Nutrition in patients with head and neck cancer

Nutrition in Patients with Head and Neck Cancer. Malnutrition is common in patients with head and neck cancer. Due to natural course of disease or therapy, malnutrition may increase. This leads to a reduced prognosis, quality of life, and should be considered in early stages of the disease. First choice is an enteral feeding via a nasogastral feeding tube or a PEG. In special cases a parenteral nutrition may be necessary.     

Life-satisfaction in patients with head and neck cancer

Life-satisfaction is a measure of a patient's perception of the difference between his reality and his needs, or wants. This study reports the results of a longitudinal survey of patients’self-reported life-satisfaction following treatment for head and neck cancer. Life-satisfaction scores improved with time, and were related to pain, speech difficulty, and dysphagia. Lack of adequate family support was also important, although an uncommon problem. Treatment modality did not emerge as a significant determinant of life-satisfaction; speech difficulties were more likely to be due to articulation problems than voicing difficulty.     

Measuring comorbidity in patients with head and neck cancer

BACKGROUND: Comorbidities are diseases or conditions that coexist with a disease of interest. The importance of comorbidities is that they can alter treatment decisions, change resource utilization, and confound the results of survival analysis. OBJECTIVE: The objective of this study was to determine the best comorbidity index to use in survival analysis of patients with squamous cell carcinoma of the head and neck. METHOD: Four validated indexes, with very different methodologies (i.e., the Charlson Index, the Cumulative Illness Rating Scale, the Kaplan-Feinstein Classification, the Index of Co-existent Disease), were tested using data from 379 unselected consecutive patients with complete 3-year follow-up from the Kingston Regional Cancer Center. Kaplan-Meier analysis and Cox Proportional Hazards Regression were used to stratify patients into three levels of increasing severity of comorbidity for each index. The Proportion of Variance Explained and Receiver Operating Characteristics curves were used to compare the performance of the indexes. CONCLUSION: The Kaplan-Feinstein Classification was the most successful in stratifying patients in this population.     

Surgery in elderly patients with head and neck cancer

A retrospective analysis of 19 patients aged 70 years or more with head and neck cancer, admitted between January 1982 and March 1983, was performed. Of these patients, radical surgical excision was performed on seven. At present recurrence has been observed in only one. Associated illness was found in 11 patients, hypertension and cardiac disease, in four cases each, being most frequent. Surgical operation should be performed even on elderly patients if the operation is indicated. However, careful and delicate management before, during and after the operation is essential.     

Aspiration in chemoradiated patients with head and neck cancer

OBJECTIVE: To review the incidence of aspiration after chemoradiation therapy in patients with head and neck cancer (HNC). DESIGN: Retrospective review. SETTING: Academic institution. PATIENTS: One hundred thirty patients with advanced HNC underwent chemoradiation therapy at our institution between 1998 and 2002 as part of a larger, multi-institutional, prospective study of induction chemotherapy followed by chemoradiation therapy; the 118 patients (91%) for whom oropharyngeal motility (OPM) study data were available are discussed in this article. MAIN OUTCOME MEASURES: Incidence of trace ( 5%) aspiration (deep laryngeal or tracheal penetration) as determined by pretreatment and posttreatment OPM studies and correlation of the findings with the patients' reported symptoms. RESULTS: Eighty-one patients (69%) underwent at least 1 OPM study demonstrating aspiration within the first year after chemoradiation therapy, with 30 (25%) demonstrating frank aspiration. Of the patients who aspirated, 61 (75%) reported no symptoms of coughing or choking (80% of trace and 67% of frank aspirators). The patients with cancer of the larynx and hypopharynx were more likely to be aspirators (P = .007 and P = .004, respectively). Of the 62 patients with available pretreatment OPM data, 33 (53%) demonstrated aspiration at baseline. CONCLUSIONS: Aspiration is highly prevalent among patients with advanced HNC at baseline and is worse in the posttreatment period after chemoradiation therapy. The majority of these patients report no symptoms. All patients with advanced HNC should undergo instrumental swallow assessment, even in the absence of symptoms, to detect subclinical aspiration and to institute therapeutic maneuvers and swallow precautions as well as to determine the safety of oral feeding.     

Treatment in elderly patients with head and neck cancer

Despite the increasing number of elderly patients requiring treatment for head and neck cancer, there is insufficient available evidence about the oncological results of treatment and its tolerability in such patients. Owing to comorbidities, elderly patients often need complex evaluation and pretreatment management, which often results in their exclusion from clinical trials. The question of which patients constitute the highest-risk groups regarding treatment-related morbidity and mortality, and who can tolerate and benefit from aggressive treatment, has not been adequately studied. Biologic rather than chronologic age should be a more important factor in treatment protocols. Age-specific prospective clinical studies are needed on the treatment of head and neck cancer in elderly patients.     

Aspiration in patients with head and neck cancer and tracheostomy

Tracheopulmonary aspiration is a common occurrence in patients with dysphagia associated with head and neck cancer. We performed quantitative scintigraphic analysis of tracheopulmonary aspiration in 125 patients with head and neck cancer; 58 of these patients had a tracheostomy. Tracheopulmonary aspiration occurred in 58% of patients with a tracheostomy and in 23% of patients without a tracheostomy. In six of seven patients with a tracheostomy, tracheopulmonary aspiration significantly increased when the obturator was removed and, in these patients, occlusion of the tracheostomy tube during feedings eliminated or reduced the complication. Our studies suggest that aspiration can be monitored accurately and conveniently by scintigraphy, and that this technique is useful in the evaluation and management of dysphagia in debilitated patients.     

Serum selenium levels in patients with head and neck cancer

OBJECTIVE: The objective of this research was to estimate serum selenium levels in patients with head and neck cancer and to correlate them with tumour burden, as well as to study the effect of radiotherapy on serum selenium levels to determine its prognostic significance. DESIGN: This prospective study was carried out by selection of head and neck cancer patients using periodic random numbers. SETTING: This was a hospital-based study. METHODS: Estimation of serum selenium was done using the Atomic Absorption Spectrophotometer (Model AAS 4129; Electronic Corporation of India Ltd., Hydrabad, India) with a hydride generator after digestion of the serum sample. MAIN OUTCOME MEASURES: Patients were followed for 1 year postradiotherapy for any change in serum selenium level and its correlation with the outcome of the treatment. RESULTS: All 30 patients had serum selenium levels significantly lower as compared with controls, and these levels decreased further as tumour burden increased. Levels came within normal range after 1 year of radiotherapy in 10 patients who were cured but in the remaining patients who had residual disease, levels remained persistently low. CONCLUSIONS: The serum selenium level may serve as a useful marker in head and neck cancer.     

Otitis media with effusion in head and neck cancer patients

Fifty-two patients who had otitis media with effusion associated with head and neck malignancies were identified and studied retrospectively. Forty-three of the patients underwent myringotomy and tube for treatment of the effusion. Ten (23%) of the 43 patients had either multiple infections or continuous otorrhea necessitating tube removal. The patients identified as having the highest rate of serious complications following myringotomy and tube were those individuals who had nasopharyngeal carcinoma, with 6 (55%) of 11 patients in this group having suffered major infections during the study. Myringotomy and tube is a satisfactory treatment for most patients who have effusions as a result of non-malignant etiologies; however, infections were more common and more severe in the study group than those anticipated in noncancer patients. Expectant management and the use of amplification in selected cases may prove to be a viable alternative in patients with unilateral effusion and/or relatively mild symptoms.     

Smoking cessation in patients diagnosed with head and neck cancer

OBJECTIVE: To determine patients' smoking status after the diagnosis and treatment of squamous cell carcinoma of the head and neck (SCCHN) and to identify factors associated with smoking cessation. DESIGN: Cross-sectional survey study conducted over a 2-year period. SETTING: Head and neck surgery clinic of an academic tertiary care hospital. METHODS: Two hundred thirteen consecutive patients diagnosed with SCCHN were interviewed to ascertain patients' smoking status and the incidence of smoking cessation. Information on demographics, tobacco and alcohol history, disease characteristics, and treatment modality was also collected. MAIN OUTCOME MEASURES: The rate of smoking cessation was evaluated, in which smoking cessation is defined as the use of no cigarettes at least 1 month prior to the interview. Possible predictors of smoking cessation were evaluated. RESULTS: One hundred twenty-five patients were found to be smoking at the time of diagnosis. Among these patients, 53.6% stopped smoking after diagnosis or during treatment. In the univariate analyses, tumour site (p = .01), concurrent alcohol use (p = .03), and number of attempts to quit pre- (p = .03) and postdiagnosis (p = .001) were found to be highly predictive of patient smoking cessation. Multivariable modelling showed that gender, tumour site, and number of attempts to quit smoking were significantly and independently related to smoking cessation. CONCLUSIONS: Although smoking cessation would be presumed to be high after cancer diagnosis, this study has identified patient subgroups in which postdiagnosis smoking cessation intervention programs need to be made more effective.     

Gallium-67 scanning in patients with head and neck cancer

This study was undertaken to evaluate the use of Gallium-67 scanning in the management of patients with malignancies in the head and neck region. The principal findings are: 1. Gallium-67 accumulates preferentially in the lacrimal and salivary glands in a high proportion of cases and, almost invariably, in the mid-facial zone; 2. the uptake by the lacrimal and salivary glands is permanently enhanced by prior radiation therapy; 3. tumor identification is reliable, providing that the tumor focus measures at least 2 centimeters in diameter; 4. non-specific inflammation also accumulates this isotope; and 5. tissue analysis reveals consistently elevated Gallium-67 concentration in tumor. These characteristics of Gallium-67 may lead to its eventual useful role in the evaluation of patients with head and neck cancers.     

Paraneoplastic syndromes in patients with primary head and neck cancer

Paraneoplastic syndromes represent the clinical manifestations of the indirect and remote effects produced by tumor metabolites or other products. The clinical spectrum of the various paraneoplastic syndromes related to primary malignancies of the head and neck region is presented. A review of the literature on paraneoplastic syndromes in patients with primary head and neck cancer was carried out. Paraneoplastic syndromes related to primary malignancies of the head and neck region can be categorized as: endocrine, cutaneous or dermatologic, hematologic, neurologic, osteoarticular or rheumatologic, ocular syndromes. Sometimes, paraneoplastic syndromes can be more serious than the consequences of the primary tumor itself and can precede, follow or be concurrent to the diagnosis of a malignancy; moreover, they can dominate the clinical picture and thus lead to errors with respect to the origin and type of the primary tumor. Physicians who deal with cancer-associated syndromes should be able to differentiate the paraneoplastic syndromes from the benign disorders that mimic them. Patients with a suspected paraneoplastic disorder should undergo a complete panel of laboratory studies, in addition to imaging studies and endoscopy. Identification of paraneoplastic syndromes allow the clinician to make an early diagnosis and to provide adequate treatment of tumors, with a favorable oncologic outcome and improved life expectancy for the patient. These syndromes can follow the clinical course of the tumor and thus be useful for monitoring its evolution.     

Gastrostomy tubes in patients with advanced head and neck cancer

OBJECTIVES: To measure the percentage of patients requiring gastrostomy tubes (G-tubes) and the timing of their placement, in addition to studying whether pretreatment variables (T stage, tumor site, N stage) and intratreatment variables (weight loss during treatment) are valid predictors for the need for G-tube placement. STUDY DESIGN: Retrospective case control study. METHODS: Retrospective review of a prospectively collected database with chart reviews was carried out on 477 patients treated on a regimen of intraarterial cisplatin and concurrent radiation. The likelihood of requiring a G-tube was calculated by studying several independent variables using chi-square analysis and the unpaired t test. RESULTS: Two hundred twenty (46%) patients had G-tubes placed, with mean time of placement being on day 20 after the initiation of treatment. Patients with T4 disease were statistically more likely to require a G-tube (50% vs. 37%, P < .05). Patients were less likely to require a G-tube when the primary site of tumor involved the larynx or paranasal sinuses (P < .05). There were no statistically significant differences between the two groups with regards to patient age, sex, N stage, and weight changes over the course of treatment. The odds of requiring a G-tube were highest for tumors involving the hypopharynx (80%), oral cavity (52%), and oropharynx (49%). CONCLUSIONS: Although clinical judgment appears to be sufficient for deciding when G-tube placement is warranted in our population, the threshold for placing a tube should be lower in those patients who had a higher likelihood of requiring a G-tube during the course of treatment, including those with advanced disease of the oral cavity, oropharynx, and hypopharynx.     

Pretreatment with chemotherapy in patients with advanced head and neck cancer

Average survival for advanced head and neck cancer (AHNC) is 18 months. In an attempt to improve this we treated 29 AHNC patients between 1978-82 with two courses of chemotherapy. Chemotherapy consisted of cyclophosphamide, methotrexate, 5 fluorouracil and bleomycin; or bleomycin, cisplatinum and methotrexate. Chemotherapy was given prior to definitive therapy of radiotherapy or radiotherapy and surgery. All patients were stage 3 or 4. All patients were Eastern Co-operative Oncology Group status performance 0 or 1. Response to chemotherapy did not improve survival. Pretreatment with chemotherapy should be investigational until increased survival has been documented.