors of comprehensive PE will contribute to improving HNC patient-centered care (PCC).
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Affiliation(s)
- Eun-Jeong Kim
- Department of Industry-Academic Cooperation Foundation, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Yoo-Ri Koo
- Department of Service Design, Graduate School of Industrial Arts, Hongik University, Seoul 04066, Republic of Korea;
| | - Inn-Chul Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Republic of Korea
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Bitz HC, Sachpazidis I, Zou J, Schnell D, Baltas D, Grosu AL, Nicolay NH, Rühle A. The role of the soft palate dose regarding normal tissue toxicities in older adults with head and neck cancer undergoing definitive radiotherapy. Radiat Oncol 2024; 19:53. [PMID: 38689338 PMCID: PMC11061999 DOI: 10.1186/s13014-024-02426-5] [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: 11/09/2023] [Accepted: 02/29/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE The number of older adults with head and neck squamous cell carcinoma (HNSCC) is continuously increasing. Older HNSCC patients may be more vulnerable to radiotherapy-related toxicities, so that extrapolation of available normal tissue complication probability (NTCP) models to this population may not be appropriate. Hence, we aimed to investigate the correlation between organ at risk (OAR) doses and chronic toxicities in older patients with HNSCC undergoing definitive radiotherapy. METHODS Patients treated with definitive radiotherapy, either alone or with concomitant systemic treatment, between 2009 and 2019 in a large tertiary cancer center were eligible for this analysis. OARs were contoured based on international consensus guidelines, and EQD2 doses using α/ß values of 3 Gy for late effects were calculated based on the radiation treatment plans. Treatment-related toxicities were graded according to Common Terminology Criteria for Adverse Events version 5.0. Logistic regression analyses were carried out, and NTCP models were developed and internally validated using the bootstrapping method. RESULTS A total of 180 patients with a median age of 73 years fulfilled the inclusion criteria and were analyzed. Seventy-three patients developed chronic moderate xerostomia (grade 2), 34 moderate dysgeusia (grade 2), and 59 moderate-to-severe (grade 2-3) dysphagia after definitive radiotherapy. The soft palate dose was significantly associated with all analyzed toxicities (xerostomia: OR = 1.028, dysgeusia: OR = 1.022, dysphagia: OR = 1.027) in the multivariable regression. The superior pharyngeal constrictor muscle was also significantly related to chronic dysphagia (OR = 1.030). Consecutively developed and internally validated NTCP models were predictive for the analyzed toxicities (optimism-corrected AUCs after bootstrapping: AUCxerostomia=0.64, AUCdysgeusia=0.60, AUCdysphagia=0.64). CONCLUSIONS Our data suggest that the dose to the soft palate is associated with chronic moderate xerostomia, moderate dysgeusia and moderate-to-severe dysphagia in older HNSCC patients undergoing definitive radiotherapy. If validated in external studies, efforts should be undertaken to reduce the soft palate dose in these patients.
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Affiliation(s)
- Helena C Bitz
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
| | - Ilias Sachpazidis
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jiadai Zou
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Leipzig, Germany
| | - Daniel Schnell
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dimos Baltas
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Leipzig, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany.
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Leipzig, Germany.
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Rühle A, Weymann M, Behrens M, Marschner S, Haderlein M, Fabian A, Senger C, Dickstein DR, Kraft J, von der Grün J, Chen E, Aquino-Michaels T, Domschikowski J, Bickel A, Altay-Langguth A, Kalinauskaite G, Lewitzki V, Bonomi M, Blakaj DM, Jhawar SR, Baliga S, Barve R, Ferentinos K, Zamboglou C, Schnellhardt S, Haehl E, Spohn SKB, Kuhnt T, Zöller D, Guckenberger M, Budach V, Belka C, Bakst R, Mayer A, Schmidberger H, Grosu AL, Balermpas P, Stromberger C, Nicolay NH. A Multicenter Evaluation of Different Chemotherapy Regimens in Older Adults With Head and Neck Squamous Cell Carcinoma Undergoing Definitive Chemoradiation. Int J Radiat Oncol Biol Phys 2024; 118:1282-1293. [PMID: 37914144 DOI: 10.1016/j.ijrobp.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/26/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE The number of older adults with head and neck squamous cell carcinoma (HNSCC) is increasing, and treatment of these patients is challenging. Although cisplatin-based chemotherapy concomitantly with radiation therapy is considered the standard regimen for patients with locoregionally advanced HNSCC, there is substantial real-world heterogeneity regarding concomitant chemotherapy in older patients with HNSCC. METHODS AND MATERIALS The SENIOR study is an international multicenter cohort study including older patients (≥65 years) with HNSCC treated with definitive radiation therapy at 13 academic centers in the United States and Europe. Patients with concomitant chemoradiation were analyzed regarding overall survival (OS) and progression-free survival (PFS) via Kaplan-Meier analyses. Fine-Gray competing risk regressions were performed regarding the incidence of locoregional failures and distant metastases. RESULTS Six hundred ninety-seven patients with a median age of 71 years were included in this analysis. Single-agent cisplatin was the most common chemotherapy regimen (n = 310; 44%), followed by cisplatin plus 5-fluorouracil (n = 137; 20%), carboplatin (n = 73; 10%), and mitomycin C plus 5-fluorouracil (n = 64; 9%). Carboplatin-based regimens were associated with diminished PFS (hazard ratio [HR], 1.39 [1.03-1.89]; P < .05) and a higher incidence of locoregional failures (subdistribution HR, 1.54 [1.00-2.38]; P = .05) compared with single-agent cisplatin, whereas OS (HR, 1.15 [0.80-1.65]; P = .46) was comparable. There were no oncological differences between single-agent and multiagent cisplatin regimens (all P > .05). The median cumulative dose of cisplatin was 180 mg/m2 (IQR, 120-200 mg/m2). Cumulative cisplatin doses ≥200 mg/m2 were associated with increased OS (HR, 0.71 [0.53-0.95]; P = .02), increased PFS (HR, 0.66 [0.51-0.87]; P = .003), and lower incidence of locoregional failures (subdistribution HR, 0.50 [0.31-0.80]; P = .004). Higher cumulative cisplatin doses remained an independent prognostic variable in the multivariate regression analysis for OS (HR, 0.996 [0.993-0.999]; P = .009). CONCLUSIONS Single-agent cisplatin can be considered in the standard chemotherapy regimen for older patients with HNSCC who can tolerate cisplatin. Cumulative cisplatin doses are prognostically relevant in older patients with HNSCC.
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Affiliation(s)
- Alexander Rühle
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University of Leipzig, Leipzig, Germany; Cancer Center Central Germany (CCCG), Partner Site Leipzig, Leipzig, Germany.
| | - Maria Weymann
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Max Behrens
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Sebastian Marschner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK) Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marlen Haderlein
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin; Freie Universität Berlin, Humboldt-Universität zu Berlin; and Berlin Institute of Health, Berlin, Germany; German Cancer Consortium (DKTK) Partner Site Berlin, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, Heidelberg, Germany
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johannes Kraft
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Jens von der Grün
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany; German Cancer Consortium (DKTK) Partner Site Frankfurt, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eric Chen
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Todd Aquino-Michaels
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Amanda Bickel
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alev Altay-Langguth
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany; German Cancer Consortium (DKTK) Partner Site Frankfurt, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Goda Kalinauskaite
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin; Freie Universität Berlin, Humboldt-Universität zu Berlin; and Berlin Institute of Health, Berlin, Germany; German Cancer Consortium (DKTK) Partner Site Berlin, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, Heidelberg, Germany
| | - Victor Lewitzki
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Marcelo Bonomi
- Department of Medical Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sachin R Jhawar
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sujith Baliga
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rahul Barve
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Konstantinos Ferentinos
- Department of Radiation Oncology, German Oncology Center, European University of Cyprus, Limassol, Cyprus
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, German Oncology Center, European University of Cyprus, Limassol, Cyprus
| | - Sören Schnellhardt
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - Erik Haehl
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK) Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Simon K B Spohn
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Kuhnt
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany; Cancer Center Central Germany (CCCG), Partner Site Leipzig, Leipzig, Germany
| | - Daniela Zöller
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Volker Budach
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin; Freie Universität Berlin, Humboldt-Universität zu Berlin; and Berlin Institute of Health, Berlin, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK) Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arnulf Mayer
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany; German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany; German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin; Freie Universität Berlin, Humboldt-Universität zu Berlin; and Berlin Institute of Health, Berlin, Germany; German Cancer Consortium (DKTK) Partner Site Berlin, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University of Leipzig, Leipzig, Germany; Cancer Center Central Germany (CCCG), Partner Site Leipzig, Leipzig, Germany
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Dou A, Bouchard-Fortier G, Han K, Milosevic M, Lukovic J, L’heureux S, Li X, Doherty MC, Croke J. Utilization and Impact of a Radiation Nursing Clinic to Address Acute Care Needs for Patients with Gynecologic Cancers. Curr Oncol 2024; 31:1645-1655. [PMID: 38534958 PMCID: PMC10969712 DOI: 10.3390/curroncol31030125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The risk factors for acute care utilization in gynecologic oncology patients are poorly understood. This study aimed to evaluate risk factors for the utilization of our centre's acute care radiation nursing clinic (RNC) by gynecologic oncology patients receiving radiotherapy (RT). METHODS This was a retrospective cohort study of gynecological cancer patients treated with RT at an academic cancer centre between 1 August 2021 and 31 January 2022. Data on socio-demographics, clinical and treatment characteristics, and RNC visits were collected and summarized by descriptive statistics. The Wilcoxon rank sum test and chi-squared test/Fisher's exact test were used for comparisons of continuous and categorical variables, respectively. RESULTS RT was delivered to 180 patients, of whom 42 (23%) received concurrent chemoradiation (CCR). Compared to those receiving RT alone, patients receiving CCR had higher rates of RNC utilization (55% vs. 19%, p < 0.001). Within the CCR cohort, patients who presented to the RNC were more likely to be unpartnered (43% vs. 11%, p = 0.04), receive a referral to Psychosocial Oncology (39% vs. 5.3%, p = 0.01), and experience treatment interruptions (52% vs. 16%, p = 0.02). There were no associations between RNC visits and age, disease site, or distance from the cancer centre. CONCLUSIONS The receipt of CCR and specific psychosocial risk factors were associated with increased RNC utilization. Targeted strategies and early intervention to better meet the supportive care and psychosocial needs of this vulnerable population are needed.
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Affiliation(s)
- Aaron Dou
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Genevieve Bouchard-Fortier
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Kathy Han
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Michael Milosevic
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Jelena Lukovic
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Stephanie L’heureux
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Xuan Li
- Department of Biostatistics, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Mary C. Doherty
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, ON M5G 2M9, Canada
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Chang PMH. Is systemic anticancer treatment suitable for older patients? THE LANCET. HEALTHY LONGEVITY 2024; 5:e166-e167. [PMID: 38432245 DOI: 10.1016/s2666-7568(24)00023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Affiliation(s)
- Peter Mu-Hsin Chang
- Department of Oncology, Taipei Veterans General Hospital, Taipei 112, Taiwan; Institute of Biopharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
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Patfield A, Wykes J, Venchiarutti R, Dunn M, Clark J, Froggatt C. How age affects health-related-quality-of-life outcomes in maxillomandibular reconstructive surgery. ANZ J Surg 2024; 94:148-155. [PMID: 38156723 DOI: 10.1111/ans.18826] [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: 07/27/2023] [Revised: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Maxillomandibular reconstruction has various functional, aesthetic, and psychosocial effects that can decrease patients' health-related quality of life (HRQOL). The aim of this study was to compare HRQOL outcomes in older and younger patients undergoing maxillomandibular reconstruction. METHODS A cross-sectional study of patients undergoing maxillomandibular reconstruction surgery between November 2008 and January 2021 was conducted. Participants completed the FACE-Q Head and Neck Cancer Module, M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI). Results from these instruments were used to compare HRQOL outcomes in old (≥70 years) and young (<70 years) patients. RESULTS Ninety-nine patients who underwent maxillomandibular reconstruction completed the instruments (response rate 50%), of which 33 (33%) were aged ≥70 years. Older age was associated with improved FACE-Q speaking (+11.3, P = 0.045), FACE-Q cancer worry (-9.97, P = 0.050), and SHI score (-16.6, P = 0.013). After adjusting for the effect of radiotherapy, age was associated with improved FACE-Q speaking (+16.8, P = 0.012), FACE-Q smiling distress (+12.6, P = 0.040), FACE-Q worry (-11.0, P = 0.032), and SHI scores (-18.4, P = 0.004). Older age was associated with an increased likelihood of postoperative complications (odds ratio (OR) = 2.9, P = 0.02) and medical complications (OR = 4.6, P = 0.012). CONCLUSION In patients undergoing maxillomandibular reconstruction, older age (≥70 years) was associated with better HRQOL outcomes in domains relating to speech and cancer worry. In all other HRQOL outcomes, the two age groups performed similarly.
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Affiliation(s)
- Alexander Patfield
- Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rebecca Venchiarutti
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Catriona Froggatt
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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Cai J, Gao Y, Hu T, Zhou L, Jiang H. Impact of lifestyle and psychological resilience on survival among the oldest-old in China: a cohort study. Front Public Health 2023; 11:1329885. [PMID: 38169738 PMCID: PMC10758442 DOI: 10.3389/fpubh.2023.1329885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Healthy lifestyles and psychological resilience are important factors influencing the life expectancy of the oldest-old (≥80 years). Stratified by urban and rural groups, this study used a 10-year cohort to examine the mechanism of lifestyle and psychological resilience on the survival of the oldest-old in China. Methods This study used the China Longitudinal Healthy Longevity Survey datasets spanning from 2008 to 2018, and 9,250 eligible participants were included. The primary outcome variable was all-cause mortality, and independent variables included healthy lifestyle index and psychological resilience. Six covariates were included in the survival analysis and moderation-mediation model, such as gender and annual household income. Results This study found that the oldest-old with five healthy lifestyles had the longest survival time, averaging 59.40 months for urban individuals and 50.08 months for rural individuals. As the lifestyle index increased, the survival rate significantly increased. The Cox regression showed that for the urban oldest-old, the lifestyle index served as a protective factor for survival outcomes. However, this effect lost statistical significance among rural oldest-old individuals. For urban oldest-old individuals, psychological resilience significantly mediated and moderated the effect of the lifestyle index on survival status, but the moderating effect was not statistically significant for the rural ones. Discussion Overall, healthy lifestyles and psychological resilience can be effective in enhancing the survival of the oldest-old, and there are differences between urban and rural population, so different interventions should be adopted for urban and rural areas to achieve longer life in China.
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Affiliation(s)
| | - Yumeng Gao
- Department of Medical Insurance, Jinshan Hospital of Fudan University, Shanghai, China
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Lin H, Ye M, Lin Y, Chen F, Chan S, Cai H, Zhu J. Mobile App for Gynecologic Cancer Support for Patients With Gynecologic Cancer Receiving Chemotherapy in China: Multicenter Randomized Controlled Trial. J Med Internet Res 2023; 25:e49939. [PMID: 37955943 PMCID: PMC10682921 DOI: 10.2196/49939] [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: 06/13/2023] [Revised: 09/01/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Patients with gynecologic cancer receiving chemotherapy often report unmet supportive care needs. Compared with traditional face-to-face clinical interventions, mobile health can increase access to supportive care and may address patients' needs. Although app-based support programs have been developed to support patients with gynecologic cancer, their efficacy has not been adequately tested. OBJECTIVE The aim of this study was to examine the efficacy of a mobile app for gynecologic cancer support (MGCS) for patients with gynecologic cancer receiving chemotherapy in China. METHODS A multicenter randomized controlled trial was conducted in 2 university-affiliated hospitals in China. A total of 168 Chinese patients with gynecologic cancer were recruited and randomized to receive routine care or MGCS program plus routine care for 24 weeks. The Mishel uncertainty in illness theory guided the development of MGCS program, which has 4 modules: weekly topics, emotional care, discussion center, and health consultation. The primary outcome of this program was the assessment of the uncertainty in illness. The secondary outcomes were quality of life, symptom distress, and social support. All health outcomes were evaluated at baseline (T0), 12 weeks (T1), and 24 weeks (T2). Repeated measures analysis of covariance was used to assess the efficacy of the MGCS program. RESULTS In this trial, 67 patients in the control group and 69 patients in the intervention group completed 2 follow-up assessments (response rate, 136/168, 81%). At 12 weeks, no significant differences were observed in any of the health outcomes between the 2 groups. At 24 weeks, compared to patients in the control group, those in the intervention group reported significant decreased uncertainty in illness (P<.001; d=-0.60; adjusted mean difference -7.69, 95% CI -11.31 to -4.07) and improved quality of life (P=.04; d=0.30; adjusted mean difference 4.77, 95% CI 0.12-9.41). CONCLUSIONS The MGCS program demonstrated efficacy in supporting patients with gynecologic cancer receiving chemotherapy. This trial illustrates that an app-based program can be incorporated into routine care to support patients with cancer and suggests that allocation of more resources (grants, manpower, etc) to mobile health in clinics is warranted. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000033678; https://www.chictr.org.cn/showproj.html?proj=54807.
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Affiliation(s)
- Huicong Lin
- School of Medicine, Xiamen University, Xiamen, Fujian Province, China
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Mingzhu Ye
- Department of Gynecology and Obstetrics, Zhongshan Hospital, Xiamen University, Xiamen, Fujian Province, China
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Fuhong Chen
- Department of Nursing, First Affiliated Hospital, Xiamen University, Xiamen, Fujian Province, China
| | - Sally Chan
- President Office, Tung Wah College, Hongkong, China
| | - Hongxia Cai
- Department of Gynecology and Obstetrics, First Affiliated Hospital, Xiamen University, Xiamen, Fujian Province, China
| | - Jiemin Zhu
- Department of Nursing, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
- Cancer Care Research Unit, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
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9
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Tang Y, Hua Y, Huang X, Cao Y, Sun X. Psychological Burden of Patients with Head and Neck Cancer Undergoing Radiotherapy and Their Family Caregivers: A Cross-Sectional Survey. J Multidiscip Healthc 2023; 16:927-935. [PMID: 37051506 PMCID: PMC10083181 DOI: 10.2147/jmdh.s398064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/22/2023] [Indexed: 04/07/2023] Open
Abstract
Background The consequences of Head and neck cancer (HNC) affect both the person who receives the diagnosis and their family caregivers (FCs). Objective To investigate the psychological status of patients and their FCs, and the burden of the FCs during radiotherapy. Methods This cross-sectional study was conducted with a questionnaire survey by convenience sampling method. Patients with HNC and their caregivers (both N = 85) from the radiotherapy department of our hospital were recruited between March 2021 and March 2022. The Hospital Anxiety and Depression Scale (HADS), the Chinese version of the Connor and Davidson Resilience Scale (CD-RISC), and the Zarit Burden Interview (ZBI) were used to assess the symptoms of anxiety and depression, psychological resilience, and the impact of care work, emotions and social lives of participants. Pearson's correlation analysis and a Mann-Whitney test were used to analyse the association between the HADS and the CD-RISC scores of the patients. Results About half of the patients (56.47%) and the caregivers (62.35%) have had anxiety. The average HADS-Anxiety scores, HADS-Depression scores, and CD-RISC scores of the patients with HNC were 7.4±1.9, 6.4±2.2, and 56.8±12.6. The "Strength" and "Resilience" scores of the patients were inversely related to their HADS anxiety scores (p < 0.05). The "Resilience" and "optimism" scores of them were inversely related to HADS depression scores (p < 0.05). The average ZBI score of the caregivers was 23.8±10.1; HADS anxiety scores and HADS depression scores of the caregivers were positively associated with total ZBI scores and individual burden scores (p < 0.05). Conclusion More than half of patients with HNC undergoing radiotherapy have anxiety, and about a third have depression. The anxiety and depression status of the FCs of patients with HNC undergoing radiotherapy is related to caregiver burden, deserving the attention of clinical medical staff.
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Affiliation(s)
- Yuanyuan Tang
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Yuchen Hua
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Xiaoping Huang
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Yuandong Cao
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Xinchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
- Correspondence: Xinchen Sun, Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, People’s Republic of China, Tel +86 25 68305696, Email
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Chen M, Li R, Chen Y, Ding G, Song J, Hu X, Jin C. Unmet supportive care needs and associated factors: Evidence from 4195 cancer survivors in Shanghai, China. Front Oncol 2022; 12:1054885. [PMID: 36530993 PMCID: PMC9748420 DOI: 10.3389/fonc.2022.1054885] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Cancer survivors at different stages of life often have different needs that make it challenging for services to provide satisfactory care. Few studies have considered whether services are truly meeting the needs of cancer patients by exploring and identifying their perspectives on unmet needs. OBJECTIVE The aim of this study was to identify the unmet needs of cancer survivors and to further determine the potential impact of socio-demographic factors. METHODS A cross-sectional study that included 4195 cancer patients was conducted in Shanghai, China. Using Maslow's hierarchy of needs theory as a conceptual framework, the questionnaire included five dimensions: information, life and finances, continuing care, emotions, and self-actualization. Correlation analysis and ordered logistic regression analysis was used to explore the relationship between demographic sociological factors and unmet needs for supportive care. RESULTS The most common unmet supportive care needs include information needs (2.91 ± 1.32), self-actualization needs (2.69 ± 1.32) and continuing care needs (2.59 ± 1.30). Unmet needs for life and finances were more pronounced among cancer participants in the 45-69 age group. After adjusting for confounders, we found that each 6-month increase in the time since diagnosis was associated with a 0.8% (OR: 0.992, 95% CI: 0.985-0.998) reduction in high need for continuing care and a 0.9% (OR:0.991, 95% CI: 0.983-0.999) reduction in high need for self-actualization, respectively. CONCLUSIONS Information needs are the most important concern among the diverse unmet needs of cancer survivors. Time since diagnosis is associated with unmet supportive care needs of cancer survivors. The findings highlight the large gap between actual health services and patients' unmet need for supportive care, which will provide the basis for a patient-centered supportive care system for cancer survivors.
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Affiliation(s)
- Minxing Chen
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Ruijia Li
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Yujie Chen
- School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gang Ding
- Oncology Department, Shanghai International Medical Center, Shanghai, China
| | - Jie Song
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Xiaojing Hu
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
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Identification of molecular classification and gene signature for predicting prognosis and immunotherapy response in HNSCC using cell differentiation trajectories. Sci Rep 2022; 12:20404. [PMID: 36437265 PMCID: PMC9701758 DOI: 10.1038/s41598-022-24533-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a highly heterogeneous malignancy with poor prognosis. This article aims to explore the clinical significance of cell differentiation trajectory in HNSCC, identify different molecular subtypes by consensus clustering analysis, and develop a prognostic risk model on the basis of differentiation-related genes (DRGs) for predicting the prognosis of HNSCC patients. Firstly, cell trajectory analysis was performed on single-cell RNA sequencing (scRNA-seq) data, four molecular subtypes were identified from bulk RNA-seq data, and the molecular subtypes were predictive of patient survival, clinical features, immune infiltration status, and expression of immune checkpoint genes (ICGs)s. Secondly, we developed a 10-DRG signature for predicting the prognosis of HNSCC patients by using weighted correlation network analysis (WGCNA), differential expression analysis, univariate Cox regression analysis, and multivariate Cox regression analysis. Then, a nomogram integrating the risk assessment model and clinical features can successfully predict prognosis with favorable predictive performance and superior accuracy. We projected the response to immunotherapy and the sensitivity of commonly used antitumor drugs between the different groups. Finally, we used the quantitative Reverse Transcription-Polymerase Chain Reaction (qRT-PCR) analysis and western blot to verify the signature. In conclusion, we identified distinct molecular subtypes by cell differentiation trajectory and constructed a novel signature based on differentially expressed prognostic DRGs, which could predict the prognosis and response to immunotherapy for patients and may provide valuable clinical applications in the treatment of HNSCC.
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12
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Auger S, Davis A, Rosenberg AJ. Recommendations for Care of Survivors of Head and Neck Cancer. JAMA 2022; 328:1637-1638. [PMID: 36201185 DOI: 10.1001/jama.2022.17064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This JAMA Clinical Guidelines Synopsis summarizes the American Head and Neck Society’s 2021 consensus statement on care of survivors of head and neck cancer.
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Affiliation(s)
- Samuel Auger
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Andrew Davis
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
| | - Ari J Rosenberg
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
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Novel Systemic Treatment Modalities Including Immunotherapy and Molecular Targeted Therapy for Recurrent and Metastatic Head and Neck Squamous Cell Carcinoma. Int J Mol Sci 2022; 23:ijms23147889. [PMID: 35887235 PMCID: PMC9320653 DOI: 10.3390/ijms23147889] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022] Open
Abstract
Head and neck squamous cell carcinomas (HNSCCs) are the sixth most common cancers worldwide. More than half of patients with HNSCC eventually experience disease recurrence and/or metastasis, which can threaten their long-term survival. HNSCCs located in the oral cavity and larynx are usually associated with tobacco and/or alcohol use, whereas human papillomavirus (HPV) infection, particularly HPV16 infection, is increasingly recognized as a cause of oropharyngeal HNSCC. Despite clinical, histologic, and molecular differences between HPV-positive and HPV-negative HNSCCs, current treatment approaches are the same. For recurrent disease, these strategies include chemotherapy, immunotherapy with PD-1-inhibitors, or a monoclonal antibody, cetuximab, that targets epidermal growth factor; these therapies can be administered either as single agents or in combination. However, these treatment strategies carry a high risk of toxic side effects; therefore, more effective and less toxic treatments are needed. The landscape of HNSCC therapy is changing significantly; numerous clinical trials are underway to test novel therapeutic options like adaptive cellular therapy, antibody-drug conjugates, new targeted therapy agents, novel immunotherapy combinations, and therapeutic vaccines. This review helps in understanding the various developments in HNSCC therapy and sheds light on the path ahead in terms of further research in this field.
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