Health related quality of life (HRQoL) and demographic characteristics of long term head and neck cancer survivors submitted to concomitant chemoradiation in Brazil

18572 Background: Head and neck cancer (HNC) is a stigmatizing disease. In order to identify special needs in these patients (pts), we evaluated HRQoL and the demographic characteristics of HNC pts who had survived at least one year after chemoradiation. Methods: Our survey, done in may 2005, identified 42 pts alive (from 527 admitted from May 2002 to May 2004 treated with either exclusive (n = 19) or adjuvant (n = 23) chemoradiation. These pts as well 16 normal controls, were interviewed and invited to complete EORTC-QLQ-C30 and HN35. These questionnaires had already been validated for Brazilian Portuguese. Primary site was 12 oral cavity, 14 pharynx, 13 larynx, 3 not determined. Age 60.3 ± 9.0 y, 36 male and 6 female; 39 were squamous cell carcinoma and 3 other type; 28 were stage III or IV; 40 had no evidence of disease and two had recurrent disease at the time of survey. Comparison between groups were done by using the Mann-Whitney test and differences of at least 10 points was considered of clinical significance. Simple correlations were conducted between HRQoL variables and clinical correlates and demographics. The level of significance was established at p < 0.05. This work was conducted according to Helsinki declaration and Brazilian law. Results: Scores relative to global QoL (p = 0.18) and emotional function (p = 0.59) did not differ in pts as compared to controls. Pts presented worse scores in swallowing, senses, speech, pain, dental problems, xerostomia and mouth opening (all p < 0.05). Emotional function (r = 0.316, p = 0.041) and financial worries (r = −0.509, p = 0.001) impacted on global QoL, what did not happen with marital status, income and level of education, age or previous surgery. Chronic pain was more prevalent in oral cavity tumors than in other sites such as pharynx or larynx tumors (p = 0.046 and p = 0.030, respectively). Pts with larynx tumors presented worse cough score as compared to those with pharynx tumors (p = 0.009). Conclusions: Providing continuous oral and dental care seems to be important to address survivors’ concerns. Financial distress could be ameliorated by a better social support system. Tumor site seem to affect differently some domains of HRQoL, in contrast to organ preservation. No significant financial relationships to disclose.

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Course of Self-Reported Dysphagia, Voice Impairment and Pain in Head and Neck Cancer Survivors

Biology ◽

10.3390/biology10020144 ◽

2021 ◽

Vol 10 (2) ◽

pp. 144

Author(s):

Veit Zebralla ◽

Susanne Wiegand ◽

Andreas Dietz ◽

Gunnar Wichmann ◽

Thomas Neumuth ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Assessment Tool ◽

Outpatient Setting ◽

Functional Impairments ◽

Substantial Impact ◽

Related Quality ◽

Eortc Qlq ◽

The Impact

Background: Head and neck cancer (HNC)-specific symptoms have a substantial impact on health-related quality of life. The aim of this study was to determine whether self-reported dysphagia, voice problems and pain of HNC patients changed over time and whether specific clinical or sociodemographic variables were associated with these symptoms. Methods: HNC patients (n = 299) in an outpatient setting answered questionnaires (Eating Assessment Tool-10; questions from the EORTC QLQ-C30 and EORTC H&N35) on dysphagia, voice problems and pain, collected with the software “OncoFunction” at three different timepoints (t1–t3) after diagnosis. The mean score changes from t1 to t3 were expressed in terms of effect sizes d. The impact of sociodemographic and clinical factors on the course of the variables was tested with multivariate analyses of variance. Results: Dysphagia, voice impairment and pain in HNC survivors significantly improved over a period of approximately 14 months after diagnosis. Tumor site, stage, treatment modality, occupational state and ECOG state were significantly correlated with self-reported functional outcome. The pain level of the HNC patients was rather low. Conclusions: Patients suffer from functional impairments after HNC treatment, but an improvement in self-reported symptoms could be demonstrated within this time period.

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Prevalence, trends, and demographic characteristics associated with self-reported financial stress among head and neck cancer patients in the United States of America

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2021.103154 ◽

2021 ◽

pp. 103154

Author(s):

Tarun K. Jella ◽

Thomas B. Cwalina ◽

Rishi Sachdev ◽

Todd Otteson ◽

Nicole Fowler

Keyword(s):

United States ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

United States Of America ◽

Financial Stress ◽

The United States ◽

Demographic Characteristics ◽

Prevalence Trends

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Quality Indicators: Measurement and Predictors in Head and Neck Cancer Free Flap Patients

Otolaryngology ◽

10.1177/0194599817742373 ◽

2018 ◽

Vol 158 (2) ◽

pp. 265-272 ◽

Cited By ~ 13

Author(s):

Antoine Eskander ◽

Stephen Y. Kang ◽

Benjamin Tweel ◽

Jigar Sitapara ◽

Matthew Old ◽

...

Keyword(s):

Head And Neck Cancer ◽

Length Of Stay ◽

Oral Cavity ◽

Head And Neck ◽

Neck Cancer ◽

Free Flap ◽

Preoperative Assessment ◽

Assessment Clinic ◽

Primary Radiotherapy ◽

The Impact

Objective To determine the predictors of length of stay (LOS), readmission within 30 days, and unplanned return to the operating room (OR) within 30 days in head and neck free flap patients. Study Design Case series with chart review. Setting Tertiary academic cancer hospital. Subjects and Methods All head and neck free flap patients at The Ohio State University (OSU, 2006-2012) were assessed. Multivariable logistic regression to assess the impact of patient factors, flap and wound factors, and intraoperative factors on the aforementioned quality metric outcomes. Results In total, 515 patients were identified, of whom 66% had oral cavity cancers, 33% had recurrent tumors, and 28% underwent primary radiotherapy. Of the patients, 31.5% had a LOS greater than 9 days, predicted by longer operative time, oral cavity and pharyngeal tumor sites, blood transfusion, diabetes mellitus, and any complication. A total of 12.6% of patients were readmitted within 30 days predicted by absent OSU preoperative assessment clinic attendance and any complication, and 14.8% of patients had an unplanned OR return predicted by advanced age. Conclusions When assessing quality metrics, adjustment for the complexity involved in managing patients with head and neck cancer with a high comorbidity index, clean contaminated wounds, and a high degree of primary radiotherapy is important. Patients seen in a preoperative assessment clinic had a lower risk of readmission postoperatively, and this should be recommended for all head and neck free flap patients. Quality improvement projects should focus on predictors and prevention of complications as this was the number one predictor of both increased length of stay and readmission.

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A Scoping Review of Physiotherapeutic Interventions for Trismus in Head and Neck Cancer: Where Is the Manual Therapy?

Physiotherapy Canada ◽

10.3138/ptc-2020-0068 ◽

2021 ◽

pp. e20200068

Author(s):

Joni Nedeljak ◽

Susan Armijo-Olivo ◽

Ivonne A. Hernandez ◽

Suresh Nayar ◽

Margaret L. McNeely

Keyword(s):

At Risk ◽

Head And Neck Cancer ◽

Head And Neck ◽

Manual Therapy ◽

Neck Cancer ◽

Scoping Review ◽

Mouth Opening ◽

Common Side Effect ◽

Completion Rates ◽

Mesh Terms

Purpose: Trismus, or restricted mouth opening, is a common side effect of treatment for head and neck cancer. This scoping review examined the characteristics, extent, and nature of existing research on manual therapy and jaw-mobilizing devices to prevent and manage trismus related to head and neck cancer. Method: Six electronic databases were searched using the terms trismus, head and neck cancer, and physical therapy and the associated MeSH terms. The review focused on the factors related to intervention delivery: timing, adherence, completion rates, and adverse events. Results: Nine studies were included. Eight examined the use of a jaw-mobilizing device, and one explored the benefit of remote telephone support. Two studies involved cancer survivors at risk of trismus, five involved survivors with trismus, and two included survivors both with and at risk of trismus. No studies were found examining physiotherapist provision of manual therapy. Within-group comparisons supported the benefit of using a jaw-mobilizing device to manage trismus, whereas significant between-groups differences were found only in non-randomized controlled trials. Survivor symptoms and intervention burden were reported reasons for poor adherence and completion rates. Conclusions: No benefit was found for the use of jaw-mobilizing devices for the prevention of trismus. Given the potential of manual therapy to enhance outcomes, physical therapist–led research is warranted.

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Prognostic factors associated with a restricted mouth opening (trismus) in patients with head and neck cancer: Systematic review

Head & Neck ◽

10.1002/hed.26327 ◽

2020 ◽

Vol 42 (9) ◽

pp. 2696-2721 ◽

Cited By ~ 1

Author(s):

Sarah J. Geer ◽

Phillip V. Rijn ◽

Jan L.N. Roodenburg ◽

Pieter U. Dijkstra

Keyword(s):

Systematic Review ◽

Head And Neck Cancer ◽

Prognostic Factors ◽

Head And Neck ◽

Neck Cancer ◽

Mouth Opening ◽

Factors Associated

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Impact on Health-Related Quality of Life of Induction Chemotherapy Compared With Concurrent Cisplatin and Radiation Therapy in Patients With Head and Neck Cancer

Clinical Oncology ◽

10.1016/j.clon.2019.05.007 ◽

2019 ◽

Vol 31 (9) ◽

pp. e123-e131

Author(s):

D. Adkins ◽

J. Ley ◽

P. Oppelt ◽

H.A. Gay ◽

M. Daly ◽

...

Keyword(s):

Quality Of Life ◽

Radiation Therapy ◽

Head And Neck Cancer ◽

Head And Neck ◽

Induction Chemotherapy ◽

Neck Cancer ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Impact of exercise with TheraBite device on trismus and health-related quality of life: A prospective study

Ear Nose & Throat Journal ◽

10.1177/0145561320961727 ◽

2020 ◽

pp. 014556132096172

Author(s):

Charlotte Montalvo ◽

Caterina Finizia ◽

Nina Pauli ◽

Bodil Fagerberg-Mohlin ◽

Paulin Andréll

Keyword(s):

Quality Of Life ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Oncologic Treatment ◽

The Impact

Trismus is a common symptom in patients with head and neck cancer that affects many aspects of daily life negatively. The aim of this study was to investigate the impact of structured exercise with the jaw-mobilizing device TheraBite on trismus, trismus-related symptomatology, and health-related quality of life (HRQL) in patients with head and neck cancer. Fifteen patients with trismus (maximum interincisal opening [MIO] ≤35 mm) after oncologic treatment for head and neck cancer, underwent a 10-week exercise program with the TheraBite device and were followed regularly. Time between oncologic treatment and start of TheraBite exercise ranged from 0.7 to 14.8 years (average 6.2 years). MIO, trismus-related symptoms, and HRQL was assessed before and after exercise and after 6 months. A significant improvement in MIO was observed post-exercise (3.5 mm, 15.3%, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1%, p = 0.0029). A statistically significant correlation was found between increased MIO and fewer trismus-related symptoms. In conclusion, exercise with TheraBite improved MIO and trismus-related symptoms in patients with trismus secondary to head and neck cancer. Structured exercise with the jaw-mobilizing device seems to be beneficial for patients with trismus independent of time since oncologic treatment.

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Health-related quality of life became worse in short-term during treatment in head and neck cancer patients: a prospective study

Health and Quality of Life Outcomes ◽

10.1186/s12955-020-01543-5 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Emanuelle do Nascimento Santos Lima ◽

Isabela Borges Ferreira ◽

Paula Philbert Lajolo ◽

Carlos Eduardo Paiva ◽

Yara Cristina de Paiva Maia ◽

...

Keyword(s):

Quality Of Life ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Physical Symptoms ◽

Functional Score ◽

Time Points ◽

Related Quality ◽

A Prospective Study

Abstract Background Quality of life (QoL) is influenced in head and neck cancer (HNC) patients by a set of factors related to diagnosis, treatment and tumor impacts. The aim of this study was to evaluate the Quality of Life (QoL) changes in Head and Neck cancer (HNC) patients during treatment (radiotherapy and/or chemoradiotherapy). Methods QoL was evaluated prospectively in 63 HNC patients during radiotherapy and/or chemoradiotherapy at three moments: before or at beginning (T0), in the middle (T1 ~ four weeks) and immediately at the end (T2 ~ eight weeks) of treatment. The differences between the scores at different time points was verified using Friedman’s non-parametric test. Negative changes between time points were evaluated, with differences (delta) of ±10 points being considered to be clinically significant. Results The total mean age was 59.1 ± 9.5y, and 82.5% were male. The oral cavity and larynx were more frequent tumors. The functional score for ‘role’ was decreased at time points T1 and T2 as compared to T0, while an improvement in scores was observed for cognitive function. Several physical symptoms also worsened over time, such as: fatigue, nausea and vomiting, dry mouth and sticky saliva, swallowing and skin symptoms, senses and teeth problems. A high frequency of altered and clinically meaningful values were observed for most of domains, ranging from 6 to 74%. Conclusions The QoL became worse at approximately one month after treatment beginning in HNC patients, and this remained until the end of therapy. Protocols directing to early nutritional counseling and management of symptoms of nutritional impact are important to improve clinical outcomes. This is part of preventive actions aiming to make the exhausting treatment process less traumatic and easier to complete.

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