Quality of life in patients with nasopharyngeal carcinoma receiving IMRT vs IMPT: a multicenter prospective longitudinal study

PURPOSE

Nasopharyngeal carcinoma (NPC) patients may experience symptom distress and depression during and after radiation therapy, which negatively impacts quality of life (QOL). We sought to identify trajectories of symptom distress, depression, social support, and QOL in patients with NPC receiving intensity-modulated radiation therapy (IMRT) vs intensity-modulated proton therapy (IMPT).

METHODS

A multicenter prospective longitudinal study recruited NPC patients from two leading medical centers in Taiwan. The 121 NPC patients were followed from before RT (T0), at 4 weeks after beginning RT (T1), at 6 weeks of RT or the end of treatment (T2), and at 4 weeks post-RT (T3). Generalized estimating equation analysis was used to identify the factors related to QOL.

RESULTS

Patients' symptom distress and depression increased from T0, peaked at T2, and decreased at T3. Physical-QOL and psychosocial-QOL decreased from T0 to T2, then increased by T3. Patients who had early-stage cancer, received a lower RT dose, had less symptom distress, and had less depression were more likely to have better QOL. Greater physical-QOL was associated with IMPT receipt, higher education level, early cancer stage, lower radiation dose, less symptom distress, and less depression. Patients who had good physical performance, received a lower radiation dose, had less symptom distress, and had less depression were more likely to have better psychosocial-QOL.

CONCLUSION

Radiation dose, symptom distress, and depression were the most important factors affecting QOL in patients with NPC. Understanding the factors associated with the trajectory of QOL can guide care during radiation treatment.

Effects of a return to work program on the health and barriers to returning to work in head and neck cancer patients: A randomized controlled trial

Objective

The aim of the study was to evaluate the effects of a return to work (RTW) program on perceived health status, barriers to returning to work, fear of cancer progression, social support, physical function, and psychosocial function in head and neck cancer (HNC) patients.

Methods

A randomized controlled trial with repeated measures was conducted. The 70 HNC patients were randomly assigned into two groups: 35 in the experimental group (RTW) and 35 in the control group (usual care). Patients were assessed at four time points: baseline (T0) (6 months after completing treatment), and then at 9-, 12-, and 15-months (T1, T2, and T3, respectively) after completing treatment. Patients completed a self-reported questionnaire, including measures of perceived health status, barriers to returning to work, fear of cancer progression, social support, physical function, and psychosocial function.

Results

Patients in the experimental group had significantly greater perceived health status and better psychosocial function compared to those in the control group. Compared to T0, at T4, participants in both groups had significantly lower levels of barriers to returning to work, fear of cancer progression, social support, and higher levels of physical function.

Conclusions

The RTW program effectively improved perceived health status and psychosocial function in HNC patients. Survivorship care should include a transitional return-to-work program to help patients transition back to work.

Trial registration

NCT04322695.

Effects of a Nurse-led Survivorship Care Program on the Health and Resilience of Primary Caregivers of Patients With Advanced Head and Neck Cancer: A Randomized Controlled Trial

OBJECTIVES

The present study aimed to evaluate the effects of a nurse-led survivorship care program (SCP) on emotional distress, social support, physical health, mental health, and resilience in primary caregivers of patients with advanced head and neck cancer.

DATA SOURCES

A randomized controlled trial was conducted. One hundred patient-primary caregiver dyads were randomized into the nurse-led SCP group (experimental) or the usual care group (control). Participants completed a self-reported questionnaire, including measures of emotional distress, social support, physical health, mental health, and resilience. After 6 months, the experimental group reported a significant improvement in emotional distress, social support, physical health, mental health, and resilience. Compared with the control group, measures of emotional distress, physical health, overall resilience, and the resilience aspects of equanimity and perseverance improved in the experimental group.

CONCLUSION

An SCP may feasibly help alleviate emotional distress, improve social support, increase physical and mental health, and strengthen resilience in the primary caregivers of patients with head and neck cancer. Health care providers should encourage primary caregivers to join an SCP.

IMPLICATIONS FOR NURSING PRACTICE

The nurse-led SCP can be applied before patients complete treatment, which may increase the positive effect on physical health and adaptation.

Factors Facilitating or Creating Barriers to Returning to Work in Head and Neck Cancer Patients Within the First 6 Months After Treatment

Head and neck cancer (HNC) patients who are unable to return to work after completing treatment might face financial loss and reduced self-esteem. The aim of this study was to identify factors influencing a return to work in HNC cancer patients in the first 6 months after treatment. This cross-sectional study examined HNC patients who completed treatment from the outpatient radiation department of a single cancer center in northern Taiwan. Patients were assessed according to psychological distress, patient-perceived health status, barriers to returning to work, and facilitators of returning to work. Of the 106 HNC patients surveyed, 54.7% successfully returned to work. Barriers to returning to work included poor self-perception of health, greater psychological distress, and age ≥50 years. Patients who had higher psychological distress, returned to work after start of the pandemic, or received reconstruction surgery were less likely to experience a positive environment facilitating a return to work.

Trajectories of resilience and related factors in primary caregivers of patients with advanced head and neck cancer: A longitudinal cohort study

PURPOSE

Primary caregivers (PC) of patients with advanced head and neck cancer (HNC) report stress during caregiving time post-treatment. We sought to identify the trajectories of resilience from initial completion of treatment to 1-year post-treatment in PC of patients with advanced HNC and to determine the factors associated with trajectories of resilience.

DESIGN

In this prospective cohort study with convenience sampling, patient-PC dyads were recruited from a medical center in northern Taiwan between August 2015 and July 2020.

METHODS

We recruited 120 patient-PC dyads and followed up at treatment completion and 1, 6, and 12 months post-treatment. Generalized estimating equation analysis was performed to identified factors related to resilience.

FINDINGS

PCs' overall resilience increased from initial completion of treatment to peak at 1-year post-treatment. Patient factors associated with greater overall resilience included older age, higher performance status, and shorter time since cancer diagnosis; PC factors included reporting more social support, better physical health, and better mental health.

CONCLUSIONS

PC mental health was the most important factor in the resilience trajectory of patients with advanced HNC cancer.

CLINICAL RELEVANCE

Quantifying the relevant factors of trajectories of resilience will help to identify vulnerable PCs and guide survivorship care in the early stages of the post-treatment period.

Comparison of physical and psychosocial function post-treatment among oral cancer patients with low-to-moderate and high nicotine dependence

PURPOSE

After suddenly stopping smoking after an initial oral cancer (OC) diagnosis, patients may restart smoking and nicotine dependence. This study sought to identify factors associated with high nicotine dependence in OC patients who restarted smoking post-treatment.

DESIGN

A cross-sectional study.

METHODS

A group of 220 OC patients who restarted smoking post-treatment were recruited from the outpatient radiation department of a single cancer center in northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed for nicotine and smoking dependence, physical activity and function, socio-emotional function, social support, and depression.

RESULTS

Among patients who restarted smoking after treatment for OC, 75.9% reported low-to-moderate dependence on smoking, while 24.1% reported high nicotine dependence. Factors associated with high nicotine dependence included higher incidence of smoking per day, greater dependence on smoking, less physical activity per week, and poorer social-emotional function. Those highly dependent on nicotine were younger, unmarried, had less education, and had begun smoking earlier than those with low-to-moderate nicotine dependence.

CONCLUSIONS

The amount of smoking per day, greater smoking behavioral dependence, less physical activity per week, and worse social-emotional function affected high nicotine dependence.

CLINICAL RELEVANCE

Smoking cessation training and counseling for OC patients may help them better control their use of tobacco after treatment.

[The Nutritional Assessment and Management of Patients With Gastrointestinal Cancer]

The gastrointestinal dysfunction and nutrient malabsorption associated with gastrointestinal tumors and related treatments may result in malnutrition in gastrointestinal (GI) cancer patients. Malnutrition has been associated with decreased treatment tolerance, poor quality of life, and increased mortality in this patient population. In this article, the relevant literature is reviewed and the factors, assessment tools, and management strategies related to malnutrition are summarized. In clinical care, healthcare providers should conduct early assessments of nutritional status and provide individualization nutritional counselling to promote treatment that effectively prolongs patient survival. This article may be used by nurses as a reference in caring for GI cancer patients.

Association between multidisciplinary team care and the completion of treatment for oral squamous cell carcinoma: A cohort population-based study

OBJECTIVES

This study investigates the relationship between multidisciplinary team care (MDTC) and patient completion of their treatment regimen for oral squamous cell carcinoma (OSCC).

METHODS

We conducted a retrospective cohort study in patients diagnosed with OSCC in Taiwan from 1 January 2016 to 30 June 2018 using a linked cancer registry database.

RESULTS

Of the 969 OSCC MDTC patients in the study cohort, 6.3% reported incomplete treatment, with 1.3% interrupting ongoing treatment and 5.0% terminating definitive treatment. Patients who had advanced-stage disease, experienced primary cancer recurrence or a secondary cancer, or were treated with surgery combined with chemotherapy, radiotherapy or chemoradiotherapy were more likely to terminate treatment before completion. The major reasons for interruption of ongoing treatment included 'patient or their family considered the patient to be in poor physical condition' and 'difficulty enduring physical discomfort caused by treatment'. The major reason for termination of definitive treatment was 'patient or their families or friends experienced negative treatment effects and worried about the side-effects of treatment'.

CONCLUSION

Advanced-stage cancer, recurrence or secondary cancer, and surgery combined with chemotherapy, radiotherapy or chemoradiotherapy negatively affected treatment completion. MDTC allows for shared decision-making to determine the optimal treatment.

Body mass index and self-care behaviors related to oral health-related quality of life in patients with oral squamous cell carcinoma within three months posttreatment

PURPOSE

Oral dysfunction is a common adverse event of treatment and may affect oral health-related quality of life (OHRQoL). This study aimed to identify factors associated with OHRQoL in patients with oral squamous cell carcinoma (OSCC) within the first three months posttreatment.

METHODS

This cross-sectional study examined OSCC patients who received treatment from the outpatient radiation department of a single cancer center in northern Taiwan. Demographic and clinical characteristics were recorded, and patients were assessed using the Self-Care Behaviors Scale (SCB), Oral Health Impact Profile (OHIP), and Karnofsky Performance Status (KPS) questionnaires.

RESULTS

Among 148 OSCC patients, 11.5% reported being underweight and 70.3% reported normal weight. The most common self-care factors associated with adverse effects were decreased appetite and fatigue. Psychological disability, functional limitation, and physical pain were the most negative OHRQoL factors. Poor OHRQoL was associated with more severe adverse effects after self-care behaviors, using feeding tubes during treatment, and having BMI less than 25, which together explained 33.5% of the variance in OHRQoL.

CONCLUSIONS

The severity of adverse effects after self-care behaviors and using feeding tubes during treatment strongly influenced overall OHRQoL and seven specific dimensions of OHRQoL.

Factors Associated With Resilience Among Primary Caregivers of Patients With Advanced Cancer Within the First 6 Months Post-Treatment in Taiwan: A Cross-Sectional Study

PURPOSE

To identify factors associated with resilience in primary caregivers of patients with advanced oral cavity cancer within the first 6 months post-treatment.

DESIGN

A cross-sectional study.

METHODS

We recruited patient-primary caregiver dyads from the outpatient radiation department of a medical center in Northern Taiwan. Patients were assessed using a set of structured questionnaires to measure performance status and demographic and clinical characteristics. Primary caregivers were measured in their social support, resilience, and care characteristics.

RESULTS

Of the 148 dyads surveyed, 33.8% of primary caregivers reported moderately low to moderate resilience, and 61.5% reported low resilience. Greater resilience of primary caregivers was associated with the primary caregiver factors of younger age, lower educational level, and more affectionate social support; and greater resilience was associated with the patient factors of better performance status and older age. These factors explained 40.4% of the variance in resilience.

CONCLUSIONS

Patients' performance status and primary caregivers' affectionate social support strongly influence overall resilience and each domain of resilience.

CLINICAL RELEVANCE

Providing primary caregivers with sufficient social resources and a support group can help them cope with the demands of caregiving for loved ones with oral cavity cancer.

Orbital myiasis complicating squamous cell carcinoma of eyelid

Myiasis is infestation of the body by fly maggots. Immobile patients with skin wounds in exposed areas are at high risk of developing myiasis. We report a case of orbital myiasis from the species Chrysomya bezziana complicating squamous cell carcinoma of the eyelid. Magnetic resonance imaging of the orbit is useful for delineating the extent of the infestation and identifying residual maggots. In extensive orbital myiasis, exenteration is needed to prevent intracranial extension of tissue destruction.

Enophthalmos caused by an orbital venous malformation

Orbital vascular malformations usually present with proptosis. We report a case where a patient with an orbital venous malformation presented with enophthalmos. Since many underlying orbital pathologies, including orbital metastases, can cause enophthalmos, it is important to investigate patients properly. Computed tomographic imaging of the orbit remains the most useful tool in the management of patients with enophthalmos.

Subcutaneous extralesional triamcinolone acetonide injection versus conservative management in the treatment of chalazion

OBJECTIVE

To compare the efficacy of subcutaneous extralesional triamcinolone acetonide injection versus conservative treatment for chalazion.

DESIGN

Randomised controlled trial.

SETTING

Eye clinics of two regional hospitals in Hong Kong.

PATIENTS

Patients over 18 years old presenting with primary chalazion were randomised into two groups. In group 1, 12 patients were treated with lid hygiene, warm compresses, and chloramphenicol 1% ointment 4 times a day. In group 2, 16 patients were treated with 0.3 mL triamcinolone acetonide (10 mg/mL) injection to the subcutaneous tissue extralesionally via the percutaneous route. Exclusion criteria were: acutely infected chalazion with preseptal cellulitis, recurrent chalazion, small chalazion (< or =2 mm), and prior treatment to chalazion.

MAIN OUTCOME MEASURES

Size of chalazion, recurrence of chalazion, intra-ocular pressure, and complications from treatment, including skin pigmentary change or atrophy and pyogenic granuloma.

RESULTS

There was a clinically and statistically significant difference between the success rates in group 1 (58.3%) and group 2 (93.8%). In group 1, the mean prior duration of chalazion before treatment was significantly shorter in success cases than in failed cases. One patient with multiple chalazia in group 2 developed hypopigmentary skin changes at one treatment site.

CONCLUSION

Subcutaneous extralesional triamcinolone acetonide injection was more effective than conservative treatment for chalazion.