A Pilot Study of a Comprehensive Palliative Care Intervention to Improve Symptoms and Coping During Curative-Intent Chemoradiation in Patients with Head and Neck Cancer

Background: Few large studies describe initial disease trajectories and subsequent mortality in people with head and neck cancer. This is a necessary first step to identify the need for palliative care and associated services. Aim: To analyse data from the Head and Neck 5000 study to present mortality, place and mode of death within 12 months of diagnosis. Design: Prospective cohort study. Participants: In total, 5402 people with a new diagnosis of head and neck cancer were recruited from 76 cancer centres in the United Kingdom between April 2011 and December 2014. Results: Initially, 161/5402 (3%) and 5241/5402 (97%) of participants were treated with ‘non-curative’ and ‘curative’ intent, respectively. Within 12 months, 109/161 (68%) in the ‘non-curative’ group died compared with 482/5241 (9%) in the ‘curative’ group. Catastrophic bleed was the terminal event for 10.4% and 9.8% of people in ‘non-curative’ and ‘curative’ groups, respectively; terminal airway obstruction was recorded for 7.5% and 6.3% of people in the same corresponding groups. Similar proportions of people in both groups died in a hospice (22.9% ‘non-curative’; 23.5% ‘curative’) and 45.7% of the ‘curative’ group died in hospital. Conclusion: In addition to those with incurable head and neck cancer, there is a small but significant ‘curative’ subgroup of people who may have palliative needs shortly following diagnosis. Given the high mortality, risk of acute catastrophic event and frequent hospital death, clarifying the level and timing of palliative care services engagement would help provide assurance as to whether palliative care needs are being met.

Download Full-text

Individualised mindfulness-based stress reduction for head and neck cancer patients undergoing radiotherapy of curative intent: a descriptive pilot study

European Journal of Cancer Care ◽

10.1111/ecc.12474 ◽

2016 ◽

Vol 26 (2) ◽

pp. e12474 ◽

Cited By ~ 11

Author(s):

A. Pollard ◽

J.L. Burchell ◽

D. Castle ◽

K. Neilson ◽

M. Ftanou ◽

...

Keyword(s):

Head And Neck Cancer ◽

Pilot Study ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Stress Reduction ◽

Curative Intent ◽

Mindfulness Based Stress Reduction

Download Full-text

Feasibility of a collaborative palliative and oncology care intervention to improve symptoms and coping during head and neck chemoradiation.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.73 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 73-73

Author(s):

Jessica Ruth Bauman ◽

Jessie Panick ◽

Thomas James Galloway ◽

John A. Ridge ◽

Melissa McShane ◽

...

Keyword(s):

Palliative Care ◽

Head And Neck ◽

Care Utilization ◽

Curative Intent ◽

Enrollment Rate ◽

Phone Calls ◽

Care Intervention ◽

Patient Reported ◽

Oncology Care ◽

And Coping

73 Background: Patients receiving curative chemoradiation treatment (CRT) for head and neck cancer (HNC) undergo one of the most intensive treatments in oncology, resulting in immense physical and psychological symptoms. Integrated palliative care can improve symptoms and coping in patients with advanced cancer, but has not been evaluated in patients with curable solid tumors. Thus, we are conducting the first pilot study of a collaborative palliative and oncology care intervention among patients receiving CRT to assess feasibility and acceptability. Methods: Eligible participants include newly diagnosed HNC patients starting curative-intent CRT. The intervention entails weekly in-person palliative care (PC) visits integrated with standard oncology care during CRT, followed by 4 weekly phone calls after CRT ends. The PC visits are conducted primarily by a PC RN, with a supervising MD or NP available. Visits focus on coping and managing prominent symptoms during CRT. PC clinicians also receive a weekly patient-reported symptom assessment. Acceptability of the intervention is assessed at 1 month post CRT. The primary outcome is feasibility, defined as a >50% enrollment rate with >70% of participants attending at least half of the PC visits. Planned accrual is 20 patients. Results: We have enrolled 88% (14/16) of eligible patients to date. 11/14 (79%) have p16+ disease. All 14 have completed CRT and are evaluable for feasibility. Participants attended 98% (94/96) of all possible PC visits and completed 99% (95/96) of weekly symptom assessments. PC clinicians spent an average of 35.5 minutes (SD 15.1) per visit with participants. Among the 10 participants who completed the intervention and are evaluable for acceptability, 100% found the intervention “very helpful” and would “definitely recommend” it to others undergoing CRT. Conclusions: An integrated PC intervention to improve symptoms and coping during CRT for HNC is both feasible and acceptable with a high enrollment rate, excellent intervention compliance, and high patient satisfaction. Future studies will evaluate the effects of the integrated intervention on patient-reported outcomes and health care utilization. Clinical trial information: NCT03760471.

Download Full-text

A Pilot Study of a Collaborative Palliative and Oncology Care Intervention for Patients with Head and Neck Cancer

Journal of Palliative Medicine ◽

10.1089/jpm.2020.0656 ◽

2021 ◽

Author(s):

Jessica R. Bauman ◽

Jessie R. Panick ◽

Thomas J. Galloway ◽

John A. Ridge ◽

Marcin A. Chwistek ◽

...

Keyword(s):

Head And Neck Cancer ◽

Pilot Study ◽

Head And Neck ◽

Neck Cancer ◽

Care Intervention ◽

Oncology Care

Download Full-text

Active matrix metalloproteinase-8 and interleukin-6 detect periodontal degeneration caused by radiotherapy of head and neck cancer: a pilot study

Expert Review of Proteomics ◽

10.1080/14789450.2020.1858056 ◽

2021 ◽

pp. 1-8

Author(s):

Mutlu Keskin ◽

Hanna Lähteenmäki ◽

Nilminie Rathnayake ◽

Ismo T. Räisänen ◽

Taina Tervahartiala ◽

...

Keyword(s):

Head And Neck Cancer ◽

Pilot Study ◽

Matrix Metalloproteinase ◽

Head And Neck ◽

Neck Cancer ◽

Interleukin 6 ◽

Active Matrix

Download Full-text

Effect of Epoetin Alfa on Survival and Cancer Treatment–Related Anemia and Fatigue in Patients Receiving Radical Radiotherapy With Curative Intent for Head and Neck Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.22.3693 ◽

2009 ◽

Vol 27 (34) ◽

pp. 5751-5756 ◽

Cited By ~ 39

Author(s):

Peter J. Hoskin ◽

Martin Robinson ◽

Nicholas Slevin ◽

David Morgan ◽

Kevin Harrington ◽

...

Keyword(s):

Head And Neck Cancer ◽

Adverse Events ◽

Cancer Treatment ◽

Head And Neck ◽

Neck Cancer ◽

Functional Assessment ◽

Radical Radiotherapy ◽

Epoetin Alfa ◽

Local Tumor ◽

Curative Intent

Purpose To evaluate the effect of epoetin alfa on local disease-free survival (DFS), overall survival (OS), and cancer treatment–related anemia and fatigue in patients with head and neck cancer receiving radical radiotherapy with curative intent. Patients and Methods Patients (N = 301) with hemoglobin (Hb) less than 15 g/dL were randomly assigned in a ratio of 1:1 to receive radiotherapy plus epoetin alfa (10,000 U subcutaneously [SC] three times weekly if baseline Hb was < 12.5 g/dL; 4,000 U SC three times weekly if baseline Hb ≥ 12.5 g/dL) or radiotherapy alone. Hb levels were monitored weekly. The primary end point was local DFS, defined as the time from random assignment to local disease recurrence or death. Secondary efficacy end points included OS, local tumor response, and local tumor control. Patients were followed at 1, 4, 8, and 12 weeks postradiotherapy and annually for 5 years. Cancer treatment–related anemia and fatigue were evaluated with the Functional Assessment of Cancer Therapy-Anemia and Functional Assessment of Cancer Therapy-Head and Neck. Adverse events were recorded up to 12 weeks postradiotherapy. Results Hb levels increased from baseline with epoetin alfa. The median duration of local DFS was not statistically different between groups (observation, 35.42 months; epoetin alfa, 31.47 months; hazard ratio, 1.04; 95% CI, 0.77 to 1.41). Groups did not significantly differ in DFS, OS, tumor outcomes, or cancer treatment–related anemia or fatigue. No new or unexpected adverse events were observed. Conclusion Addition of epoetin alfa to radical radiotherapy did not affect survival, tumor outcomes, anemia, or fatigue positively or negatively in patients with head and neck cancer.

Download Full-text