Prevalence of obstructive sleep apnea after treatment for advanced T-stage head and neck cancer

PURPOSE

Treatment of head and neck cancer (HNC) may lead to obstructive sleep apnea (OSA), but conclusive results on the prevalence of OSA are lacking. The objective of this study is to investigate the prevalence of OSA in a cohort of patients treated for advanced T-stage HNC.

METHODS

A cross-sectional study was conducted in two tertiary cancer care centers including patients at least 1 year after treatment with curative intent with surgery and/or (chemo)radiotherapy ((C)RT) for advanced T-staged (T3-4) cancer of the oral cavity, oropharynx, hypopharynx, or larynx. A polysomnography (PSG) was performed in all participants. OSA was defined as an apnea-hypopnea index (AHI) of 15 events/h or higher or an AHI of 5 events/h and higher with OSA related symptoms, such as sleeping problems, daytime dysfunction and/or cardiac/metabolic comorbidities collected through file review and questionnaires.

RESULTS

Of the 67 participants, 48 (72%, 95% CI 59-82%) were diagnosed with OSA. Possible risk factors are male gender, higher BMI, greater neck circumference, more nicotine pack years, cardiometabolic comorbidities, use of medication with sleepiness as side effect, present tonsils, lower T-stage (T3 vs. T4 stage), higher AJCC stage and a HPV-negative tumor.

CONCLUSION

In this population of advanced T-stage HNC patients, the prevalence of OSA was 72%, which is considerably higher than in the general population (2-50%). Given the high prevalence, screening of this entire subgroup for OSA may be indicated. Future studies to identify high risk factors and develop an OSA screening protocol are needed.

Protection of melatonin treatment and combination with traditional antibiotics against septic myocardial injury

BACKGROUND

Heart failure is a common complication of sepsis with a high mortality rate. It has been reported that melatonin can attenuate septic injury due to various properties. On the basis of previous reports, this study will further explore the effects and mechanisms of melatonin pretreatment, posttreatment, and combination with antibiotics in the treatment of sepsis and septic myocardial injury.

METHODS AND RESULTS

Our results showed that melatonin pretreatment showed an obvious protective effect on sepsis and septic myocardial injury, which was related to the attenuation of inflammation and oxidative stress, the improvement of mitochondrial function, the regulation of endoplasmic reticulum stress (ERS), and the activation of the AMPK signaling pathway. In particular, AMPK serves as a key effector for melatonin-initiated myocardial benefits. In addition, melatonin posttreatment also had a certain degree of protection, while its effect was not as remarkable as that of pretreatment. The combination of melatonin and classical antibiotics had a slight but limited effect. RNA-seq detection clarified the cardioprotective mechanism of melatonin.

CONCLUSION

Altogether, this study provides a theoretical basis for the application strategy and combination of melatonin in septic myocardial injury.

Partly recovery and compensation in anterior cingulate cortex after SSRI treatment-evidence from multi-voxel pattern analysis over resting state fMRI in depression

BACKGROUND

Anterior cingulate cortex (ACC) plays an essential role in the pathophysiology of major depressive disorder (MDD) and its treatment. However, it's still unclear whether the effects of disease and antidepressant treatment on ACC perform diversely in neural mechanisms.

METHODS

Fifty-nine MDD patients completed resting-state fMRI scanning twice at baseline and after 12-week selective serotonin reuptake inhibitor (SSRI) treatment, respectively in acute state and remission state. Fifty-nine demographically matched healthy controls were enrolled. Using fractional amplitude of low-frequency fluctuation (fALFF) in ACC as features, we performed multi-voxel pattern analysis over pretreatment MDD patients vs health control (HC), and over pretreatment MDD patients vs posttreatment MDD patients.

RESULTS

Discriminative regions in ACC for MDD impairment and changes after antidepressants were obtained. The intersection set and difference set were calculated to form ACC subregions of recovered, unrecovered and compensative, respectively. The recovered ACC subregion mainly distributed in rostral ACC (80 %) and the other two subregions had nearly equal distribution over dorsal ACC and rostral ACC. Furthermore, only the compensative subregion had significant changed functional connectivity with cingulo-opercular control network (CON) after antidepressant treatment.

LIMITATIONS

The number of subjects was relatively small. The results need to be validated with larger sample sizes and multisite data.

CONCLUSIONS

This finding suggested that the local function of ACC was partly recovered on regulating emotion after antidepressant by detecting the common subregional targets of depression impairment and antidepressive effect. Besides, changed fALFF in the compensative ACC subregion and its connectivity with CON may partly compensate for the cognition deficits.

Royal jelly reduce DNA damage induced by alkylating agent in mice

Royal jelly (RJ) is a creamy white-yellow liquid that is secreted by the mandibular and hypopharyngeal glands of bees to nourish the larvae. RJ has gained increasing interest in recent years owing to its antioxidant potential. However, little is known about adequate RJ dosing and its effects on genetic material. Thus, the aim of this study was to evaluate the in vivo effects of RJ on genotoxicity and mutagenicity induced by the alkylating agent methyl methanesulfonate (MMS). In this study, 3-month-old Swiss albino male mice (N = 66) were divided into 11 groups for experimentation. Experiments were performed by administering lyophilized RJ (150 mg/kg, 300 mg/kg, and 1000 mg/kg) or water via gavage as pre- and posttreatment processes with the alkylating agent MMS. After treatment, blood samples were collected from the mice via an incision at the end of the tail to conduct comet assays at times of 24 h and 48 h posttreatment. The mice were then euthanized to remove the bone marrow for a micronucleus test. Overall, regardless of dose, RJ did not exhibit genotoxic, mutagenic activity and the administration of high doses, mainly in the form of posttreatment, presented antigenotoxic and antimutagenic actions. Further, a dose-response correlation was observed in the RJ posttreatment groups. These results demonstrate that RJ administration was effective in reversing the damage caused by the alkylating agent MMS.

Silibinin protects against sepsis and septic myocardial injury in an NR1H3-dependent pathway

Cardiac dysfunction resulting from sepsis causes high morbidity and mortality. Silibinin (SIL) is a secondary metabolite isolated from the seed extract of the milk thistle plant with various properties, including anti-inflammatory, anti-fibrotic, and anti-oxidative activities. This study, for the first time, examined the effects and mechanisms of SIL pretreatment, posttreatment and in combination with classical antibiotics in septic myocardial injury. The survival rate, sepsis score, anal temperature, routine blood parameters, blood biochemical parameters, cardiac function indicators, pathological indicators of myocardial injury, NR1H3 signaling pathway, and several sepsis-related signaling pathways were detected 8 h following cecal ligation and puncture (CLP). Our results showed that SIL pretreatment showed a significant protective effect on sepsis and septic myocardial injury, which was explained by the attenuation of inflammation, inhibition of oxidative stress, improvement of mitochondrial function, regulation of endoplasmic reticulum stress (ERS), and activation of the NR1H3 pathway. SIL posttreatment and the combination of SIL and azithromycin (AZI) showed a certain therapeutic effect. RNA-seq detection further clarified the myocardial protective mechanisms of SIL. Taken together, this study provides a theoretical basis for the application strategy and combination of SIL in septic myocardial injury.

Posttreatment after Lenvatinib in Patients with Advanced Hepatocellular Carcinoma

BACKGROUND

There is no standard posttreatment for patients with advanced hepatocellular carcinoma (HCC) in whom lenvatinib therapy has failed. This study aimed to investigate rates of migration to posttreatment after lenvatinib and to explore candidates for second-line agents in the patients with failed lenvatinib therapy.

METHODS

We retrospectively collected data on patients with advanced HCC who received lenvatinib as the first-line agent in 7 institutions.

RESULTS

Overall survival and progression-free survival (PFS) of 178 patients who received lenvatinib as the first-line agent were 13.3 months (95% confidence interval [CI], 11.5-15.2) and 6.7 months (95% CI, 5.6-7.8), respectively. Sixty-nine of 151 patients (45.7%) who discontinued lenvatinib moved on to posttreatment. The migration rates from lenvatinib to the second-line agent and from the second-line agent to the third-line agent were 41.7 and 44.4%, respectively. Based on multivariate analysis, response to lenvatinib (complete or partial response according to modified RECIST) and discontinuation of lenvatinib due to radiological progression, as well as male were associated with a significantly higher probability of migration to posttreatment after lenvatinib. On the other hand, alpha-fetoprotein levels of 400 ng/mL or higher was correlated with a significantly lower probability of migration to posttreatment after lenvatinib. Of 63 patients who received second-line systemic therapy, 53 (84.2%) were administered sorafenib. PFS, objective response rate (ORR), and disease control rate (DCR) for sorafenib treatment were 1.8 months (95% CI, 0.6-3.0), 1.8%, and 20.8%, respectively. According to the Cox regression hazard model, Child-Pugh class B significantly contributed to shorter PFS. PFS, ORR, and DCR of 22 patients who received regorafenib after lenvatinib in any lines were 3.2 months (range, 1.5-4.9 months), 13.6%, and 36.3%, respectively. Similarly, PFS, ORR, and DCR of 17 patients who received regorafenib after lenvatinib in the third-line (after sorafenib) were 3.8 months (range, 1.1-6.5 months), 17.6%, and 41.2%, respectively.

CONCLUSION

Sorafenib may not be a candidate for use as a posttreatment agent after lenvatinib, according to the results of the present study. Regorafenib has the potential to become an appropriate posttreatment agent after lenvatinib.

Enhancing biological stability of disinfectant-free drinking water by reducing high molecular weight organic compounds with ultrafiltration posttreatment

The production of biologically stable drinking water is challenging in conventional surface water treatment plants. However, attainment of biological stability is essential to avoid regrowth in disinfectant-free distribution systems. A novel application of ultrafiltration as a posttreatment step to enhance biological stability of drinking water produced in an existing conventional surface water treatment plant was investigated. The conventional full-scale plant comprised coagulation/sedimentation/filtration, UV-disinfection, biological activated carbon filtration and chlorine dioxide post-disinfection. The produced water exhibited substantial regrowth of Aeromonads, invertebrates and colony counts in the distribution network. Recent literature attributes this phenomenon to the specific presence of slowly biodegradable, high molecular weight (MW) biopolymeric organic compounds. Hence, the aim of this study is to enhance the biological stability of conventionally treated surface water by reducing the concentration of high-MW organic compounds. For this purpose, biological active carbon filtrate was subjected to ultrafiltration with membrane pore sizes of 10 kDa, 150 kDa and 0.12 μm respectively, operating in parallel. The UF performance was evaluated in terms of the achieved reduction in particulate and high-MW organic carbon (PHMOC); the biopolymer fraction in Liquid Chromatography-Organic Carbon Detection; biomass (cells, ATP); Assimilable Organic Carbon (AOC) by the AOC-P17/NOX method for easily biodegradable, low-MW compounds and by the AOC-A3 method for slowly biodegradable, high-MW compounds; and overall microbial growth potential (MGP) as assessed by Biomass Production Potential (BPP) and Bacterial Growth Potential (BGP) bio-assays. Results showed increasing removal of high-MW organic carbon with decreasing UF pore size, i.e., 30%, 60% and 70% removal was observed for the 0.12 μm, 150 kDa and 10 kDa membranes, respectively. Biomass and particulates retention was more than 95% for all UF membranes. AOC-A3, BPP and BGP were substantially reduced by 90%, 70% and 50%, respectively. These respective reductions were similar for all three UF membranes despite their difference in pore size. Easily biodegradable organic compounds (as AOC-P17/NOX) were not reduced by any of the membranes, which was in accordance with expectations considering the low MW of the compounds involved. Based on the obtained results, growth potential appears to be largely attributable to high-MW organic compounds which are retained by a 0.12 μm UF membrane. Furthermore, the quality of all three UF permeates was equal to or better than in reference cases (literature data) which exhibit little regrowth in their disinfectant-free distribution networks. The results demonstrate that ultrafiltration posttreatment in conventional surface water treatment plants is a potentially promising approach to enhance the biological stability of drinking water.

Performance of dissolved organic matter removal from membrane bioreactor effluent by magnetic powdered activated carbon

Magnetic powdered activated carbon (Mag-PAC) was successfully developed and applied as an adsorbent for dissolved organic matter (DOM) removal from the effluent of a membrane bioreactor (MBR) using batch experiments. The results show that a coating of iron oxide particles is consistently distributed on the surface of powdered activated carbon (PAC), resulting in a decrease in the specific surface area and in the pH at the point of zero charge, even though the particle sizes of Mag-PAC and PAC were similar. A Mag-PAC dosage of 4 g/L exhibited efficient and fast DOM adsorption with a relatively short contact time of 5 min. The iron oxide coating on the surface of PAC may play an important role in the DOM removal efficiency. Temkin isotherm and pseudo-second order kinetic models well described the DOM adsorption, suggesting that the adsorption of DOM onto Mag-PAC could be mainly governed by a chemisorption mechanism. Humic acid- and fulvic acid-like compounds and aromatic DOM with molecular weights (MWs) between 2610 Da and 3030 Da were efficiently removed by Mag-PAC, whereas aromatic DOM with an MW of 1760 Da was poorly removed. Our results demonstrate that the application of Mag-PAC for DOM adsorption is attractive and yields benefits as a posttreatment system for MBR effluent due to its efficient and fast DOM adsorption.

Do orthopedic corrections of growing retrognathic hyperdivergent patients produce stable results?

OBJECTIVES

To determine if posterior dental intrusion produces stable orthodontic and orthopedic corrections in growing retrognathic hyperdivergent patients.

MATERIALS AND METHODS

The sample included 14 subjects (five males and nine females), who were 13.4 ± 0.7 years pretreatment, treated for 3.5 years, and followed for 3.6 years posttreatment. During the initial orthopedic phase, 150 g NiTi coil springs were attached to two palatal miniscrew implants (MSIs) for maxillary intrusion; two buccal mandibular MSIs were used for posterior vertical control. Full orthodontic therapy was initiated to correct the malocclusions during the orthodontic phase. Patients were recalled a minimum of 1 year posttreatment (mean 3.6 ±1.6 years). Patients were compared to matched untreated controls.

RESULTS

Relative to the untreated controls, during treatment and retention, maxillary and mandibular molars underwent 2.8 mm and 3.7 mm of relative posterior intrusion, respectively. Maxillary incisors were extruded 1.3 mm and the mandibular incisors underwent 2.9 mm of relative intrusion. Overall orthopedic changes included a reduction in the mandibular plane angle (MPA; 3.3°), an increase in SN-Pg (2.4°), an increase in S-N-B (2.1°), and a 4.3 mm relative reduction in anterior facial height. The maxillary incisors, which showed 0.6 mm of intrusion (relative to controls), was the only dental or skeletal measure to show a statistically significant between-group posttreatment difference.

CONCLUSIONS

Except for maxillary incisor position, the substantial dental intrusion and associated orthopedic corrections that were produced during treatment remained stable post-treatment.

Performance of whole-body 18F-FDG PET/CT as a posttreatment surveillance tool for sinonasal malignancies

PURPOSE

To determine the diagnostic utility of posttreatment surveillance whole-body ¹⁸F-FDG PET/CT in detecting local tumor recurrence (R), regional lymph-node metastasis (LM), and distant metastasis (DM) in asymptomatic sinonasal cancer patients.

METHODS

Eighty consecutive patients (53 men, 27 women; mean age, 60 years; range, 28-92 years) who had undergone 197 posttreatment whole-body ¹⁸F-FDG PET/CT examinations for sinonasal malignancies between January 2009 and August 2017 were retrospectively reviewed. ¹⁸F-FDG PET/CT findings were categorized as positive or negative for R, LM, and DM, separately. Outcomes of ¹⁸F-FDG PET/CT scans were compared with the final diagnosis confirmed by histological analysis or follow-up period for a minimum 12 months. The diagnostic accuracy of scans was calculated for each site using contingency tables. Impact on the management of ¹⁸F-FDG PET/CT examinations was additionally evaluated.

RESULTS

¹⁸F-FDG PET/CT scans identified 37/44 of local recurrences, 21/23 of LMs, and 30/37 of DMs. For local recurrence, sensitivity, specificity, positive predictive value, and negative predictive value were 84% (68-97%), 95% (80-100%), 84% (68-97%), and 95% (80-100%), respectively. For LM, the respective values were 91% (75-100%), 99% (83-100%), 91% (75-100%), and 99% (83-100%). For DM, the values were 81% (64-97%), 99% (85-100%), 97% (81-100%), and 96% (81-100%), respectively. ¹⁸F-FDG PET/CT accounted for a change in management of 85% patients with recurrences.

CONCLUSIONS

Whole-body ¹⁸F-FDG PET/CT is a suitable surveillance tool for sinonasal malignancies in detecting locoregional and distant recurrences in asymptomatic patients without any evidence of recurrence on regular follow-up and endoscopy during the posttreatment period.

Removal of bioavailable dissolved organic nitrogen in wastewater by membrane bioreactors as posttreatment: Implications for eutrophication control

Bioavailable dissolved organic nitrogen (ABDON) is the component of dissolved organic nitrogen (DON) which supports the growth of algae. Previous research indicates that a membrane bioreactor (MBR) is effective in reducing DON, however, its ability to remove ABDON remains unknown. The present study investigated three full-scale MBRs (membrane type: hydrophilic polyvinylidene fluoride and membrane pore size: 0.04-0.1 µm) as posttreatment for the removal of ABDON. Results showed that the concentrations of ABDON were not significantly different between influent and effluent at each MBR (p = 0.067-0.614, t-test). Analysis of DON molecular composition via ultrahigh resolution mass spectrometry provides supporting evidence that bacterial biomass produced/released ABDON during the biological processes, which would be one of the possible reasons for the low removal efficiency of ABDON (<0%-14.0%) occurred in the MBR process. Overall, MBRs as posttreatments would have a smaller-than expected impact on primary productivity in receiving waters since a substantial fraction of DON stimulating algal growth cannot be removed by this treatment.

[Electroacupuncture Treatment Conduced Before and After Surgery Is Better in Promoting Reco-very of Gastrointestinal Function in Colorectal Cancer Patients Undergoing Radical Resection]

OBJECTIVE

To investigate the effect of electroacupuncture (EA) at different time-points on postoperative gastrointestinal function in patients undergoing colorectal cancer surgery.

METHODS

Eighty patients with colorectal cancer undergoing laparotomy were randomly assigned to intravenous anesthesia, EA A, EA B, and EA C groups (n＝20 cases in each group). All the patients in the four groups received intravenous anesthesia with midazolam, sufentanil, cisatracurium besylate and Propofol, postoperative gastrointestinal decompression and drug analgesia. EA (2－3 mA, 2 Hz) was applied to Zhongwan (CV 12) and Tianshu (ST 25), Neiguan (PC 6), Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39) on the right side for 30 min, once (one day before surgery) in the EA A group, twice (one day and 30 min before surgery) in the EA B group, and 3 times (one day, 30 min before and one day after surgery) in the EA C group. The acupoints used after surgery were PC 6, ST 36, ST 37 and ST 39. The time of postoperative ventilation, defecation, food-intake and water drinking, stomach tube removal and abdominal drainage tube removal, the volumes of stomach tube drainage and abdominal drainage, and postoperative adverse reactions were recorded.

RESULTS

The first ventilation time, after surgery in the EA C group was significantly earlier than those in the intravenous anesthesia, EA A and EA B groups (P<0.05); and the water intake and abdomicnal drainage tube removal time after surgery in the EA C group were significantly earlier than those in the intravenous anesthesia group (P<0.05). No significant differences were found among the 4 groups in the time of defecation, food intake, stomach tube removal, stomach tube drainage and abdominal drainage volumes, and numbers of patients with nausea, vomiting, fever and other adverse reactions (P>0.05)．.

CONCLUSION

EA treatment combined with intravenous anesthesia conducted before and after surgery is effective in promoting the recovery of gastrointestinal function in patients undergoing colorectal cancer laparotomy, and is obviously better than simple pre-operative EA.

Evaluation of posttreatment stability after orthodontic treatment in the mixed and permanent dentitions

OBJECTIVE

To investigate posttreatment changes in the maxillary and mandibular arches in patients who underwent orthodontic treatment during the mixed and permanent dentitions.

MATERIALS AND METHODS

The sample was collected retrospectively from three private practices and consisted of 42 patients who were at least 10 years out of orthodontic treatment. The longitudinal records of study casts and cephalometric radiographs were analyzed to quantify posttreatment changes.

RESULTS

Minimal changes in maxillary and mandibular irregularity occurred after an average of 16.98 years from completion of treatment. More than 10 years posttreatment, approximately 81% of the maxillary anterior teeth and 88% of the mandibular anterior teeth showed clinically acceptable incisor alignment (<3.5 mm). Mandibular fixed retainers greatly aided in maintaining the stability of the mandibular incisor alignment. However, posttreatment changes in maxillary incisor irregularity did not appear to be influenced by the presence of a mandibular fixed retainer. When compared with longitudinal changes observed in untreated subjects, the increase in incisor irregularity resembled a pattern similar to the regression line of untreated subjects and seems to be entirely age related. Arch width and arch depth was consistently decreased after treatment, but the magnitude of change was minimal at about 1 mm. No associations were found between any of the cephalometric measurements and changes in incisor irregularities.

CONCLUSIONS

Orthodontic treatment stability can be achieved and mandibular fixed retention appears to be a valuable contributor, especially in patients with further growth expected.

Immediate fullweightbearing after tarsometatarsal arthrodesis for hallux valgus correction--Does it increase the complication rate?

BACKGROUND

The arthrodesis of the first tarsometatarsal joint has a high correction potential in the treatment of hallux valgus deformity. Compared to distal correction procedures, a pseudarthrosis rate of 12-20% is quoted, however. In a prospective study the results of two different treatment procedures after correction arthrodesis were compared.

METHODS

In 17 cases the patients were mobilised with a short arthrodeses shoe with floor contact (NWB group) and in 17 cases in a short arthrodeses shoe with immediate fullweightbearing (FWB group). Clinical and radiological evaluation was done preoperatively, six weeks and one year postoperatively, including visual analogue pain scale and AOFAS score pre- and one year postoperatively.

RESULTS

There was no increased complication rate in the group with FWB group. The patients in the FWB group were significantly earlier fit for work.

CONCLUSION

Immediate fullweightbearing after TMT I arthrodesis using a plantar plate should be established as a standard posttreatment.

Posttreatment Imaging of the Paranasal Sinuses Following Endoscopic Sinus Surgery

Endoscopic sinus surgery is a minimally invasive option for the treatment of several nonneoplastic indications, particularly for medically refractory sinusitis and polyposis. Numerous interventions can be performed through endoscopic sinus surgery, many of which may be performed together during the same procedure. There are also a variety of complications that can result from endoscopic sinus surgery. Radiological imaging plays an important role in the evaluation of patients after endoscopic sinus surgery. Thus, it is important to be familiar with the expected and complicated imaging findings associated with endoscopic sinus surgery, which are reviewed in this article.

Disparity in actions of rosiglitazone against cisplatin-induced nephrotoxicity in female Sprague-Dawley rats

Cisplatin is one of the most common chemotherapeutic drugs used against various solid, tumours. Despite of its therapeutic benefits, its use in clinical practice is often limited because of dose, related toxicity. The nephrotoxic potential of cisplatin has been ascribed to its accumulation in the, renal tubular cells generating reactive oxygen species (ROS), activation of Bax, increased secretion of, TNFα and activation of certain inflammatory mediators like cytokines. The present investigation was, undertaken with an objective to study the effect of rosiglitazone against cisplatin induced, nephrotoxicity. Pretreatment of rosiglitazone prevents cisplatin induced nephrotoxicity which was, clearly evident from the renal biochemical parameters like reduced BUN, creatinine and TNFα levels, and increased albumin levels, which was also supported by histopathological studies of the kidneys. In contrast, posttreatment of rosiglitazone was not able to protect the renal damage in cisplatin induced, renal toxicity. These results showed the variation of pre & posttreatment effects of rosiglitazone, against the cisplatin induced nephrotoxicity.

Head and neck cancer patients want us to support them psychologically in the posttreatment period: Survey results

OBJECTIVES

No study systematically has investigated the supportive care needs of general head and neck cancer patients using validated measures. These needs include physical and daily living needs, health system and information needs, patient care and support needs, psychological needs, and sexuality needs. Identifying the unmet needs of head and neck cancer patients is a necessary first step to improving the care we provide to patients seen in our head and neck oncology clinics. It is recommended as the first step in intervention development in the Pan-Canadian Clinical Practice Guideline of the Canadian Partnership Against Cancer (see Howell, 2009). This study aimed to identify: (1) met and unmet supportive care needs of head and neck cancer patients, and (2) variability in needs according to demographics, disease variables, level of distress, and quality-of-life domains.

METHODS

Participants were recruited from the otolaryngology-head and neck surgery clinics of two university teaching hospitals. Self-administered questionnaires included sociodemographic and medical questions, as well as validated measures such as the Supportive Care Needs Survey-Short Form (SCNS-SF34), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-General (FACT-G) and Head and Neck Module (FACT-H&N) (quality of life measures).

RESULTS

One hundred and twenty-seven patients participated in the survey. 68% of them experienced unmet needs, and 25% revealed a clinically significant distress level on the HADS. The highest unmet needs were psychological (7 of top 10 needs). A multiple linear regression indicated a higher level of overall unmet needs when patients were divorced, had a high level of anxiety (HADS subscale), were in poor physical condition, or had a diminished emotional quality of life (FACT-G subscales).

SIGNIFICANCE OF RESULTS

The results of this study highlight the overwhelming presence of unmet psychological needs in head and neck cancer patients and underline the importance of implementing interventions to address these areas perceived by patients as important. In line with hospital resource allocation and cost-effectiveness, one may also contemplate screening patients for high levels of anxiety, as well as target patients who are divorced and present low levels of physical well-being, as these patients may have more overall needs to be met.