Concomitant twice-a-day radiotherapy and chemotherapy in unresectable head and neck cancer patients: A long-term quality of life analysis.

BACKGROUND: The purpose of this study is to make a comparative analysis between acute toxicity with late toxicity. This study is based upon a French quality of life (QoL) questionnaire in a cohort of advanced head and neck (H&N) cancer patients treated by concomitant twice-a-day continuous radiotherapy with no acceleration and chemotherapy with cisplatin and 5-fluorouracil. METHODS: From September 1992 to November 1997, a prospective data bank of 91 patients was constituted. In November 1999, 31 patients were still alive and followed for more than 3 years. All patients had stage IV strictly unresectable squamous cell carcinoma of oropharynx or hypopharynx. A French specific H&N cancer QoL questionnaire was used at the end of radiotherapy and at the last date of follow-up of each patient (during 1999). p values reflect comparison of percentages obtained at the end of treatment with percentages at long-term follow-up. Statistical analysis was performed using chi(2) test (p <.05 considered as significant). Percentages obtained by the QoL questionnaire correspond to moderate-severe problems only. RESULTS: Twenty-nine of 31 (94%) patients participated in the QoL study. Acute treatment toxicities were severe with declines in virtually all QoL and functional domains. Globally, with an average long-term follow-up of 4.5 years (range 3-7 years after treatment), there is a statistical improvement in the following symptoms: dry mouth and sticky saliva (97% versus 55%, p <.05); tasting problems (35% versus 21%, not significant); swallowing problems (77% versus 36%, p <.05); and H&N pain (86% versus 9%, p <.05). Financial problems were not improved (21% versus 14%, not significant), and psychological problems (59% versus 5%) were statistically significant. Fourteen of 29 (48%) patients were drinking and 8 of 29 (28%) were smoking at long-term follow-up; at the diagnosis they were 86% and 90%, respectively. At long-term follow-up 22 of 29 presented good or very good QoL, and 25 of 29 said they had improved their initial QoL. CONCLUSION: The interest of twice-a-day radiotherapy with concomitant chemotherapy is to increase total radiotherapy equivalent dose without increasing late toxicity and also to improve locoregional control, survival, and long-term QoL/effectiveness ratio. Best supportive care is recommended to obtain both good QoL and cancer control in a long-term follow-up.     

Quality of life and illness perceptions in patients with recently diagnosed head and neck cancer

BACKGROUND: The purpose of this study was to investigate which illness perceptions of patients recently diagnosed with head and neck cancer explain variance in their quality of life (QOL) to identify potential targets for interventions aimed at improving QOL. METHODS: Sixty-eight patients (mainly with stage III and IV disease) completed the Illness Perception Questionnaire-Revised (IPQ-R) and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). RESULTS: Pretreatment cross-sectional results from this prospective study show that, after controlling for age and comorbidity, illness perceptions were significantly related to the QLQ-C30 physical, role, emotional, cognitive, social functioning, and global health subscales. Patients with increased attention to symptoms, who believed in a greater likelihood of recurrence, who were more likely to engage in self-blame, and who had a stronger emotional reaction to the illness had lower QOL scores. CONCLUSION: Our results suggest that restructuring negative pretreatment illness perceptions may help patients to cope more adequately during and after treatment.     

Health-related quality of life profiles based on survivorship status for head and neck cancer patients

BACKGROUND: As the methodologies for evaluating health-related quality of life (HRQOL) in head and neck cancer patients have matured over the past 10 years, there has been an increasing focus on reporting longitudinal data. These studies have primarily focused on long-term survivors. This study addresses the HRQOL of both long-term and short-term survivors. METHODS: This is a prospective, longitudinal study of 479 head and neck cancer patients followed for at least 3 years after diagnosis. Analysis of longitudinally collected HRQOL scores was based on survivorship status. RESULTS: The HRQOL for 3 survivorship groups: short-term (died <1 year), intermediate-term (died 1-3 years), and long-term survivors (alive >3 years) were different at all time points (pretreatment, 3, 6, and 12 months). Differences were greatest between the short-term and long-term survivors. Long-term survivors demonstrated the best HRQOL and an improving HRQOL trajectory at 12 months. The HRQOL of short-term survivors declined precipitously throughout all available follow-up. Intermediate-term survivors did show some improvement following treatment but had a declining HRQOL trajectory at 12 months. CONCLUSION: The HRQOL profiles of head and neck cancer patients differed significantly depending on survivorship status. Long-term HRQOL results should be analyzed within the context of the results for all of the patients eligible to have been included in the initial study cohort.     

Effects of psychosocial intervention on quality of life in patients with head and neck cancer

BACKGROUND: A longitudinal, prospective, case-control study evaluated if a psychosocial support program improved health-related quality of life (HRQL) in head and neck (H&N) cancer patients. METHODS: One hundred forty-four H&N cancer patients were included: 52 study patients and 92 controls. The study group met the support team repeatedly throughout the first year after diagnosis. HRQL was assessed three times during the first year and after 3 years using the EORTC QLQ-C30, EORTC QLQ-H&N35, and HADS. RESULTS: A few statistically significant differences were found, all favoring the controls. Controls reported better global quality of life after 1 year and felt less ill after 3 years. Depression and treatment-related side effects were prevalent in both groups. CONCLUSIONS: Our psychosocial support program did not improve HRQL in H&N cancer patients. Its effectiveness may be improved by evaluating and actively integrating HRQL assessments during the program, thereby enabling rapid and adequate symptomatic treatment and/or psychologic intervention.     

成人头颈部白癜风患者生活质量调查

目的：探讨影响成人头颈部白癜风患者生活质量的相关因素并进行量化分析,为临床选择合理的治疗方案提供线索。方法：以头面部脂溢性皮炎患者作为对照组,采用简体中文版皮肤病生活质量指数（dermatology life quality index,DLQI）和流调中心抑郁量表（center for epidemiologic studies depression scale,CES-D）,对确诊为头颈部白癜风和头面部脂溢性皮炎的患者进行面对面调查评估。结果：成人头颈部白癜风患者DLQI和CES-D分值显著高于对照组（P〈0.05）,且DLQI分值与CES-D之间存在正相关（r=0.48,P〈0.05）。结论：头颈部白癜风可以严重影响患者的生活质量,应及早进行治疗和心理疏导。     

阶梯式心理护理对头颈肿瘤患者焦虑抑郁和生活质量的影响

目的探讨阶梯式心理护理对头颈肿瘤患者焦虑与抑郁情绪和生活质量的影响。方法将86例有焦虑或抑郁情绪的头颈肿瘤住院患者随机分为干预组和对照组各43例,两组均给予常规健康教育和出院后随访,干预组在此基础上实施4步阶梯式心理护理方案,包括2周观察等待、4周指导性自助、6周面对面问题解决疗法、4周专业心理干预和(或)药物疗法,干预前后评估患者焦虑抑郁状况和生活质量。结果干预后干预组焦虑抑郁评分显著低于对照组,干预有效率显著高于对照组(均P 0. 01),干预组在疼痛、吞咽、感觉、发声和进食等生活质量方面有显著改善,与对照组比较,差异有统计学意义(P 0. 05,P 0. 01)。结论以阶梯式护理为指导的心理护理可有效改善头颈肿瘤患者的焦虑、抑郁状况,在一定程度上提升患者生活质量。     

The impact of head and neck cancer and facial disfigurement on the quality of life of patients and their partners

BACKGROUND: Psychological and physical stresses from head and neck cancer can be substantial for patients and partners. There is minimal research exploring treatment impact, particularly facial disfigurement after surgery. MATERIALS AND METHODS: Twenty-eight surgery and radiotherapy/brachytherapy/chemoradiation patients and 25 of their partners were compared with 23 radiotherapy/brachytherapy patients and 19 partners. Participants completed the Hospital Anxiety and Depression Scale, Psychosocial Adaptation to Illness Scale, Dyadic Adjustment Scale, and European Organisation for Research and Treatment of Cancer Quality Of Life Scale, including the Head and Neck Cancer module. The Dropkin Disfigurement and Dysfunction scale classified surgical impairment. RESULTS: Partners reported greater distress than patients on some scales. Patients did not have a lower quality of life compared with normal populations and other cancer patients. However, on the EORTC they did and were comparable to a normed sample of head and neck cancer patients. Treatment modality was not predictive of psychological vulnerability. DISCUSSION: Head and neck cancer patients do not necessarily experience poor quality of life. The disease can have a significant impact on partners.     

Elective gastrostomy,nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapy

Background: Chemoradiotherapy for treatment of advanced head and neck cancer (HNC) is used to achieve organ preservation without compromising survival. Because chemoradiotherapy usually impacts adversely on nutritional and functional status, feeding by percutaneous endoscopic gastrostomy (PEG) is often part of the management regimen for these patients, but the presence of a PEG tube can also be associated with reduced quality of life (QOL). This study aimed to examine the factors associated with PEG insertion and the effects of PEG use on QOL and functional outcomes in HNC patients receiving chemoradiotherapy. Method: Survey of 36 consecutive patients treated by primary chemoradiotherapy for HNC. Patient weight, age, tumour type, details of PEG insertion, feeding regimens and treatment were noted. The survey comprised the Performance Status Scale, the Functional Measure for Swallowing, Nutritional Mode and a self‐assessment of QOL. Results: PEG insertion within 1 month of treatment was associated with smaller fall in body mass index at 12 months than PEG insertion 1 month or more after the start of the treatment (P < 0.05). Body mass index change was inversely correlated with health‐related quality of life and significantly related to lower speech and swallowing function scores. Longer PEG duration correlated with poorer performance status and swallowing function (P < 0.01). Longer PEG duration also predicted poorer overall QOL (P < 0.01) and poorer swallowing (P < 0.01) and speech (P < 0.05). Nutritional mode was related to overall QOL (P < 0.01). Conclusions: Nutritional support for HNC patients undergoing chemoradiotherapy is an essential component of patient care. Early PEG insertion and shorter PEG duration are associated with more favourable QOL‐related outcomes.     

Influence of social support on health-related quality of life outcomes in head and neck cancer

BACKGROUND: Evidence that social support influences health-related quality of life (HRQOL) in oncologic patients could be particularly important for head and neck cancer because this disease can affect speech, eating, and facial aesthetics. METHODS: Multiple regression analyses were used in this prospective, observational study to determine the association between 394 patients' ratings of perceived post-treatment social support and HRQOL outcomes while controlling for possible confounding variables. RESULTS: Higher social support scores were significantly associated with higher scores in speech (p = .007), aesthetics (p = .015), social disruption (p = .045), and general mental health (p = .016) and with fewer depressive symptoms (p = .023) but not with general physical health (p = .191) or eating (p = .114). The magnitude of differences in the HRQOL outcomes for patients whose social support scores fell in the lowest and highest quartiles were clinically meaningful. CONCLUSIONS: Given the association between social support and HRQOL outcomes in this patient population, modification of perceived social support through clinical interventions could improve the survivorship of these patients.