Long-Term Quality of Life Following Head and Neck Radiation: A Study Using the Vanderbilt Head and Neck Symptom Survey

PURPOSE/OBJECTIVE(S)

Head and neck (H&N) radiation (RT) is characterized by significant acute toxicity, but long-term quality of life (QoL) following H&N RT is not well defined. This study sought to prospectively characterize, by subsite, long-term QoL in patients who underwent H&N RT using the Vanderbilt Head and Neck Symptom Survey (VHNSS) version 2.0.

MATERIALS/METHODS

In patients treated with H&N RT between 2010 and 2021, the VHNSS was prospectively collected prior to beginning RT and at follow-up visits after completion of RT. Responses were broken down into symptom clusters for characterization of specific side effects and scored from 0 (asymptomatic) to 10 (severe symptoms). Patients were stratified by disease site and type of RT, with three main subgroups of interest: p16+ oropharynx (OPX) treated with definitive RT, nasopharynx (NPX) treated with definitive RT, and oral cavity (OC) treated with postoperative RT (PORT). To characterize long-term QoL, surveys collected 2 years (±3 months) after completion of RT were analyzed. Survey response distributions are reported as median and interquartile ranges. Comparisons between groups were made using the Mann-Whitney U test.

RESULTS

A total of 65 patients (33 OPX [50.8%], 19 NPX [29.2%], 13 OC [20.0%]) had survey responses at 2 years. Median age was 56 (range 20-86). 48 (73.8%) patients were male. Concurrent chemotherapy was administered to 52 patients (80.0%). At 2 years, among OPX patients, trouble hearing (1.5 [0-5]) represented the greatest symptom burden, though this was still less than NPX (4.0 [2.0-7.5]; p = 0.099) patients but greater than OC (0.0 [0.0-1.5]; p = 0.16) patients. OPX patients had significantly less difficulty swallowing solids (0.8 [0.1-2.0]) compared to NPX (2.5 [1.1-5.1]; p = 0.018) and OC (3.5 [1.9-5.1]; p = 0.002) patients. OPX patients also experienced less dry mouth (1.0 [0.2-3.3]) than NPX (3.2 [1.5-6.6]; p = 0.012) and OC (2.4 [1.8-5.4]; p = 0.056) patients. OPX patients reported less trismus (0.0 [0.0-0.2]) than NPX (4.0 [0.0-7.0]; p<0.001) and OC (1.0 [0.5-3]; p = 0.002) patients. OPX patients had less neck tightness (0.0 [0.0-2.0]) than NPX (2.0 [0.0-3.0]; p = 0.022) patients and less voice dysfunction (0.0 [0.0-0.7]) than OC (3.0 [1.2-3.5]; p = 0.011) patients. Lastly, OPX patients had better mental health (0.0 [0.0-1.2]) than NPX (2.0 [0.0-5.0]; p = 0.019) and OC (2.0 [0.0-3.2]; p = 0.086) patients. There was no difference in taste/smell among OPX (0.9 [0.0-2.7]), NPX (2.3 [0.7-5.1]; p = 0.100), and OC (1.5 [1.1-3.4]; p = 0.230) patients.

CONCLUSION

The VHNSS was able to characterize long-term QoL in patients treated with H&N RT. In general, patients with OPX treated with definitive RT have improved long-term QoL relative to patients with NPX or OC cancers, though at least a quarter of patients still report significant dry mouth, taste/smell, and hearing difficulties. Additional work should seek to identify, and, where possible through timely rehabilitation, proactively mitigate late symptoms in patients following H&N RT.

Patient and Caregivers Opinions on Receiving Radiology Results before Oncologist Appointments

PURPOSE/OBJECTIVE(S)

With the passing of the Cures Act, patients now have immediate access to radiology reports and can review the results before discussing the findings with a physician. In Oncology, the results of these imaging reports can be especially sensitive as the results can lead to difficult discussions about patient prognosis, or the need for invasive medical, surgical, or radiation therapies. It is unclear whether immediate access may increase anxiety, stress, and confusion before discussions with an oncologist. In this study, we hypothesized that in the oncology setting, immediate access to imaging reports before meeting with their oncologist would be associated with worsened patient anxiety.

MATERIALS/METHODS

Patients and their caregivers were invited to complete an investigator-developed anonymous multiple-choice survey prior to a scheduled follow-up appointment with their radiation oncologist. Survey questions assessed preferences for reviewing the radiology report prior to their oncology visit, their reported level of anxiety before undergoing diagnostic imaging, after directly receiving their results, and after they have the discussion of their results with the oncologist. Additional metrics collected included patient demographics, the time interval between discussing the results with an oncologist, preference for reviewing the images or just the radiology report, satisfaction with having immediate access to the report, and if they would prefer being blinded from the results until after discussing with their oncologist. Survey items were scored descriptively through summary statistics.

RESULTS

In this interim report of 54 individuals surveyed over a two-week period (89% were patients, 11% were caregivers/family members), a combined 33% reported a high level of anxiety before undergoing their scan. Levels of high anxiety decreased to 20% for those who received their report prior to reviewing with their oncologist and further lowered to 13% after reviewing the report and images with their oncologist. 57% of responders reported discussing the results with an oncologist within 2 days of receiving results. 46% preferred reviewing only radiology reports and not the images, 35% favored reviewing both imaging and the report together and 19% had no preference. Only 18.5% of responders preferred viewing the reports before discussing them with their oncologist and only 20% felt it was beneficial having early access to them.

CONCLUSION

Anxiety associated with oncology-related imaging improved after immediate access to the report and after discussions with oncologists. A small proportion of patients preferred having early access to imaging reports and most patients preferred reviewing only the report, not the images. Strategies including shortened intervals between immediate access and discussions with oncologists may minimize anxiety associated with imaging as most patients preferred first discussing the results with their oncologist.

Incidence of Major Depression, Suicidal Ideation, and Mental Health Treatment Amongst Cancer Survivors

PURPOSE/OBJECTIVE(S)

Receiving a cancer diagnosis and undergoing subsequent treatments can result in a significant psychological burden for cancer patients. However, there is conflicting literature on the incidence of major depression in cancer patients compared to patients without cancer. The purpose of this study was to investigate and further clarify the incidence of major depression, associated treatments, and suicidal ideation in cancer survivors compared to a non-cancer cohort.

MATERIALS/METHODS

This is a retrospective, population-based study using survey responses from the National Survey on Drug Use and Health collected from January 2015 to December 2019. Survey data sets were queried for all respondents aged 18 years or older who provided a cancer history. Patients with a reported history of cancer ("cancer survivors") were further stratified by whether they reported a "recent" cancer diagnosis within the past 12 months. Survey responses were then evaluated for recent diagnoses of and treatments for major depressive disorder and suicidal ideation. Rates were compared between cancer survivors and participants without cancer using the Pearson χ2 test and multivariable logistic regression models, respectively.

RESULTS

Among the 212,411 survey respondents identified, 7,635 (3.6%) reported a cancer history, with 1,486 (0.7%) reporting a recent cancer history. The incidence of major depression was not different between cancer survivors and participants without cancer (9.3% vs. 9.2%; p = 0.762), though the incidence was slightly higher amongst recent cancer survivors (10.0% vs. 9.2%; p = 0.259). Among patients diagnosed with major depression, cancer survivors were significantly more likely to receive treatment for depression (78.6% vs. 60.3%, p<0.001), with 72.6% discussing depressive symptoms with a medical professional and 64.3% receiving prescription medication. Suicidal ideation was significantly lower among cancer survivors (5.1% vs. 6.2%, p<0.001) including recent survivors (5.0% vs. 6.2%, p<0.001). Suicidal ideation was higher in patients with underlying major depression in both cancer survivors and participants without cancer (30.6% vs. 35.6%, p = 0.015). On logistic regression, respondents with underlying depression receiving treatment were more likely to have suicidal ideation (OR: 1.49; p<0.001) while having a cancer diagnosis did not correlate with suicidal ideation (OR: 0.87; p = 0.869).

CONCLUSION

There was no significant overall difference in the incidences of major depression between cancer survivors and patients without cancer. However, one consideration is the under-diagnosis depression among cancer survivors. Symptoms of depression may be overlooked and mistakenly attributed to appropriate grief from a cancer diagnosis. Among patients diagnosed with major depression, cancer survivors were more likely to receive treatment for depression. These results highlight the importance of early depression assessment and treatment for cancer survivors.

Real-time detection of lipid bilayer assembly and detergent-initiated solubilization using optical cavities

The cellular membrane governs numerous fundamental biological processes. Therefore, developing a comprehensive understanding of its structure and function is critical. However, its inherent biological complexity gives rise to numerous inter-dependent physical phenomena. In an attempt to develop a model, two different experimental approaches are being pursued in parallel: performing single cell experiments (top down) and using biomimetic structures (bottom up), such as lipid bilayers. One challenge in many of these experiments is the reliance on fluorescent probes for detection which can create confounds in this already complex system. In the present work, a label-free detection method based on an optical resonant cavity is used to detect one of the fundamental physical phenomena in the system: assembly and solubilization of the lipid bilayer. The evanescent field of the cavity strongly interacts with the lipid bilayer, enabling the detection of the bilayer behavior in real-time. Two independent detection mechanisms confirm the formation and detergent-assisted solubilization of the lipid bilayers: (1) a refractive index change and (2) a material loss change. Both mechanisms can be monitored in parallel, on the same device, thus allowing for cross-confirmation of the results. To verify the proposed method, we have detected the formation of self-assembled phosphatidylcholine lipid bilayers from small unilamellar vesicles on the device surface in real-time. Subsequently, we exposed the bilayers to two different detergents (non-ionic Triton X-100 and anionic sodium dodecyl sulfate) to initiate solubilization, and this process was also detected in real-time. After the bilayer solubilization, the device returned to its initial state, exhibiting minimal hysteresis. The experimental wash-off was also collected and analyzed using dynamic light scattering.

Mutations in PNPLA6 are linked to photoreceptor degeneration and various forms of childhood blindness

Blindness due to retinal degeneration affects millions of people worldwide, but many disease-causing mutations remain unknown. PNPLA6 encodes the patatin-like phospholipase domain containing protein 6, also known as neuropathy target esterase (NTE), which is the target of toxic organophosphates that induce human paralysis due to severe axonopathy of large neurons. Mutations in PNPLA6 also cause human spastic paraplegia characterized by motor neuron degeneration. Here we identify PNPLA6 mutations in childhood blindness in seven families with retinal degeneration, including Leber congenital amaurosis and Oliver McFarlane syndrome. PNPLA6 localizes mostly at the inner segment plasma membrane in photoreceptors and mutations in Drosophila PNPLA6 lead to photoreceptor cell death. We also report that lysophosphatidylcholine and lysophosphatidic acid levels are elevated in mutant Drosophila. These findings show a role for PNPLA6 in photoreceptor survival and identify phospholipid metabolism as a potential therapeutic target for some forms of blindness.

Topical axitinib suppresses angiogenesis pathways induced by pulsed dye laser

BACKGROUND

The recurrence of port-wine stain (PWS) blood vessels by pulsed dye laser (PDL)-induced angiogenesis is a critical barrier that must be overcome to achieve a better therapeutic outcome.

OBJECTIVES

To determine whether PDL-induced angiogenesis can be suppressed by topical axitinib.

METHODS

The mRNA expression profiles of 86 angiogenic genes and phosphorylation levels of extracellular signal regulated kinases (ERKs), phosphorylated protein kinase B (AKT) and ribosomal protein S6 kinase (p70S6K) in rodent skin were examined with or without topical axitinib administration after PDL exposure.

RESULTS

The PDL-induced increased transcriptional levels of angiogenic genes peaked at days 3-7 post-PDL exposure. Topical application of 0·5% axitinib effectively suppressed the PDL-induced increase in mRNA levels of the examined angiogenic genes and activation of AKT, P70S6K and ERK from days 1 to 7 post-PDL exposure. After topical administration, axitinib penetrated into rodent skin to an approximate depth of 929·5 μm.

CONCLUSIONS

Topical application of 0·5% axitinib can systematically suppress the PDL-induced early stages of angiogenesis via inhibition of the AKT/mammalian target of rapamycin/p70S6K and Src homology 2 domain containing transforming protein-1/mitogen-activated protein kinase kinase/ERK pathway cascades.

MicroRNA-mediated regulation of melanoma

Melanoma is one of the most aggressive and deadly skin cancers, and, in its advanced stages, accounts for > 80% mortality. The incidence of melanoma is increasing worldwide; however, beyond surgical removal of the tumour, there is currently no curative therapy available, especially for its advanced stages. This may, in part, be owing to incomplete understanding of the molecular mechanisms that regulate the initiation and/or progression of melanoma to metastasis. The molecular mechanisms leading to the development and progression of melanoma are the focus of intense investigation, and many genetic/epigenetic alterations affecting melanoma progression and development have been identified. microRNAs (miRNAs) are emerging as important causal modulators in the development and progression of melanoma. The understanding of miRNA-mediated regulation of tumours has grown immensely over the last few years, as it has been understood to regulate most biological processes. Here, we review the currently available data on miRNAs associated with melanoma, highlighting those deregulated miRNAs that target important genes and pathways involved in the progression of melanocytes to primary and metastatic melanoma. We also review their potential clinical utility as biomarkers and potential use in targeted therapy.

Role of domains in Escherichia coli and mammalian mitochondrial elongation factor Ts in the interaction with elongation factor Tu

Bovine mitochondrial elongation factor Ts (EF-Tsmt) stimulates the activity of Escherichia coli elongation factor Tu (EF-Tu). In contrast, E. coli EF-Ts is unable to stimulate mitochondrial EF-Tu. EF-Tsmt forms a tight complex with E. coli EF-Tu governed by an association constant of 8.6 x 10(10). This value is 100-fold stronger than the binding constant for the formation of the E. coli EF-Tu.Ts complex. To test which domain of EF-Tsmt is important for its strong binding with EF-Tu, chimeras were made between E. coli EF-Ts and EF-Tsmt. Replacing the N-terminal domain of E. coli EF-Ts with that of EF-Tsmt increases its binding to E. coli EF-Tu 2-3-fold. Replacing the N-terminal domain of EF-Tsmt with the corresponding region of E. coli EF-Ts decreases its binding to E. coli EF-Tu approximately 4-5-fold. A chimera consisting of the C-terminal half of E. coli EF-Ts and the N-terminal half of EF-Tsmt binds to E. coli EF-Tu as strongly as EF-Tsmt. A chimera in which Subdomain N of the core of EF-Ts is replaced by the corresponding region of EF-Tsmt binds E. coli EF-Tu approximately 25-fold more tightly than E. coli EF-Ts. Thus, the higher strength of the interaction between EF-Tsmt and EF-Tu can be localized primarily to a single subdomain.

Glia-dependent neurotoxicity and neuroprotection in mesencephalic cultures

Dopaminergic neurotoxicities of 6-hydroxydopamine (6-OHDA) and the lipopolysaccharide (LPS) were compared in rat mesencephalic cultures plated on poly-L-lysine or on glial monolayers. In the neuron-enriched cultures plated on polylysine, 6-OHDA killed 89% of the tyrosine hydroxylase (TH)-immunopositive neurons, but LPS was not neurotoxic. Conversely, in mixed neuron/glial cultures, 6-OHDA killed only 27% of the TH-immunopositive neurons while LPS killed 70%. The mixed neuronal/glial mesencephalic culture offers a better in vitro model for studying possible mechanisms involved in Parkinson's disease.