Drug-related problems in head and neck cancer patients identified by repeated medication reviews on consecutive therapy cycles

2020 ◽  
pp. 107815522096217
Author(s):  
Corinna Vucur ◽  
Daniel A Wirtz ◽  
Leonie Weinhold ◽  
Matthias Zipfel ◽  
Matthias Schmid ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Laboratory Data ◽  
University Hospital ◽  
Drug Related Problems ◽  
Medication Regimen Complexity ◽  
Medication Reviews ◽  
The Mean ◽  
Repeated Medication

Background Head and neck cancer (HNC) patients are particularly vulnerable to drug-related problems (DRPs) given the toxicity of concomitant chemoradiotherapy (CCRT). Objective To investigate the number and type of potential DRPs (pDRPs) in HNC outpatients undergoing five consecutive cycles of CCRT. Methods A single-centre, non-randomized, non-interventional, observational study was conducted at the Oncological Outpatient Clinic of the Center for Integrated Oncology at the University Hospital Bonn, Germany. Clinical pharmacists took a comprehensive medication history, documented laboratory data, assessed patients’ symptom burden, and retrospectively performed medication reviews at study entry and on the first day of each therapy cycle without any clinical intervention. Results In 26 patients, the mean number of pDRPs continuously increased during therapy course, from 4.8 (SD 2.7, range 2–12) at cycle 1 to 6.9 (SD 2.6, range 2–12) at cycle 5, with drug-drug interactions, adverse drug reactions, inappropriate durations of use, and inappropriate dosage intervals being the most common. Considering only new and recurrent pDRPs, the mean number was 4.3 (SD 2.3, range 2–9) at cycle 1 and lower in the further therapy course with an average of 1.3 (SD 1.7, range 0–7) at cycle 2 and 1.9 (SD 1.5, range 0–5) at cycle 5. The number of pDRPs was found to be associated with medication regimen complexity and health-related quality of life assessed in the first therapy cycle. Conclusion pDRPs frequently occurred in HNC outpatients demonstrating the need for pharmaceutical care. A methodological framework for repeated medication reviews was established, facilitating implementation into routine healthcare practice.

Serum enzymes in head and neck cancer. II Aliesterase

1987 ◽  
Vol 101 (8) ◽  
pp. 819-822 ◽  
Author(s):  
Harbans Lal ◽  
H. C. Madan ◽  
G. S. Kohli ◽  
S. P. S. Yadav
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Mean Value ◽  
Serum Enzymes ◽  
The Mean

AbstractSerum aliesterase levels have been estimated in 38 patients with head and neck cancer. The mean value was significantly lower than in controls. The decrease in activity was greater in patients with ulcerative growths and it progressed with advancement in the stage of cancer.With radiotherapy, a progressive and significant increase in serum aliesterase activity was observed. In patients with non-malignant growths the activity was comparable with that in controls.

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.

Utility of the LigaSure vessel sealing system during major head and neck cancer surgery

2012 ◽  
Vol 126 (8) ◽  
pp. 815-817 ◽  
Author(s):  
N Fakhry ◽  
J Michel ◽  
L Santini ◽  
A Lagier ◽  
F Turner ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Cancer Surgery ◽  
University Hospital ◽  
Sutureless Technique ◽  
Vessel Sealing System ◽  
Vessel Sealing ◽  
Ligasure Vessel Sealing System ◽  
Primary Means

AbstractObjective:To evaluate the haemostatic efficacy and safety of the LigaSure vessel sealing system in major head and neck cancer surgery.Methods:This two-year, prospective study included 34 patients who underwent major head and neck cancer surgery at a university hospital. The LigaSure Precise handpiece and LigaSure 8 vessel sealing system were utilised as the primary means of haemostasis, except when sealing vessels larger than 7 mm in diameter. Surgical outcomes were evaluated. In addition, in each patient the diameter of the largest vein and artery sealed (all were >2 mm) was measured before sealing.Results:In all cases except one (33/34 patients), a sutureless technique was performed. Post-operative bleeding was observed in two cases. Thirty veins and 22 arteries were measured. The mean diameter of the largest sealed vein was 3.8 mm, while that of the largest sealed artery was 2.7 mm.Conclusion:Our experience indicates that the surgical technique described is safe and effective. The main advantages of the LigaSure system are that it simplifies the procedure and eliminates the need for clips and suture ligations.

Quantitative estimates of the effects of concomitant chemotherapy on acute dysphagia in patients receiving radical treatment for head and neck cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22134-e22134
Author(s):  
S. Bhide ◽  
S. Gulliford ◽  
R. A'Hern ◽  
E. Hall ◽  
K. Newbold ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Radiation Dose ◽  
Head And Neck ◽  
Neck Cancer ◽  
Dose Response ◽  
Concomitant Chemotherapy ◽  
Response Curves ◽  
Pharyngeal Mucosa ◽  
The Mean ◽  
Dose Response Curves

e22134 Purpose: To generate quantitative parameters describing the effect of concomitant chemotherapy on incidence of grade 3 dysphagia (CTCAE v3.0, assisted feeding) using dose response curves in patients receiving radical treatment for head and neck cancer. Methods: Patients treated at a single centre in prospective phase I and II trials of concomitant chemo-IMRT (CRT) (n=85) and the phase III trial of IMRT vs. conventional radiotherapy (PARSPORT) (n=82) formed the basis of this non-randomized comparison. Patients in the PARSPORT trial received radiation alone (RT). Radiation dose for all patients was radiobiologically equivalent to at least 70Gy in 35 fractions. Concomitant chemotherapy was cisplatin (100 mg/m2) on days 1 and 29. G3 dysphagia was recorded prospectively. Dose volume histograms (DVH) were generated for the pharyngeal mucosa. The mean dose (converted to equivalent dose in 2Gy/fraction, MD2) was used as a univariate descriptor of the DVH, for the generation of the dose response curves. A logistic function of the form p=1/[1+(MD50/D)k] was fitted where, p is the probability of the incidence of toxicity, D is the mean dose, MD50 is the mean dose at which 50% of patients experience toxicity and k describes the increase in incidence with increasing dose. The dose response curves were fitted using non-linear logistic regression. Results: The mean MD2 to the pharyngeal mucosa were 56Gy and 55.8Gy respectively, in the CRT and RT groups. There was a statistically significant difference of 25% (95% CI: 10–38, p=0.002) in the incidence of G3 dysphagia between the CRT (68%) and RT (43%) groups. Fitting dose response curves to the clinical data yielded parameter values (95% CIs) of MD50=46 Gy (42–49), k=4.8 (2.3–7.2) for the CRT group and MD50= 58 Gy (55–61), k=3 (1.6-.45) for RT group. Dose response gradients for CRT and RT showed approximately 1.95% and 1.3% increase (respectively) in probability of G3 dysphagia resulting from an increase in mean dose of 1Gy between doses of 30Gy to 70Gy. Conclusions: Addition of concomitant chemotherapy increases the incidence of G3 dysphagia by 0.65% for every 1 Gy increase in radiation dose. The observed MD50 for G3 dysphagia is lower for RT alone (46 Gy vs. 58 Gy). No significant financial relationships to disclose.

QOL assessment in head and neck cancer patients undergoing neoadjuvant chemotherapy and its impact on overall survival.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17519-e17519
Author(s):  
Sachin Dhumal ◽  
Vijay Maruti Patil ◽  
Vanita Noronha ◽  
Amit Joshi ◽  
Atanu Bhattacharjee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Treatment Options ◽  
Life Assessment ◽  
The Mean

e17519 Background: NACT (neoadjuvant chemotherapy) is one of the treatment options in advanced head and neck cancer (H&N cancer); however there is limited quality of life data available in these patients. Methods: Between August 2013- April 2014, 90 technically unresectable H&N cancer patients who were underwent NACT at our centre were selected for this analysis. EORTC QLQ-C30 and HN35 version 3.0 was used for quality of life assessment at baseline and after 02 cycles of NACT. PFS and OS was estimated by Kaplan Meier method. The mean change in QOL at various domains was calculated with 95% CI. The relationship between change in QOL domain and OS was analysed. Results: The median age of the cohort was 45 years (Range 21-65 years). The predominant subsite was oral cavity, in 62 patients (68.9%).The median PFS and OS was 10.53 months (95%CI 8.1-13.0) and 20.8 months (95%CI 15.1-26.5). The mean scores for all domains of QOL are shown in table 1. Conclusions: NACT leads to improvement in QOL in patients treated with head and neck cancers and its has impact on OS.[Table: see text]

Serum enzymes in head and neck cancer. IV: 5-nucleotidase

1989 ◽  
Vol 103 (2) ◽  
pp. 200-202 ◽  
Author(s):  
H. Lal ◽  
L. Kumar ◽  
G. S. Kohli ◽  
A. Sharma ◽  
H. Goel
Keyword(s):  
Enzyme Activity ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Mean Value ◽  
Serum Enzymes ◽  
Nucleotidase Activity ◽  
Cervical Metastasis ◽  
The Mean

AbstractSerum 5-nucleotidase levels have been estimated in a group of 50 patients with head and neck cancer. The mean value was significantly higher in patients compared to the controls. In patients with non-malignant growths, the activity was comparable with the controls. The increase was higher in patients with proliferative lesions than those with ulcerative growths. Enzyme activity was found to be increased with the advancement in the stage of cancer. The rise was comparatively higher in patients with cervical metastasis. After radiotherapy, a gradual and significant reduction of serum 5-nucleotidase activity was observed.

scholarly journals Retrospective analysis of random and systematic errors in radiation therapy of head and neck cancer patients and its clinical predictive implications with VMAT treatment

2019 ◽  
Vol 7 (7) ◽  
pp. 2758
Author(s):  
Jui Deb ◽  
Santanu Chaudhuri ◽  
Debashis Panda ◽  
Sujit Nath Sinha ◽  
Sasi Kumar ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Systematic Errors ◽  
Guidance System ◽  
Reference Image ◽  
Cbct Image ◽  
The Mean ◽  
Immobilization Techniques

Background: The accuracy of radiotherapy is based on the matching of 2D portal/CBCT image with a reference image. The aim of this study is to determine the random and systematic setup errors (in cm) in radiotherapy of head and neck cancer patients and to derive the setup margin and its clinical implications.Methods: Author retrospectively reviewed the records of 25 head and neck cancer (HNC) patients treated with radiotherapy between Dec 2017 and July 2018. After immobilization, setup accuracy was assessed by registration of XVI image with planning reference image using Elekta XVI image guidance system and the isocenter correction was applied. For each patient 10 CBCT image sets were taken. The translational errors in X, Y and Z directions were used to estimate systematic (Σ) and random (σ) errors and to derive the final setup margin by using van Herk’s formula (2.5Σ + 0.7σ).Results: The mean translational errors ranges from -0.23 cm to 0.32 cm in Lateral (X), -0.15 to 0.16 cm in Longitudinal (Y) and -0.11 to 0.17 cm in vertical (Z) directions. The Mean and SD for systematic errors 0.21±0.13, 0.11±0.18, 0.14±0.11 and random error (in cm) are -0.03±0.33, 0.00±0.21 and 0.05±0.30 in X, Y and Z axis respectively. The final total margin for CTV to PTV including setup margin in the X, Y and Z directions (in cm) were 0.56, 0.61, and 0.47 respectively.Conclusion: Thus, the precise immobilization techniques are very important to reduce the setup margins, and the number of CBCTs during head and neck radiotherapy treatment.

scholarly journals The Accuracy and Dosimetry of Individualized 3D-Printing Template Assisted I125 Radioactive Seed Implantation for Recurrent/Secondary Head and Neck Cancer

2020 ◽  
Author(s):  
Bin Qiu ◽  
Yuliang Jiang ◽  
Zhe Ji ◽  
Haitao Sun ◽  
Jinghong Fan ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
3D Printing ◽  
Head And Neck ◽  
Neck Cancer ◽  
Mean Deviation ◽  
Conformity Index ◽  
Seed Implantation ◽  
Technical Success Rate ◽  
Radioactive Seed ◽  
The Mean

Abstract Background: Individualized 3D-printing template (3D-PT) is developed to facilitate I125 radioactive seed implantation (RSI), while most of the previous studies were focused on the efficacy and safety profiles, study on the accuracy of I125 RSI is lacking. Therefore, the aim of this study is to evaluate the accuracy of intraoperative needle puncture and post-plan dosimetry of individualized 3D-PT assisted I125 RSI for recurrent/secondary head and neck cancer.Methods: From February 2017 to January 2020, clinical data of 41 patients (mean age, 58.5 ± 16.1 years; 28 males) with recurrent (48.8%)/secondary (51.2%) head and neck cancer underwent individualized 3D-PT assisted I125 RSI under CT guidance in our institute were retrospectively reviewed.Results: A total of 430 needles [mean, 10.5 (range 3–17) per patient] were inserted. Technical success rate was 100% without major complication. The mean needle’s entrance deviation was 0.090 cm (95% Confidence Interval, 0.081–0.098). The mean intraoperative depth and angular of the needle were consistent with that of pre-plan (6.23 ± 0.24 vs. 6.21 ± 0.24 cm, p = 0.903; 83.14 ± 3.64 vs. 83.09 ± 3.66 degrees, p = 0.985, respectively). The mean deviation between the needle’s pre-planned and intraoperative depth and angular were 0.168 ± 0.024 cm and 1.56 ± 0.14 degrees, respectively. The post-plan dosimetry parameters, including D90, D100, V100, V150, V200, conformity index, external index, and homogeneity index, were all well coordinate with pre-planned dosimetry without significant deference (all p ＞ 0.05).Conclusion: Within the limitation of this study, individualized 3D-PT assisted I125 RSI may be accurate obtaining favorable post-plan dosimetry for patients with recurrent/secondary head and neck cancer, further prospective study is warranted.

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