Hypothyroidism and risks of cerebrovascular complications among patients with head and neck cancer after radiotherapy

Abstract Background: Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear.Methods: Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to >50% stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group.Results: 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement.Conclusion: Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.

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Hypothyroidism and Risks of Cerebrovascular Complications Among Patients with Head and Neck Cancer After Radiotherapy

10.21203/rs.3.rs-55917/v3 ◽

2021 ◽

Author(s):

Chi-Hung Liu ◽

Joseph Tung-Chieh Chang ◽

Tsong-Hai Lee ◽

Pi-Yueh Chang ◽

Chien-Hung Chang ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Cox Models ◽

Cerebrovascular Complications ◽

Significant Difference ◽

The Impact ◽

Cumulative Time ◽

The Eu

Abstract Background: Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear.Methods: Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to >50% stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group.Results: 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement.Conclusion: Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.

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Hypothyroidism and Risks of Cerebrovascular Complications Among Patients with Head and Neck Cancer After Radiotherapy

10.21203/rs.3.rs-55917/v2 ◽

2020 ◽

Author(s):

Chi-Hung Liu ◽

Joseph Tung-Chieh Chang ◽

Tsong-Hai Lee ◽

Pi-Yueh Chang ◽

Chien-Hung Chang ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Cox Models ◽

Cerebrovascular Complications ◽

Significant Difference ◽

The Impact ◽

Cumulative Time ◽

The Eu

Abstract Background: Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear.Methods: Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to >50% stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group.Results: 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement.Conclusion: Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.

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The Impact of a Community-Based Oral, Head and Neck Cancer Screening for Reducing Tobacco Consumption

Otolaryngology ◽

10.1177/0194599811415804 ◽

2011 ◽

Vol 145 (5) ◽

pp. 778-782 ◽

Cited By ~ 9

Author(s):

Edie R. Hapner ◽

Kellie L. Bauer ◽

Justin C. Wise

Keyword(s):

Head And Neck Cancer ◽

Cancer Screening ◽

Head And Neck ◽

Neck Cancer ◽

Large Scale ◽

Tobacco Consumption ◽

Community Based ◽

Chi Square Analysis ◽

The Impact

Objective. Examine the usefulness of large-scale community-based head and neck cancer screening for reducing tobacco use in an at-risk population. Questions answered: (1) Is participating in a community-based head and neck cancer screening related to a reduction in tobacco usage? (2) Do differing factors between participants predict behavior change? Study Design. Survey based with a longitudinal follow-up component. Setting. Atlanta Motor Speedway during a National Association of Stock Car Auto Racing (NASCAR) race event. Subjects and Methods. Recruited NASCAR fans (n = 620). Initial screening and 11-question survey for 6-month telephone follow-up. Results. One hundred fifty-six participants (25%) required medical follow-up. Chi-square analysis indicated a significantly higher proportion of smokers (13%) evidenced positive findings compared to nonsmokers (8%) or past smokers (6%). Kruskal-Wallis analysis followed by Dunn’s multiple comparison post hoc test indicated smokers were from a significantly lower socioeconomic status background compared to nonsmokers. Analysis of variance indicated contacted participants reported smoking significantly fewer cigarettes per day 6 months postscreening compared to the number of cigarettes smoked at the baseline. Forty-four (59%) participants reported reducing the number of cigarettes smoked per day, and 11 participants reported quitting smoking. Conclusion. The authors have demonstrated that large-scale community-based head and neck cancer screenings can be effectively implemented in nonmedical venues. This study demonstrated that targeting education for reduction of risk factors in the NASCAR population positively affected tobacco cessation.

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The Association of Cachexia with Head and Neck Cancer Burden and Pathologic Features

Proceedings of IMPRS ◽

10.18060/24742 ◽

2020 ◽

Vol 3 ◽

Author(s):

Marelle Rukes ◽

Alexander Jones ◽

Leah Novinger ◽

Kyle Davis ◽

Vincent Campiti ◽

...

Keyword(s):

Weight Loss ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Head And Neck Carcinoma ◽

Depth Of Invasion ◽

Skeletal Muscle Index ◽

Pathologic Features ◽

Significant Difference ◽

The Impact

Background and Hypothesis: Head and neck cancer (HNC) is frequently associated with cachexia, characterized by involuntary weight loss, sarcopenia, and malnutrition. In HNC patients, dysphagia and anorexia from obstructive aerodigestive tumors propagates cachexia even further. However, the impact of pathologic features and burden of HNC on cachexia has yet to be investigated. We therefore hypothesize that larger, more aggressive tumors impose greater cachexia severity in HNC patients. Methods: A single-institution, retrospective study of adult patients undergoing surgical resection of head and neck carcinoma from 2014-2017 was performed. Patients without 30-day preoperative abdominal CT imaging for skeletal muscle index (SMI, cm2/m2) measurements were excluded. Patient demographics, comorbidities, nutrition data, and cancer pathology reports were collected. Cachexia was defined as unintentional weight loss >5% over 6 months or >2% with BMI <20 kg/m2. Statistical analyses were performed using 2-sided one-way Welch’s ANOVA or Pearson’s c2 tests. Significance was determined at p <0.05. Results: The cohort included 125 predominantly white (92.0%), male (75.2%) HNC patients age 59.9 ± 11.5 years. Sixty-seven (53.6%) patients had cachexia, twenty (16.0%) of whom were severe (weight loss ≥15%). Patients with severe cachexia had larger tumors (5.5 ± 2.1 cm, p=0.021) than patients with mild-to-moderate cachexia (weight loss 5-14.9%; 4.9 ± 2.1 cm) or no cachexia (4.1 ± 1.9 cm). Worsening cachexia severity was also associated with lower SMI (p=0.004), BMI (p=0.002), and serum albumin (p=0.011). There was no statistically significant difference between cachexia groups comparing patient age, comorbidities, tumor grade, depth of invasion, nodal metastases, cancer stage, perineural invasion, lymphovascular invasion, or extranodal extension. Conclusion and Potential Impact: Tumor burden of HNC patients, but not adverse pathologic features, is associated with greater cachexia severity. Identifying pro-cachectic markers produced by larger tumors could provide a molecular target for anti-cachexia therapies and improve cancer patient outcomes.

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Measuring impact of survivorship care plans on head and neck cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.73 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 73-73

Author(s):

Bridgett Ann Harr ◽

Joanna Bodmann ◽

Shlomo A. Koyfman ◽

Tobenna Igweonu Nwizu ◽

Nikhil Purushottam Joshi ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Survivorship Care Plan ◽

Patient Specific ◽

Survivorship Care ◽

Care Plans ◽

The Impact ◽

Over Time

73 Background: At our institution, patients who have completed treatment for a locoregionally confined head and neck cancer are followed in a multidisciplinary head and neck survivorship clinic initiated by the administration of a formal, patient specific survivorship care plan (SCP). We sought to assess the impact of these SCP visits on patient understanding of their disease, its treatment, and potential late effects and follow up plans. Methods: An IRB approved survey was administered by an uninvolved third party, to an unselected sequential series of head and neck cancer survivorship patients at the time of a regularly scheduled follow up visit. The survey focused on the knowledge recalled from the SCP, and whether this changed over time. We analyzed two cohorts of patients, based on whether the SCP had been given to them within the last 18 months or not. Results: Preliminary results from the first 20 patients surveyed are presented. These patients received their SCP 3-27 months before being surveyed. Primary tumor sites included oropharynx (16) and larynx (4) and most patients had been treated with intensity modulated radiation therapy (19) and concurrent cisplatin (11). Conclusions: Although patients’ recall about receiving a formal SCP appeared to diminish over time, the information provided by this SCP plan and subsequent survivorship visits was retained. Whether this reflected the SCP itself, or the reinforcement of continued close follow up survivorship visits cannot be determined, but merits further investigation. [Table: see text]

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Which role plays specialized palliative care in patients with relapsed and/or metastatic head and neck cancer? A retrospective analysis in Southern Switzerland.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e17503 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e17503-e17503

Author(s):

Vittoria G. Espeli ◽

Claudia Gamondi ◽

Tanja Fusi-Schmidhauser

Keyword(s):

Palliative Care ◽

Overall Survival ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Unknown Primary ◽

Early Palliative Care ◽

Significant Difference ◽

Specialized Palliative Care ◽

The Impact

e17503 Background: early palliative care (PC) for patients with advanced cancer improves quality of life, promotes home deaths and can improve survival. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. To investigate the effect of introducing specialized PC in patients with relapsed and/or metastatic head and neck cancer. Methods: between October 2010 and December 2018, the medical charts of all patients treated in the Oncology Institute of Southern Switzerland with relapsed and/or metastatic HNC were reviewed. Site, status of disease (metastatic at diagnosis, locally or metastatic relapsed), type and lines of treatment, treatment response and referral to specialist palliative care (yes or no) were documented. Comparisons were made between patients referred and non-referred to PC. Results: sixty-two patients with relapsed/metastatic HNC were identified, 32 (51.6%) of which were referred to specialized PC. Patients were mainly men (47, 75.8%), with a median age of 66 years (range 43 – 86). Forty-two patients (67.7%) had a metastatic disease and the most common site of tumor was the oropharynx (35.5%), followed by oral cavity (32.3%), larynx (16.1%), hypopharynx (12.9%), and unknown primary (3.2%). Forty-eight patients (77.4%) were treated with systemic treatment (75% in the PC group and 80% in the non-PC group, p = 0.638). The median overall survival was 8.1 months for all patients, 8 months for the PC group and 8.7 months for the non-PC group, without significant difference (p = 0.440). Of the deceased patients, 70% of the PC group and 73.3% of the non-PC group received chemotherapy in the last three months of life. A greater percentage of patients in the PC group died at home, but without significant difference (39.2% vs. 19%, p = 0.134). Conclusions: only half of the patient had access to specialized PC. Whereas it did not seem to affect overall survival nor influence chemotherapy prescription, it seemed to favor home deaths. Further studies investigating the impact of early PC in recurrent and/or metastatic HNC are needed to improve access to PC and maximize benefits.

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Should age affect our treatment decisions for head and neck cancer?

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.5564 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 5564-5564

Author(s):

Estrella M. Carballido ◽

Jon N Burton ◽

Miguel Ricardo Pelayo ◽

Judith C McCaffrey ◽

Tapan Padhya ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Head And Neck Cancer ◽

Cell Carcinoma ◽

Head And Neck ◽

Neck Cancer ◽

Squamous Cell ◽

Neck Squamous Cell Carcinoma ◽

Comprehensive Cancer Center ◽

Significant Difference

5564 Background: Current opinion suggests elderly patients (pts) with head and neck cancer, those 65 or older, do not tolerate surgery, chemotherapy, or radiation as well as their younger counterparts. If this holds true, elderly pts may not be offered standard treatments to prevent assumed complications. Methods: A retrospective cohort study at our comprehensive cancer center was conducted of newly diagnosed pts with head and neck squamous cell carcinoma to explore differences in treatment-related complications between older and younger groups. We included data from the first 199 eligible pts (99 younger than 65 year old and 100 older than 65) evaluated between April 2009 and June 2010. Results: 79% of pts receiving treatment were male with a mean age of 54.9 and 71.6 years for the younger and older groups respectively. The older group had significantly more comorbidities (p < 0.001). The majority of older pts presented with oral cavity tumors (46%) while the oropharynx was the predominant site in the younger group (45%). 55% of younger and 49% of older pts presented with stage 4 disease across all sites. A total of 51 pts were p16 positive with no statistical differences between the groups. Surgery was the initial treatment for 57% of older pts (p < 0.008) while 46% of younger pts received concurrent chemotherapy and radiation as the primary treatment (p < 0.008). There was no statistically significant difference in surgical or radiation complications between the groups. Although most pts receiving chemotherapy experienced complications, older pts had slightly more (93% vs. 78%; p<0.031). The mean survival was 24.8 months with no statistical difference between groups. Significantly more pts in the older group, at last follow-up, were disease free (p < 0.012). Conclusions: The treatment of elderly pts with head and neck squamous cell carcinoma in our experience was congruent with that of younger pts. Elderly pts did not suffer more complications with surgery or radiation, however chemotherapy produced somewhat more complications in the elderly pts. Elderly pts did display less evidence of disease on follow-up. Age is always a consideration when treating individuals, but should not preclude the curative standard.

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Young adults with squamous cell head and neck cancer: Ten years of a single institution’s experience (1999-2008).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.5567 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 5567-5567

Author(s):

Marcos Pantarotto Alves ◽

Ana Filipa Martins Ferreira Castro ◽

Liliana Lombo ◽

Helena Rodrigues ◽

Jose D. Silva ◽

...

Keyword(s):

Young Adults ◽

Head And Neck Cancer ◽

Alcohol Consumption ◽

Head And Neck ◽

Neck Cancer ◽

Squamous Cell ◽

Locally Advanced ◽

Histopathological Diagnosis ◽

Significant Difference

5567 Background: Head and neck cancer of squamous cell type (SCHNC) is characterised by its aggressiveness and strong relationship with smoking and drinking habits. It is generally diagnosed in locally advanced stages, mainly in middle-aged men. People younger than 35yo are rarely affected by this disease, and little is known about its behaviour among young Portuguese adults. Our aim was to describe the clinical and epidemiological features of young adults with diagnosis of SCHNC in a single oncological centre in Portugal. Methods: Retrospective cohort including clinical registries’ databases for patients (pts) with diagnosis of SCHNC, with 3391 eligible pts from 1999 to 2008. Pts aged ≧18yo and ≤35yo at diagnosis with histopathological diagnosis in our Institution were included. Pts admitted to radiation therapy with no follow-up information were excluded. 39 pts fulfilled the criteria described, comprising the study population. Statistical analysis was carried out using SPSS v19.0 for Mac (IBM, 2010, EUA), with values of p<0,05 considered significant. Results: Male sex predominance (82%) was observed. The median age of presentation was 33 yo [22; 35], with 90% smokers with a median of 18,5 package-years [1; 48]. Alcohol consumption was mild to moderate (n=9; 23%) or heavy (n=15; 38%). The median of follow-up time was of 24 months [1;151]. Locally advanced diseased was present at diagnosis in 24 pts, where localised disease was commonest among women (57%) than in men (29%). Median overall survival (OS) was not reached on this population, although K-M graphs seems to show a significant difference in survival between sexes. Alcohol consumption was the most significant variable to influence the survival (p<0,01). Conclusions: SCHNC in young people is a rare condition, with distinct epidemiological and clinical features. Women seems to have greater survival rates, which may be explained by other risk factors already reported for this gender, namely HPV infection. The finding of an apparent relationship between alcohol consumption and OS, and the high prevalence of alcoholic intake habits on this parcel of the population, urge the need of development of public health programs addressed to this specific age group.

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SEVERE RADIODERMATITIS AND RISK FACTORS ASSOCIATED IN HEAD AND NECK CANCER PATIENTS

Texto & Contexto - Enfermagem ◽

10.1590/1980-265x-tce-2018-0343 ◽

2020 ◽

Vol 29 ◽

Author(s):

Aluane dos Santos Cardozo ◽

Fabiana Verdan Simões ◽

Valdete Oliveira Santos ◽

Luciana Fernandes Portela ◽

Rafael Celestino da Silva

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Treatment Interruption ◽

Treatment Technique ◽

Discontinuation Of Treatment ◽

Temporary Treatment ◽

The Impact

ABSTRACT Objective: To evaluate the association between sociodemographic, clinical, and treatment factors in the outcome of severe radiodermatitis in patients with head and neck cancer seen at the nursing consultation; and to analyze the impact of severe radiodermatitis cases on therapeutic follow-up. Method: A quantitative, documentary research conducted with medical records of 167 patients with head and neck cancer submitted to radiotherapy with curative indication followed in the nursing consultation in 2016. A structured form was used for data collection and analytical and descriptive statistics were used for its analysis. Results: Of the 99.4% patients who had radiodermatitis, 11.4% were severe cases. Severe radiodermatitis was associated with the type of equipment, treatment technique and presence of comorbidities. Of the patients who presented grade three, 53% had temporary discontinuation of treatment. Conclusion: Head and neck cancer patients who undergo radiotherapy with curative indication are at risk for severe radiodermatitis. Nursing consultation is important to minimize the severity of this event and the reduction of temporary treatment interruption due to this adverse reaction.

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