Integrated psychological care in head and neck cancer: Views from health care providers, patients, and supports

2014 ◽  
Vol 125 (6) ◽  
pp. 1345-1351 ◽  
Author(s):  
Michelle T. Jesse ◽  
Michael E. Ryan ◽  
Anne Eshelman ◽  
Tamer Ghanem ◽  
Amy M. Williams ◽  
...  
Keyword(s):  
Health Care ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Health Care Providers ◽  
Neck Cancer ◽  
Care Providers ◽  
Psychological Care

scholarly journals Organizational guidance for the care of patients with head-and-neck cancer in Ontario

2019 ◽  
Vol 27 (2) ◽  
Author(s):  
J. Irish ◽  
J. Kim ◽  
J. Waldron ◽  
A.C. Wei ◽  
E. Winquist ◽  
...  
Keyword(s):  
Health Care ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Health Care Providers ◽  
Neck Cancer ◽  
Cancer Care ◽  
Delivery Of Health Care ◽  
Health Care Services ◽  
Care Providers ◽  
Care Services

Background At the request of the Head and Neck Cancers Advisory Committee of Ontario Health (Cancer Care Ontario), a working group and expert panel of clinicians with expertise in the management of head-and-neck cancer developed the present guideline. The purpose of the guideline is to provide advice about the organization and delivery of health care services for adult patients with head-and-neck cancer. Methods This document updates the recommendations published in the Ontario Health (Cancer Care Ontario) 2009 organizational guideline The Management of Head and Neck Cancer in Ontario. The guideline development methods included an updated literature search, internal review by content and methodology experts, and external review by relevant health care providers and potential users. Results To ensure that all patients have access to the highest standard of care available in Ontario, the guideline establishes the minimum requirements to maintain a head-and-neck disease site program. Recommendations are made about the membership of core and extended provider teams, minimum skill sets and experience of practitioners, cancer centre–specific and practitioner-specific volumes, multidisciplinary care requirements, and unique infrastructure demands. Conclusions The recommendations contained in this document offer guidance for clinicians and institutions providing care for patients with head-and-neck cancer in Ontario, and for policymakers and other stakeholders involved in the delivery of health care services for head-and-neck cancer.    

Advances in Supportive Care for Late Effects of Head and Neck Cancer

2015 ◽  
Vol 33 (29) ◽  
pp. 3314-3321 ◽  
Author(s):  
Barbara A. Murphy ◽  
Jie Deng
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Health Care Providers ◽  
Neck Cancer ◽  
Late Effects ◽  
Primary Care Physicians ◽  
Nutritional Deficiencies ◽  
Care Providers ◽  
Functional Deficits

As the population of head and neck cancer survivors increases, it has become increasingly important for health care providers to understand and manage late complications of therapy. Functional deficits can be categorized as general health deficits resulting in frailty or debility, head and neck–specific functional deficits such as swallowing and speech, and musculoskeletal impairment as a result of tumor and treatment. Of critical importance is the growing data indicating that swallow therapy and physical therapy may prevent or ameliorate long-term functional deficits. Oral health complications of head and neck therapy may manifest months or years after the completion of treatment. Patients with hyposalivation are at high risk for dental caries and thus require aggressive oral hygiene regimens and routine dental surveillance. Swallowing abnormalities, xerostomia, and poor dentition may result in dietary adaptations that may cause nutritional deficiencies. Identification and management of maladaptive dietary strategies are important for long-term health. Follow-up with primary care physicians for management of comorbidities such as diabetes and hyperlipidemia may help to limit late vascular complications caused by radiation therapy. Herein, we review late effects of head and neck cancer therapy, highlighting recent advances.

scholarly journals Randomized double-blind, placebo-controlled trial evaluating oral glutamine on radiation-induced oral mucositis and dermatitis in head and neck cancer patients

2019 ◽  
Vol 109 (3) ◽  
pp. 606-614 ◽  
Author(s):  
Chih-Jen Huang ◽  
Ming-Yii Huang ◽  
Pen-Tzu Fang ◽  
Frank Chen ◽  
Yu-Tsang Wang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Oral Mucositis ◽  
University Hospital ◽  
Phase Iii ◽  
Care Providers ◽  
Double Blind ◽  
Radiation Induced

ABSTRACT Background Glutamine is the primary fuel for the gastrointestinal epithelium and maintains the mucosal structure. Oncologists frequently encounter oral mucositis, which can cause unplanned breaks in radiotherapy (RT). Objectives The aim of this study was to explore the association between oral glutamine and acute toxicities in patients with head and neck cancer undergoing RT. Methods This was a parallel, double-blind, randomized, placebo-controlled Phase III trial conducted in a university hospital. A central randomization center used computer-generated tables to allocate interventions to 71 patients with stages I–IV head and neck cancers. The patients, care providers, and investigators were blinded to the group assignment. Eligible patients received either oral glutamine (5 g glutamine and 10 g maltodextrin) or placebo (15 g maltodextrin) 3 times daily from 7 d before RT to 14 d after RT. The primary and secondary endpoints were radiation-induced oral mucositis and neck dermatitis, respectively. These were documented in agreement with the National Cancer Institute Common Terminology Criteria for Adverse Events version 3. Results The study included 64 patients (placebo n = 33; glutamine n = 31) who completed RT for the completers’ analysis. Based on multivariate analysis, glutamine had no significant effect on the severity of oral mucositis (OR: 0.3; 95% CI: 0.05, 1.67; P = 0.169). Only the change in body mass index (BMI) was significant in both multivariate completers (OR: 0.41; 95% CI: 0.20, 0.84; P = 0.015) and per-protocol analysis (OR: 0.40; 95% CI: 0.20, 0.83; P = 0.014). No difference was found in the incidence and severity of neck dermatitis between the two arms. Conclusions The decrease in BMI was strongly related to the severity of oral mucositis in the head and neck cancer patients under RT, but not to the use of glutamine. This trial was registered at clinicaltrials.gov as NCT03015077.

Impact of Socioeconomic Status (SES) on Head and Neck Cancer (HNC) Survival in an Equal Access Health Care System

2011 ◽  
Vol 81 (2) ◽  
pp. S107-S108
Author(s):  
K.P. Chu ◽  
S. Habbous ◽  
S. Huang ◽  
L. Cheng ◽  
A. Hope ◽  
...  
Keyword(s):  
Health Care ◽  
Socioeconomic Status ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Health Care System ◽  
Neck Cancer ◽  
Equal Access ◽  
Care System

scholarly journals PCN357 - SATISFACTION WITH HEALTH CARE IN LOCALLY ADVANCED HEAD AND NECK CANCER MEXICAN PATIENTS TREATED IN A THIRD LEVEL PUBLIC FACILITY

2018 ◽  
Vol 21 ◽  
pp. S75
Author(s):  
B. Martinez-Herrera ◽  
L. Balderas-Peña ◽  
D. Sat-Muñoz ◽  
B. Trujillo-Hernández ◽  
F. Gonzalez-Barba ◽  
...  
Keyword(s):  
Health Care ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Locally Advanced ◽  
Public Facility ◽  
Advanced Head ◽  
Mexican Patients

Health Care Crisis: The Head and Neck Cancer Patient and Affordable Health Insurance

1993 ◽  
Vol 72 (5) ◽  
pp. 334-340
Author(s):  
Patrick C. Hagen ◽  
Daniel W. Nuss ◽  
Michael Ellis ◽  
George D. Lyons
Keyword(s):  
Health Care ◽  
Head And Neck Cancer ◽  
Health Insurance ◽  
Head And Neck ◽  
Neck Cancer ◽  
Risk Groups ◽  
Poverty Level ◽  
Health Care Crisis ◽  
Insurance Rates ◽  
Risk Of Cancer

In an evaluation of 30 patients with head and neck cancer, we found that 14 (46%) were uninsured at the time of diagnosis and 15 (50%) had yearly incomes below the poverty level. Tobacco and alcohol were identified as risk factors in 25 (83%) of the patients. These patients spent an average of $2,781 on carcinogenic agents yearly, increasing the risk of cancer 55 times that of the unexposed population, whereas the cost of a health insurance policy was $2,321 per year. To remedy the disparities and incongruities of this situation, we advocate patient education to influence behavioral change in these high-risk groups, a lowering of insurance rates, legal reform, and continued physician activism toward managing the current health care crisis.

scholarly journals Immunotherapy for Head and Neck Cancer in the Era of Exponentially Increasing Health Care Expenditure

2017 ◽  
Vol 23 (2) ◽  
pp. 147-149
Author(s):  
Rafael Santana‐Davila ◽  
Cristina P. Rodriguez
Keyword(s):  
Health Care ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Health Care Expenditure

Addressing distress in head and neck cancer patients: A quality improvement project.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 43-43
Author(s):  
Natalie Riblet ◽  
Karen Skalla ◽  
Alison Peterson ◽  
Auden McClure ◽  
Karen Homa ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Head And Neck Cancer ◽  
Quality Improvement ◽  
Mental Health Care ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Medical Oncology ◽  
Senior Leadership

43 Background: To better address the emotional needs of cancer patients by improving mental health care in Head and Neck Cancer (HNC) Medical oncology at Norris Cotton Cancer Center, Lebanon, NH, through implementing an evidence-based process for identifying and managing psychological distress. Methods: Using quality improvement methods, mental health care in HNC Medical Oncology was evaluated and revised November 2010 through April 2012. In January 2011, a two-component intervention was put into routine care including 1) the validated National Comprehensive Cancer Network (NCCN) distress thermometer (DT) and 2) a treatment decision algorithm. A licensed nursing assistant administered the DT and providers reviewed results as part of the clinical exam. Heightened distress was defined as a score of ≥ 4. Screening processes were improved through Plan-Do-Study-Act (PDSA) cycles. Results: Prior to January 2011, identification of distress was based on provider’s clinical assessment. Of 104 patients seen between November 2010 and January 2011, 25% (26) were diagnosed with psychological problems. Cause-effect diagraming suggested that lack of a formalized process for distress assessment contributed to missed diagnoses. Providers were unfamiliar with mental health resources. As reported in Psycho-Oncology 21(Suppl. 1): 51(2012) after implementing process changes, bi-weekly distress screening rates rose from 0% to 38% between January and July 2011. With additional PDSA cycles, these rates increased to 74% between October 2011 and April 2012. Similar to proposed benchmarks, 84% (47) of newly diagnosed patients (56) were assessed for distress. Furthermore, of 138 unique patients seen, 71% (98) were screened for distress and 47% (46) of these had heightened distress. Providers addressed the needs of all those identified. Improvement was attributed to the empowerment of staff and participation of senior leadership. Barriers included a heavy reliance on the presence of trained staff. Conclusions: Quality improvement methods can be applied to the cancer setting in order to create systems of care, which more reliably identify and address distress. Teams, however, must be invested in the work and receive support from senior leadership.

Tailored survivorship care plans for head and neck cancer patients.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 51-51
Author(s):  
Andrew L. Salner ◽  
Shrujal S. Baxi ◽  
Elizabeth Fortier ◽  
Talya Salz
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Primary Care Providers ◽  
Cancer Surveillance ◽  
Survivorship Care Plans ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans ◽  
Patient Reported

51 Background: Survivorship care plans SCPs typically include generic advice for cancer surveillance, management of late effects (LEs), wellness recommendations (WRs), and cancer screening. We developed a platform called HN-STAR that uses electronic patient-reported outcomes (ePROs) and evidence-based management guidelines to generate tailored SCPs for head and neck cancer survivors (HNCSs), a population particularly vulnerable to various LEs. We surveyed HNCSs and their primary care providers (PCPs) regarding the SCP to assess its acceptability and usefulness. Methods: HNCSs at 2 cancer hospitals used HN-STAR. Prior to a routine clinic visit, HNCSs used a validated ePRO measure (PRO-CTCAE) to report 22 physical LEs and other measures to assess wellness. Based on the visit discussion, HN-STAR generated an SCP that included a treatment summary, WRs, and LE management plans. HNCSs indicated their perceptions of the SCP and intentions to adhere to WR and LE management recommendations. PCPs reported on the SCP utility and their comfort in managing WRs and LEs. Results: 47 HNCSs completed surveys (mean 5.4 yrs. from treatment completion). Most were white (89%), male (85%), had an oropharynx tumor (58%), and received multimodality therapy (81%). 51% experienced at least 9 of the 22 LEs in the last month (mean 8.2/person). 91% of HNCSs felt the SCP was easy to follow. 98% intended to follow recommendations for LEs management and 98% reported they would refer back to the SCP. 87% said they plan to share the SCP with a PCP. 23 PCPs completed the survey. 95% were satisfied with the SCP and 95% reported they would like to have one for every cancer patient. PCPs expressed varying levels of comfort in managing specific LEs of head and neck cancer (30-80%). Conclusions: Among HNCSs, an automatically generated SCP that was tailored to their WRs and LEs was acceptable, was trusted, and provided recommendations they intended to follow. PCPs found the SCP useful, and SCPs may help improve their comfort with LE management. Patient-centered SCPs that focus on existing LEs hold promise as a means to help survivors and PCPs manage survivorship issues.

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