Exhaled breath analysis in the diagnosis of head and neck cancer

Head and neck cancer (HNC) comprises a heterogeneous group of upper aerodigestive tract malignant neoplasms, the most frequent of which is squamous cell carcinoma. HNC forms the eighth most common cancer type and the incidence is increasing. However, survival has improved only moderately during the past decades. Currently, early diagnosis remains the mainstay for improving treatment outcomes in this patient population. Unfortunately, screening methods to allow early detection of HNC are not yet established. Therefore, many cases are still diagnosed at advanced stage, compromising outcomes. Exhaled breath analysis (EBA) is a diagnostic tool that has been recently introduced for many cancers. Breath analysis is non‐invasive, cost‐effective, time‐saving, and can potentially be applied for cancer screening. Here, we provide a summary of the accumulated evidence on the feasibility of EBA in the diagnosis of HNC.     

头颈部肿瘤患者放疗期间口腔健康行为的纵向调查

目的了解头颈部肿瘤患者放疗期间的口腔健康行为,为改进临床实践提供依据。方法使用自制的口腔健康行为问卷,对104例头颈部肿瘤患者在放疗第1周(入院时)、第2周、第4周、出院时进行调查;并每周检测患者是否发生口腔黏膜炎。结果至放疗第5周,所有患者均发生口腔黏膜炎;患者口腔健康行为除"使用牙线"不同时间点比较差异无统计学意义(P0.05)外,其余6项口腔健康行为放疗期间均有所改善(P0.05,P0.01);年龄对治疗期间口腔健康行为有影响(P0.05),性别及学历对入院时的口腔健康行为影响有统计学意义(均P0.05),之后影响无统计学意义(均P0.05)。结论头颈部肿瘤患者放疗期间口腔黏膜炎发生率高;口腔健康行为(除使用牙线外)在入院后有所改善。医护人员需关注头颈部肿瘤放疗患者的口腔健康行为,尤其是对年长者;制定基于循证证据的口腔照护策略,以改善患者的口腔健康行为。     

头颈癌患者患病体验及需求质性研究的Meta整合

目的 系统评价和整合头颈癌患者患病体验及需求的质性研究,为制定针对性的照护方案提供参考。方法 检索PubMed、Web of Science、Embase、Cochrane Library、中国知网、万方数据库、维普科技期刊数据库和中国生物医学文献数据库,搜集建库至2023年2月关于头颈癌患者患病体验及需求的质性研究,采用JBI质性研究质量评价标准对文献质量进行评价,并对结果进行Meta整合。结果 共纳入13篇文献,提炼出55个主题,归纳形成10个类别,合成3个整合结果：症状困扰影响患者的心理健康和社会适应,患者经历创伤后成长并采取了一系列应对策略,多元化且未得到充分满足的需求。结论 头颈癌患者身心受到严重创伤,为促进患者的创伤后成长,医护人员应该重视患者的患病体验,并以需求为导向制定个性化的延续护理方案。     

Prioritizing treatment outcomes: head and neck cancer patients versus nonpatients

BACKGROUND: Treatment decisions in head and neck cancer (HNC) might involve consideration of uncertain tradeoffs of one late effect against another or increasing toxicity or residual impairment for increased chance of survival. Understanding how patients prioritize potential outcomes, as well as whether these preferences are similar to those of nonpatients, is important to informed decision making and treatment planning. METHODS: Two hundred forty-seven newly diagnosed HNC patients from nine institutions and 131 nonpatients rank ordered a set of 12 potential treatment outcomes (eg, cure; being able to swallow; normal voice) from highest (1) to lowest (12). RESULTS: Patients and nonpatients were similar with respect to the three items most frequently ranked in the top three, that is, "being cured of cancer," "living as long as possible," and "having no pain" in that order. In contrast, patients more frequently ranked "cure" (90% vs 80%) and less frequently ranked "no pain" (34% vs 52%) in the top three. CONCLUSIONS: Survival seems to be of paramount importance to both patient and nonpatient groups, overshadowing associated toxicities and potential dysfunction. At the same time, patients might be more willing than nonpatients to undergo aggressive treatments and endure acute distress in the interest of potential long-term gains (ie, cure or longer survival).     

Targeting epidermal growth factor receptor in head and neck cancer

It is well known that growth factors play an important role in normal cell proliferation by means of stimulation of growth factor receptors located on the surface of cells. Tumor cells express high levels of growth factor receptors that can theoretically serve as therapeutic targets in cancer treatment. Tyrosine kinase (type 1) growth factor receptors include the family of erbB receptors. The most extensively studied receptor in the erbB family is the human epidermal growth factor receptor (EGFR), also known as erbB1. Studies have shown that overexpression of EGFR is involved in the development and progression of head and neck squamous cell carcinoma (HNSCC). Blocking this receptor in HNSCC cell lines and animal models inhibits tumor growth. Strategies have been developed to target EGFR, including monoclonal antibodies, tyrosine kinase-specific inhibitors, ligand-linked immunotoxins, and antisense approaches. Laboratory studies and clinical trials are under way to explore the safety and efficacy of these various approaches in a variety of cancers, including HNSCC. Preliminary results from early phase clinical trials are encouraging and may lead to the incorporation of these EGFR targeting strategies into the management of HNSCC.     

Preoperative risk assessment for gastrostomy tube placement in head and neck cancer patients

BACKGROUND: The presentation and definitive surgical treatment of head and neck malignancies have varying impact on postoperative recovery and return of swallowing function, which heretofore has not been well defined. METHODS: We performed a retrospective chart review of 142 patients who underwent extirpative surgery for head and neck cancer. RESULTS: Factors significantly associated with the need for long-term postoperative nutritional support (p < .05) included heavy alcohol use, tongue base involvement and surgery, pharyngectomy, composite resection, reconstruction with a myocutaneous flap, radiation therapy, tumor size, and moderately-to-poorly differentiated histology. Heavy alcohol users were at an absolute risk for gastrostomy tube dependence; patients who underwent radiation therapy, flap reconstruction, tongue base resection, and pharyngectomy were at a two to sevenfold increased risk for gastrostomy tube dependence, respectively. CONCLUSIONS: High-risk patients based on these criteria should receive a feeding gastrostomy at the time of their initial surgical therapy.     

Psychosocial factors involved in delayed consultation by patients with head and neck cancer

BACKGROUND: In the north of France, a delay in primary consultation has been noted among patients with head and neck cancer. This group is often correlated with lower socioeconomic status and a lack of medical information. Therefore, the choice to seek consultation is often influenced by symptoms such as pain and change in the size of tumors in the neck. We studied this delay in seeking consultation, focusing on psychosocial variables such as professional and social background, the involvement of a spouse/partner, and the presence of anxiety and depression. METHODS: Two rating scales were administered to 50 patients with large tumors (T3/T4) and 50 patients with small tumors (T1/T2), and the results were compared. These rating scales were as follows: (1) a 17-item questionnaire assessing sociodemographic data, presenting symptoms, factors generating the consultation, and reasons for delay; and (2) the Hospital Anxiety and Depression Scale (HADS). RESULTS: Both groups were predominantly male and working-class. Significant differences were observed in time since symptom onset and in conscious delay in seeking medical attention. The group with large tumors was characterized by lower involvement of a spouse/partner, conscious delay before first consultation, greater social isolation, fewer medical visits, and lower HADS anxiety scores. The group with small tumors sought consultation sooner and was characterized by greater involvement of a spouse/partner, correlated with significant anxiety. Depression was not a factor influencing delay within either group. CONCLUSIONS: The interpersonal relationship with a spouse/partner seemed to be essential in the dynamics surrounding consultation. Anxiety, rather than socioeconomics status, was a discriminating factor in the delay in seeking consultation.     

Isolated neck recurrence after definitive radiotherapy for node-positive head and neck cancer: salvage in the dissected or undissected neck

BACKGROUND: The role of salvage neck dissection for isolated regional recurrences after definitive radiotherapy (RT) is ill-defined. METHODS: Five-hundred fifty patients were treated with RT for lymph node-positive head and neck cancer. RT consisted of a median dose of 74.4 Gy. Chemotherapy was administered in 133 patients (24%). Patients were followed for neck failure after planned neck dissection (n = 341) or observation (n = 209). Salvage therapy was offered to those with isolated neck recurrences. RESULTS: There were 54 (10%) failures in the neck at a median 3.7 months after RT (range, 0 to 17 months). Thirteen patients had isolated recurrences after receiving definitive RT with (n = 11) or without (n = 2) neck dissection. Nine patients underwent attempted surgical salvage with or without re-irradiation and 4 were successfully salvaged without major complications. CONCLUSIONS: Patients with neck failure after definitive therapy usually have poor outcomes, but salvage attempts may be successful in selected patients with an isolated neck recurrence.     

Morbidity of the neck after head and neck cancer therapy

BACKGROUND: Studies on morbidity of the neck after head and neck cancer therapy are scarcely described. METHODS: Patients who underwent surgery, including neck dissection, with and without radiation therapy at least 1 year before the study were asked to participate. We assessed neck pain, loss of sensation, range of motion of the cervical spine, and shoulder pain. RESULTS: Of the 220 patients who were invited, 153 (70%) participated in the study. Neck pain was present in 33% of the patients (n = 51), and shoulder pain was present in 37% of the patients (n = 57). Neuropathic pain of the neck was present in 32% (n = 49); myofascial pain, in 46% (n = 70); and joint pain, in 24% (n = 37). Loss of sensation of the neck was present in 65% (n = 99) and was related to type of neck dissection and radiation therapy. Range of motion of the neck was significantly decreased because of the neck dissection and/or radiation therapy in lateral flexion away from the operated side. CONCLUSIONS: The occurrences of morbidity of the neck after cancer therapy were considerable and consisted of neck pain, loss of sensation, and decreased range of motion.