scholarly journals Distress Management in Patients With Head and Neck Cancer Before Start of Palliative Chemotherapy: A Practical Approach

2018 ◽  
pp. 1-10 ◽  
Author(s):  
Vijay Patil ◽  
Vanita Noronha ◽  
Amit Joshi ◽  
Jayita Deodhar ◽  
Savita Goswami ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Palliative Chemotherapy ◽  
Clinical Psychologist ◽  
Distress Screening ◽  
Exact Test ◽  
Number Of Patients ◽  
High Distress ◽  
High Level

Purpose This study reports the incidence of distress, the factors associated with distress, and a practical strategy to resolve distress in patients with head and neck cancer who are starting palliative chemotherapy. Methods Adult patients with head and neck cancer planned for palliative chemotherapy underwent distress screening before the start of treatment as part of this single-arm prospective study. Patients who had a distress score > 3 on the National Comprehensive Cancer Network (NCCN) distress thermometer were counseled initially by the clinician. Those who continued to have high distress after the clinician-led counseling were referred to a clinical psychologist and were started on palliative chemotherapy. After counseling, distress was measured again. The relation between baseline distress and compliance was tested using Fisher's exact test. Results Two hundred patients were enrolled, and the number of patients with high distress was 89 (44.5% [95% CI, 37.8% to 51.4%]). The number of patients who had a decrease in distress after clinician-led counseling (n = 88) was 52 (59.1% [95% CI, 48.6% to 68.8%]) and after psychologist-led counseling (n = 32) was 24 (75.0% [95% CI, 57.6% to 72.2%]; P = .136). Compliance rates did not differ between the patients with or without a high level of distress at baseline (74.2% v 77.4%, P = .620). Conclusion The incidence of baseline distress is high in patients awaiting the start of palliative chemotherapy. It can be resolved in a substantial number of patients using the strategy of clinician-led counseling, with additional referral to a clinical psychologist as required. Patients with a greater number of emotional problems usually require psychologist-led counseling.

Distress Screening in Head and Neck Cancer Patients Planned for Cancer‐Directed Radiotherapy

2021 ◽  
Author(s):  
Shirley Lewis ◽  
Saket Pandey ◽  
Naveen Salins ◽  
Jayita Deodhar ◽  
Vijay Patil ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Distress Screening

Implementing a Tailored Psychosocial Distress Screening Protocol in a Head and Neck Cancer Program

2021 ◽  
Author(s):  
Eden R. Brauer ◽  
Stephanie Lazaro ◽  
Charlene L. Williams ◽  
David A. Rapkin ◽  
Amy B. Madnick ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Psychosocial Distress ◽  
Distress Screening ◽  
Cancer Program ◽  
Screening Protocol

Critical Impact of Radiotherapy Protocol Compliance and Quality in the Treatment of Advanced Head and Neck Cancer: Results From TROG 02.02

2010 ◽  
Vol 28 (18) ◽  
pp. 2996-3001 ◽  
Author(s):  
Lester J. Peters ◽  
Brian O'Sullivan ◽  
Jordi Giralt ◽  
Thomas J. Fitzgerald ◽  
Andy Trotti ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Phase Iii ◽  
Treatment Center ◽  
Tumor Control ◽  
Advanced Head ◽  
Number Of Patients ◽  
Protocol Compliance ◽  
The Impact

Purpose To report the impact of radiotherapy quality on outcome in a large international phase III trial evaluating radiotherapy with concurrent cisplatin plus tirapazamine for advanced head and neck cancer. Patients and Methods The protocol required interventional review of radiotherapy plans by the Quality Assurance Review Center (QARC). All plans and radiotherapy documentation underwent post-treatment review by the Trial Management Committee (TMC) for protocol compliance. Secondary review of noncompliant plans for predicted impact on tumor control was performed. Factors associated with poor protocol compliance were studied, and outcome data were analyzed in relation to protocol compliance and radiotherapy quality. Results At TMC review, 25.4% of the patients had noncompliant plans but none in which QARC-recommended changes had been made. At secondary review, 47% of noncompliant plans (12% overall) had deficiencies with a predicted major adverse impact on tumor control. Major deficiencies were unrelated to tumor subsite or to T or N stage (if N+), but were highly correlated with number of patients enrolled at the treatment center (< five patients, 29.8%; ≥ 20 patients, 5.4%; P < .001). In patients who received at least 60 Gy, those with major deficiencies in their treatment plans (n = 87) had a markedly inferior outcome compared with those whose treatment was initially protocol compliant (n = 502): −2 years overall survival, 50% v 70%; hazard ratio (HR), 1.99; P < .001; and 2 years freedom from locoregional failure, 54% v 78%; HR, 2.37; P < .001, respectively. Conclusion These results demonstrate the critical importance of radiotherapy quality on outcome of chemoradiotherapy in head and neck cancer. Centers treating only a few patients are the major source of quality problems.

scholarly journals Reducing Referral-to-Treatment Waiting Times in Cancer Patients Using a Multidisciplinary Database

2007 ◽  
Vol 89 (2) ◽  
pp. 113-117 ◽  
Author(s):  
SAR Nouraei ◽  
J Philpott ◽  
SM Nouraei ◽  
DCK Maude ◽  
GS Sandhu ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Treatment Planning ◽  
Neck Cancer ◽  
Treatment Time ◽  
Waiting Times ◽  
Multidisciplinary Teams ◽  
Number Of Patients ◽  
Cancer Plan

INTRODUCTION Modern delivery of cancer care through patient-centred multidisciplinary teams (MDT) has improved survival. This approach, however, requires effective on-going co-ordination between multiple specialties and resources and can present formidable organisational challenges. The aim of this study was to improve the efficiency of the MDT process for head and neck cancer. PATIENTS AND METHODS A systems analysis of the MDT process was undertaken to identify bottlenecks delaying treatment planning. The MDT process was then audited. A revised process was developed and an Intranet-based data management solution was designed and implemented. The MDT process was re-evaluated to complete the audit cycle. RESULTS We designed and implemented a trust-wide menu-driven database with interfaces for registering and tracking patients, and automated worklists for pathology and radiology. We audited our MDT for 11 and 10 weeks before and following the introduction of the database, with 226 and 187 patients being discussed during each period. The database significantly improved cross-specialtity co-ordination, leading to a highly significant reduction in the number of patients whose treatment planning was delayed due to unavailability of adjunctive investigations (P < 0.001). This improved the overall efficiency of the MDT by 60%. CONCLUSIONS The NHS Cancer Plan aspires to reduce the referral-to-treatment time to 1 month. We have shown that a simple, trust-wide database reduces treatment planning delays in a sizeable proportion of head and neck cancer patients with minimal resource implications. This approach could easily be applied in other MDT meetings.

Palliative chemotherapy in head and neck cancer: balancing between beneficial and adverse effects

2020 ◽  
Vol 20 (1) ◽  
pp. 17-29 ◽  
Author(s):  
Akhil Rajendra ◽  
Vanita Noronha ◽  
Amit Joshi ◽  
Vijay Maruti Patil ◽  
Nandini Menon ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Adverse Effects ◽  
Head And Neck ◽  
Neck Cancer ◽  
Palliative Chemotherapy

scholarly journals High Level of Tobacco Carcinogen–Derived DNA Damage in Oral Cells Is an Independent Predictor of Oral/Head and Neck Cancer Risk in Smokers

2017 ◽  
Vol 10 (9) ◽  
pp. 507-513 ◽  
Author(s):  
Samir S. Khariwala ◽  
Bin Ma ◽  
Chris Ruszczak ◽  
Steven G. Carmella ◽  
Bruce Lindgren ◽  
...  
Keyword(s):  
Dna Damage ◽  
Head And Neck Cancer ◽  
Cancer Risk ◽  
Head And Neck ◽  
Neck Cancer ◽  
Independent Predictor ◽  
Tobacco Carcinogen ◽  
High Level ◽  
Oral Cells

Promoter hypermethylation of GPX3 as a predictor for chemoresistance and survival in head and neck cancer patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6027-6027 ◽  
Author(s):  
Z. Guo ◽  
Z. Chen ◽  
Z. Yang ◽  
L. Schumaker ◽  
K. J. Cullen
Keyword(s):  
Head And Neck Cancer ◽  
Survival Analysis ◽  
Relative Risk ◽  
Head And Neck ◽  
Cancer Cells ◽  
Cell Lines ◽  
Neck Cancer ◽  
Promoter Hypermethylation ◽  
Exact Test ◽  
Kaplan Meier

6027 Background: Resistance of cancer cells to cisplatin and its analogues is the major limitation in clinical application of cisplatin-based chemotherapy. The mechanisms by which cancer cells develop resistance to the drugs are still unclear, and there is no way currently to predict the drug resistance of individual tumors. By genome-wide scanning of hypermethylated genes on head and neck cancer cells, we identified glutathione peroxidase 3 (GPX3) as one of the strong candidates whose promoter hypermethylation may be associated with head and neck chemoresistance. In this study, we investigated the potential predictive value of GPX3 methylation for head and neck cancer chemoresistance and patient prognosis. Methods: Promoter methylation and expression of GPX3 gene in head and neck cancer cell lines were examined by plasmid cloning, bisulfite DNA sequencing, reverse transcription-PCR and Western blot. GPX3 methylation in primary cancer tissues was assessed by real-time methylation-specific PCR (MSP). Forty-six head and neck cancer cases, for which chemotherapy response and survival were known, were selected for analysis. Correlation of GPX3 methylation and chemoresistance was tested using two-sided Fisher’s Exact Test and its prediction for patient survival was assessed using Kaplan-Meier survival analysis. Results: Loss of GPX3 expression was observed in 4 of 8 head and neck cancer cell lines and was consistent with cisplatin resistance. Demethylating treatment of the cell lines negative for GPX3 expression significantly restored its expression. Bisulfite DNA sequencing showed that the 5’ flanking promoter region of GPX3 was heavily hypermethylated in all cell lines with expression-silencing of the gene. In the 46 head and neck cancer cases analyzed by MSP, 15 of 23 non-responding cases (65%) showed GPX3 methylation, while 4 of 23 complete and partial response cases (17%) contained low levels of GPX3 methylation (Relative Risk 3.343, two sided Fisher’s exact test, P=0.002). Kaplan-Meier survival analysis showed a relative risk of death of 1.942 in patients with GPX3 methylation. Conclusions: Our findings suggest that GPX3 methylation is a strong candidate predictor for chemoresistance and prognosis of head and neck cancer patients. No significant financial relationships to disclose.

scholarly journals 489 Assessing the Impact Of COVID-19 On Head and Neck Cancer Treatment and Preparing for The Next Wave

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Daga ◽  
L Argus ◽  
J Goswami
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Elective Surgery ◽  
Standard Of Care ◽  
Tnm Staging ◽  
World Health ◽  
Number Of Patients ◽  
Novel Coronavirus ◽  
The Impact

Abstract Introduction As of 11th of March 2020, the World Health Organization (WHO) declared the novel coronavirus 2019 (COVID-19) a pandemic. It is estimated that urgent cancer referrals have reduced 70-89% across hospitals in England during the COVID-19 pandemic, in addition to reductions in attendance for the different treatment arms. The aim of our investigation is to assess the impact of COVID-19 on MDT outcomes and patients attending/receiving treatment as compared to before for head and neck cancer. Method Data was collected retrospectively over a period of 203 days (7th January to 28th July 2020), including 66 patients prior to COVID-19 being declared a pandemic and 116 patients since, at a regional cancer centre. A total of 182 patients undergoing treatment were identified. These patients were assessed by TNM staging, MDT outcomes and final initial treatment intents, which were compared to pre-COVID outcomes. Results With respect to MDT outcomes, there was an increase in the number of patients decided for surgery from 10.61% to 23.28% (p = 0.78) during the first wave of the pandemic. Patients decided for radiotherapy and chemotherapy increased by 12.49% and 4.31% respectively. Notably, there was a decrease in further investigations and referrals from 37.88% to 18.10%. Moreover, an increase in palliative treatment intent by 10.55% was noted during the pandemic. Conclusions As the UK enters into the next peak of the pandemic, with reduced capacity for elective surgery and outpatient clinics, it is essential to consider its impact on the standard of care delivered to current cancer patients.

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