Comparison of quality of life and psychological distress in patients with tongue cancer undergoing a total/subtotal glossectomy or extended hemiglossectomy and free flap transfer: a prospective evaluation

The aim of this study was to assess changes in the quality of life and psychological distress of patients with tongue cancer undergoing total/subtotal glossectomy (TG) or extended hemiglossectomy (HG) and free flap transfer. Differences between the two groups were compared using the Short Form 8-Item Health Survey (SF-8) and Hospital Anxiety and Depression Scale (HADS). Of the 43 patients with tongue cancer, 24 (56%) underwent TG and 19 (44%) underwent HG. The general health and social functioning scores in the SF-8 and depression in the HADS were significantly worse in the TG group than in the HG group at 12 months after surgery, indicating that patients in the TG group may experience social isolation and psychological distress, and have difficulty in employability even 12 months after surgery. In contrast, all items of the SF-8 in the HG group were nearly equal to those in the general population. Due to the extensive psychological impact on patients with tongue cancer who are planned for an extended resection, curative surgery with free flap transfer and multidisciplinary psychiatric support are essential to improve quality of life and manage psychological distress.     

口腔癌患者的心理困扰及生存质量研究

目的: 探讨口腔癌患者的心理现状及其影响因素,以及与生存质量相关的因素。方法: 使用心理困扰温度计（distress themometer,DT）和华盛顿大学生存质量量表（University of Washington Quality of Life Questionnaire,UW-QOL）对郑州大学第一附属医院2016年10月—2017年9月收治的250例口腔癌患者进行问卷调查。应用SPSS20.0软件包对数据进行统计学分析。结果: 发放问卷250份,实际回收有效问卷239份。在239例口腔癌患者中,DT分数≥4分139例（58.2%）,UWQOL量表平均得分53.3±17.1;<4分的患者100例（41.8%）,UWQOL量表平均得分52.8±17.4,DT总平均得分4.56±2.18。单因素分析结果显示,心理困扰与年龄、文化程度、收入水平、病理分期、颌骨切除、复发6个因素有关（χ²值分别为5.12、21.31、34.2、10.69、31.3和7.84,P<0.05）。Logistic回归分析显示,年龄、颌骨切除、复发是影响口腔癌患者心理困扰的危险因素（OR值分别为4.06、5.12和5.79,P<0.05）。Spearman相关分析显示,UWQOL量表中疼痛、娱乐、情绪、焦虑4个条目得分与心理困扰得分呈负相关（r分别为-0.58、-0.84、-0.66和-0.69,P<0.05）。结论: 口腔癌患者的心理困扰发生率较高;年龄越小、做过颌骨切除、复发的患者心理困扰程度更严重。对口腔癌患者施行个体化的治疗方案、术后护理及心理疏导,可能会减轻患者的心理困扰程度。     

97例口腔癌患者术前生存质量的初步评价

目的:描述口腔癌患者术前的生存质量(quality of life,QOL)状况;分析社会人口学特点、临床特点对术前QOL的影响.方法:采用36条目简明健康状况调查问卷(SF-36)中文版和华盛顿大学生存质量问卷(UW-QOL)第4版,对97例口腔鳞癌患者术前的QOL进行测量.将97例患者分别按社会人口学特点和临床特点分组.组间差异采用SPSS12.0软件包进行Mann-Whitney U检验.将癌症患者SF-36的得分与普通人群参考值进行独立样本t检验.结果:①与普通人群配伍组比较,高龄患者有着相似的QOL值,而低龄患者则在躯体角色、身体疼痛和情感角色等领域表现出较低的QOL值;②T分期是影响术前QOL的最重要因素;③社会人口学特点如性别、年龄和共病等对QOL的影响主要体现在活力、躯体功能、躯体角色、情绪等反映身体状况和心理状况的指标上,而与口腔相关的特异性问题(口干除外)基本无关.而临床特点如肿瘤分期和部位对QOL的影响则不仅表现在与口腔相关的多项特异性问题上,如咀嚼、吞咽、发音、味觉等,还与身体疼痛、躯体角色、情感角色等反映身体状况和心理状况的指标密切相关.结论:与普通人群参考值进行比较.能更精确地反映口腔癌患者的QOL信息;临床特点对术前QOL的影响大于社会人口学特点;将普适性测量与头颈特异性量表结合,能更全面地评价口腔癌患者的QOL.联合使用UW-QOL和SF-36能较好地达到这一目的.     

Functional status of patients with oral cancer and its relation to style of coping, social support and psychological status

Sixty-eight patients were evaluated 6 months to 6 years after treatment for oral cancer using standardized questionnaires to explore the influence of age, sex, site and stage of tumour, and primary treatment on their functional status measured by the University of Washington Quality of Life Questionnaire (UW-QoL), and the association between functional status and psychological outcome measured by the Hospital Anxiety and Depression Scale (HADS), style of coping measured by the Mental Adjustment to Cancer Questionnaire (MAC-Q), and social support measured by the Short-Form Social Support Questionnaire (SSQ-6). Young patients, women, patients with advanced tumours, those with oropharyngeal tumours and those who had been treated with both surgery and radiotherapy reported worse function. The worse the functional domain, the more likely it was to be associated with anxiety, depression and ineffective coping style, and better functional scores were weakly associated with fighting spirit, level of social support and satisfaction with that support. We have identified patients at need and highlighted their problems. Dealing with these problems may ultimately improve the perception of function after treatment of oral cancer.     

Comparison between the radial forearm and groin soft tissue free flaps for reconstruction in patients with oral cavity cancer: a quality of life analysis

The purpose of this study was to compare the effects of the radial forearm free flap (RFFF) and groin soft tissue free flap (GSFF) on the quality of life (QoL) of patients undergoing reconstructive surgery after resection for oral cancer. A retrospective analysis of 48 patients was performed. The Vancouver Scar Scale (VSS), University of Washington Quality of Life (UW-QOL) questionnaire, and 14-item Oral Health Impact Profile (OHIP-14) questionnaire were used to evaluate the donor site scars and QoL of the patients. The postoperative hospital stay was significantly longer in the RFFF group than in the GSFF group (P = 0.001). Furthermore, the total VSS score (P = 0.011), VSS score for pigmentation (P < 0.001), and OHIP-14 scores for psychological discomfort (P = 0.026) and social disability (P = 0.044) were all significantly higher in the RFFF group than in the GSFF group, while the UW-QOL scores for appearance (P = 0.037) and mood (P = 0.036) were significantly lower in the RFFF group than in the GSFF group. Compared with the RFFF, the GSFF scar is more concealed, with better aesthetics at the donor site, and this flap can result in improved postoperative QoL for patients with oral cancer.     

Metastatic tumours to the oral cavity: a survival study with a special focus on gingival metastases

Aims: To describe survival from oral metastases, particularly gingival metastases, and to identify clinical prognostic variables.
Materials and Methods: A series of 39 patients were studied, analysing age, gender, primary tumour site, oral metastases site and histological type.
Results: Mean age: 62.3±9.2 years, with similar prevalence by gender. The most frequent sites for primary tumours were the kidney (20.5%), lung (20.5%) and breast (20.5%). Gingival metastases represented 63.6% of all oral soft tissue metastases (7/11). The average time between primary tumour diagnosis and appearance of the gingival metastases was 9.7±13.4 months. The median survival time since gingival metastases appearance was 5.2 months [95% confidence interval (CI)=0–13.6]; no statistically significant difference with other oral locations was found by the Kaplan–Meier curves (log rank: 0.29; p >0.05). Oral metastases involving the gingiva were more frequently found in the maxilla (85.7% versus 14.3%), whereas intra-osseous metastatic tumours were more frequent in the mandible (77.8% versus 22.2%; p <0.05; odds ratio=21; 95% CI=2.0–210.1). None of the variables considered had a prognostic value as indicated by the Kaplan–Meier test.
Practical implications: The data in this paper show that 25% (and in other studies up to 37%) of oral metastases came from unknown primary tumours; thus a biopsy with histopathologic analysis is mandatory for every patient with a gingival mass.
Conclusions: This study reinforces the significance of gingival metastases as a poor prognosis indicator. Dental practitioners should suspect that gingival masses mimicking benign or inflammatory lesions may represent a sign of underlying malignant tumours.     

Quality of life,psychological wellbeing and treatment needs of trauma and head and neck cancer patients

There is increasing evidence that patients treated for trauma or cancer of the head and neck may go on to experience psychological distress. We aimed to measure the impact of this on their quality of life (QoL) and to explore their willingness to be referred for psychological support. A total of 96 patients with facial injuries and 124 with cancer of the head and neck completed a self-reported questionnaire to identify psychological distress (Hospital Anxiety and Depression Scale (HADS) and the Acute Stress Disorder (ASD) Scale), quality of life (WHOQoL-BREF), satisfaction with treatment, and willingness to accept psychological support. Thirty-nine percent of patients showed high levels of depressive symptoms and 43% reported high levels of anxiety; 43% in the trauma group and 12% in the cancer group had high ASD scores. Patients with high scores on the HADS reported poorer QoL, and 40% of those with high levels of psychological distress were willing to consider psychological support. Despite the fact that patients report high levels of satisfaction with their medical and surgical care, many have psychological problems and have needs that are not being met. A large proportion would use psychological support services.     

Health-related quality of life after mandibular resection for oral cancer: Reconstruction with free fibula flap

Objectives: Mandibular resection for oral cancer is often necessary to achieve an adequate margin of tumor clearance. Mandibular resection has been associated with a poor health-related quality of life (HRQOL), particularly before free fibula flap to reconstruct the defect. The aim of this study was to evaluate health-related quality of life in patients who have had mandibular resections of oral cancer and reconstruction with free fibula flap. Study Designs: There were 115 consecutive patients between 2008 and 2011 who were treated by primary surgery for oral squamous cell carcinoma, 34 patients had a mandibular resection. HRQOL was assessed by means of the 14-item Oral Health Impact Profile (OHIP-14) and University of Washington Quality of Life (UW-QOL) questionnaires after 12 months postoperatively. Results: In the UW-QOL the best-scoring domain was mood, whereas the lowest scores were for chewing and saliva. In the OHIP-14 the lowest-scoring domain was social disability, followed by handicap, and psychological disability. Conclusions: Mandible reconstruction with free fibula flap would have significantly influenced on patients’quality of life and oral functions. The socio-cultural data show a fairly low level of education for the majority of patients. Key words:Health-related quality of life, free fibula flap, mandibulectomy, UW-QOL, OHIP-14.     

Long-term quality of life measured by the University of Washington QoL questionnaire (version 4) in patients with oral cancer treated with or without reconstruction with a microvascular free flap

We used the University of Washington Quality of Life (UW-QoL) questionnaire (version 4) to assess the long-term quality of life (QoL) of patients with oral squamous cell carcinoma treated with or without reconstruction with a microvascular free flap, and all patients with T2–T4 oral squamous cell carcinoma (SCC) treated in this way were eligible for the study. A total of 139 patients’ personal details, medical history, and QoL scores were collected and analysed. The mean (SD) overall QoL score was 73.09 (14.8) for patients with T2–T4 oral SCC. The mean (SD) global QoL scores of patients who had had reconstructions was 75.68 (13.85) and of patients who had not 71.00 (15.34) (t = 1.864, df = 137, p = 0.064). Univariate and multivariate analyses indicated that site of tumour, T stage, and the need for postoperative radiotherapy had significant effects on the global QoL scores. Among patients with T2 oral SCC there was no significant difference between patients who did and did not have reconstructions. However, there were significant differences among patients with T3/T4 SCC in scores for appearance, recreation, mood, anxiety, chewing, swallowing, and speech depending on whether they did or did not have reconstructions. There were significant differences in the domains recreation, chewing, speech, and taste, depending on the primary site of the tumour. We conclude that reconstruction with a microvascular free flap had a beneficial effect on the treatment of SCC and improved the QoL of patients with oral SCC.     

Depression and anxiety in patients with oral squamous cell carcinoma

Squamous cell carcinoma is the most common malignant tumor in the oral and maxillofacial regions, accounting for about 80% of the malignant oral lesions and around 2% - 3% of systemic malignant lesions. Oral squamous cell carcinoma (OSCC), which occurs in…     

The correlation between indices of deprivation and health-related quality of life in patients with oral and oropharyngeal squamous cell carcinoma

Deprivation influences the incidence and outcome of patients with cancer. Health-related quality of life (HR-QoL) is an important measure of outcome but there is little on this subject and its correlation with deprivation in patients with oral and oropharyngeal cancer. Our aim was to ascertain the extent of deprivation in a cohort of patients who had operations for primary oral and oropharyngeal cancer and how deprivation affected HR-QoL in these patients during and after their treatment. A total of 278 consecutive patients who were operated on for oral and oropharyngeal cancer were included in this study. Validated measures of deprivation scores (Townsend, Carstairs, Jarman and Index of Multiple Deprivation 2000) were calculated, as well as patient-based indicators of social circumstances (marital status, smoking habit, alcohol intake). Comparison was made with the University of Washington-Quality of Life (UW-QoL) scores before and after treatment (6, 12, and 24 months).     

Outcome of local failures after oral cancer – recurrence vs. second primary

J Oral Pathol Med (2010) 39 : 657–661 Background/objective: A high risk of new mucosal malignancies of the upper aerodigestive tract (UADT) is seen in patients successfully treated for oral cancer. The prognosis is unclear for these patients. A typical failure may be located at the site of the first tumor i.e. a local recurrence; or separately as a second primary tumor (SPT). It is unknown whether these two types of local failures have different prognosis. Study design: Longitudinal observational cohort study employing prospectively collected data over 25 years. Methods: The rate of local recurrences and UADT SPTs was analyzed in 151 patients previously treated for T1N0M0 oral squamous cell carcinoma. Survival after failure was compared between patients with local recurrence and local SPT. Results: All patients had a 5‐year cancer specific survival of 86.3%. Of the 151 patients, 20 had a local recurrence, and 16 had an UADT SPT. After a local failure, survival was median 17.2 months for local recurrence and 18.9 for UADT SPT (cancer specific). Time from primary tumor treatment to local recurrence was median 42 and months vs. 125 months for UADT SPTs. A similar linear pattern of presentation over time was seen for both tumor types. Conclusion: Outcome was poor after the date of the local failure. No difference in survival was seen whether the failure was a local recurrence or a second primary tumor. The similarity in survival and pattern of presentation suggests that these two entities may be biologically analogous.     

216例口腔鳞癌患者术后心理困扰影响因素及放疗前、后生存质量评价

目的:调查口腔鳞癌患者术后心理困扰程度的影响因素及放疗对生存质量的影响.方法 :对216例口腔鳞癌术后患者采用单因素分析和回归分析,评价心理困扰与社会经济和治疗因素的关系.采用中文版欧洲癌症研究与治疗组织的生存质量核心量表及头颈癌特异模块问卷,通过配对t 检验对受试者放疗前及放疗后3 个月的生存质量进行评估.采用SPS...     

Quality of life assessment in temporomandibular joint ankylosis patients after interpositional arthroplasty: a prospective study

Temporomandibular joint (TMJ) ankylosis significantly impacts both physical and psychosocial patient wellbeing. A complete evaluation of treatment outcomes necessitates knowing the extent to which a patient’s quality of life (QoL) is impacted. This study was performed to evaluate the impact of TMJ ankylosis on QoL in 25 TMJ ankylosis patients treated by interpositional arthroplasty. The patients completed OHIP-14 and UWQoL questionnaires once before and then at 3 months after the surgery. There was a significant improvement in mean cumulative scores for both questionnaires. With the exception of functional limitation, all OHIP domains showed significant improvement. Preoperatively, the worst scores were found in the psychological distress domain, followed by the social handicap, physical pain and physical disability domains. More than half of the subjects (56%) reported having suicidal thoughts. Amongst the individual UWQoL domains, appearance, chewing, anxiety (P < 0.01), recreation and mood (P < 0.05) showed improved scores. Appearance and chewing were the top ranked priority domains before and after surgery. No significant change was found in speech, taste, sleep, or breathing. Psychosocial factors were found to play a much bigger role than previously thought. The physical, psychological, and social factors were intricately related and dynamically interacted with each other. Surgical treatment produced a definitive QoL improvement in the patients.     

Treatment outcomes of proton beam therapy combined with retrograde intra-arterial infusion chemotherapy for locally advanced oral cancer in the elderly

The aim of this study was to evaluate the therapeutic efficacy and safety of proton beam therapy combined with retrograde intra-arterial infusion chemotherapy in elderly patients with locally advanced oral cancer. Between February 2009 and October 2019, 42 oral cancer patients aged ≥75 years were treated with this therapy. Median age was 80 years (range 75–90 years) and the median follow-up duration was 39 months (range 2–106 months). Of the 42 patients, 34 (81%) were diagnosed with stage IV cancer. The 3-year overall survival, local control, progression-free survival, and disease-specific survival rates were 56%, 69%, 32%, and 67%, respectively. Regarding acute toxicities, grade 3 neutropenia was observed in six patients (14%), anaemia in five (12%), acute kidney injury in one (2%), and oral mucositis in 18 (42%). Late toxicities of grade 3 were observed in seven patients: dysphagia in six (14%) and osteonecrosis of the jaw in one (2%). This study showed that proton beam therapy combined with retrograde intra-arterial infusion chemotherapy was effective for elderly patients with oral cancer, and toxicities were tolerable and manageable. The study findings suggest that this therapy is a potential treatment option for elderly oral cancer patients with difficulty in surgery and systemic chemotherapy.     

Follow up imaging of oral,oropharyngeal and hypopharyngeal cancer patients: Comparison of PET-CT and MRI post treatment

There is currently no consensus as to the ideal timing, frequency and modality of imaging for follow up of head and neck cancer patients. The aim of this study was to analyze the diagnostic accuracy of PET-CT versus MRI, and imaging at 3 versus 6 months for follow up of head and neck cancer patients treated with curative intent with no clinical signs of treatment failure.Materials and methodsA retrospective study was performed for all head and neck cancers treated with curative intent at the Royal Derby Hospital. Data collected included demographic information, site of primary cancer, staging, treatment provided, type of follow up imaging performed and results of follow up imaging. Inclusion in the study was for oral, oropharyngeal and hypopharyngeal cancers treated with curative intent, asymptomatic patients, those who have had follow up imaging within 6 months of treatment, and those followed up for at least 2.5 years since treatment.ResultsA total of 140 patients were included in the study. 25% of patients had evidence of recurrent/metastatic disease on imaging, 60% of which were identified within 6 months post treatment. The majority (60%) of failures were due to distant metastases. The sensitivity and specificity of both MRI and PET-CT was higher at 6 months post-treatment compared to 3 months post-treatment. Overall the sensitivity and specificity for PET-CT and MRI within 3–6 months post treatment were 94.7% and 83.5% and 60% and 85.7% respectively for identifying treatment failure.ConclusionFollow up Imaging at 6 months post treatment is more likely to accurately identify treatment failures with fewer false positives than imaging at 3 months. PET-CT is preferable to MRI for identifying post treatment locoregional and distant treatment failure.     

Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia

Vered Y, Soskolne V, Zini A, Livny A, Sgan‐Cohen HD. Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia. Community Dent Oral Epidemiol 2011; 39: 145–153. © 2010 John Wiley & Sons A/S Abstract – Objectives: To examine associations between psychosocial profile (psychological distress and social support) and changing oral health status (dental caries and periodontal disease), among a group of immigrants from Ethiopia to Israel. Methods: Three hundred and forty immigrants, aged 18–75 years, with a mean age of 38.4 ± 13.5 years, comprised the study population and were followed over a 5‐ year period. Dental caries was recorded employing the DMFT index. Periodontal health status was recorded employing the Community Periodontal Index (CPI). Participants were interviewed using a structured written questionnaire which included two validated psychosocial scales, for psychological distress and social support. Bivariate and multivariate analyses were performed. Results: Among subjects with psychological distress, the adjusted mean caries (DMFT) increment in 2004–2005, since baseline (1999–2000), was 3.52 ± 0.19 when compared to 0.35 ± 0.15 among subjects with no psychological distress (P < 0.001). Correspondingly, the percentage of people with increased periodontal pockets was 40%, when compared to 7%, respectively (P < 0.001). In multiple linear regression analysis employing the DMFT as a continuous variable, and in multiple logistic regression analysis employing the DMFT as a dichotomous variable (% caries versus % caries‐free), the four variables that reached statistical significance as predictors of caries status were previous caries experience, psycholog‐ical distress, social support, and age. Gender, income, and education were not significantly related to current caries prevalence. In a multiple logistic regression analysis, the three variables that reached statistical significance as predictors of periodontal disease (shallow and deeppockets) were previous periodontal disease experience, psychological distress, and age. Social support, gender, income, and education were not significantly associated with periodontal disease prevalence. Conclusions: This study presents persuasive evidence that supports the role of psychological distress and social support as determinants of changing oral health levels, among a low socioeconomic, relatively homogenous immigrant minority population.     

Quality of life and psychological well‐being among endodontic patients: a case‐control study

Background: Much is already known about the consequences of endodontic disease from clinicians’ perspectives; a significant omission is an understanding from patients’ perspectives. This study aimed to determine oral health‐related quality of life (OHQoL) and psychological distress among subjects referred for endodontic care compared to patients in periodontal maintenance. Methods: This was a case‐control study involving 200 patients; 100 patients requiring endodontic treatment and 100 control subjects (periodontal maintenance patients). OHQoL was assessed using the short form Oral Health Impact Profile measure (OHIP‐14) and psychological well‐being using the short form of the General Health Questionnaire (GHQ‐12). Variations in OHIP‐14 and GHQ‐12 scores between the ‘case’ and ‘control’ group were determined, and the magnitude of such differences through effect size (ES) calculations. Results: There were significant differences in OHIP‐14 summary scores between the case and control groups (p < 0.001) and significant differences across all seven domain scores (p < 0.05). The ES was moderate (0.63) with respect to summary OHIP‐14 scores. There were also significant differences in GHQ‐12 scores between the case and control groups (p < 0.05), but the ES was small (0.36). Conclusions: OHQoL and psychological well‐being is compromised among patients seeking endodontic treatment, and to a greater magnitude than patients in periodontal maintenance.     

正畸治疗对口腔相关生活质量影响的研究

[摘要] 目的 研究正畸治疗对口腔相关生活质量的影响,分析这些影响在不同的人群以及在各个维度中是否存在差异。方法 随机抽取正畸治疗患者182例进行问卷调查,采用《一般情况调查表》、《口腔相关生活质量调查表OHIP-14(中文版)》对患者进行测评,并对他们在量表上的得分进行比较。结果 正畸治疗对口腔生活质量有明显影响,在治疗第1个月时影响最大,对功能障碍、生理疼痛、心理不适、社交障碍等维度的影响均较明显。在性别和安氏分类方面得分没有显著差别,成年组较未成年组在总分及各分维度上均有明显差别,是否拔牙的患者之间在总量表得分、生理疼痛、心理障碍和社交障碍等维度也呈现出显著性差异。结论 正畸治疗影响患者的生活质量,在矫治的第1个月尤为明显,成年人和拔牙患者受到的影响也更为显著。     

股前外侧穿支皮瓣修复口腔癌术后缺损患者的生活质量评估

目的 评估应用游离股前外侧穿支皮瓣（ALTF）修复口腔颌面部恶性肿瘤切除术后组织缺损患者的生活质量（QOL）。方法 以2012年1月-2013年7月应用ALTF修复口腔颌面部恶性肿瘤切除术后组织缺损的32例患者为研究对象,应用口腔健康影响程度量表（OHIP-14）和简明健康状况调查问卷（SF-36）对患者术后12个月的QOL进行调查和评估。结果 SF-36问卷得分位于前3的项目是躯体疼痛、生理功能和躯体角色,得分分别是78.58±14.82、72.08±27.86和60.00±42.63;得分较低的是情感角色（41.67±39.62）、心理健康（50.75±13.07）和健康变化（54.17±21.75）。分析OHIP-14量表得分,恢复较好的项目是社交障碍和残障,得分分别为34.50±11.32和36.04±12.05;恢复较差的项目是生理性疼痛和心理不适,得分分别为73.50±18.96和60.17±25.66。结论 采用ALTF修复口腔颌面部恶性肿瘤切除术后组织缺损,能够恢复患者外形、语言和咀嚼功能的基本需求,提高患者的QOL。