Effect of early integration of specialized palliative care into standard oncologic treatment on the quality of life of patients with advanced head and neck cancers: A phase III randomized controlled trial.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12013-12013
Author(s):  
Pankaj Singhai ◽  
Vijay Maruti Patil ◽  
Mary Ann Muckaden ◽  
Jayita Deodhar ◽  
Naveen Salins ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Systemic Therapy ◽  
Phase 3 ◽  
Early Palliative Care

12013 Background: Early palliative care is an important aspect of palliative treatment but has never been evaluated in head and neck cancer. Hence we performed this study. Methods: This was an open-label phase 3 randomised study which enrolled adult patients with squamous cell carcinoma of the head and neck region which warranted palliative systemic therapy. They were 1:1 allocated to either systemic therapy with (EPC arm) or without the addition of early palliative care service (STD arm). Patients were administered the Edmonton Symptom Assessment Scale (ESAS-r) and FACIT HN questionnaire at baseline and 4 weekly thereafter for 12 weeks. The primary endpoint was change in the quality of life (QOL) measured using FACIT HN 12 weeks after randomization. The secondary endpoints were changed in symptom burden at 12 weeks in ESAS-r and overall survival. A repeated-measures analysis of covariance (ANCOVA) was performed to examine the effects of arm and stratum on change in QOL (or symptom score), after controlling for baseline score. Results: Ninety patients were randomised in each arm between 1st June 2016 to 14th August 2017. The compliance with the questionnaires was 100% at baseline. In EPC arm the 70 patients were alive at 3 months and 67 (95.7%) completed the FACIT HN and 64 (91.4%) completed ESAS-r questionnaires. While in the STD arm out of 69 alive the corresponding figures were 61(88.4%) and 59 (85.5%) respectively. There was no statistical difference in change in QOL scores and ΔESAS-r at 12 weeks between the 2 arms (Table). The median overall survival was similar between the 2 arms. (Hazard ratio for death-1.006 (95%CI 0.7347-1.346)). Conclusion: In this phase 3 study, integration of early palliative care in head and neck cancer patients did not result in improvement in the quality of life scores, symptom scores or overall survival. Clinical trial information: CTRI/2016/03/006693 . [Table: see text]

Effect of Early Palliative Care on Quality of Life of Advanced Head and Neck Cancer Patients: A Phase III Trial

2021 ◽  
Author(s):  
Vijay Maruti Patil ◽  
Pankaj Singhai ◽  
Vanita Noronha ◽  
Atanu Bhattacharjee ◽  
Jayita Deodhar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Phase Iii ◽  
Early Palliative Care

Abstract Background Early palliative care (EPC) is an important aspect of cancer management but has never been evaluated in patients with head and neck cancer. Hence, we performed this study to determine whether the addition of EPC to standard therapy leads to an improvement in the quality of life (QOL), decrease in symptom burden and improvement in overall survival. Methods Adult patients with squamous cell carcinoma of the head and neck region planned for palliative systemic therapy, were allocated 1:1 to either standard systemic therapy without (STD arm) or with comprehensive EPC service referral (EPC arm). Patients were administered the revised Edmonton Symptom Assessment Scale (ESAS-r) and the Functional Assessment of Cancer Therapy for head and neck cancer (FACIT HN) questionnaire at baseline and every 1 month thereafter for 3 months. The primary endpoint was a change in the QOL measured at 3 months after random assignment. All statistical tests were 2-sided. Results Ninety patients were randomly assigned to each arm. There was no statistical difference in the change in the FACT-H&N total score (P = .94), FACT-H&N Trial Outcome Index (P = .95), FACT- G (general) total (P = .84) and ESAS-r scores at 3 months between the two arms. The median overall survival was similar between the two arms (Hazard ratio for death = 1.01, 95% CI = 0.74–1.35). There were 5 in-hospital deaths in both arms (5.6% for both, P = .99). Conclusions In this phase III study, the integration of EPC in head and neck cancer patients did not lead to an improvement in the QOL or survival.

Aspiration Prevention Surgery under Local Anesthesia for Palliative Care in Patients with Head and Neck Cancer: A Report of Two Cases

ORL ◽  
2020 ◽  
pp. 1-7
Author(s):  
Misaki Sekiguchi Koyama ◽  
Rumi Ueha ◽  
Takao Goto ◽  
Taku Sato ◽  
Akane Tachibana ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Local Anesthesia ◽  
Neck Cancer ◽  
Respiratory Impairment ◽  
Severe Dysphagia ◽  
Type Of Surgery

Aspiration prevention (AP) surgery may improve the quality of life (QOL) of patients with severe dysphagia. However, not all patients can endure this type of surgery under general anesthesia because of their poor status. Herein, we describe the cases of 2 patients with head and neck cancer (HNC) who underwent AP surgery for palliative care. Although both patients had tracheostomy due to severe dysphagia and respiratory impairment and frequently needed suction, they were successfully managed with AP surgery under local anesthesia. A tracheostoma was reshaped to be sufficiently large for an airway to be secured without a cannula. Their respiratory failure gradually improved, and suction frequency markedly decreased after surgery; thus, they could receive medical treatment at home. When patients with HNC under palliative care have a tracheal cannula and cannot vocalize, AP surgery under local anesthesia is an option to improve their QOL.

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

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.

An international phase 3 trial in head and neck cancer: Quality of life and symptom results

Cancer ◽  
2013 ◽  
Vol 120 (3) ◽  
pp. 390-398 ◽  
Author(s):  
Andrew Bottomley ◽  
Gloria Tridello ◽  
Corneel Coens ◽  
Frederic Rolland ◽  
Margot E.T. Tesselaar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Phase 3

scholarly journals A Principal Component of Quality of Life Measures Is Associated with Survival for Head and Neck Cancer Patients Treated with Radiation Therapy

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1155
Author(s):  
Mark Farrugia ◽  
Han Yu ◽  
Sung Jun Ma ◽  
Austin J. Iovoli ◽  
Kristopher Attwood ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Principal Component Analysis ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Principal Component ◽  
Post Treatment

Background: Health-related quality of life (HRQOL) metrics can be associated with survival in head and neck cancer (HNC); however, the impact of HRQOL recovery and the relevant HRQOL domains regarding outcome are unclear. Methods: Using a single-institution database, we retrospectively reviewed HNC patients treated with definitive or postoperative radiation therapy between 2013 and 2018. The recovery of individual HRQOL domains were determined by the ratio of the post-treatment to baseline scores. Univariate and Multivariate Cox regression were used to analyze survival outcomes. Principal component analysis was used to adjust for multicollinearity of HRQOL domains. Results: In 218 HNC patients who received radiation therapy, median follow-up was 24.8 months (interquartile range (IQR) 14.5–32.0). Principal component analysis evaluating the recovery of HRQOL domains revealed two independent principal components (PC), PC1 and PC2. PC1, which received contributions from the functional domains; physical (PF), role (RF), emotional (EF), cognitive (CF), and global health status (GQOL) was significantly associated with disease-free (HR = 0.77, 95% CI 0.61–0.98, p = 0.034) and overall survival (HR = 0.76, 95% CI 0.65–0.91, p = 0.004) on multivariate analysis and PC2, had no correlation with outcome and was mainly represented by social functioning. Unplanned hospitalization was significantly associated with lower PC1 scores (β = −0.997, Std. Error = 0.244, p < 0.001). Conclusion: Our study provides evidence that post-treatment recovery of HRQOL domains were associated with overall survival (OS) in HNC. PC1 is an attractive clinical tool to assess the recovery across multiple different HRQOL and the relationship with survival. Future prospective studies may identify patients who could benefit from additional rehabilitation based on PC1 score.

Sign in / Sign up

Export Citation Format

Share Document