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Carlson ML, Lohse CM, Agazzi S, Babu SC, Barker FG, Barnett S, Bi WL, Biggs N, Boahene KD, Breen JT, Brown KD, Cayé-Thomasen P, Cosetti MK, Deep NL, Dey JK, Dornhoffer JR, Forner D, Gurgel RK, Hansen MR, Hunter JB, Kalamarides M, Kim IA, King AT, Kircher ML, Lassaletta L, Link MJ, Lloyd SKW, Lund-Johansen M, Marinelli JP, Matthies C, Mehta V, Moore EJ, Nassiri AM, Neff BA, Nelson RF, Olson JJ, Patel NS, Celda MP, Plitt AR, Price DL, Thomas Roland J, Sweeney AD, Tasche KK, Tatagiba M, Tveiten Ø, Van Gompel JJ, Vrabec JT, Wanna GB, Weisskopf PA. Rationale for the Development of a Novel Clinical Grading Scale for Postoperative Facial Nerve Function: Results of a Multidisciplinary International Working Group. Otol Neurotol 2023; 44:e747-e754. [PMID: 37875014 DOI: 10.1097/mao.0000000000004039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE The objective of the current study was to present the results of an international working group survey identifying perceived limitations of existing facial nerve grading scales to inform the development of a novel grading scale for assessing early postoperative facial paralysis that incorporates regional scoring and is anchored in recovery prognosis and risk of associated complications. STUDY DESIGN Survey. SETTING A working group of 48 multidisciplinary clinicians with expertise in skull base, cerebellopontine angle, temporal bone, or parotid gland surgery. RESULTS House-Brackmann grade is the most widely used system to assess facial nerve function among working group members (81%), although more than half (54%) agreed that the system they currently use does not adequately estimate the risk of associated complications, such as corneal injury, and confidence in interrater and intrarater reliability is generally low. Simplicity was ranked as the most important attribute of a novel postoperative facial nerve grading system to increase the likelihood of adoption, followed by reliability and accuracy. There was widespread consensus (91%) that the eye is the most critical facial region to focus on in the early postoperative setting. CONCLUSIONS Members were invited to submit proposed grading systems in alignment with the objectives of the working group for subsequent validation. From these data, we plan to develop a simple, clinically anchored, and reproducible staging system with regional scoring for assessing early postoperative facial nerve function after surgery of the skull base, cerebellopontine angle, temporal bone, or parotid gland.
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Affiliation(s)
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Siviero Agazzi
- Department of Neurosurgery, University of South Florida, Tampa, Florida
| | | | - Frederick G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel Barnett
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nigel Biggs
- Department of Otolaryngology, Head, Neck and Skull Base Surgery, St Vincent's Hospital, Sydney, Australia
| | - Kofi D Boahene
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joseph T Breen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida
| | - Kevin D Brown
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine of Mount Sinai, New York, New York
| | - Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery
| | | | - David Forner
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Richard K Gurgel
- Department of Otolaryngology, University of Utah Health, Salt Lake City, Utah
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michel Kalamarides
- Department of Neurosurgery, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Irene A Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Andrew T King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester, UK
| | - Matthew L Kircher
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Chicago, Illinois
| | - Luis Lassaletta
- Department of Otolaryngology, IdiPAZ Institute for Health Research, La Paz University Hospital; Biomedical Research Networking Centre on Rare Diseases (CIBERER-U761), Institute of Health Carlos III, Madrid, Spain
| | | | - Simon K W Lloyd
- Department of Otolaryngology Head and Neck Surgery, Manchester Royal Infirmary, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Cordula Matthies
- Department of Neurosurgery, University of Würzburg, Würzburg, Germany
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery
| | - Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery
| | - Rick F Nelson
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Neil S Patel
- Department of Otolaryngology, University of Utah Health, Salt Lake City, Utah
| | | | | | | | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Øystein Tveiten
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | | | | | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine of Mount Sinai, New York, New York
| | - Peter A Weisskopf
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
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Noel CW, Sutradhar R, Chan WC, Fu R, Philteos J, Forner D, Irish JC, Vigod S, Isenberg-Grzeda E, Coburn NG, Hallet J, Eskander A. Gaps in Depression Symptom Management for Patients With Head and Neck Cancer. Laryngoscope 2023; 133:2638-2646. [PMID: 36748910 DOI: 10.1002/lary.30595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/27/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To understand practice patterns and identify care gaps within a large-scale depression screening program for patients with head and neck cancer (HNC). STUDY DESIGN Retrospective cohort study. METHODS This was a population-based study of adults diagnosed with a HNC between January 2007 and October 2020. Each patient was observed from time of first symptom assessment until end of study date, or death. The exposure of interest was a positive depressive symptom screen on the Edmonton Symptom Assessment System (ESAS). Outcomes of interest included psychiatry/psychology assessment, social work referral, or palliative care assessment. Cause specific hazard models with a time-varying exposure were used to investigate the exposure-outcome relationships. RESULTS Of 14,054 patients with HNC, 9016 (64.2%) reported depressive symptoms on at least one ESAS assessment. Within 60 days of first reporting depressive symptoms, 223 (2.7%) received a psychiatry assessment, 646 (7.9%) a social work referral, and 1131 (13.9%) a palliative care assessment. Rates of psychiatry/psychology assessment (HR 3.15 [95% CI 2.67-3.72]), social work referral (HR 1.83 [95% CI 1.64-2.02]), and palliative care assessment (HR 2.34 [95% CI 2.19-2.50]) were higher for those screening positive for depression. Certain patient populations were less likely to receive an assessment including the elderly, rural residents, and those without a prior psychiatric history. CONCLUSION A high proportion of head and neck patients report depressive symptoms, though this triggers a referral in a small number of cases. These data highlight areas for improvement in depression screening care pathways. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2638-2646, 2023.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Rui Fu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Simone Vigod
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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3
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Clark A, Forner D, Noel CW, Corsten G, Hong P. Need for Tympanostomy Tubes in Children With Recurrent Acute Otitis Media Without Middle Ear Effusion. Otolaryngol Head Neck Surg 2023; 169:694-700. [PMID: 36939487 DOI: 10.1002/ohn.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Children with recurrent acute otitis media (RAOM) presenting without middle ear effusion (MEE) do not meet indications for surgical intervention as outlined by Clinical Practice Guidelines (CPGs). The objective of this study was to determine which patients presenting with RAOM without MEE ultimately received tympanostomy tubes. STUDY DESIGN Case series. SETTING Single academic pediatric otolaryngology clinic. METHODS Children (0-12 years) presenting with RAOM and no MEE were identified from October 2017 to December 2019. As per CPGs, no surgery was offered initially. Patients were given a semiurgent return appointment should they experience another suspected otitis media episode. If MEE was observed, tympanostomy tube insertion was offered. Patients were followed for 1-year following enrollment. RESULTS One-hundred and twenty-four patients were included. The median age was 3.15 years old (interquartile range: 4.10). Seventy-five (60%) patients did not require additional follow-up and thus did not require tympanostomy tubes. Forty-nine (40%) patients were seen again; of these, 11 patients received tympanostomy tubes. Therefore, of patients presenting with no MEE, 91% did not require tympanostomy tubes. Patients who had surgery were younger on initial assessment than those who did not (mean difference 2.68 years, 95% confidence interval: 2.14-3.23). CONCLUSION This study demonstrates the practical effect of adhering to CPGs for RAOM and suggests that many children may not require tympanostomy tube placement within the 1st year after the consultation if they did not initially present with MEE.
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Affiliation(s)
- Alexander Clark
- Division Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Forner
- Division Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gerard Corsten
- Division Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Paul Hong
- Division Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
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Noel CW, Hueniken K, Forner D, Liu G, Eng L, Hosni A, Hahn E, Irish JC, Gilbert R, Yao CMKL, Monteiro E, O’Sullivan B, Waldron J, Huang SH, Goldstein DP, de Almeida JR. Association of Household Income at Diagnosis With Financial Toxicity, Health Utility, and Survival in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:63-70. [PMID: 36416855 PMCID: PMC9685545 DOI: 10.1001/jamaoto.2022.3755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/02/2022] [Indexed: 11/24/2022]
Abstract
Importance While several studies have documented a link between socioeconomic status and survival in head and neck cancer, nearly all have used ecologic, community-based measures. Studies using more granular patient-level data are lacking. Objective To determine the association of baseline annual household income with financial toxicity, health utility, and survival. Design, Setting, and Participants This was a prospective cohort of adult patients with head and neck cancer treated at a tertiary cancer center in Toronto, Ontario, between September 17, 2015, and December 19, 2019. Data analysis was performed from April to December 2021. Exposures Annual household income at time of diagnosis. Main Outcome and Measures The primary outcome of interest was disease-free survival. Secondary outcomes included subjective financial toxicity, measured using the Financial Index of Toxicity (FIT) tool, and health utility, measured using the Health Utilities Index Mark 3. Cox proportional hazards models were used to estimate the association between household income and survival. Income was regressed onto log-transformed FIT scores using linear models. The association between income and health utility was explored using generalized linear models. Generalized estimating equations were used to account for patient-level clustering. Results There were 555 patients (mean [SD] age, 62.7 [10.7] years; 109 [20%] women and 446 [80%] men) included in this cohort. Two-year disease-free survival was worse for patients in the bottom income quartile (<$30 000: 67%; 95% CI, 58%-78%) compared with the top quartile (≥$90 000: 88%; 95% CI, 83%-93%). In risk-adjusted models, patients in the bottom income quartile had inferior disease-free survival (adjusted hazard ratio, 2.13; 95% CI, 1.22-3.71) and overall survival (adjusted hazard ratio, 2.01; 95% CI, 0.94-4.29), when compared with patients in the highest quartile. The average FIT score was 22.6 in the lowest income quartile vs 11.7 in the highest quartile. In adjusted analysis, low-income patients had 12-month FIT scores that were, on average, 134% higher (worse) (95% CI, 16%-253%) than high-income patients. Similarly, health utility scores were, on average, 0.104 points lower (95% CI, 0.026-0.182) for low-income patients in adjusted analysis. Conclusions and Relevance In this cohort study, patients with head and neck cancer with a household income less than CAD$30 000 experienced worse financial toxicity, health status, and disease-free survival. Significant disparities exist for Ontario's patients with head and neck cancer.
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Affiliation(s)
- Christopher W. Noel
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Geoffrey Liu
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lawson Eng
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M. K. L. Yao
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology–Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Brian O’Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David P. Goldstein
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Sajisevi M, Caulley L, Eskander A, Du Y(J, Auh E, Karabachev A, Callas P, Conradie W, Martin L, Pasternak J, Golbon B, Rolighed L, Abdelhamid Ahmed AH, Badhey A, Cheung AY, Corsten M, Forner D, Liu JC, Mavedatnia D, Meltzer C, Noel JE, Patel V, Sharma A, Tang AL, Tsao G, Venkatramani M, Williams M, Wrenn SM, Zafereo M, Stack BC, Randolph GW, Davies L. Evaluating the Rising Incidence of Thyroid Cancer and Thyroid Nodule Detection Modes: A Multinational, Multi-institutional Analysis. JAMA Otolaryngol Head Neck Surg 2022; 148:811-818. [PMID: 35834240 PMCID: PMC9284406 DOI: 10.1001/jamaoto.2022.1743] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance There is epidemiologic evidence that the increasing incidence of thyroid cancer is associated with subclinical disease detection. Evidence for a true increase in thyroid cancer incidence has also been identified. However, a true increase in disease would likely be heralded by an increased incidence of thyroid-referable symptoms in patients presenting with disease. Objectives To evaluate whether modes of detection (MODs) used to identify thyroid nodules for surgical removal have changed compared with historic data and to determine if MODs vary by geographic location. Design, Setting, and Participants This was a retrospective analysis of pathology and medical records of 1328 patients who underwent thyroid-directed surgery in 16 centers in 4 countries: 4 centers in Canada, 1 in Denmark, 1 in South Africa, and 12 in the US. The participants were the first 100 patients (or the largest number available) at each center who had thyroid surgery in 2019. The MOD of the thyroid finding that required surgery was classified using an updated version of a previously validated tool as endocrine condition, symptomatic thyroid, surveillance, or without thyroid-referable symptoms (asymptomatic). If asymptomatic, the MOD was further classified as clinician screening examination, patient-requested screening, radiologic serendipity, or diagnostic cascade. Main Outcomes and Measures The MOD of thyroid nodules that were surgically removed, by geographic variation; and the proportion and size of thyroid cancers discovered in patients without thyroid-referable symptoms compared with symptomatic detection. Data analyses were performed from April 2021 to February 2022. Results Of the 1328 patients (mean [SD] age, 52 [15] years; 993 [75%] women; race/ethnicity data were not collected) who underwent thyroid surgery that met inclusion criteria, 34% (448) of the surgeries were for patients with thyroid-related symptoms, 41% (542) for thyroid findings discovered without thyroid-referable symptoms, 14% (184) for endocrine conditions, and 12% (154) for nodules with original MOD unknown (under surveillance). Cancer was detected in 613 (46%) patients; of these, 30% (183 patients) were symptomatic and 51% (310 patients) had no thyroid-referable symptoms. The mean (SD) size of the cancers identified in the symptomatic group was 3.2 (2.1) cm (median [range] cm, 2.6 [0.2-10.5]; 95% CI, 2.91-3.52) and in the asymptomatic group, 2.1 (1.4) cm (median [range] cm, 1.7 [0.05-8.8]; 95% CI, 1.92-2.23). The MOD patterns were significantly different among all participating countries. Conclusions and Relevance This retrospective analysis found that most thyroid cancers were discovered in patients who had no thyroid-referable symptoms; on average, these cancers were smaller than symptomatic thyroid cancers. Still, some asymptomatic cancers were large, consistent with historic data. The substantial difference in MOD patterns among the 4 countries suggests extensive variations in practice.
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Affiliation(s)
- Mirabelle Sajisevi
- Department of Surgery, Division of Otolaryngology, University of Vermont Medical Center, Burlington
| | - Lisa Caulley
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Canada,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Yue (Jennifer) Du
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Ontario, Canada
| | - Edel Auh
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Alexander Karabachev
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Peter Callas
- Larner College of Medicine, University of Vermont, Burlington
| | - Wilhelmina Conradie
- Division of Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Cape Town, South Africa,Breast and Endocrine Unit, Tygerberg Hospital, Cape Town, South Africa
| | - Lindi Martin
- Division of Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jesse Pasternak
- Department of Surgery, University of Toronto, Ontario, Canada
| | - Bahar Golbon
- Department of Surgery, University of Toronto, Ontario, Canada
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Amr H. Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Arvind Badhey
- Department of Otolaryngology, University of Massachusetts, Worcester
| | - Anthony Y. Cheung
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Martin Corsten
- Division of Otolaryngology–Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Forner
- Division of Otolaryngology–Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey C. Liu
- Department of Otolaryngology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania,Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | | | - Julia E. Noel
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Vishaal Patel
- Department of Otolaryngology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Arun Sharma
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Alice L. Tang
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gabriel Tsao
- The Permanente Medical Group, Fremont, California
| | | | - Michelle Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sean M. Wrenn
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Brendan C. Stack
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Louise Davies
- Veterans Affairs Outcomes Group, White River Junction, Vermont,Section of Otolaryngology–Head & Neck Surgery, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire,Associate Editor, JAMA Otolaryngology−Head & Neck Surgery
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6
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Forner D, Mok F, Verma N, Karam I, Goldstein D, Higgins K, Enepekides D, Nadler A, Pugash R, Husain Z, Chan K, Smoragiewicz M, Cohen L, Hazey JW, Fung EC, Kang SY, Seim NB, Simpson C, Eskander A. Placement technique impacts gastrostomy tube-related complications amongst head and neck cancer patients. Oral Oncol 2022; 130:105903. [DOI: 10.1016/j.oraloncology.2022.105903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/17/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
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Noel CW, Sutradhar R, Gotlib Conn L, Forner D, Chan WC, Fu R, Hallet J, Coburn NG, Eskander A. Development and Validation of a Machine Learning Algorithm Predicting Emergency Department Use and Unplanned Hospitalization in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2022; 148:764-772. [PMID: 35771564 DOI: 10.1001/jamaoto.2022.1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Patient-reported symptom burden was recently found to be associated with emergency department use and unplanned hospitalization (ED/Hosp) in patients with head and neck cancer. It was hypothesized that symptom scores could be combined with administrative health data to accurately risk stratify patients. Objective To develop and validate a machine learning approach to predict future ED/Hosp in patients with head and neck cancer. Design, Setting, and Participants This was a population-based predictive modeling study of patients in Ontario, Canada, diagnosed with head and neck cancer from January 2007 through March 2018. All outpatient clinical encounters were identified. Edmonton Symptom Assessment System (ESAS) scores and clinical and demographic factors were abstracted. Training and test cohorts were randomly generated in a 4:1 ratio. Various machine learning algorithms were explored, including (1) logistic regression using a least absolute shrinkage and selection operator, (2) random forest, (3) gradient boosting machine, (4) k-nearest neighbors, and (5) an artificial neural network. Data analysis was performed from September 2021 to January 2022. Main Outcomes and Measures The main outcome was any 14-day ED/Hosp event following symptom assessment. The performance of each model was assessed on the test cohort using the area under the receiver operator characteristic (AUROC) curve and calibration plots. Shapley values were used to identify the variables with greatest contribution to the model. Results The training cohort consisted of 9409 patients (mean [SD] age, 63.3 [10.9] years) undergoing 59 089 symptom assessments (80%). The remaining 2352 patients (mean [SD] age, 63.3 [11] years) and 14 193 symptom assessments were set aside as the test cohort (20%). Several models had high predictive accuracy, particularly the gradient boosting machine (validation AUROC, 0.80 [95% CI, 0.78-0.81]). A Youden-based cutoff corresponded to a validation sensitivity of 0.77 and specificity of 0.66. Patient-reported symptom scores were consistently identified as being the most predictive features within models. A second model built only with symptom severity data had an AUROC of 0.72 (95% CI, 0.70-0.74). Conclusions and Relevance In this study, machine learning approaches predicted with a high degree of accuracy ED/Hosp in patients with head and neck cancer. These tools could be used to accurately risk stratify patients and may help direct targeted intervention.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Rui Fu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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8
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Noel CW, Hueniken K, Forner D, Goldstein DP, de Almeida JR. Annual household income and its association with financial toxicity, health utility, and survival in head and neck cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18040 Background: While several studies have documented a link between socioeconomic status and survival in head and neck cancer, nearly all have used ecologic, community-based measures. Studies using more granular patient level data are lacking. We sought to determine the association between baseline annual household income with financial toxicity, health utility and survival. Methods: This was a prospective cohort of adult head and neck cancer patients treated at tertiary cancer center between September 17, 2015, and December 19, 2019. Our primary exposure was annual household income at time of diagnosis. Outcomes of interest included disease-free survival, financial toxicity, measured using the FIT tool, and health utility, measured using the Health Utilities Index Mark 3. Cox proportional hazards models were used to estimate the relationship between household income and survival. Income was regressed onto log-transformed FIT scores using linear models. The association between income and health utility was explored using generalized linear models. A generalized estimating equations approach was incorporated to account for patient level clustering. Results: There were 555 patients included in this cohort. Two-year disease-free survival was worse for patients in the bottom income quartile (< $30,000 - 67% [95%CI 58-78])) compared to the top quartile (≥$90,000 - 88% [95%CI 83-93]). In risk adjusted models, patients in the bottom income quartile had inferior disease-free survival (aHR 2.13 [95%CI 1.22-3.71]) but not overall survival (aHR 2.01 [95%CI 0.94-4.29]). The average FIT score was 22.6 in the lowest income quartile vs. 11.7 in the highest quartile. In adjusted analysis, low-income patients had 12-month FIT scores that were, on average, 134% higher (worse) [95%CI 16%-253%] than high-income patients. Similarly, health utility scores were, on average, 0.106 [95%CI 0.029-0.184] points lower for low-income patients. Conclusions: Head and neck cancer patients with a household income < $30,000 experienced worse financial toxicity, health status and disease-free survival. Significant disparities exist for Ontario’s head and neck cancer patients.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - David Paul Goldstein
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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9
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Noel CW, Du Y(J, Baran E, Forner D, Husain Z, Higgins KM, Karam I, Chan KKW, Hallet J, Wright F, Coburn NG, Eskander A, Gotlib Conn L. Enhancing Outpatient Symptom Management in Patients With Head and Neck Cancer: A Qualitative Analysis. JAMA Otolaryngol Head Neck Surg 2022; 148:333-341. [PMID: 35238872 PMCID: PMC8895314 DOI: 10.1001/jamaoto.2021.4555] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Patients with head and neck cancer manage a variety of symptoms at home on an outpatient basis. Clinician review alone often leaves patient symptoms undetected and untreated. Standardized symptom assessment using patient-reported outcomes (PROs) has been shown in randomized clinical trials to improve symptom detection and overall survival, although translation into real-world settings remains a challenge. OBJECTIVE To better understand how patients with head and neck cancer cope with cancer-related symptoms and to examine their perspectives on standardized symptom assessment. DESIGN, PARTICIPANTS, AND SETTING This was a qualitative analysis using semistructured interviews of patients with head and neck cancer and their caregivers from November 2, 2020, to April 16, 2021, at a regional tertiary center in Canada. Purposive sampling was used to recruit a varied group of participants (cancer subsite, treatment received, sociodemographic factors). Drawing on the Supportive Care Framework, a thematic approach was used to analyze the data. Data analysis was performed from November 2, 2020, to August 2, 2021. MAIN OUTCOMES AND MEASURES Patient perception of ambulatory symptom management and standardized symptom assessment. RESULTS Among 20 participants (median [range] age, 59.5 [33-74] years; 9 [45%] female; 13 [65%] White individuals), 4 themes were identified: (1) timely physical symptom management, (2) information as a tool for symptom management, (3) barriers to psychosocial support, and (4) external factors magnifying symptom burden. Participants' perceptions of standardized symptom assessment varied. Some individuals described the symptom monitoring process as facilitating self-reflection and symptom detection. Others felt disempowered by the process, particularly when symptom scores were inconsistently reviewed or acted on. CONCLUSIONS AND RELEVANCE This qualitative analysis provides a novel description of head and neck cancer symptom management from the patient perspective. The 4 identified themes and accompanying recommendations serve as guides for enhanced symptom monitoring.
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Affiliation(s)
- Christopher W. Noel
- Department of Otolaryngology−Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Yue (Jennifer) Du
- Department of Otolaryngology−Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elif Baran
- Department of Otolaryngology−Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Division of Otolaryngology−Head and Neck Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin M. Higgins
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin K. W. Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Frances Wright
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G. Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Ontario Health Cancer Care, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology−Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Gotlib Conn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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10
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Forner D, Noel CW, Guttman MP, Haas B, Enepekides D, Rigby MH, Taylor SM, Nathens AB, Eskander A. Volume-outcome relationships in laryngeal trauma processes of care: a retrospective cohort study. Eur J Trauma Emerg Surg 2022; 48:4131-4141. [PMID: 35320370 DOI: 10.1007/s00068-022-01950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The extent to which patients with laryngeal trauma undergo investigation and intervention is largely unknown. The objective of this study was to therefore determine the association between hospital volume and processes of care in patients sustaining laryngeal trauma. METHODS This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program database. Adult patients (≥ 18) who sustained traumatic laryngeal injuries between 2012 and 2016 were eligible. The exposure of interest was average annual laryngeal trauma volume categorized into quartiles. The primary and secondary outcomes of interest were the performances of diagnostic and therapeutic laryngeal procedures respectively. Multivariable logistic regression under a generalized estimating equations approach was utilized. RESULTS In total, 1164 patients were included. The average number of laryngeal trauma cases per hospital ranged from 0.2 to 7.2 per year. Diagnostic procedures were performed in 31% of patients and therapeutic in 19%. In patients with severe laryngeal injuries, diagnostic procedures were performed on a higher proportion of patients at high volume centers than low volume centers (46% vs 25%). In adjusted analysis, volume was not associated with the performance of diagnostic procedures. Patients treated at centers in the second (OR 1.94 [95% CI 1.29-2.90]) and third (OR 1.67 [95% CI 1.08-2.57]) volume quartiles had higher odds of undergoing a therapeutic procedure compared to the lowest volume quartile. CONCLUSION Hospital volume may be associated with processes of care in laryngeal trauma. Additional research is required to investigate how these findings relate to patient and health system outcomes.
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Affiliation(s)
- David Forner
- Division of Otolaryngology, Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Christopher W Noel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Matthew P Guttman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Barbara Haas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Danny Enepekides
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology, Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 047, Toronto, ON, M4N 3M5, Canada
| | - Matthew H Rigby
- Division of Otolaryngology, Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - S Mark Taylor
- Division of Otolaryngology, Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Avery B Nathens
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Antoine Eskander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, ON, Canada. .,Department of Otolaryngology, Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 047, Toronto, ON, M4N 3M5, Canada.
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11
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Curry DE, Forner D, Rigby MH, Trites JR, Corsten M, Taylor SM. Oncological and functional outcomes following treatment of T1a glottic squamous cell carcinoma with transoral laser microsurgery. J Otolaryngol Head Neck Surg 2022; 51:2. [PMID: 35057857 PMCID: PMC8772184 DOI: 10.1186/s40463-021-00553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Laryngeal cancers of glottic origin comprise a large proportion of head and neck malignancies. Transoral laser microsurgery (TLM) and radiation therapy are mainstays in the treatment of early stage glottic cancer, but debate persists as to which modality is functionally superior. Furthermore, there is a paucity of North American data related to functional and oncological outcomes in T1a glottic cancer. Here, we assessed oncological and functional outcomes of T1a glottic squamous cell carcinoma (SCC) with TLM to supplement evidence from jurisdictions outside North America.
Methods This study is a retrospective cohort study performed from a prospectively collected tertiary center institutional TLM database. Patients who were diagnosed with T1a glottic SCC and underwent TLM as their primary treatment were included. Functional outcomes were analyzed using the Voice Handicap Index-10 (VHI-10) questionnaire. Ultimate control with TLM only was considered to be those patients with locoregional control with repeat TLM procedures, but without addition of other modalities. Student’s t-test was used to test significance and Kaplan–Meier survival analysis was used to assess oncological outcomes.
Results 48 patients met study criteria. The mean follow-up time was 74 months. The 5-year locoregional, ultimate control with TLM only and laryngeal preservation rates were 83.2%, 90.4% and 100%, respectively. The overall survival and disease-specific survival were 87.2% and 100%, respectively. VHI-10 scores were available for 13/48 patients and mean scores improved non-significantly from pre-op (mean: 11.23; range: 2 to 30; median: 10) and post op (mean: 7.92; range: 0 to 18; median: 8) scoring (p-value = 0.15). Sub-stratification of voice data revealed a significant improvement between pre and post-operative scores (mean difference − 10.6, 95% CI: − 0.99 to − 20.21, p-value = 0.035) for patients with abnormal pre-operative scores (VHI > 11). Conclusion To our knowledge, the current work represents one of the first North American studies to report both functional and oncologic outcomes for TLM treatment of T1a glottic SCC. The oncologic and functional outcomes presented here add to existing evidence in favor of TLM as a safe and effective primary treatment option for early staged T1a glottic cancer. Graphical abstract ![]()
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Affiliation(s)
- Dennis E Curry
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3052, Dickson Bldg., 5820 University Avenue, Halifax, NS, B3H 1V8, Canada.
| | - David Forner
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3052, Dickson Bldg., 5820 University Avenue, Halifax, NS, B3H 1V8, Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3052, Dickson Bldg., 5820 University Avenue, Halifax, NS, B3H 1V8, Canada
| | - Jonathan R Trites
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3052, Dickson Bldg., 5820 University Avenue, Halifax, NS, B3H 1V8, Canada
| | - Martin Corsten
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3052, Dickson Bldg., 5820 University Avenue, Halifax, NS, B3H 1V8, Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Suite 3052, Dickson Bldg., 5820 University Avenue, Halifax, NS, B3H 1V8, Canada.
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12
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Noel CW, Forner D, Chepeha DB, Baran E, Chan KKW, Parmar A, Husain Z, Karam I, Hallet J, Coburn NG, Eskander A. The Edmonton Symptom Assessment System: A narrative review of a standardized symptom assessment tool in head and neck oncology. Oral Oncol 2021; 123:105595. [PMID: 34775181 DOI: 10.1016/j.oraloncology.2021.105595] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 10/01/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Symptom burden is common in head and neck cancer patients though it frequently remains undetected and untreated. The Edmonton Symptom Assessment System - revised version (ESAS-r) is a generic symptom scale deployed in many outpatient settings worldwide. The ESAS-r is meant to improve symptom detection and management. We sought to review the ESAS-r and its psychometric properties in a head and neck oncology population. METHODS Narrative Review. RESULTS Over the past 30 years, the ESAS-r has emerged as one of the most used symptom scales for cancer patients. Its psychometric properties in a heterogenous cancer population are well supported, proving to be reliable and valid in a variety of settings. The linking of ESAS-r scores with Ontario administrative health data has led to a detailed assessment of validity in head and neck cancer. The ESAS-r can discriminate between high and low levels of symptom burden and is responsive to change over time in this patient population. ESAS-r scores have also been shown to be a strong predictor of future emergency department use and unplanned hospitalization in head and neck cancer patients. CONCLUSIONS The ESAS-r is reliable and valid in the head and neck cancer population and may serve as a useful clinical endpoint in research studies.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Division of Otolaryngology Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Elif Baran
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ambica Parmar
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre and Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada.
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13
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Forner D, Lee DJ, Grewal R, MacDonald J, Noel CW, Taylor SM, Goldstein DP. Advance care planning in adults with oral cancer: Multi-institutional cross-sectional study. Laryngoscope Investig Otolaryngol 2021; 6:1020-1023. [PMID: 34667844 PMCID: PMC8513442 DOI: 10.1002/lio2.647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/16/2021] [Accepted: 08/17/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Patients undergoing head and neck surgery are often elderly and frail with significant comorbidities. Discussion and documentation of what patients would desire for end-of-life care and decision-making is, therefore, essential for delivering patient-centered care. MATERIALS AND METHODS This was a retrospective, cross-sectional study of patients undergoing surgery for head and neck cancer at two large, academic, tertiary care centers in Canada. Advance care planning was defined as any documentation of advance directives, resuscitation orders, or end-of-life care preferences. RESULTS Among 301 patients, advance care planning was documented for 31 (10.3%). Patients with locally advanced disease (T3+) were twice as likely to have advance care planning documentation compared to those with early disease (RR 1.97, 95%CI [0.98, 3.97]). CONCLUSIONS In this multi-institutional cross-sectional study of two large academic centers, we have demonstrated that advance care planning and documentation is overall poor in patients undergoing surgery for oral cancer. These findings may have health policy implications, as advance care planning is associated with increased patient and provider satisfaction and improved alignment of patient goals and care delivered. Future work will investigate barriers and facilitators to advance care-planning documentation in this setting.
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Affiliation(s)
- David Forner
- Division of Otolaryngology—Head & Neck Surgery, Queen Elizabeth II Health Sciences CentreDalhousie UniversityHalifaxNova ScotiaCanada
| | - Daniel J. Lee
- Department of Otolaryngology—Head & Neck SurgeryUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Rajan Grewal
- Department of Otolaryngology—Head & Neck SurgeryUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - Jenna MacDonald
- Division of Otolaryngology—Head & Neck Surgery, Queen Elizabeth II Health Sciences CentreDalhousie UniversityHalifaxNova ScotiaCanada
| | - Christopher W. Noel
- Department of Otolaryngology—Head & Neck SurgeryUniversity Health Network, University of TorontoTorontoOntarioCanada
| | - S. Mark Taylor
- Division of Otolaryngology—Head & Neck Surgery, Queen Elizabeth II Health Sciences CentreDalhousie UniversityHalifaxNova ScotiaCanada
| | - David P. Goldstein
- Department of Otolaryngology—Head & Neck SurgeryUniversity Health Network, University of TorontoTorontoOntarioCanada
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14
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Forner D, Noel CW, Grant A, Hong P, Corsten M, Wu V, Taylor SM, Trites JRB, Rigby MH. Management of Peritonsillar Abscesses in Adults: Survey of Otolaryngologists in Canada and the United States. OTO Open 2021; 5:2473974X211044081. [PMID: 34541442 PMCID: PMC8445538 DOI: 10.1177/2473974x211044081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The management of peritonsillar abscess (PTA) has evolved over time. We sought to define contemporary practice patterns for the diagnosis and treatment of PTA. Study Design Cross-sectional survey. Setting The 15-question survey was distributed to members of the Canadian Society of Otolaryngology–Head and Neck Surgery (CSO) and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). Methods An iterative, consensus-based process was used for survey development. Primary outcomes were to determine methods of diagnosis and first-line treatments for PTA. Exploratory, secondary outcomes were analyzed using multivariable logistic regression models. Results The survey response rate was 12.6% (n = 1176). Most participants were attending staff (86%) in a community hospital setting (60%) and had been in practice for more than 20 years (38%). Most respondents (78%) indicated that at least half of the time, cross-sectional imaging had already been performed before they were consulted. Half of respondents (49%) indicated that they perform incision and drainage of the abscess as first-line treatment, while few (16%) provide medical management alone. In exploratory analysis, participants from the AAO-HNS had higher odds of imaging already being performed before consultation (odds ratio [OR], 11.7; 95% CI, 4.6-29.4) and increased odds of using medical management alone as a first-line treatment (OR, 2.4; 95% CI, 1.3-4.2) compared to respondents from the CSO. Conclusion There is wide practice variation in the diagnosis and management of acute, uncomplicated PTA among otolaryngologists in Canada and the United States. The use of cross-sectional imaging and medical management alone may differ between countries of practice.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.,Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amy Grant
- Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.,Maritime SPOR (Strategy for Patient-Oriented Research) Support Unit (MSSU), Halifax, Nova Scotia, Canada.,IWK Health Center, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R B Trites
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew H Rigby
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Staibano P, Forner D, Noel CW, Zhang H, Gupta M, Monteiro E, Sawka AM, Pasternak JD, Goldstein DP, de Almeida JR. Ultrasonography and Fine-Needle Aspiration in Indeterminate Thyroid Nodules: A Systematic Review of Diagnostic Test Accuracy. Laryngoscope 2021; 132:242-251. [PMID: 34411290 DOI: 10.1002/lary.29778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/01/2021] [Accepted: 07/14/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS Sonographic risk criteria may assist in further prognostication of indeterminate thyroid nodules (ITNs). Our aim was to determine whether sonographic criteria could further delineate the post-test probability of malignancy in ITNs. STUDY DESIGN Meta-analysis of diagnostic test accuracy. METHODS A systematic review of Web of Science, MEDLINE, EMBASE, and CINAHL was performed from inception to April 15, 2021. Eligible studies included those which reported ultrasonographic evaluations with the American Thyroid Association (ATA) or the Thyroid Imaging Reporting and Data System (TIRADS) in adult patients with ITNs. ATA or TIRADS were scored as low (negative) or high (positive) malignancy risk using a previously validated binary classification. Primary outcomes included pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio for all sonographic criteria. Studies were appraised using Quality Assessment of Diagnostic Accuracy Studies and the data were pooled using bivariate random-effects models. RESULTS Seventeen studies were included in the analysis. For Bethesda III, ATA had a specificity (0.90, 95% confidence interval (CI): 0.74-0.94), but a sensitivity of 0.52 (95% CI: 0.25-0.77). Conversely, K-TIRADS had the highest sensitivity (0.78, 95% CI: 0.62-0.89) with a specificity of 0.53 (95% CI: 0.31-0.74). Furthermore, American College of Radiology and EU TIRADS had specificities of 0.60 (95% CI: 0.36-0.80) and 0.81 (95% CI: 0.73-0.87) with sensitivities of 0.70 (95% CI: 0.37-0.90) and 0.38 (95% CI: 0.20-0.60), respectively. There were few studies with Bethesda IV nodules. CONCLUSIONS Though dependent on malignancy rates, Bethesda III nodules with low-suspicion TIRADS features may benefit from clinical observation, whereas nodules with high-suspicion ATA features may require molecular testing and/or surgery. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Phillip Staibano
- Department of Otolaryngology-Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Han Zhang
- Department of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Michael Gupta
- Department of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Eric Monteiro
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anna M Sawka
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Jesse D Pasternak
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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16
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Noel CW, Griffiths R, Siu J, Forner D, Urbach D, Freeman J, Goldstein DP, Irish JC, Higgins KM, Devon K, Pasternak JD, Eskander A. A Population-Based Analysis of Outpatient Thyroidectomy: Safe and Under-Utilized. Laryngoscope 2021; 131:2625-2633. [PMID: 34378810 DOI: 10.1002/lary.29816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/23/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Performance of thyroidectomy on an outpatient basis has gained popularity although many jurisdictions have not shifted their practice despite a strong safety profile. We sought to assess the uptake and safety of outpatient thyroidectomy in Ontario. STUDY DESIGN Retrospective cohort study. METHODS This was a population-based retrospecive cohort of adult patients undergoing hemithyroidectomy or total thyroidectomy between 1993 and 2017 in Ontario, Canada. Outpatient surgery was defined as discharge home on the same day of surgery. Outcomes of interest include 30-day all cause death, hematoma, emergency department use, and readmission. To adjust for confounding, propensity scores were calculated. Logistic regression models with inverse probability of treatment weighting (IPTW) were then used to estimate the exposure-outcome relationship. RESULTS The final cohort consisted of 81,199 patients: 8,442 underwent same day surgery and 72,757 were admitted. The proportion of patients undergoing outpatient thyroidectomy increased overtime (2.3% in 1993-1994 to 17.8% in 2016-2017). Factors associated with higher odds of outpatient thyroidectomy included: younger age, less material deprivation, less comorbidities, and higher surgeon volume. The absolute number of deaths (≤5) and hematomas (64, 0.8%) in the outpatient cohort was low. After IPTW adjustment, patients with outpatient management had lower odds of neck hematoma (OR 0.73[95CI% 0.58-0.93)], but higher odds of emergency department use (OR 1.67[95%CI 1.56-1.79]). CONCLUSIONS Outpatient thyroidectomy is not associated with an increased mortality risk. Less than one in five patients undergo outpatient thyroidectomy in Ontario, despite a well-established safety profile. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Griffiths
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Jennifer Siu
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Urbach
- Women's College Hospital and Departments of Surgery and Health Policy, Management and Evaluation, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kevin M Higgins
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Surgical Oncology, Sunnybrook Health Sciences Centre and Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Karen Devon
- Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jesse D Pasternak
- Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Surgical Oncology, Sunnybrook Health Sciences Centre and Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada
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17
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Kim JH, Grose E, Philteos J, Forner D, Noel CW, Wu V, Eskander A. Readability of the American, Canadian, and British Otolaryngology-Head and Neck Surgery Societies' Patient Materials. Otolaryngol Head Neck Surg 2021; 166:862-868. [PMID: 34372717 PMCID: PMC9066686 DOI: 10.1177/01945998211033254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Patient education materials across 3 national English otolaryngology–head and neck surgery (OHNS) societies: the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), the Canadian Society of Otolaryngology–Head and Neck Surgery (CSOHNS), and Ear, Nose, and Throat United Kingdom (ENT UK) were examined to determine whether they are written at a level suitable for patient comprehension. Study Design Cross-sectional study. Setting Online patient materials presented through OHNS national societies. Methods Readability was calculated using the Flesch-Kincaid Grade Level, Flesch-Kincaid Reading Ease Score, and Simple Measure of Gobbledygook Index. All public patient education materials available through the CSOHNS, AAO-HNS, and ENT UK websites were assessed. Patient education materials were grouped into categories by subspecialty. Results In total, 128 patient materials from the 3 societies were included in the study. All 3 societies required a minimum grade 9 reading comprehension level to understand their online materials. According to Flesch-Kincaid Grade Level, the CSOHNS required a significantly higher reading grade level to comprehend the materials presented when compared to AAO-HNS (11.3 vs 9.9; 95% CI, 0.5-2.4; P < .01) and ENT UK (11.3 vs 9.4; 95% CI, 0.9-2.9; P < .01). Patient education materials related to rhinology were the least readable among all 3 societies. Conclusion This study suggests that the reading level of the current patient materials presented through 3 national OHNS societies are written at a level that exceeds current recommendations. Promisingly, it highlights an improvement for the readability of patient materials presented through the AAO-HNS.
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Affiliation(s)
- Joo Hyun Kim
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elysia Grose
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Department of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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18
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Noel CW, Keshavarzi S, Forner D, Stephens RF, Watson E, Monteiro E, Hosni A, Hansen A, Goldstein DP, de Almeida JR. Construct Validity of the EuroQoL-5 Dimension and the Health Utilities Index in Head and Neck Cancer. Otolaryngol Head Neck Surg 2021; 166:877-885. [PMID: 34311628 PMCID: PMC9066667 DOI: 10.1177/01945998211030173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective The objective of this study was to evaluate the construct validity of 2 health utility instruments—the EuroQoL–5 Dimension (EQ-5D) and the Health Utilities Index–Mark 3 (HUI-3)—and to compare them with disease-specific measures in patients with head and neck cancer. Study Design Prospective cross-sectional analysis. Setting Princess Margaret Cancer Centre. Methods Patients were administered the EQ-5D, HUI-3, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its head and neck cancer module (EORTC QLQ-H&N35), and the University of Washington Quality of Life Questionnaire (UWQoL). Several a priori expected relations were examined. The correlative and discriminative properties of the various instruments were examined. Results A total of 209 patients completed the 4 questionnaires. A significant ceiling effect was observed among EQ-5D responses (23% reported a maximum score of 1). The EQ-5D (rho = 0.79) and HUI-3 (rho = 0.60) had a strong correlation with the social-emotional domain of the UWQoL. The EQ-5D had a moderate correlation with the physical domain of the UWQoL (rho = 0.42), whereas the HUI-3 had a weak correlation (rho = 0.29). The EQ-5D and HUI-3 were able to distinguish among levels of health severity measured on the EORTC QLQ-C30 though not the QLQ-H&N35. Comparatively, the UWQoL was able to distinguish levels of disease severity on the EORTC QLQ-C30 and QLQ-H&N35. Conclusion The results of this study demonstrate that disease-specific domains from head and neck quality-of-life instruments are not strongly correlated with the EQ-5D and HUI-3. Consideration should be put toward development of a disease-specific preference-based measure for health economic evaluation. Level of evidence 4.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sareh Keshavarzi
- Department of Biostatistics, University Health Network, Toronto, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Canada
| | - Robert F Stephens
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Canada
| | - Erin Watson
- Department of Dentistry, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Canada
| | - Aaron Hansen
- Department of Medical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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19
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Lee C, Forner D, Noel CW, Taylor V, MacKay C, Rigby MH, Corsten M, Trites JR, Taylor SM. Functional and Oncologic Outcomes of Octogenarians Undergoing Transoral Laser Microsurgery for Laryngeal Cancer. OTO Open 2021; 5:2473974X211046957. [PMID: 34604690 PMCID: PMC8485289 DOI: 10.1177/2473974x211046957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/31/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the oncologic and functional outcomes of transoral laser microsurgery (TLM) for glottic cancers in patients ≥80 years. STUDY DESIGN Prospectively collected case series. SETTING QEII Health Sciences Centre, Halifax, Canada. METHODS This case series used a prospectively collected glottic cancer database to examine consecutive elderly patients (≥80 years old) undergoing TLM. Kaplan-Meier analysis was used to evaluate rates of disease-free, disease-specific, and overall survival as the primary end points of oncologic control. Secondary functional outcomes included voice function, length of hospital stay, and time to readmission. RESULTS From 2005 to 2017, 17 octogenarian patients underwent TLM for glottic cancer. Median follow-up was 4.19 years (interquartile range, 0.71-6.95). Kaplan-Meier estimates of 5-year survival were 78.4% (disease free), 92.9% (disease specific), and 81.9% (overall). The median length of hospital stay was 1 day (range, 0-8). There was only 1 readmission within 30 days of surgery. No patients in this study developed significant surgical or postoperative complications requiring unplanned readmissions. Patient-perceived voice function improved to normal after treatment in 62.5% of patients. CONCLUSION The results of this study suggest that TLM is a safe and effective treatment modality for glottic cancer in patients aged ≥80 years, providing good oncologic control and satisfactory functional outcomes.
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Affiliation(s)
- Changseok Lee
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - David Forner
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - Christopher W. Noel
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Victoria Taylor
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - Colin MacKay
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - Matthew H. Rigby
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - Martin Corsten
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - Jonathan R. Trites
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
| | - S. Mark Taylor
- Division of Otolaryngology–Head and Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Canada
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20
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Kuta V, Forner D, Azzi J, Curry D, Noel CW, Munroe K, Bullock M, McDonald T, Taylor SM, Rigby MH, Trites J, Johnson-Obaseki S, Corsten MJ. Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi-institutional Study. OTO Open 2021; 5:2473974X211015937. [PMID: 34250424 PMCID: PMC8239982 DOI: 10.1177/2473974x211015937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/19/2021] [Indexed: 12/22/2022] Open
Abstract
Objective Patient-centered decision making is increasingly identified as a desirable component of medical care. To manage indeterminate thyroid nodules, patients are offered the options of surveillance, diagnostic hemithyroidectomy, or molecular testing. Our objective was to identify factors associated with decision making in this population. Study Design This is a retrospective cross-sectional study of patients with Bethesda III and IV thyroid nodules. Setting Multi-institutional. Methods Factors of interest included age, sex, socioeconomic status (SES), nodule size, institution, attending surgeon, surgeon payment model, and hospital type. Our outcome of interest was the initial management decision made by patients. Results A total of 956 patients were included. The majority of patients had Bethesda III nodules (n = 738, 77%). A total of 538 (56%) patients chose surgery, 413 (43%) chose surveillance, and 5 (1%) chose molecular testing. There was a significant variation in management decision based on attending surgeon (proportion of patients choosing surgery: 15%-83%; P≤.0001). Fee-for-service surgeon payment models (odds ratio [OR], 1.657; 95% CI, 1.263-2.175; P < .001) and community hospital settings (OR, 1.529; 95% CI, 1.145-2.042; P < .001) were associated with the decision for surgery. Larger nodule size, younger patients, and Bethesda IV nodules were also associated with surgery. Conclusion While it seems appropriate that larger nodules, younger age, and higher Bethesda class were associated with decision for surgery, we also identified attending surgeon, surgeon payment model, and hospital type as important factors. Given this, standardizing management discussions may improve patient-centered shared decision making.
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Affiliation(s)
- Victoria Kuta
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Canada
| | - David Forner
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Canada
| | - Jason Azzi
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Dennis Curry
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kelti Munroe
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Martin Bullock
- Department of Pathology, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Canada
| | - Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Canada
| | - Matthew H Rigby
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Canada
| | - Jonathan Trites
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology-Head & Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Martin J Corsten
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Center, Dalhousie University, Halifax, Canada
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21
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Fu TS, Scheffler P, Forner D, Noel CW, Huang SH, Gilbert RW, Goldstein DP, O'Sullivan B, Mehanna HM, Waldron J, de Almeida JR. A cost-utility analysis comparing CT surveillance, PET-CT surveillance, and planned postradiation neck dissection for advanced nodal HPV-positive oropharyngeal cancer. Cancer 2021; 127:3372-3380. [PMID: 34062618 DOI: 10.1002/cncr.33653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/14/2021] [Accepted: 03/21/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The cost utility of image-guided surveillance using computed tomography (CT) and positron emission tomography (PET)-CT to planned postradiation neck dissection (PRND) was compared for the management of advanced nodal human papillomavirus-positive oropharyngeal cancer following chemoradiation. METHODS A universal payer perspective was adopted. A Markov model was designed to simulate four treatment approaches with 3-month cycles over a lifetime horizon: 1) CT surveillance, 2) standard PET-CT surveillance, 3) a novel PET-CT approach with repeat PET at 6 months postchemoradiation for equivocal responders, and 4) PRND. Parameters including probabilities of CT nodal progression/resolution, PET avidity, recurrence, and survival were obtained from the literature. Costs were reported in 2019 Canadian dollars and utilities were expressed in quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were performed to evaluate model uncertainty. RESULTS PET-CT surveillance dominated CT surveillance and PRND in the base case scenario, and the novel PET-CT approach was the most cost-effective strategy across a wide range of variables tested in one-way sensitivity analysis. On probabilistic sensitivity analysis, novel PET-CT surveillance was the most cost-effective strategy in 78.1% of model iterations at a willingness-to-pay of $50,000/QALYs. Novel PET-CT surveillance resulted in a 49% lower rate of neck dissection compared with traditional PET-CT, and yielded an incremental benefit of 0.14 QALYs with average cost savings of $1309. CONCLUSIONS Image-guided surveillance including PET-CT and CT are more cost effective than PRND. The novel PET-CT approach with repeat PET for equivocal responders was the dominant strategy and yielded both higher benefit and lower costs compared with standard PET-CT surveillance.
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Affiliation(s)
- Terence S Fu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Scheffler
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hisham M Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, United Kingdom
| | - John Waldron
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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22
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Forner D, Murnaghan S, Porter G, Mason RJ, Hong P, Taylor SM, Bentley J, Hirsch G, Noel CW, Rigby MH, Corsten M, Trites JR, Taylor V, Kendell C, Jorgensen M, Urquhart R. Psychosocial Distress in Adult Patients Awaiting Cancer Surgery during the COVID-19 Pandemic. Curr Oncol 2021; 28:1867-1878. [PMID: 34068441 PMCID: PMC8161781 DOI: 10.3390/curroncol28030173] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023] Open
Abstract
Cancer causes substantial emotional and psychosocial distress, which may be exacerbated by delays in treatment. The COVID-19 pandemic has resulted in increased wait times for many patients with cancer. In this study, the psychosocial distress associated with waiting for cancer surgery during the pandemic was investigated. This cross-sectional, convergent mixed-methods study included patients with lower priority disease during the first wave of COVID-19 at an academic, tertiary care hospital in eastern Canada. Participants underwent semi-structured interviews and completed two questionnaires: Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS). Qualitative analysis was completed through a thematic analysis approach, with integration achieved through triangulation. Fourteen participants were recruited, with cancer sites including thyroid, kidney, breast, prostate, and a gynecological disorder. Increased anxiety symptoms were found in 36% of patients and depressive symptoms in 14%. Similarly, 64% of patients experienced moderate or high stress. Six key themes were identified, including uncertainty, life changes, coping strategies, communication, experience, and health services. Participants discussed substantial distress associated with lifestyle changes and uncertain treatment timelines. Participants identified quality communication with their healthcare team and individualized coping strategies as being partially protective against such symptoms. Delays in surgery for patients with cancer during the COVID-19 pandemic resulted in extensive psychosocial distress. Patients may be able to mitigate these symptoms partially through various coping mechanisms and improved communication with their healthcare teams.
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Affiliation(s)
- David Forner
- Division of Otolaryngology—Head & Neck Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (D.F.); (P.H.); (S.M.T.); (M.H.R.); (M.C.); (J.R.T.); (V.T.)
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
| | - Sarah Murnaghan
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
| | - Geoffrey Porter
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
- Division of General Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Ross J. Mason
- Department of Urology, Dalhousie University, Halifax, NS B3H 2Y9, Canada;
| | - Paul Hong
- Division of Otolaryngology—Head & Neck Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (D.F.); (P.H.); (S.M.T.); (M.H.R.); (M.C.); (J.R.T.); (V.T.)
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
| | - S. Mark Taylor
- Division of Otolaryngology—Head & Neck Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (D.F.); (P.H.); (S.M.T.); (M.H.R.); (M.C.); (J.R.T.); (V.T.)
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
| | - James Bentley
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS B3H 2Y9, Canada;
| | - Gregory Hirsch
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
- Division of Cardiac Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Christopher W. Noel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada;
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Matthew H. Rigby
- Division of Otolaryngology—Head & Neck Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (D.F.); (P.H.); (S.M.T.); (M.H.R.); (M.C.); (J.R.T.); (V.T.)
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
| | - Martin Corsten
- Division of Otolaryngology—Head & Neck Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (D.F.); (P.H.); (S.M.T.); (M.H.R.); (M.C.); (J.R.T.); (V.T.)
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
| | - Jonathan R. Trites
- Division of Otolaryngology—Head & Neck Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (D.F.); (P.H.); (S.M.T.); (M.H.R.); (M.C.); (J.R.T.); (V.T.)
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
| | - Victoria Taylor
- Division of Otolaryngology—Head & Neck Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (D.F.); (P.H.); (S.M.T.); (M.H.R.); (M.C.); (J.R.T.); (V.T.)
| | - Cynthia Kendell
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
| | - Margaret Jorgensen
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (S.M.); (G.P.); (G.H.); (C.K.); (M.J.)
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23
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Forner D, Noel CW, Boland L, Pieterse AH, Borkhoff CM, Hong P. The Multifocal Approach to Sharing in Shared Decision Making: A Critical Appraisal of the MAPPIN'SDM. Med Decis Making 2021; 42:114-124. [PMID: 33966516 DOI: 10.1177/0272989x211010738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Shared decision making integrates health care provider expertise with patient values and preferences. The MAPPIN'SDM is a recently developed measurement instrument that incorporates physician, patient, and observer perspectives during medical consultations. This review sought to critically appraise the development, sensibility, reliability, and validity of the MAPPIN'SDM and to determine in which settings it has been used. METHODS This critical appraisal was performed through a targeted review of the literature. Articles outlining the development or measurement property assessment of the MAPPIN'SDM or that used the instrument for predictor or outcome purposes were identified. RESULTS Thirteen studies were included. The MAPPIN'SDM was developed by both adapting and building on previous shared decision making measurement instruments, as well as through creation of novel items. Content validity, face validity, and item quality of the MAPPIN'SDM are adequate. Internal consistency ranged from 0.91 to 0.94 and agreement statistics from 0.41 to 0.92. The MAPPIN'SDM has been evaluated in several populations and settings, ranging from chronic disease to acute oncological settings. Limitations include high reading levels required for self-administered patient questionnaires and the small number of studies that have employed the instrument to date. CONCLUSION The MAPPIN'SDM generally shows adequate development, sensibility, reliability, and validity in preliminary testing and holds promise for shared decision making research integrating multiple perspectives. Further research is needed to develop its use in other patient populations and to assess patient understanding of complex item wording.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Christopher W Noel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Laura Boland
- Knowledge Translation Laboratory, Health Sciences, Western University, London, ON, Canada.,Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Pediatric Outcomes Research Team, Department of Pediatrics and Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
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24
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Noel CW, Sutradhar R, Zhao H, Delibasic V, Forner D, Irish JC, Kim J, Husain Z, Mahar A, Karam I, Enepekides DJ, Chan KKW, Singh S, Hallet J, Coburn NG, Eskander A. Reply to K. Yokoyama et al. J Clin Oncol 2021; 39:2417-2419. [PMID: 33950700 DOI: 10.1200/jco.21.00688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christopher W Noel
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rinku Sutradhar
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Haoyu Zhao
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Victoria Delibasic
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - David Forner
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jonathan C Irish
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - John Kim
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Zain Husain
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Alyson Mahar
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Irene Karam
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Danny J Enepekides
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kelvin K W Chan
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Simron Singh
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Julie Hallet
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Natalie G Coburn
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Antoine Eskander
- Christopher W. Noel, MD, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Rinku Sutradhar, PhD, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada; Haoyu Zhao, MPH, and Victoria Delibasic, BHSc, ICES, Toronto, ON, Canada; David Forner, MD, MSc, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada; Jonathan C. Irish, MD, MSc, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; John Kim, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Zain Husain, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Alyson Mahar, PhD, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada; Irene Karam, MD, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Danny J. Enepekides, MD, MPH, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Kelvin K. W. Chan, MD, MSc, PhD, and Simron Singh,MD, MPH, Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Julie Hallet, MD, MSc, and Natalie G. Coburn, MD, MPH, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; and Antoine Eskander, MD, ScM, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, ICES, Toronto, ON, Canada, Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Forner D, Purcell C, Taylor V, Noel CW, Pan L, Rigby MH, Corsten M, Trites JR, Eskander A, McDonald T, Taylor SM. Carbon footprint reduction associated with a surgical outreach clinic. J Otolaryngol Head Neck Surg 2021; 50:26. [PMID: 33875009 PMCID: PMC8054848 DOI: 10.1186/s40463-021-00510-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Healthcare systems generate substantial carbon footprints that may be targeted to decrease greenhouse gas emissions. Outreach clinics may represent tools to assist in this reduction by optimizing patient related travel. Therefore, we sought to estimate the carbon footprint savings associated with a head and neck surgery outreach clinic. METHODS This study was a cross-sectional survey of patient travel patterns to a surgical outreach clinic compared to a regional cancer treatment centre from December 2019 to February 2020. Participants completed a self-administered survey of 12 items eliciting travel distance, vehicle details, and ability to combine medical appointments. Canadian datasets of manufacturer provided vehicular efficiency were used to estimate carbon emissions for each participant. Geographic information systems were used for analyses. RESULTS One hundred thirteen patients were included for analysis. The majority of patients (85.8%) used their own personal vehicle to travel to the outreach clinic. The median distance to the clinic and regional centre were 29.0 km (IQR 6.0-51.9) and 327.0 km (IQR 309.0-337.0) respectively. The mean carbon emission reduction per person was therefore 117,495.4 g (SD: 29,040.0) to 143,570.9 g (SD: 40,236.0). This represents up to 2.5% of an average individual's yearly carbon footprint. Fewer than 10% of patients indicated they were able to carpool or group their appointments. CONCLUSION Surgical outreach clinics decrease carbon footprints associated with patient travel compared to continued care at a regional centre. Further research is needed to determine possible interventions to further reduce carbon emissions associated with the surgical care of patients.
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Affiliation(s)
- David Forner
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Chad Purcell
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Victoria Taylor
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christopher W Noel
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Larry Pan
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Radiation Oncology, Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R Trites
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Forner D, Noel CW, Shuman AG, Hong P, Corsten M, Rac VE, Pieterse AH, Goldstein D. Shared Decision-making in Head and Neck Surgery: A Review. JAMA Otolaryngol Head Neck Surg 2021; 146:839-844. [PMID: 32701131 DOI: 10.1001/jamaoto.2020.1601] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Shared decision-making is a partnership between physicians and patients whereby patient values and preferences are incorporated with the best medical evidence. Shared decision-making may reduce decisional conflict, improve value-choice congruence, and increase patient involvement. Despite potential benefit in many key areas of otolaryngology-head and neck surgery, both clinical and research focuses on shared decision-making are scarce. Head and neck surgical oncology is of particular interest owing to the frequency by which preference-sensitive decisions must be made. Information used in this review was obtained between January 1 and February 1, 2020. Observations Various conceptual models have been developed in an attempt to define the concept of shared decision-making. More than 40 instruments have endeavored to measure the construct of shared decision-making. However, in head and neck surgery, few studies to date have explicitly done so. Situations of clinical equipoise, such as in the management of indeterminate thyroid nodules and in the treatment of laryngeal cancer, are frequent. In contrast, value-option incongruence may occur when patient values do not align with the most oncologically sound treatment choice, such as when the resection and reconstruction of oral cancer may leave patients with significant sequelae. Several patient decision aids have been developed to improve shared decision-making in specific clinical scenarios, for example, in considering total laryngectomy or primary chemoradiotherapy. Conclusions and Relevance Despite its potential benefit, there is a dearth of research and clinical applications of shared decision-making in head and neck surgery. Shared decision-making represents an area of substantial need in this regard, and additional efforts should be put forth.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Andrew G Shuman
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Valeria E Rac
- Toronto Health Economics and Technology Assessment Collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - David Goldstein
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto and University Health Network, Toronto, Ontario, Canada
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Noel CW, Sutradhar R, Li Q, Forner D, Hallet J, Cheung M, Singh S, Coburn NG, Eskander A. Association of Immigration Status and Chinese and South Asian Ethnicity With Incidence of Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 146:1125-1135. [PMID: 33151263 DOI: 10.1001/jamaoto.2020.4197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Head and neck cancer (HNC) incidence varies worldwide, although it remains one of the most common cancers among those of East Asian and South Asian ethnicity. Objective To determine the association of Chinese and South Asian ethnicity, independent of immigration status, with HNC incidence. Design, Setting, and Participants This was a retrospective population-based matched cohort study that examined data collected between 1994 and 2017 in Ontario, Canada. Data were analyzed between July 2019 and March 2020. Individuals who immigrated to Canada between 1985 and 2017 were classified as immigrants, whereas Canadian-born individuals and those who immigrated prior to 1985 were classified as long-standing residents. Two separate, matched cohorts were created: an immigration cohort, consisting of immigrants and long-standing residents hard matched on age and sex, and an ethnicity cohort, where participants were further matched on ethnicity (Chinese, South Asian, or non-Chinese/non-South Asian). Exposures Chinese ethnicity, South Asian ethnicity, and immigration status. Main Outcomes and Measures Patients newly diagnosed with primary HNC were captured in both the immigration and the ethnicity cohorts. Cause-specific hazard models were used to estimate the association of immigration status and ethnicity with HNC incidence. Results In the immigration cohort, 3 328 434 matched individuals (mean [SD] age, 36.73 [13.46] years; 52.8% female) were followed, across which 3173 unique HNC diagnoses were made. The hazard ratio (HR) for a new diagnosis of oropharynx cancer was lower in immigrants compared with long-standing residents (HR, 0.26 [95% CI, 0.22-0.31]). In the ethnicity cohort, after adjusting for age, sex, rurality, and deprivation, the rate of HNC diagnosis was higher for Chinese individuals (HR, 1.49 [95% CI, 1.36-1.64]) and South Asian individuals (HR, 1.29 [95% CI, 1.14-1.45]), although it was lower for immigrants (HR, 0.48 [95% CI, 0.44-0.52]) when compared with non-Chinese and non-South Asian individuals. There was no difference in the incidence of nasopharynx cancer when comparing immigrants and long-standing residents of Chinese ethnicity. Conclusions and Relevance Immigration status appears to offer a protective effect against a diagnosis of HNC. Chinese and South Asian ethnic groups may experience higher HNC incidence when compared with the general Ontario population.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - Qing Li
- Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew Cheung
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Simron Singh
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Noel CW, Forner D, Goldstein DP, Metser U, Ferris RL, Waldron J, de Almeida JR. Elective neck dissection versus positron emission tomography-computed tomography-guided management of the neck in clinically node-negative early oral cavity cancer: A cost-utility analysis. Cancer 2021; 127:1993-2002. [PMID: 33635537 DOI: 10.1002/cncr.33446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In early oral cavity cancer, elective neck dissection (END) for the clinically node-negative (cN0) neck improves survival compared with observation. This paradigm has been challenged recently by the use of positron emission tomography-computed tomography (PET-CT) imaging in the cN0 neck. To inform this debate, we performed an economic evaluation comparing PET-CT-guided therapy with routine END in the cN0 neck. METHODS Patients with T1-2N0 lateralized oral tongue cancer were analyzed. A Markov model over a 40-year time horizon simulated treatment, disease recurrence, and survival from a US health care payer perspective. Model parameters were derived from a review of the literature. RESULTS The END strategy was dominant, with a cost savings of $1576.30 USD, an increase of 0.055 quality-adjusted life years (QALYs), a net monetary benefit of $4303 USD, and a 0.22 life-year advantage. END was sensitive to variation in cost and utilities in deterministic and probabilistic sensitivity analyses. PET-CT became the preferred strategy when decreasing occult nodal disease to 18% and increasing the negative predictive value (NPV) of PET-CT to 89% in 1-way sensitivity analyses. In probabilistic sensitivity analysis, assuming a cost effectiveness threshold of $50,000 USD/QALY, END was dominant in 64% of simulations and cost effective in 69.8%. CONCLUSION END is a cost-effective strategy compared with PET-CT in patients who have node-negative oral cancer. Although lower PET standardized uptake value thresholds would result in fewer false negatives and improved NPV, it is still uncertain that PET-CT would be cost effective, as this would likely result in more false positive tests.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ur Metser
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert L Ferris
- University of Pittsburgh and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Lee DJ, Forner D, End C, Yao CMKL, Samargandy S, Monteiro E, Witterick IJ, Freeman JL. Outpatient versus inpatient superficial parotidectomy: clinical and pathological characteristics. J Otolaryngol Head Neck Surg 2021; 50:10. [PMID: 33579392 PMCID: PMC7881444 DOI: 10.1186/s40463-020-00484-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022] Open
Abstract
Background Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy. Methods A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications. Results There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952). Conclusion Superficial parotidectomy can be performed safely as an outpatient procedure without elevated risk of complications. Graphical abstract ![]()
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Affiliation(s)
- Daniel J Lee
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - David Forner
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, ON, Canada
| | - Christopher End
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Shireen Samargandy
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sinai Health System, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sinai Health System, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada
| | - Jeremy L Freeman
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada. .,Department of Otolaryngology - Head & Neck Surgery, Sinai Health System, 600 University Avenue, Suite 401, Toronto, ON, M5G 1X5, Canada.
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Noel CW, Sutradhar R, Zhao H, Delibasic V, Forner D, Irish JC, Kim J, Husain Z, Mahar A, Karam I, Enepekides DJ, Chan KKW, Singh S, Hallet J, Coburn NG, Eskander A. Patient-Reported Symptom Burden as a Predictor of Emergency Department Use and Unplanned Hospitalization in Head and Neck Cancer: A Longitudinal Population-Based Study. J Clin Oncol 2021; 39:675-684. [PMID: 33405964 DOI: 10.1200/jco.20.01845] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To determine the association between patient-reported symptom burden and subsequent emergency department use and unplanned hospitalization (ED/Hosp) in a head and neck cancer (HNC) patient population. METHODS This was a population-based study of patients diagnosed with HNC who had completed at least one outpatient Edmonton Symptom Assessment System (ESAS) assessment between January 2007 and March 2018 in Ontario, Canada. Logistic regression models were used to determine the relationship between outpatient ESAS scores and subsequent 14-day ED/Hosp use. A generalized estimating equation approach with an exchangeable correlation structure was incorporated to account for patient-level clustering. RESULTS There were 11,761 patients identified, completing a total of 73,282 ESAS assessments and experiencing 5,203 ED/Hosp events. Six of the nine ESAS symptom scores were positively associated with ED/Hosp use, with pain, appetite, shortness of breath, and tiredness demonstrating the strongest associations. A global ESAS score was calculated by selecting the highest individual symptom score (h-ESAS). Among patients reporting a maximum h-ESAS score of 10, 15.1% had an ED/Hosp event within 14 days compared with 1.5% for those with the lowest possible score of zero. In adjusted analysis, the odds of ED/Hosp use increased with h-ESAS (1.23 per one-unit increase [95% CI, 1.22 to 1.25]). When treated as a categorical variable, patients with the maximum h-ESAS score of 10 had 9.23 (95% CI, 7.22 to 11.33) higher odds of ED/Hosp use, relative to the minimum score of zero. CONCLUSION ESAS scores are strongly associated with subsequent ED/Hosp events in patients with HNC. Clinician education around how ESAS data might inform patient care may enhance symptom detection and management.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | | | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan C Irish
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Kim
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny J Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Simron Singh
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Noel CW, Sutradhar R, Li Q, Forner D, Hallet J, Cheung M, Singh S, Coburn NG, Eskander A. Chinese and South Asian ethnicity, immigration status and head and neck cancer outcomes: A population based study. Oral Oncol 2020; 113:105118. [PMID: 33341005 DOI: 10.1016/j.oraloncology.2020.105118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE While it is known that certain ethnic and immigrant groups are at increased risk of developing head and neck cancer, the individual effects of immigration status and ethnicity on head and neck cancer outcomes is less clear. We sought examine the independent effects of immigration and Chinese and South Asian ethnicity on overall survival in a head and neck cancer patient population. METHODS This was a population-based retrospective matched cohort study using linked Ontario administrative databases between 1994 and 2017. Incident cancer cases were captured in long-standing residents of Chinese and South Asian ethnicity, Chinese and South Asian immigrants, as well as a reference population. Subjects were followed until death. A hard-matching approach was used to adjust for key differences and ensure both groups were balanced with respect to age, sex and cancer site. Cox proportional hazard models were used to estimate the impact of Chinese and South Asian ethnicity on overall survival while further adjusting for baseline covariates. RESULTS Among 1639 immigrants with head and neck cancer, matched to 3278 controls, the overall 5-year survival rate was 66% and 59%, respectively. After adjusting for between group-differences, all-cause mortality was lower for immigrants (HR 0.76[95%CI 0.69-0.83]) and individuals of Chinese ethnicity (HR 0.78[95%CI 0.68-0.90]), relative to the general population. CONCLUSIONS In Ontario, immigrants experience lower mortality rates following a head and neck cancer diagnosis. Individuals of Chinese ethnicity with head and neck cancer experience a survival advantage, relative to South Asian individuals and the general population.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, Canada
| | - Qing Li
- Institute for Clinical and Evaluative Sciences, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Matthew Cheung
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Simron Singh
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Natalie G Coburn
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Clinical and Evaluative Sciences, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Forner D, Horwich P, Trites JR, Hollenhorst H, Bullock M, Lamond NWD. The abscopal effect in head-and-neck squamous cell carcinoma treated with radiotherapy and nivolumab: a case report and literature review. Curr Oncol 2020; 27:330-335. [PMID: 33380865 PMCID: PMC7755449 DOI: 10.3747/co.27.6687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction The abscopal effect is a rarely observed outcome of radiotherapy wherein there is a reduction in metastatic disease burden outside of the targeted treatment area. Likely due to an in situ vaccine effect of radiotherapy, the abscopal effect may be augmented by immunotherapy. This report is the first case of the abscopal effect observed in metastatic head-and-neck squamous cell carcinoma (hnscc) treated with concurrent radiotherapy and single-agent nivolumab. Case Description An otherwise healthy 57-year-old man underwent craniofacial resection and adjuvant chemoradiotherapy for advanced sinonasal squamous cell carcinoma. Distant metastatic disease developed shortly after primary treatment, and immunotherapy in the form of nivolumab was initiated. Subsequent oligometastatic progression despite immunotherapy prompted palliative radiotherapy to a single metastasis due to pending symptomatology. Post-radiotherapy, the abscopal effect was observed with all distant sites of metastatic disease shrinking. Five months following treatment, a sustained reduction in disease burden has been demonstrated. Summary We present the first case of the abscopal effect in a patient with metastatic hnscc treated with palliative radiotherapy concurrent with single-agent nivolumab immunotherapy, and only the third case of the abscopal effect in metastatic head-and-neck cancer. Dual treatment with immunotherapy and radiotherapy may be an important treatment option in the future, mediated through the abscopal effect.
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Affiliation(s)
- D Forner
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Queen Elizabeth ii Health Sciences Centre and Dalhousie University, Halifax, NS
| | - P Horwich
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, U.S.A
| | - J R Trites
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Queen Elizabeth ii Health Sciences Centre and Dalhousie University, Halifax, NS
| | - H Hollenhorst
- Department of Radiation Oncology, Department of Medicine, Queen Elizabeth ii Health Sciences Centre and Dalhousie University, Halifax, NS
| | - M Bullock
- Department of Pathology, Department of Medicine, Queen Elizabeth ii Health Sciences Centre and Dalhousie University, Halifax, NS
| | - N W D Lamond
- Division of Medical Oncology, Department of Medicine, Queen Elizabeth ii Health Sciences Centre and Dalhousie University, Halifax, NS
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Forner D, Hong P, Corsten M, Rac VE, Martino R, Shuman AG, Chepeha DB, Sawka AM, de Almeida JR, Irish JC, Brown DH, Taylor SM, Gullane PJ, Trites JR, Gilbert R, Rigby MH, Ringash J, Goldstein D. Needs assessment for a decision support tool in oral cancer requiring major resection and reconstruction: a mixed-methods study protocol. BMJ Open 2020; 10:e036969. [PMID: 33234615 PMCID: PMC7684801 DOI: 10.1136/bmjopen-2020-036969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Advanced oral cancer and its ensuing treatment engenders significant morbidity and mortality. Patients are often elderly with significant comorbidities. Toxicities associated with surgical resection can be devastating and they are often highlighted by patients as impactful. Given the potential for suboptimal oncological and functional outcomes in this vulnerable patient population, promotion and performance of shared decision making (SDM) is crucial.Decision aids (DAs) are useful instruments for facilitating the SDM process by presenting patients with up-to-date evidence regarding risks, benefits and the possible postoperative course. Importantly, DAs also help elicit and clarify patient values and preferences. The use of DAs in cancer treatment has been shown to reduce decisional conflict and increase SDM. No DAs for oral cavity cancer have yet been developed.This study endeavours to answer the question: Is there a patient or surgeon driven need for development and implementation of a DA for adult patients considering major surgery for oral cancer? METHODS AND ANALYSIS This study is the first step in a multiphase investigation of SDM during major head and neck surgery. It is a multi-institutional convergent parallel mixed-methods needs assessment study. Patients and surgeon dyads will be recruited to complete questionnaires related to their perception of the SDM process (nine-item Shared Decision-Making Questionnaire, SDM-Q-9 and SDM-Q-Doc) and to take part in semistructured interviews. Patients will also complete questionnaires examining decisional self-efficacy (Ottawa Decision Self-Efficacy Scale) and decisional conflict (Decisional Conflict Scale). Questionnaires will be completed at time of recruitment and will be used to assess the current level of SDM, self-efficacy and conflict in this setting. Thematic analysis will be used to analyse transcripts of interviews. Quantitative and qualitative components of the study will be integrated through triangulation, with matrix developed to promote visualisation of the data. ETHICS AND DISSEMINATION This study has been approved by the research ethics boards of the Nova Scotia Health Authority (Halifax, Nova Scotia) and the University Health Network (Toronto, Ontario). Dissemination to clinicians will be through traditional approaches and creation of a head and neck cancer SDM website. Dissemination to patients will include a section within the website, patient advocacy groups and postings within clinical environments.
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Affiliation(s)
- David Forner
- Otolaryngology -- Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Hong
- Otolaryngology -- Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
- Otolaryngology -- Head & Neck Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Otolaryngology -- Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Valeria E Rac
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative and Toronto General Hospital Research Institute (TGHRI), University Health Network, Toronto, Ontario, Canada
| | - Rosemary Martino
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Andrew G Shuman
- Otolaryngology -- Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas B Chepeha
- Otolaryngology -- Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Anna M Sawka
- Endocrinology, University Health Network, Toronto, Ontario, Canada
| | - John R de Almeida
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Otolaryngology -- Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Otolaryngology -- Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Dale H Brown
- Otolaryngology -- Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - S Mark Taylor
- Otolaryngology -- Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patrick J Gullane
- Otolaryngology -- Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Jonathan R Trites
- Otolaryngology -- Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ralph Gilbert
- Otolaryngology -- Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Matthew H Rigby
- Otolaryngology -- Head & Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jolie Ringash
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Radiation Oncology, University Health Network, Toronto, Ontario, Canada
| | - David Goldstein
- Otolaryngology -- Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
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Forner D, Ungar G, Meier J, Hong P. Oral literacy in pediatric otolaryngology surgical consultations amongst parents with high levels of decisional conflict. Int J Pediatr Otorhinolaryngol 2020; 138:110269. [PMID: 32741748 DOI: 10.1016/j.ijporl.2020.110269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Oral literacy is an important aspect of physician and patient/family communication. Adequate communication is essential in the shared decision-making process and is inherently important in pediatric surgical consultations where parents must make decisions for their children. The aim of this study was to describe oral literacy in pediatric otolaryngology consultations and how it may relate to shared decision-making in a cohort of parents experiencing significant decisional conflict. METHODS Thirty-six parent/patient-physician interactions from two pediatric otolaryngology clinics were recorded. Parents completed the Decision Conflict Scale (DCS), and both parents and physicians completed the Shared Decision-making (SDM-Q-9/SDM-Q-Doc) questionnaires. Language complexity was assessed by the Flesch Reading Ease Scale (FRES), the Simple Measure of Gobbledygook (SMOG) Readability Formula, and a series of grammar statistics. The Pearson product-moment was used to examine the correlation between measures. RESULTS The mean age of parents was 32.3 (mother) and 34.8 (father) years, with the majority having a college education or greater (77.8%). The mean DCS score was 85.8 (range 56-100), and all parents reported clinically significant conflict scores (DCS score > 25). Physicians spoke at a higher-grade level (mean difference SMOG 1.2 (95% CI: 0.8-1.6)), with more words per sentence (mean difference 3.7 (95% CI: 2.4-4.9)), and longer words (mean difference 0.1 (95% CI: 0.03-0.16)). Parents who had higher language complexity experienced less decisional conflict (SMOG vs DCS, r = -0.471, p = 0.004; words per sentence, r = -0.414, p = 0.012; word length, r = -0.419, p = 0.011), but there was no correlation between physician language complexity and DCS or SDM-Q-9 scores. CONCLUSION Physicians demonstrated higher language complexity than that of parents in this study. Differences in language complexity between physicians and parents do not appear to play a substantial role in decisional conflict or the perception of shared decision-making in general. However, parents who use a more complex vocabulary may experience less conflict.
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Affiliation(s)
- David Forner
- IWK Health Centre, Halifax, Nova Scotia, Canada; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Gilanders Ungar
- IWK Health Centre, Halifax, Nova Scotia, Canada; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeremy Meier
- Primary Children's Hospital, Salt Lake City, UT, USA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Paul Hong
- IWK Health Centre, Halifax, Nova Scotia, Canada; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Noel CW, Forner D, Wu V, Enepekides D, Irish JC, Husain Z, Chan KKW, Hallet J, Coburn N, Eskander A. Predictors of surgical readmission, unplanned hospitalization and emergency department use in head and neck oncology: A systematic review. Oral Oncol 2020; 111:105039. [PMID: 33141060 DOI: 10.1016/j.oraloncology.2020.105039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To identify predictors of unplanned hospitalization and emergency department (ED) use among head and neck oncology patients. METHODS Peer reviewed publications were identified through a systematic search of MEDLINE, Embase and Cochrane CENTRAL. Studies describing a cohort of HNC patients that detailed predictors of unplanned hospitalization or ED use in risk-adjusted models were eligible for inclusion. The methodologic quality of included studies was assessed using the Quality In Prognostic Studies (QUIPS) tool and an adapted version of the GRADE framework. RESULTS Of the 932 articles identified, 39 studies met our inclusion criteria with 31/39 describing predictors of surgical readmission and 10/39 describing predictors of ED use or unplanned hospitalization during radiation/chemoradiation treatment. Risk factors were classified into either 'patient-related', 'cancer severity' or 'process' factors. In the subset of studies looking at readmission following surgery wound complications (10/14 studies), presence of comorbidity (16/28 studies), low socioeconomic status (8/17 studies), cancer stage (9/14 studies), and prolonged hospital stay (7/18 studies) were the variables most frequently associated with readmission on multivariable analysis. Presence of comorbidity (6/10) and chemotherapy use (4/10) were more frequently associated with ED use and unplanned hospitalization. CONCLUSIONS Several consistent predictors have been identified across a variety of studies. This work is a critical first step towards the development of readmission and ED prediction models. It also enables meaningful comparison of hospital readmission rates with risk adjustment in HNC patients.
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Affiliation(s)
- Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin K W Chan
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
| | - Julie Hallet
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Natalie Coburn
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
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Forner D, Hoit G, Noel CW, Eskander A, de Almeida JR, Rigby MH, Naimark D. Decision Modeling for Economic Evaluation in Otolaryngology-Head and Neck Surgery: Review of Techniques. Otolaryngol Head Neck Surg 2020; 164:741-750. [PMID: 32957833 DOI: 10.1177/0194599820957288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Decision making in health care is complex, and substantial uncertainty can be involved. Structured, systematic approaches to the integration of available evidence, assessment of uncertainty, and determination of choice are of significant benefit in an era of "value-based care." This is especially true for otolaryngology-head and neck surgery, where technological advancements are frequent and applicable to an array of subspecialties. Decision analysis aims to achieve these goals through various modeling techniques, including (1) decision trees, (2) Markov process, (3) microsimulation, and (4) discrete event simulation. While decision models have been used for decades, many clinicians and researchers continue to have difficulty deciphering them. In this review, we present an overview of various decision analysis modeling techniques, their purposes, how they can be interpreted, and commonly used syntax to promote understanding and use of these approaches. Throughout, we provide a sample research question to facilitate discussion of the advantages and disadvantages of each technique.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Institute of Healthy Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Graeme Hoit
- Institute of Healthy Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Institute of Healthy Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Institute of Healthy Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - John R de Almeida
- Institute of Healthy Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Matthew H Rigby
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Naimark
- Institute of Healthy Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Forner D, Noel CW, Guttman MP, Haas B, Enepekides D, Rigby MH, Nathens AB, Eskander A. Blunt Versus Penetrating Neck Trauma: A Retrospective Cohort Study. Laryngoscope 2020; 131:E1109-E1116. [PMID: 32894596 DOI: 10.1002/lary.29088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES/HYPOTHESIS Despite being common, neck injuries have received relatively little attention for important quality of care metrics. This study sought to determine the association between blunt and penetrating neck injuries on mortality and length of stay, and to identify additional patient and hospital-level characteristics that impact these outcomes. STUDY DESIGN Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program database. METHODS Adult patients (≥18) who sustained traumatic injuries involving the soft tissues of the neck between 2012 and 2016 were eligible. Multiple imputation was used to account for missing data. Logistic regression and negative binomial models were used to analyze 1) in-hospital mortality and 2) length of stay respectively while adjusting for potential confounders and accounting for clustering at the hospital level. RESULTS In a cohort of 20,285 patients, the crude mortality rate was lower in those sustaining blunt neck injuries compared to penetrating injuries (4.9% vs. 6.0%, P < .01), while length of hospital stay was similar (median 9.9 vs. 10.2, P = 0.06). In adjusted analysis, blunt neck injuries were associated with a reduced odds of mortality during hospital admission (odds ratio: 0.66, 95% confidence intervals [0.564, 0.788]), as well as significant reductions in length of stay (rate ratio: 0.92, 95% confidence intervals [0.880, 0.954]). CONCLUSIONS Blunt neck injuries are associated with lower mortality and length of stay compared to penetrating injuries. Areas of future study have been identified, including elucidation of processes of care in specific organs of injury. LEVEL OF EVIDENCE Level 3 Laryngoscope, 131:E1109-E1116, 2021.
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Affiliation(s)
- David Forner
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Matthew P Guttman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Haas
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Enepekides
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Avery B Nathens
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Forner D, Noel CW, Densmore R, Goldstein DP, Corsten M, Pieterse AH, Shuman AG, Hong P, Rac VE. Shared Decision Making for Surgical Care in the Era of COVID-19. Otolaryngol Head Neck Surg 2020; 164:297-299. [PMID: 32867581 DOI: 10.1177/0194599820954138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The global pandemic caused by severe acute respiratory syndrome coronavirus 2 has upended surgical practice. In an effort to preserve resources, mitigate risk, and maintain health system capacity, nonurgent surgeries have been deferred in many jurisdictions, with urgent procedures facing increasing wait times and unpredictability given potential future surges. Shared decision making, a process that integrates patient values and preferences with the scientific expertise of clinicians, may be of particular benefit during these unprecedented times. Aligning patient choices with their values, reducing unnecessary health care use, and promoting consistency between providers are now more critical than ever before. We review important aspects of shared decision making and provide guidance for its perioperative application during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Densmore
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew G Shuman
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Valeria E Rac
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital Research Institute (TGHRI), University Health Network (UHN), Toronto, Ontario, Canada.,Diabetes Action Canada, CIHR SPOR Network, Toronto, Ontario, Canada
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de Almeida JR, Noel CW, Forner D, Zhang H, Nichols AC, Cohen MA, Wong RJ, McMullen C, Graboyes EM, Divi V, Shuman AG, Rosko AJ, Lewis CM, Hanna EY, Myers J, Paleri V, Miles B, Genden E, Eskander A, Enepekides DJ, Higgins KM, Brown D, Chepeha DB, Witterick IJ, Gullane PJ, Irish JC, Monteiro E, Goldstein DP, Gilbert R. Development and validation of a Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN-HN) in a scarce resource setting: Response to the COVID-19 pandemic. Cancer 2020; 126:4895-4904. [PMID: 32780426 PMCID: PMC7436362 DOI: 10.1002/cncr.33114] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/22/2022]
Abstract
Background In the wake of the coronavirus disease 2019 (COVID‐19) pandemic, access to surgical care for patients with head and neck cancer (HNC) is limited and unpredictable. Determining which patients should be prioritized is inherently subjective and difficult to assess. The authors have proposed an algorithm to fairly and consistently triage patients and mitigate the risk of adverse outcomes. Methods Two separate expert panels, a consensus panel (11 participants) and a validation panel (15 participants), were constructed among international HNC surgeons. Using a modified Delphi process and RAND Corporation/University of California at Los Angeles methodology with 4 consensus rounds and 2 meetings, groupings of high‐priority, intermediate‐priority, and low‐priority indications for surgery were established and subdivided. A point‐based scoring algorithm was developed, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN). Agreement was measured during consensus and for algorithm scoring using the Krippendorff alpha. Rankings from the algorithm were compared with expert rankings of 12 case vignettes using the Spearman rank correlation coefficient. Results A total of 62 indications for surgical priority were rated. Weights for each indication ranged from −4 to +4 (scale range; −17 to 20). The response rate for the validation exercise was 100%. The SPARTAN‐HN demonstrated excellent agreement and correlation with expert rankings (Krippendorff alpha, .91 [95% CI, 0.88‐0.93]; and rho, 0.81 [95% CI, 0.45‐0.95]). Conclusions The SPARTAN‐HN surgical prioritization algorithm consistently stratifies patients requiring HNC surgical care in the COVID‐19 era. Formal evaluation and implementation are required. Lay Summary Many countries have enacted strict rules regarding the use of hospital resources during the coronavirus disease 2019 (COVID‐19) pandemic. Facing delays in surgery, patients may experience worse functional outcomes, stage migration, and eventual inoperability. Treatment prioritization tools have shown benefit in helping to triage patients equitably with minimal provider cognitive burden. The current study sought to develop what to the authors' knowledge is the first cancer–specific surgical prioritization tool for use in the COVID‐19 era, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN). This algorithm consistently stratifies patients requiring head and neck cancer surgery in the COVID‐19 era and provides evidence for the initial uptake of the SPARTAN‐HN.
To the authors' knowledge, the Surgical Prioritization and Ranking Tool and Navigation Aid for Head and Neck Cancer (SPARTAN‐HN) is the first cancer surgery–specific prioritization tool for use during the coronavirus disease 2019 (COVID‐19) pandemic. The SPARTAN‐HN algorithm is reliable and valid for the stratification of patients with head and neck cancer who require urgent cancer care in resource‐restricted practice environments.
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Affiliation(s)
- John R de Almeida
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David Forner
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Han Zhang
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Marc A Cohen
- Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Wong
- Department of Otolaryngology-Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Caitlin McMullen
- Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Vasu Divi
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew J Rosko
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Carol M Lewis
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ehab Y Hanna
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey Myers
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Brett Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danny J Enepekides
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kevin M Higgins
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dale Brown
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Division of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Wu V, Noel CW, Forner D, Mok F, Zirkle M, Eskander A, Lin V, Lee JM. Otolaryngology needs among an adult homeless population: a prospective study. J Otolaryngol Head Neck Surg 2020; 49:47. [PMID: 32646479 PMCID: PMC7346481 DOI: 10.1186/s40463-020-00445-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/30/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Homeless individuals frequently experience poor access to healthcare, delayed clinical presentation, and higher disease burden. Providing subspecialty otolaryngology care to this population can be challenging. We previously reported on the prevalence of hearing impairment in Toronto's homeless community. As a secondary objective of this study, we sought to define otolaryngology specific need for this population. METHODS One hundred adult homeless individuals were recruited across ten homeless shelters in Toronto, Canada using a stratified random sampling technique. An audiometric evaluation and head and neck physical examination were performed by an audiologist and otolaryngology resident, respectively. Basic demographic and clinical information was captured through verbal administration of a survey. Descriptive statistics were used to estimate frequency of otolaryngology specific diseases for this population. RESULTS Of the 132 individuals who were initially approached to participant, 100 (76%) agreed. There were 64 males, with median age of 46 years (IQR 37-58 years). The median life duration of homelessness was 24 months (IQR 6-72 months). Participants had a wide range of medical comorbidities, with the most common being current tobacco smoking (67%), depression (36%), alcohol abuse (32%), and other substance abuse (32%). There were 22 patients with otolaryngology needs as demonstrated by one or more abnormal findings on head and neck examination. The most common finding was nasal fracture with significant nasal obstruction (6%). Eleven patients required referral to a staff otolaryngologist based on concerning or suspicious findings, including two head and neck masses, 6 were later seen in follow-up. CONCLUSION There were substantial otolaryngology needs amongst a homeless population within a universal healthcare system. Future research should focus on further elucidating head and neck related issues in this population and expanding the role of the otolaryngologist in providing care to homeless individuals.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Christopher W Noel
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - David Forner
- Department of Otolaryngology, Head & Neck Surgery, Dalhousie University, Halifax, Canada
| | - Florence Mok
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada
| | - Molly Zirkle
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, Toronto, Canada.,Department of Otolaryngology, Head & Neck Surgery, St. Michael's Hospital, Toronto, Canada
| | - Antoine Eskander
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada.,Department of Otolaryngology, Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Vincent Lin
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada. .,Department of Otolaryngology, Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.
| | - John M Lee
- Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Canada. .,Li Ka Shing Knowledge Institute, Toronto, Canada. .,Department of Otolaryngology, Head & Neck Surgery, St. Michael's Hospital, Toronto, Canada.
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Forner D, Curry DE, Hancock K, MacKay C, Taylor SM, Corsten M, Trites JR, Rigby MH. Medical Intervention Alone vs Surgical Drainage for Treatment of Peritonsillar Abscess: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 163:915-922. [PMID: 32482146 DOI: 10.1177/0194599820927328] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Peritonsillar abscesses (PTAs) are common emergency consultations for otolaryngologists. Medical management alone may offer satisfactory treatment without the risk associated with surgical drainage. Therefore, we performed a systematic review of medical treatment alone compared to surgical drainage for the treatment of PTA. DATA SOURCES MEDLINE, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov. REVIEW METHODS Studies comparing the outcomes of medically treated to surgically treated patients were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. All screening and data extraction were completed by 2 independent reviewers. Meta-analysis was performed using a random-effects model. Subgroup and sensitivity analyses were performed. RESULTS Ten cohort studies and 2 randomized studies were included (ntotal = 33,468). Study quality was low, with only 1 study providing multivariable analysis. The combined rate of treatment failure in patients initially treated with medical management alone was 5.7% compared to 5.5% in the surgical group. There was no statistically significant difference in the odds of treatment failure between interventions through random-effects meta-analysis (odds ratio [OR], 1.10; 95% CI, 0.53-2.26; I 2 = 41%; P = .13). Subgroup analysis excluding pediatric-specific studies revealed similar odds of treatment failure when initially managed with medical intervention (OR, 0.92; 95% CI, 0.56-1.50; P = .39; I 2 = 0%). CONCLUSION Meta-analysis of available studies demonstrated no difference in odds of treatment failure for patients with PTA managed through medical intervention alone compared to surgical intervention. These findings should be interpreted with caution due to high probability of bias and overall low quality of studies.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dennis E Curry
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristy Hancock
- W. K. Kellogg Health Sciences Library, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Colin MacKay
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R Trites
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew H Rigby
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Wu V, Noel CW, Forner D, Zhang Z, Higgins KM, Enepekides DJ, Lee JM, Witterick IJ, Kim JJ, Waldron JN, Irish JC, Hua Q, Eskander A. Considerations for head and neck oncology practices during the coronavirus disease 2019 (COVID-19) pandemic: Wuhan and Toronto experience. Head Neck 2020; 42:1202-1208. [PMID: 32338807 PMCID: PMC7267482 DOI: 10.1002/hed.26205] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 12/16/2022] Open
Abstract
The practices of head and neck surgical oncologists must evolve to meet the unprecedented needs placed on our health care system by the Coronavirus disease 2019 (COVID-19) pandemic. Guidelines are emerging to help guide the provision of head and neck cancer care, though in practice, it can be challenging to operationalize such recommendations. Head and neck surgeons at Wuhan University faced significant challenges in providing care for their patients. Similar challenges were faced by the University of Toronto during the severe acute respiratory syndrome (SARS) pandemic in 2003. Herein, we outline our combined experience and key practical considerations for maintaining an oncology service in the midst of a pandemic.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Christopher W. Noel
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, University of TorontoTorontoOntarioCanada
| | - David Forner
- Institute of Health Policy, Management and Evaluation, University of TorontoTorontoOntarioCanada
- Division of Otolaryngology—Head and Neck SurgeryDalhousie UniversityHalifaxNova ScotiaCanada
| | - Zhi‐Jian Zhang
- Department of Otolaryngology—Head and Neck SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Kevin M. Higgins
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Danny J. Enepekides
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - John M. Lee
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Ian J. Witterick
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - John J. Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
| | - John N. Waldron
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation OncologyUniversity of TorontoTorontoOntarioCanada
| | - Jonathan C. Irish
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Qing‐Quan Hua
- Department of Otolaryngology—Head and Neck SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Antoine Eskander
- Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoOntarioCanada
- Institute of Health Policy, Management and Evaluation, University of TorontoTorontoOntarioCanada
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Forner D, Ungar G, Chorney J, Meier J, Hong P. Turn analysis and patient-centredness in paediatric otolaryngology surgical consultations. Clin Otolaryngol 2020; 45:725-731. [PMID: 32368851 DOI: 10.1111/coa.13564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/13/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Physician and patient/parent communication is of utmost importance in consultations to improve the shared decision-making (SDM) processes. This study investigated SDM-related outcomes through turn analysis and an assessment of patient-centred dialogue. DESIGN Multi-centre prospective cohort study analysing audio- and video-recorded patient/parent-physician interactions. SETTING Two tertiary paediatric hospitals in Halifax, Nova Scotia and Salt Lake City, Utah. PARTICIPANTS Paediatric otolaryngologists, patients and parents during consultation for adenotonsillectomy. MAIN OUTCOME MEASURES Medical dialogue measures (turn analysis, patient-centredness scores via the Roter Interaction Analysis System) and SDM questionnaires (SDM-Q-9). RESULTS Turn density was significantly higher for physicians than patients/parents (P < .001), as were total statements (P < .001), and total time talking (P < .001). The opening statement was completed by the physician in 91.5% of interactions and was significantly longer than family opening statements (P = .003). The mean number of informed consent elements addressed per interaction was 4.5 out of 6. The mean patient-centredness score was 0.2 (range 0-0.56). Significant negative correlations between patient-centredness score and physician turn density (r = -.390, P = .002), physician mean turn time (r = -.406, P = .001), total physician statements (r = -.426, P = .001) and total physician speaking time (r = -.313, P = .016) were noted. There were no correlations in SDM questionnaire scores with turn analysis variables, informed consent elements or patient-centredness scores. CONCLUSIONS Surgeons dominated the consultation in terms of talking, mostly in a unidirectional manner. Neither patient-centredness nor turn analysis correlated with perceptions of SDM from the parents' perspective.
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Affiliation(s)
- David Forner
- IWK Health Centre, Halifax, NS, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Gilanders Ungar
- IWK Health Centre, Halifax, NS, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.,Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jill Chorney
- IWK Health Centre, Halifax, NS, Canada.,Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jeremy Meier
- Primary Children's Hospital, Salt Lake City, UT, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Paul Hong
- IWK Health Centre, Halifax, NS, Canada.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
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Forner D, Lee DJ, Walsh C, Witterick IJ, Taylor SM, Freeman J. Outpatient versus Inpatient Parotidectomy: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 162:818-825. [PMID: 32286187 DOI: 10.1177/0194599820911725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Parotidectomies are commonly performed procedures by head and neck surgeons. Although parotidectomies are historically inpatient procedures, recent observational evidence has highlighted the potential for parotidectomies to be performed on an outpatient basis. This systematic review and meta-analysis sought to compare complications and unplanned health care utilization between patients undergoing outpatient versus inpatient parotidectomy. DATA SOURCES A systematic review was performed using MEDLINE, EMBASE, and the Cochrane Library. REVIEW METHODS Studies comparing the outcomes of outpatient parotidectomy with those of inpatient parotidectomy were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. Postoperative complications (hematoma, facial nerve dysfunction, seroma, fistulisation, Frey syndrome, and wound infection) and rates of 30-day readmission, reintervention, and emergency department presentation were compared. RESULTS We screened 1018 nonduplicate articles to include 5 studies, all of which were retrospective cohort studies. There were fewer complications found in the outpatient group (relative risk = 0.61, 95% confidence interval: 0.40-0.93). Outpatient procedures were more commonly performed on patients who lived close to the hospital, had fewer comorbidities, and had less extensive planned surgery. CONCLUSION Outpatient parotidectomy appears safe in select patients with outcomes comparable with inpatient surgery. However, evidence overall is of low quality, and further work is needed to delineate a satisfactory set of criteria for appropriate patient identification.
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Affiliation(s)
- David Forner
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Ontario, Canada
| | - Daniel J Lee
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Chris Walsh
- Sidney Liswood Health Sciences Library, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - S Mark Taylor
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Lee C, Forner D, Bullock M, Rigby MH, Corsten M, Trites JR, Taylor SM. Open resection and reconstruction of a Nasoseptal Chondrosarcoma: case report and literature review. J Otolaryngol Head Neck Surg 2020; 49:15. [PMID: 32209139 PMCID: PMC7092573 DOI: 10.1186/s40463-020-00409-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/17/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Primary chondrosarcomas of the nasal septum are rare, with a variety of clinical features that evade detection and treatment. While endoscopic surgery has become increasingly accessible, open approaches may be needed to provide adequate visualization for tumour ablation and reconstruction. We report the resection and reconstructive considerations of a septal chondrosarcoma. CASE PRESENTATION A 75-year-old woman presented with a 3-year history of a slow growing, firm mass in the nasal tip causing protrusion and septal fullness. Computed Tomography scan of the paranasal sinuses revealed a well-circumscribed, 2.2 cm mass at the anterior nasal septum extending into the right vestibule. Biopsy of the cartilaginous lesion confirmed the diagnosis of a low-grade chondrosarcoma by histopathology. The tumour was removed using a transcolumellar open rhinoplasty approach with a large septal resection. Primary reconstruction of the surgical defect was performed using an L-shaped strut from the nasal keystone area to the columella. Follow-up examinations demonstrated no evidence of recurrent disease with satisfactory functional and cosmetic outcomes at 1-year. CONCLUSION This report describes a case of nasal septal chondrosarcoma successfully treated with surgical excision using an open rhinoplasty approach. Only 5-10% of chondrosarcomas are located in the head and neck region and arise rarely in the nasal septum in approximately 2-4%. With this mass, an open rhinoplasty approach was required to allow optimal exposure of the margins and to facilitate reconstruction without disruption of normal sinonasal anatomy and function. Although rare, chondrosarcoma of the nasal septum should be considered in the differential diagnosis of nasal masses.
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Affiliation(s)
- Changseok Lee
- Division of Otolaryngology - Head & Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada.
| | - David Forner
- Division of Otolaryngology - Head & Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Bullock
- Division of Otolaryngology - Head & Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head & Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Corsten
- Division of Otolaryngology - Head & Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan R Trites
- Division of Otolaryngology - Head & Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head & Neck Surgery, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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Forner D, Rigby MH, Corsten M, Trites JR, Pyne J, Taylor SM. Oncological and functional outcomes after repeat transoral laser microsurgery for the treatment of recurrent early glottic cancer. J Laryngol Otol 2020; 134:1-5. [PMID: 32079549 DOI: 10.1017/s0022215120000407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Transoral laser microsurgery for glottic squamous cell carcinoma is the standard of care at many institutions. Repeat transoral laser microsurgery for recurrence may avoid the need for radiotherapy and total laryngectomy. This study aimed to identify oncological and functional outcomes in a cohort of patients who had undergone repeat transoral laser microsurgery procedures. METHOD A retrospective review of prospectively collected data of patients treated with transoral laser microsurgery for carcinoma in situ or tumour stages T1 or T2 glottic cancer, from 2003 to 2018. RESULTS Twenty patients were identified. Additional treatment was not needed in 45 per cent of patients. The five-year overall survival rate was 90 per cent. The disease-specific survival rate was 100 per cent. The laryngeal preservation rate was 85 per cent. There was improvement in mean Voice Handicap Index-10 scores following repeat transoral laser microsurgery treatment, when comparing the pre- and post-operative periods (mean scores = 15.5 vs 11.5, p = 0.373). CONCLUSION Repeat transoral laser microsurgery can be an oncologically safe alternative to other salvage therapies for glottic squamous cell carcinoma recurrence, without sacrificing functional outcomes.
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Affiliation(s)
- D Forner
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - M H Rigby
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - M Corsten
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - J R Trites
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - J Pyne
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - S M Taylor
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
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Forner D, Rigby MH, Hart RD, Trites JR, Taylor SM. Oncological and functional outcomes following transoral laser microsurgery in patients with T2a vs T2b glottic squamous cell carcinoma. J Otolaryngol Head Neck Surg 2019; 48:27. [PMID: 31174618 PMCID: PMC6556033 DOI: 10.1186/s40463-019-0346-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background There is a paucity of evidence comparing oncological and voice outcomes between T2a and T2b glottic squamous cell carcinoma (SCC) patients treated with transoral laser microsurgery (TLM). This study identified functional and oncological outcomes in this cohort. Methods Retrospective review of prospectively collected data of patients treated with TLM for T2 glottic SCC from 2003 to 2017. Results In total, 75 patients were included. Five-year local control rates were significantly different between T2a and T2b patients (75.2% vs 57.0%, p = 0.022). There was no difference in five-year survival between patients with T2a disease and T2b disease (69.5% vs 73.4%, p = 0.627). There was no significant difference in mean VHI-10 scores in the pre-operative period (18.3 vs 21.4, p = 0.409). However, patients with T2b disease had significantly worse perceived voice outcomes post-operatively (6.6 vs 21.3 p = 0.001). Patients with T2a disease saw significant improvements in mean VHI-10 scores following surgery (18.3 vs 6.6, p = 0.000), while T2b patients did not (21.4 vs 21.3, p = 0.979). The overall laryngeal preservation rate was 94.7%, with 11.5% of T2b patients requiring salvage organ sacrifice. Conclusions This study highlights positive functional outcomes for T2a glottic SCC. Patients with T2b disease appear to have significantly worse oncological and functional outcomes, including worse voice quality following surgery and higher rates of salvage laryngectomy.
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Affiliation(s)
- David Forner
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave., 3rd Floor Dickson Bldg, Halifax, Nova Scotia, B3H 2Y9, Canada.
| | - Matthew H Rigby
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave., 3rd Floor Dickson Bldg, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Robert D Hart
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave., 3rd Floor Dickson Bldg, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Jonathan R Trites
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave., 3rd Floor Dickson Bldg, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave., 3rd Floor Dickson Bldg, Halifax, Nova Scotia, B3H 2Y9, Canada
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Forner D, Rigby MH, Wilke D, Taylor SM, Lamond N. Risk stratification models in human papillomavirus-associated oropharyngeal squamous cell carcinoma: the Nova Scotia distribution. J Otolaryngol Head Neck Surg 2019; 48:3. [PMID: 30642398 PMCID: PMC6332880 DOI: 10.1186/s40463-019-0325-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The incidence of oropharyngeal squamous cell carcinoma is increasing with a growing proportion of diagnoses associated with human papillomavirus (p16 + OSCC), which generally confers a favorable prognosis. For these reasons, novel risk stratification models specific to the p16 + OSCC population have recently been proposed to guide future research on treatment de-intensification for appropriate patients. This study aimed to quantify patient risk distribution using multiple published risk models and investigate the hypothesis that the local p16 + OSCC population includes a smaller proportion of low-risk patients due to a high prevalence of concurrent tobacco exposure. METHODS A retrospective cohort study was performed including patients diagnosed with p16 + OSCC in Nova Scotia between 2011 and 2015. Patient identification was obtained through the CCNS registry and an institutional database. Exclusion criteria included HPV negative status, second primary cases, incomplete data availability, and local recurrence cases. RESULTS Following exclusion, 117 patients met study criteria. The majority had small primary tumors (70.9% ≤ T2) and advanced nodal status on presentation (60.7% ≥ N2b). Most patients had a positive smoking history (62.4%), with 53.0% of patients having a pack-year history greater than 10 pack-years. In four of the five risk stratification models, the majority of the study population fell into the lowest risk category. The risk stratification distribution of our local population was similar to the populations used to validate the published models, with the largest single category difference being 13.3% (range - 12.3 to + 13.3%). CONCLUSIONS This is the first study to compare multiple currently published risk stratification models to a local population and address the uncertainty of risk stratification in the Nova Scotian p16 + OSCC population. Despite a high prevalence of concurrent tobacco exposure, the study population was found to be overall low risk, with similar risk compared to model validation populations.
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Affiliation(s)
- David Forner
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. .,Division of Medical Oncology, Department of Internal Medicine, QEII - Bethune Building, Dalhousie University, Suite 470, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada.
| | - Matthew H Rigby
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Derek Wilke
- Department of Radiation Oncology, Dalhousie, Halifax, Nova Scotia, Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nathan Lamond
- Division of Medical Oncology, Department of Internal Medicine, QEII - Bethune Building, Dalhousie University, Suite 470, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada
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Forner D, Williams BA, Makki FM, Trites JR, Taylor SM, Hart RD. Late free flap failure in head and neck reconstruction: A systematic review. Ear Nose Throat J 2018; 97:213-216. [PMID: 30036435 DOI: 10.1177/014556131809700712] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Our objectives were to review all reported cases of late flap failure in head and neck surgery and describe any relevant patterns. We conducted a systematic review of all published cases of free flap failure after postoperative day 7 in head and neck surgery from January 1990 to January 2018. Data were collected with respect to flap type, site of reconstruction, reason for failure, and time to failure. A total of 45 cases of late free flap failure in the head and neck were identified. Among the 34 cases in which the necessary data were available for analysis, 50% of late failures occurred between postoperative day 7 and 14. Common reasons for failure were abscess and vascular compromise. We conclude that most late flap failures occur in the second postoperative week. In patients with risk factors for flap failure, close monitoring for up to 14 days after surgery could detect flap compromise before the flap is lost.
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Affiliation(s)
- David Forner
- ENT Clinic, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, 5820 University Ave., Halifax, NS B3H 1V7 Canada
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Forner D, Bullock M, Manders D, Wallace T, Chin CJ, Johnson LB, Rigby MH, Trites JR, Taylor MS, Hart RD. Secretory carcinoma: the eastern Canadian experience and literature review. J Otolaryngol Head Neck Surg 2018; 47:69. [PMID: 30446016 PMCID: PMC6240209 DOI: 10.1186/s40463-018-0315-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 11/04/2018] [Indexed: 12/21/2022] Open
Abstract
Background Secretory Carcinoma (SC) is a recently described malignancy affecting salivary glands of the head and neck, with a paucity of evidence regarding the natural history, morbidity, and mortality. This study aimed to investigate the current treatment options utilized for SC, as well as its presentation and outcomes. Methods This study is a retrospective case series and includes patients diagnosed with SC at four Maritime Canadian institutions. Literature review of patient outcomes following treatment of SC is also included. Results Thirteen patients were identified. Parotid was the most common subsite (69%), followed by minor salivary gland (23%) and submandibular gland (8%). All patients were S100 positive and had at least one additional positive confirmatory stain, including mammaglobin, CK7, or vimentin. Two patients had N2b disease. All patients were treated with primary surgery, and four were offered adjuvant radiotherapy. There was one instance of locoregional recurrence, and one of metastasis. Three patients displayed perineural invasion on pathology, and one patient displayed lymphovascular invasion. Conclusion Secretory Carcinoma remains understudied regarding its natural history, presentation, and treatment options. This study is the largest single case series in Canada, and highlights the young age and possible aggressiveness of SC. As well, we provide the most comprehensive literature review to date, with a focus on treatment and outcomes for this disease entity. Electronic supplementary material The online version of this article (10.1186/s40463-018-0315-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David Forner
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave. 3rd Floor Dickson Bldg, Halifax, NS, B3H 2Y9, Canada.
| | - Martin Bullock
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Daniel Manders
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Timothy Wallace
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave. 3rd Floor Dickson Bldg, Halifax, NS, B3H 2Y9, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Cumberland Regional Health Care Center, Amherst, NS, Canada
| | - Christopher J Chin
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave. 3rd Floor Dickson Bldg, Halifax, NS, B3H 2Y9, Canada.,Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Saint John Regional Hospital, Saint John, NB, Canada
| | - Liane B Johnson
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave. 3rd Floor Dickson Bldg, Halifax, NS, B3H 2Y9, Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave. 3rd Floor Dickson Bldg, Halifax, NS, B3H 2Y9, Canada
| | - Jonathan R Trites
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave. 3rd Floor Dickson Bldg, Halifax, NS, B3H 2Y9, Canada
| | - Mark S Taylor
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave. 3rd Floor Dickson Bldg, Halifax, NS, B3H 2Y9, Canada
| | - Robert D Hart
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, Dalhousie University, 5820 University Ave. 3rd Floor Dickson Bldg, Halifax, NS, B3H 2Y9, Canada
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