Telehealth Interventions in Head and Neck Cancer Patients: A Systematic Review

BACKGROUND

Head and neck cancer (HNC) and its treatments often result in adverse effects that impair a patient's quality of life. Although intensive rehabilitative strategies can be used, their applicability can be limited due to patient-specific and socioeconomic barriers. Telehealth interventions represent a possible novel approach to increase access to these services and improve posttreatment quality of life in the HNC population.

OBJECTIVE

The objective of this systematic review was to identify studies investigating telemedicine-based interventions for HNC patients to determine whether there is a consensus concerning the cost-effectiveness, clinical utility, and accessibility of this model for rehabilitation.

METHODS

PubMed, EMBASE, Web of Science, and CINAHL were used to identify literature without time limit for publication. A critical appraisal of individual sources was conducted by 2 reviewers. Sixteen studies met inclusion criteria.

RESULTS

Studies related to telehealth interventions in the HNC population are limited. Salient themes included feasibility of telehealth as an intervention, effects on self-management and knowledge, impact on quality of life, physical and psychiatric symptoms, and cost.

CONCLUSION

Although the current literature presents promising data, indicating that telehealth interventions may be both effective and cost-efficient in the management of HNC patients, more research is needed to definitively elucidate their role in management.

IMPLICATIONS FOR PRACTICE

Telehealth interventions are valuable for clinicians as an alternative to expand access to care across the cancer continuum, to strengthen patients' knowledge and consequently their self-management, and to provide continuity of services as well as for remote monitoring of symptoms and response to treatment.

Medical Cannabis as Adjunctive Therapy for Head and Neck Cancer Patients

The goal of this systematic review was to define a consensus within the current literature regarding the impact/effect of cannabis or cannabinoids on the treatment of patients with head and neck cancer. We conducted a review of PubMed, Embase, and Web of Science databases, using a comprehensive search strategy, focusing on articles relating to head & neck cancer and cannabis/cannabinoids without a time limit for publication.

Two, independent reviewers screened articles based on title/abstract and included the ones selected by both. We then conducted a full-text review and excluded all articles which did not meet inclusion criteria. A single reviewer then assessed studies for methodological quality and extracted relevant data using a premade data collection tool. We identified five studies that met inclusion criteria. Studies were of varying quality and the majority investigated recreational cannabis use with only one study reporting dosing across participants. Lack of standardized cannabis exposure presents a wide array of potential confounding variables across the remaining studies. Meta-analysis was not attempted due to variability in reported outcomes.

It is impossible to draw any conclusions regarding the benefit or adverse effects of current medical cannabis products in this patient population. The literature regarding the effect of cannabis/cannabinoids on head & neck cancer patients is limited. However, the current lack of evidence does not definitively disprove the efficacy of cannabis. High-quality studies are necessary for physicians to provide advice to patients who are either using or interested in cannabis as an adjunctive treatment.

Management of Non-High-Risk Salivary Gland Carcinomas With Surgery Alone

Background

Risk stratification and appropriate treatment selection are essential for the management of head and neck malignancies, in order to optimize long-term outcomes. Salivary gland carcinomas (SGCs) pose a particular challenge due to their extensive biologic heterogeneity. Primary surgical resection remains the mainstay of treatment; however, outcomes with single modality therapy for 'non-high-risk' lesions are less elucidated in the literature present on the subject. We present our experience with non-high-risk salivary gland malignancies treated by surgery alone. 

Methods

A retrospective analysis of SGCs from 1998-2011 was completed after receiving Institutional Review Board approval. Patient demographic, tumor, treatment, and outcome data were obtained from chart review. The primary outcomes of interest were overall survival (OS) and recurrence-free survival (RFS).

Results

Of the 62 patients identified, 49 patients underwent resection of the primary tumor alone, while an ipsilateral selective neck dissection was included for 13 patients. The median follow-up was 5.05 years. Of the tumors, 79% were low-intermediate grade, 3% high grade, and 17% poorly classified. The OS and RFS were 91% and 87% at five years and 80% and 79% at 10 years, respectively. The combined failure rate of local, regional, and distance was 13%.

Conclusion

Surgery alone is an appropriate treatment strategy for patients with non-high-risk salivary gland malignancy, affording a high likelihood of long-term RFS and OS.

Multidisciplinary Management of Salivary Gland Cancers

BACKGROUND

Salivary carcinomas are a rare group of biologically diverse neoplasms affecting the head and neck. The wide array of different histological entities and clinical presentations has historically limited attempts to establish well-defined treatment algorithms. In general, low-risk lesions can be managed with a single treatment modality, whereas advanced lesions require a more complex, multidisciplinary approach.

METHODS

The relevant literature was reviewed, focusing on diagnostic and treatment algorithms for salivary malignancies.

RESULTS

Salivary carcinomas with high-risk features require an aggressive treatment approach with complete surgical resection, neck dissection to appropriate cervical lymph-node basins, and postoperative radiotherapy.

CONCLUSIONS

The heterogeneity of salivary neoplasms represents a unique clinical challenge. Despite the multidisciplinary management paradigm detailed in this review, outcomes for advanced disease are unsatisfactory. Future progress will likely require the addition of novel systemic therapeutic strategies.

Adjuvant radiotherapy versus concurrent chemoradiotherapy for the management of high-risk salivary gland carcinomas

BACKGROUND

Given the aggressive behavior of advanced salivary malignancies, the purpose of the current study was to explore the utility of adjuvant chemoradiotherapy (CRT) in this population.

METHODS

A retrospective study of salivary carcinomas treated from 1998 to 2013 with postoperative CRT (37 patients) or radiotherapy (RT; 103 patients) was completed.

RESULTS

The decision to utilize adjuvant CRT versus RT was influenced by tumor grade and histology, cervical lymph node status, surgical margins, and perineural invasion. In both treatment cohorts, high locoregional control rates were obtained (79% for CRT vs 91% for RT; p = .031). Multivariate Cox regression analysis did not identify a difference in 3-year progression-free survival (PFS) with the use of CRT versus RT (hazard ratio [HR] = 0.783; 95% confidence interval [CI] = 0.396-1.549; p = .482).

CONCLUSION

Until prospective evidence is available, such as from Radiation Therapy Oncology Group 1008, the standard use of CRT for advanced salivary malignancies cannot be recommended. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.

High-Grade Salivary Duct Carcinoma of the Parotid Gland: Clinicopathologic Features and Treatment Outcomes

Objectives:

(1) Analyze the treatment approach for these rare salivary gland neoplasms at our institution. (2) Demonstrate observed patterns of failure and survival for high-grade salivary duct carcinoma (HGSDC) involving the parotid glands.

Methods:

Clinical data on 17 patients with nonmetastatic HGSDC involving parotid salivary glands from 1998 to 2012 were abstracted from our institutional database. Inclusion required surgical resection with postoperative radiotherapy (n = 8) or concurrent chemoradiotherapy (n = 9). Demographics, histopathologic features, treatment course, and clinical outcomes were recorded. Specimens were re-reviewed by a dedicated head and neck pathologist. Overall survival (OS) and disease-free survival (DFS) were estimated via Kaplan-Meier method, and comparisons were made with the log-rank test.

Results:

Median patient age was 65 years (range, 52-83 years) with a male:female ratio of 7.5:1 and median follow-up of 37 months. Most commonly, these cases presented as pT4a (n = 14) with adverse clinical features, including perineural invasion (76.5%), positive lymph nodes (76.5%), and vascular invasion (58.8%). Three-year DFS and OS were 35.7% and 61.4%, respectively. The pattern of treatment failure was predominately distant (n = 11) versus locoregional (n = 3). Univariate analysis of demographic, histopathologic, and treatment characteristics did not reveal a significant association with OS or DFS. Median survival after metastasis was 13 months, with only a single patient having a sustained treatment response >2 years after disease dissemination.

Conclusions:

In this series, we highlight the aggressive nature of high-grade salivary duct carcinoma, which has a significant risk of distant recurrence and poor overall survival.

Posterior Reversible Encephalopathy Syndrome on Computed Tomography Perfusion in a Patient on "Triple H" Therapy

INTRODUCTION

This article reports a case of posterior reversible encephalopathy syndrome on compyted tomography (CT) perfusion in a patient on "Triple H" (hypertension, hypervolemia, and hemodilution) therapy following aneurysmal rupture repair.

CASE REPORT

"Triple H" therapy is used in the postoperative course for treatment of vasospasm to prevent stroke and hemorrhage by maintaining cerebral perfusion pressure.

DISCUSSION

A potential complication includes vasogenic edema from dysfunction of cerebral blood vessel autoregulation. CT perfusion can detect alterations in cerebral blood flow and volume caused by these hemodynamic changes.