Clinical Decision Making with Head and Neck Cancer Patients with Dysphagia

2019 ◽  
Vol 40 (03) ◽  
pp. 213-226
Author(s):  
Heather Starmer ◽  
Jeffrey Edwards
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surgical Removal ◽  
Epidemiologic Factors ◽  
Cancer Management ◽  
Nonsurgical Patient

AbstractDysphagia is a common challenge faced by patients with head and neck cancer. Management of these patients is quite distinct from many other dysphagia etiologies due to the nature of surgical removal of organs critical to swallowing, the ability to provide preventative therapies, and the variable risk for complications related to dysphagia. Thus, clinicians providing care to the head and neck cancer population need to understand these differences when employing clinical decision making. In addition, changes in the demographics of head and neck cancer, related predominantly to the epidemic of oropharyngeal cancer associated with the human papillomavirus, have further transformed both the types of patients and the types of treatments offered. These epidemiologic factors further complicate the decision-making process for clinicians. This article provides a framework for decision making in the surgical and nonsurgical patient with head and neck cancer.

scholarly journals Deliberações clínicas na atuação em pacientes com câncer de cabeça e pescoço: atualidades e desafios na disfagia

2020 ◽  
Vol 31 (4) ◽  
pp. 693-697
Author(s):  
Guilherme Maia Zica ◽  
Andressa Silva de Freitas
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision

Starmer H, Edwards J. Clinical Decision Making with Head and Neck Cancer Patients with Dysphagia. Semin Speech Lang. 2019 Jun;40(3):213-226.

Clinical Practices in Head and Neck Cancer: A Speech-Language Pathologist Practice Pattern Survey

2021 ◽  
pp. 000348942110010
Author(s):  
Ashley M. Logan ◽  
Mario A. Landera
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Best Practices ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Years Of Experience ◽  
Group Consensus ◽  
Clinical Practices

Objective: Clinical practices of speech-language pathologists (SLP) treating head and neck cancer (HNC) patients range widely despite literature trending toward best practices. This survey study was designed to identify current patterns and assess for gaps in clinical implementation of research evidence. Method: A web-based survey was distributed to SLPs via listserv and social media outlets. Descriptive statistics and group calculations were completed to identify trends and associations in responses. Results: Of 152 received surveys, the majority of respondents were hospital-based (86%) and had greater than 5 years of experience (65%). There was group consensus for the use of prophylactic exercise programs (95%), recommendations for SLP intervention during HNC treatment (75%), and use of maintenance programs post-treatment (97%). Conversely, no group consensus was observed for use of pre-treatment swallow evaluations, frequency of service provision, and content of therapy sessions. Variation in clinical decision making was noted in use of prophylactic feeding tubes and number of patients taking nothing by mouth during treatment. No associations were found between years of experience and decision-making practices, nor were any associations found between practice setting and clinical decision making. Conclusion: Despite the growing body of literature outlining evidence-based treatment practices for HNC patients, clinical practice patterns among SLPs continue to vary widely resulting in inconsistent patient care across practice settings. As compared to prior similar data, increased alignment with best practices was observed relative to early referrals, implementation of prophylactic intervention programs, and intervention with the SLP during the period of HNC treatment.

scholarly journals Leveraging patient‐reported outcomes data to inform oncology clinical decision making: Introducing the FACE‐Q Head and Neck Cancer Module

Cancer ◽  
2018 ◽  
Vol 125 (6) ◽  
pp. 863-872 ◽  
Author(s):  
Jennifer R. Cracchiolo ◽  
Anne F. Klassen ◽  
Danny A. Young‐Afat ◽  
Claudia R. Albornoz ◽  
Stefan J. Cano ◽  
...  
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Patient Reported Outcomes ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cancer Module ◽  
Patient Reported ◽  
The Face

scholarly journals The Importance of Verification CT-QA Scans in Patients Treated with IMPT for Head and Neck Cancers

2020 ◽  
Vol 7 (1) ◽  
pp. 41-53
Author(s):  
Jaden D. Evans ◽  
Riley H. Harper ◽  
Molly Petersen ◽  
William S. Harmsen ◽  
Aman Anand ◽  
...  
Keyword(s):  
Decision Making ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Cox Model ◽  
Clinical Decision ◽  
Concurrent Chemotherapy ◽  
Cumulative Probability ◽  
Kaplan Meier

Abstract Purpose To understand how verification computed tomography-quality assurance (CT-QA) scans influenced clinical decision-making to replan patients with head and neck cancer and identify predictors for replanning to guide intensity-modulated proton therapy (IMPT) clinical practice. Patients and Methods We performed a quality-improvement study by prospectively collecting data on 160 consecutive patients with head and neck cancer treated using spot-scanning IMPT who underwent weekly verification CT-QA scans. Kaplan-Meier estimates were used to determine the cumulative probability of a replan by week. Predictors for replanning were determined with univariate (UVA) and multivariate (MVA) Cox model hazard ratios (HRs). Logistic regression was used to determine odds ratios (ORs). P < .05 was considered statistically significant. Results Of the 160 patients, 79 (49.4%) had verification CT-QA scans, which prompted a replan. The cumulative probability of a replan by week 1 was 13.7% (95% confidence interval [CI], 8.82-18.9), week 2, 25.0% (95% CI, 18.0-31.4), week 3, 33.1% (95% CI, 25.4-40.0), week 4, 45.6% (95% CI, 37.3-52.8), and week 5 and 6, 49.4% (95% CI, 41.0-56.6). Predictors for replanning were sinonasal disease site (UVA: HR, 1.82, P = .04; MVA: HR, 3.64, P = .03), advanced stage disease (UVA: HR, 4.68, P < .01; MVA: HR, 3.10, P < .05), dose > 60 Gy equivalent (GyE; relative biologic effectiveness, 1.1) (UVA: HR, 1.99, P < .01; MVA: HR, 2.20, P < .01), primary disease (UVA: HR, 2.00 versus recurrent, P = .01; MVA: HR, 2.46, P = .01), concurrent chemotherapy (UVA: HR, 2.05, P < .01; MVA: not statistically significant [NS]), definitive intent treatment (UVA: HR, 1.70 versus adjuvant, P < .02; MVA: NS), bilateral neck treatment (UVA: HR, 2.07, P = .03; MVA: NS), and greater number of beams (5 beam UVA: HR, 5.55 versus 1 or 2 beams, P < .02; MVA: NS). Maximal weight change from baseline was associated with higher odds of a replan (≥3 kg: OR, 1.97, P = .04; ≥ 5 kg: OR, 2.13, P = .02). Conclusions Weekly verification CT-QA scans frequently influenced clinical decision-making to replan. Additional studies that evaluate the practice of monitoring IMPT-treated patients with weekly CT-QA scans and whether that improves clinical outcomes are warranted.

scholarly journals Wiring multiple microenvironment proteomes uncovers the biology in head and neck cancer

2021 ◽  
Author(s):  
Ariane F Busso-Lopes ◽  
Cesar Rivera ◽  
Leandro X Neves ◽  
Daniela C Granato ◽  
Fabio MS Patroni ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Immune Modulation ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Nodal Metastasis ◽  
Immune Markers ◽  
Multiple Sampling ◽  
Metastatic Cells

The poor prognosis of head and neck cancer (HNC) is associated with the presence of metastasis within the lymph nodes (LNs). Herein, the proteome of 140 multisite samples from a 59-HNC patient cohort, including primary and matched LN-negative or -positive tissues, saliva, and blood cells, reveals insights into the biology and potential metastasis biomarkers that may assist in clinical decision making. Protein profiles are strictly associated with immune modulation across datasets, and this provides the basis for investigating immune markers associated with metastasis. The proteome of LN metastatic cells recapitulates the proteome of the primary tumor sites. Conversely, the LN microenvironment proteome highlights the candidate prognostic markers. By integrating prioritized peptide, protein, and transcript levels with machine learning models, we identified a nodal metastasis signature in the blood and saliva. In summary, we present the deepest proteome characterization wiring multiple sampling sites in HNC, thus providing a promising basis for understanding tumoral biology and identifying metastasis-associated signatures.

scholarly journals Circulating Non-Coding RNAs in Head and Neck Cancer: Roles in Diagnosis, Prognosis, and Therapy Monitoring

Cells ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 48
Author(s):  
Araceli Diez-Fraile ◽  
Joke De Ceulaer ◽  
Charlotte Derpoorter ◽  
Christophe Spaas ◽  
Tom De Backer ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Clinical Decision Making ◽  
Therapy Monitoring ◽  
Clinical Decision ◽  
Upper Aerodigestive Tract ◽  
Non Coding Rna ◽  
Non Coding Rnas ◽  
Trna Halves

Head and neck cancer (HNC), the seventh most common form of cancer worldwide, is a group of epithelial malignancies affecting sites in the upper aerodigestive tract. The 5-year overall survival for patients with HNC has stayed around 40–50% for decades, with mortality being attributable mainly to late diagnosis and recurrence. Recently, non-coding RNAs, including tRNA halves, YRNA fragments, microRNAs (miRNAs), and long non-coding RNAs (lncRNAs), have been identified in the blood and saliva of patients diagnosed with HNC. These observations have recently fueled the study of their potential use in early detection, diagnosis, and risk assessment. The present review focuses on recent insights and the potential impact that circulating non-coding RNA evaluation may have on clinical decision-making in the management of HNC.

scholarly journals Immune Check-Point Inhibitors and Standard Chemoradiotherapy in Definitive Head and Neck Cancer Treatment

2021 ◽  
Vol 11 (5) ◽  
pp. 393
Author(s):  
Francesca De Felice ◽  
Daniela Musio ◽  
Vincenzo Tombolini
Keyword(s):  
Clinical Trials ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Therapeutic Strategies ◽  
Check Point ◽  
Clinical Tool ◽  
Cancer Management ◽  
Check Point Inhibitors

In head and neck cancer management, there is a need for tailored approaches to optimally implement clinical outcomes. Based on the assumption that efficacy and long-term toxicity are not satisfactory for standard concurrent platinum-based chemoradiotherapy, several trials have been designed to test whether induction immunotherapy and/or concomitant immunotherapy and radiotherapy result in improved survival and toxicity outcomes. Here, we present an overview of the most recent concomitant therapeutic strategies for head and neck cancer, focusing on the knowledge available regarding check-point inhibitors. The aim is to present the characteristics of the main check-point inhibitors and to summarize the clinical trials on the combination of immune check-point inhibitors and (chemo)radiotherapy in the definitive HNC setting, in order to provide a useful clinical tool for further research.

scholarly journals Outcomes of head and neck cancer management from two cancer centres in Southern and Northern Europe during the first wave of COVID-19

2021 ◽  
pp. 030089162110079
Author(s):  
Marta Tagliabue ◽  
Beth Russell ◽  
Charlotte Moss ◽  
Rita De Berardinis ◽  
Francesco Chu ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Ace Inhibitors ◽  
Northern Europe ◽  
Nasopharyngeal Swab ◽  
Cancer Management ◽  
The United Kingdom ◽  
Tertiary Hospitals ◽  
Using Data

Objective: To describe the approach and outcomes from two cancer centres in Southern and Northern Europe during the first wave of coronavirus disease 2019 (COVID-19) of patients with head and neck cancer (HNC). Methods: Data collection was performed on a retrospective cohort of patients surgically treated for primary HNC between March and May 2020, using data from two tertiary hospitals: the European Institute of Oncology (Milan) and Guy’s & St Thomas’ NHS Foundation Trust (London). Results: We included 77 patients with HNC. More patients with COVID-19 were taking angiotensin-converting enzyme (ACE) inhibitors and had Clavien-Dindo Classification grade I compared to negative patients, respectively (60% vs 22% [ p = 0.058] and 40% vs 8% [ p = 0.025]). Multivariate logistic regression analyses confirmed our data ( p = 0.05 and 0.03, respectively). Sex and age were statistically significantly different ( p = 0.05 and <0.001 respectively), showing more male patients (75% vs 53.66%, respectively) and more elderly patients in Italy than in the United Kingdom (patients aged >63 years: 69.44% vs 29.27%). Conclusions: This study presents a large cohort of patients with HNC with nasopharyngeal swab during the first peak of the COVID-19 pandemic in Europe. Patients with HNC with COVID-19 appeared more likely to develop postsurgical complications and to be taking ACE inhibitors. The preventive measures adopted guaranteed the continuation of therapeutic surgical intervention.

Pain in head and neck cancer: management and challenges during recovery

2021 ◽  
Vol 62 (2) ◽  
Author(s):  
Ankita KAR ◽  
Nirmalendu SAHA ◽  
Asheem RAMIZ ◽  
Udayan BHAUMIK ◽  
Satish C
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Cancer Management
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