The impact of sentinel lymph node biopsy on the quality of life in patients with oral cavity squamous cell carcinoma

IntroductionSentinel lymph node biopsy is a proven method for staging the neck in patients with early oral cavity squamous cell carcinoma because it results in less comorbidity than the traditional method of selective neck dissection, with the same oncological results. However, the real effect of that method on the quality of life of such patients remains unknown.ObjectiveThe present study aimed to evaluate the quality of life of patients with oral cavity squamous cell carcinoma T1/T2N0 submitted to sentinel lymph node biopsy compared to those that received selective neck dissection.MethodsCross-sectional study including 24 patients, after a 36 month follow-up, 15 of them submitted to the sentinel lymph node biopsy and 9 to selective neck dissection. All patients answered the University of Washington quality of life questionnaire.ResultsThe evaluation of the questionnaires showed a late worsening of the domains appearance (p = 0.035) and chewing (p = 0.041), as well as a decrease of about 10% of general quality of life (p = 0.025) in patients undergoing selective neck dissection ??in comparison to those undergoing sentinel lymph node biopsy.ConclusionPatients with early-stage oral cavity squamous cell carcinoma undergoing sentinel lymph node biopsy presented better late results of general quality of life, mainly regarding appearance and chewing, when compared to patients submitted to selective neck dissection.     

头颈肿瘤与外科治疗对患者生存质量的影响

目的探讨头颈肿瘤及外科治疗对患者生存质量（quality of life，QOL）的影响。方法用头颈肿瘤行为状态量表（performance status scale for head and neckc ancer patients，PSS-HN），癌症治疗功能评估调查问卷（functional assessment of cancer therapy—head and neck，FACT—H＆N），对27例喉癌、14例舌癌和8例放疗后局部复发的鼻咽癌患者，共49例病例进行评估，探讨不同部位的肿瘤对患者QOL的影响；肿瘤对患者生理状况、功能状况、情感状况、社会和家庭状况的影响；不同的外科治疗方式对QOL的影响以及QOL在于术治疗前后不同时间点的变化。结果头颈肿瘤患者在患病后QOL下降；不同部位的肿瘤对患者QOL的影响程度不同，以舌癌对患者的QOL影响最大（PSS-HN评分比较P=0．0361，FACT—H＆N评分比较P=0．0487）。肿瘤对患者的生理状况、功能状况、情感状况、社会和家庭状况等各个方面均有影响，尤以对情感状况影响最大（FACT—H＆N评分比较F=2．78，P=0．0311）。外科治疗可使患者的QOL较手术前下降，术后可随时问而逐步改善，术后6个月接近术前水平（PSS—HN评分比较t=2．03，P=0．1120；FACT—H＆N评分比较t=1．03，P=0．1180）。不同的手术方式与修复手段对QOL的影响不同，喉部分切除术组在术后6个月FACT—H＆N为107．20分，喉全切除术组在手术后6个月为97．71分，二者的差异有统计学意义（t=3．02，P=0．0430）。舌癌直接拉拢缝合组在术后6个月FACT—H＆N为119．24分，舌癌游离前臂皮瓣修复者在术后6个月为111．39分，其差异有统计学意义（t=3．00，P=0．0472）。结论头颈肿瘤患者的QOL可以用问卷、量表进行评估；可以通过治疗方案的选择、手术方式与修复手段的选择进行干预。     

The impact of treatment center on the outcome of patients with laryngeal cancer treated with surgery and radiotherapy

For laryngeal cancer, surgical excision of the primary tumor should be undertaken with the aim of achieving tumor-free margins. Adequate pathological assessment of the specimen and the competency of the treatment center play a crucial role in achieving cure. The present study aimed to analyze the significance of place of surgery on the outcome of patients with laryngeal cancer who underwent surgical operation in other centers and were subsequently referred to Doküz Eylul University Head and Neck Tumour Group (DEHNTG) for postoperative irradiation. Patients were divided into three groups according to their place of surgery. The first group (Group I) consisted of patients who had their surgical operation at DEUH. Patients in the second group (Group II) were referred from centers with oncological surgical experience. The third group (Group III) consisted of patients referred from hospitals with no surgical teams experienced in head and neck cancer treatment. The clinical and pathological features of patients in these three groups were analyzed to assess the impact of place of surgery on clinical outcome as well as the prognostic factors for survival. The study population consisted of 253 patients who were treated between 1991 and 2006 with locally advanced laryngeal cancer according to the protocol of DEHNTG. The median follow-up was 48 (3–181) months. The 5 years overall, loco-regional disease-free and distant disease-free survivals were 66, 88 and 91%, respectively. When patients’ clinical and histopathological features were analyzed for the impact of place of surgery, surgical margin positivity rates were found to be higher in Group III (P = 0.032), although the other two groups had more advanced clinical and pathological N stage disease (P = 0.012, P = 0.001). In multivariate analysis, older age (P < 0.0001), presence of perinodal invasion (P = 0.012), time interval between surgery and radiotherapy longer than 6 weeks (P = 0.003) and tumor grade (P = 0.049) were the most significant factors. For loco-regional failure-free survival, advanced clinical stage (P = 0.002), place of surgery (P = 0.031) and presence of clinical subglottic invasion (P = 0.029) were shown to be important prognostic factors. For distant metastasis-free survival, only pathological (+) lymph node status (P = 0.046) was a significant factor in multivariate analysis. The significance of place of surgery as well as other well-known prognostic factors underlines the importance of an experienced multidisciplinary treatment team if best results are to be obtained for the patient.     

The quality of life impact of dysphonia

Dysphonia can affect social life and employment, but formal studies of its general health impact are lacking. The aims of this study were (i) to compare self-rated general health status as measured by the SF-36 in a large cohort of dysphonic patients with those from normative groups; and (ii) to examine the differential impact of dysphonia on the various health status domains. The 163 dysphonic voice clinic attendees (38 men, 125 women) were drawn from recruits to a prospective trial of speech therapy efficacy. The Short-Form 36 (SF-36) scores were compared with published data on 744 age-matched healthy controls. Patients with dysphonia had significantly poorer self-reported health than the controls on all eight SF-36 subscales (limitation of physical activity P < 0.05; other seven, all P < 0.001, Student's t-test). We thus conclude that dysphonia in patients without obvious laryngeal disease has an adverse impact on all health status subscales as measured by the SF-36. The study provides further evidence for the inclusion quality of life measures in otolaryngology baseline and outcome assessments.     

鼻咽癌放疗后口干燥症及其对生活质量的影响

目的观察鼻咽癌患者放疗后口干燥症的情况及其对日常生活的影响,探讨影响口干燥症的相关因素,以期提高鼻咽癌患者的生活质量。方法选择放疗后满1年复查的鼻咽癌患者79例,复查时进行面对面访谈方式的口干问卷调查,根据调查结果分析口干燥症的严重程度及其对生活质量的影响。结果全组口干燥症的发生率为100%,中重度发生率为74.7%,其中13.9%的患者夜晚经常喝水,74.7%的患者吃饭时需饮水,59.5%的患者感到说话困难,91.1%的患者认为日常生活明显受影响。结论鼻咽癌放疗后口干燥症的发生率较高,因此需要一种安全、简便、廉价、有效的方法治疗放疗后口干燥症,以提高患者的生活质量。     

The impact of neck dissection on health-related quality of life

OBJECTIVE: To compare health-related quality of life in patients having no neck dissection and those having a selective dissection, with particular reference to shoulder dysfunction. DESIGN: Prospective study. SETTING: Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, England. PATIENTS: Two hundred seventy-eight consecutive patients undergoing primary surgery for previously untreated oral and oropharyngeal squamous cell carcinoma between January 1, 1995, and December 31, 1999. MAIN OUTCOME MEASURE: The University of Washington Quality of Life questionnaire, administered on the day before surgery and at 6 months, at 12 months, and more than 18 months after surgery. RESULTS: No neck dissection was performed in 58 patients (21%), a unilateral dissection in 181 (65%), and a bilateral dissection in 39 (14%). Patients with no neck dissection and those with unilateral level III or IV dissections had similar mean scores for shoulder dysfunction, whereas patients with unilateral level V and bilateral level III and IV dissections recorded much worse scores on average. CONCLUSIONS: There is little subjective morbidity associated with shoulder dysfunction after a unilateral level III or IV neck dissection compared with patients undergoing primary surgery without a neck dissection. More extensive surgery in the neck, whether bilaterally removing levels I to III or IV or extending posteriorly to include level V, is associated with statistically significantly worse shoulder dysfunction.     

The impact of laryngopharyngeal reflux on patient-reported quality of life

OBJECTIVES/HYPOTHESIS: The objectives were to assess patient-reported outcomes, specifically, the health-related quality of life of patients with laryngopharyngeal reflux, and to compare those reported levels with the health-related quality of life of patients with gastroesophageal reflux disease and a general population. STUDY DESIGN: Prospective study. METHODS: As part of a prospective study to validate a health-related quality of life instrument for laryngopharyngeal reflux, patient-reported data were collected before the initiation of therapy. Use of the Short Form-36 (SF-36), a generic instrument, allowed the health-related quality of life of the patients with laryngopharyngeal reflux to be compared with benchmarks existing for patients with gastroesophageal reflux disease and a general U.S. population. RESULTS: The 117 patients with laryngopharyngeal reflux often reported multiple symptoms, most frequently, chronic throat-clearing (85.5%), globus (82.1%), and hoarseness (80.3%). Their mean health-related quality of life was statistically significantly worse than that of a general U.S. population in seven of the eight SF-36 domains. The most dramatic differences between patients with laryngopharyngeal reflux and the general population were in social functioning and bodily pain (P <.001). Mean scores for patients with laryngopharyngeal reflux were significantly lower than those for patients with gastroesophageal reflux disease in social functioning (P <.001) and vitality (P =.0017). In five of the six remaining domains, patients with laryngopharyngeal reflux reported lower mean scores than did patients with gastroesophageal reflux disease, but those differences were not statistically significant. CONCLUSION: The study's assessment of health-related quality of life suggests that laryngopharyngeal reflux has a significant negative impact on the lives of patients. Although its impact is similar in some respects to that of gastroesophageal reflux disease, laryngopharyngeal reflux has a more significant impact on patients' social functioning and vitality.     

Long-term quality of life of patients with head and neck cancer

Objectives: To describe prospectively the long‐term changes of quality of life and mood in patients with squamous cell carcinoma of the head and neck treated with surgery and/or radiotherapy. Patients and Methods: One hundred seven patients completed the European Organization for Research and Treatment of Cancer (EORTC) Core Questionnaire, the EORTC Head and Neck Cancer Module, and the Center for Epidemiological Studies Depression Scale before treatment, and 6, 12, 24, and 36 months later. Results: There was limited deterioration of physical and role functioning and of many head and neck symptoms at 6 months, with improvement thereafter. After 36 months only physical functioning, taste/smell, dry mouth, and sticky saliva were significantly worse, compared with baseline. Female sex, higher cancer stage, and combination treatment were associated with more symptoms and worse functioning. Despite physical deterioration, there was a gradual improvement of depressive symptomatology and global quality of life. Conclusion: Treatment for head and neck cancer results in short‐term morbidity, most of which resolves within 1 year. Despite an initially high level of depressive symptomatology, there is gradual improvement of psychological functioning and global quality of life over the course of 3 years. In this prospective study, the impact of the disease and its treatment in long‐term survivors seems to be less severe than it is often assumed to be.     

中晚期喉癌患者术后发音生存质量评估

目的 通过对中晚期喉癌患者行三种不同术式后的发音生存质量分析,指导喉癌治疗方案的选择.方法对30例喉次全切除患者、30例喉全切除未行发音重建患者、30例喉全切除行发音重建患者,采用修改后的美国密执安大学头颈癌患者生存质量量表（university of Michican head and neck quality of life,HNQOL）进行问卷调查,分析三种不同术式患者的生存质量及生存质量随时间发展的变化规律.结果喉全切除行发音重建组在语言交流、嗅觉情况、社会交往及娱乐工作状态方面与喉次全切除组比较无显著性差异,而未行发音重建组与喉次全切除组有显著性差异.结论喉全切除行发音重建可明显提高术后的生存质量.应积极通过临床治疗,心理治疗及社会干预帮助其康复,提高术后生存质量.     

Concepts for measuring quality of life in patients with chronic sinusitis]

BACKGROUND: In 1997, Benninger developed the Rhinosinusitis Disability Index (RSBI) for patients who suffered from chronic sinusitis. Its content related validity and construct related validity were established, as were its sensitivity and reliability. The aim of our study is to introduce a concept to measure quality of life in these patients according to circumstances prevalent in Germany. METHODS: The questionnaire (Rhinusitis-Beeintr?chtigungs-Index, RSBI) contains 30 questions that describe the 5 aspects of quality of life. Moreover we used a standardized data sheet to acquire further information about history and diagnostic results. Using this method it is possible to specificity more precisely the patients current complaints and condition. Evaluation is possible according to complex of questions as well as simple items. The influence of treatment on quality of life can be measured as the sum of the specific scores and is expressed comprehensively in the total score. The concept of the study includes a prospective inquiry as well as before and after surgical intervention. CONCLUSION: A disadvantage of the American RSDI is that the clinical symptoms are not described in a detailed catalogue which allows the correlation of the clinical factors. Therefore we added a detailed questionnaire concerning the clinical symptoms and the individual treatment of the patient (RSBI). That permits comprehensive analysis of quality of life as it relates to different aspects of disease and different strategies in treatment.     

The impact of tinnitus on quality of life in older adults

Few population-based data exist to assess the impact of tinnitus on quality of life. As part of the Epidemiology of Hearing Loss Study, self-reported data on tinnitus and quality of life were obtained by interview at the first follow-up examination (1998-2000; N = 2800; ages 53-97 years). The Medical Outcomes Study Short Form Health Survey (SF-36) was used to assess quality of life. Adjusted mean SF-36 scores decreased (worsened) with increasing tinnitus severity (None, Mild, Moderate, Severe) for the Role-Physical, Bodily Pain, Vitality, and Mental Health domains, and the Physical Component Summary scale (F-tests for linear trend, p < .05). Scores tended to be lower for those who first reported tinnitus at the follow-up (five-year incidence of tinnitus) compared to those who reported tinnitus at the baseline and follow-up examinations (prevalent tinnitus). This study documents clear associations between tinnitus and reduced quality of life in this large cohort of older adults.     

Creation of a quality of life instrument for nonmelanoma skin cancer patients

Objective: Malignancies of the skin are the most common cancers among humans. The cervicofacial region is most affected by cutaneous malignancies, with approximately 80% of nonmelanoma skin cancers (NMSC) occurring in the head and neck. Treatment of cervicofacial skin cancers also is more likely to result in significant patient morbidity, because of the functional and cosmetic importance of this region. Unlike other malignancies, skin cancer has not been well investigated in terms of patient quality of life (QOL) assessment. Furthermore, no validated disease‐specific QOL instrument currently exists for skin cancer. The aim of this study was to construct a new QOL instrument, The Facial Skin Cancer Index (FSCI), that captures the relevant QOL issues for NMSC patients. Study Design: Cross‐sectional study of patients presenting to a dermatologic surgery clinic with NMSC of the head and neck. Methods: For stage I, item generation, a sample of 20 patients with cervicofacial NMSC and six health care providers specializing in the care of NMSC patients completed semistructured interviews. For stage II, item reduction, a second sample (n = 52) of NMSC patients rated the items in terms of their importance for QOL among skin cancer patients. Domains of the FSCI were evaluated in terms of data quality, item variability, internal consistency, and range and skewness of scale score on aggregation and floor and ceiling effects. Results: A total of 71 distinct items were generated in stage I. After using the outlined item reduction techniques in stage II, the FSCI was reduced from 71 to 36 items, representing 6 domains. With the exception of Physical Functioning (alpha = 0.63) that suggested adequate reliability, all subscale scores showed excellent reliability coefficients, with Cronbach's alpha ranging from 0.78 (Lifestyle) to 0.87 (Social/Family). Conclusions: A new disease‐specific QOL instrument for patients with NMSC of the head and neck has been created. Validation studies are currently underway. Future directions will include sensitivity analysis to determine whether the FSCI is sensitive to change over time among patients undergoing treatment for NMSC.     

Quality of life of patients with squamous cell carcinoma of the oral cavity]

OBJECTIVE: The aim of this study was to assess the changes in quality of life during and after treatment in patients with cancer of the oral cavity. PATIENTS AND METHODS: In the period between October 1999 and September 2000, 57 patients of the Department of Craniomaxillofacial Surgery, University of Cologne, underwent surgery, radiation therapy or the combination of both for the treatment of cancer of the oral cavity. Before, during and after the therapy their quality of life was measured with two psychometric scales. RESULTS: The average loss of quality of life in the female group was less than in the male group. Younger patients suffered more than older ones did. All patients had a loss of quality of life 3 months after the beginning of the therapy. The biggest decrease was in the group of patients treated with combined therapy, and the lowest loss in the radiated group. During the assessment period of 9 months, there were significant differences between all three groups. The size of the tumor did not show any influence on the reduction of quality of life. Patients with cancer of the tongue or maxilla showed more loss of quality of life than patients with tumors located in other regions of the oral cavity. CONCLUSION: Location of the tumor, age, gender of the patient, and type of therapy influenced the quality of life, while the size of the tumor did not.     

The impact of cochlear implantation on tinnitus, stress and quality of life in postlingually deafened patients

Tinnitus is a common complaint in the candidates for cochlear implantation (CI). Tinnitus-related distress has often been measured in these patients using categorical ratings, which lack information about tinnitus severity, stress and health-related quality of life or their correlation. Here, using 4 validated questionnaires, we evaluated psychometric parameters and the quality of life of 32 postlingually deafened patients before and after CI. The data regarding pre-CI were collected retrospectively. Of all patients included in this study, 28 (87.5%) suffered from tinnitus before implantation. Following a mean of 24 months after surgery, these patients reported a significant decrease (39.2%) of tinnitus impairment, as measured by the Tinnitus Questionnaire. In none of the 28 patients has tinnitus worsened. Moreover, the 4 tinnitus-free patients remained so after the CI surgery. In addition, the implant supply resulted in 36.7% reduction in perceived stress and in 15.4% reduction in evasive coping. In addition, the focus on positive coping has improved by 12.3%, whereas the health-related quality of life improved by 53.4% in all patients. Tinnitus impairment and stress were reduced more strongly in patients who had initially higher scores. Interestingly, a significant correlation between the psychometric scores was found mainly after CI. Our results indicate that patients with higher tinnitus-related distress have a lower quality of life, lesser coping abilities and perceive more stress, but before implantation it is masked by deafness. We conclude that tinnitus-related screening of patients before and after CI is an important step in the identification of individuals who would benefit from specific fitting and/or tinnitus therapy after implantation.