Prognostic Nutritional Index Predicts Toxicity in Head and Neck Cancer Patients Treated with Definitive Radiotherapy in Association with Chemotherapy

Background: The Prognostic Nutritional Index (PNI) is a parameter of nutritional and inflammation status related to toxicity in cancer treatment. Since data for head and neck cancer are scanty, this study aims to investigate the association between PNI and acute and late toxicity for this malignancy. Methods: A retrospective cohort of 179 head and neck cancer patients treated with definitive radiotherapy with induction/concurrent chemotherapy was followed-up (median follow-up: 38 months) for toxicity and vital status between 2010 and 2017. PNI was calculated according to Onodera formula and low/high PNI levels were defined according to median value. Odds ratio (OR) for acute toxicity were calculated through logistic regression model; hazard ratios (HR) for late toxicity and survival were calculated through the Cox proportional hazards model. Results: median PNI was 50.0 (interquartile range: 45.5–53.5). Low PNI was associated with higher risk of weight loss > 10% during treatment (OR = 4.84, 95% CI: 1.73–13.53 for PNI < 50 versus PNI ≥ 50), which was in turn significantly associated with worse overall survival, and higher risk of late mucositis (HR = 1.84; 95% CI:1.09–3.12). PNI predicts acute weight loss >10% and late mucositis. Conclusions: PNI could help clinicians to identify patients undergoing radiotherapy who are at high risk of acute and late toxicity.     

Perioperative enteral nutrition and quality of life of severely malnourished head and neck cancer patients: a randomized clinical trial

BACKGROUND AND AIMS: This study evaluated the use of perioperative nutritional support on Quality of Life (QOL) in malnourished head and neck cancer patients undergoing surgery. METHODS: 49 Malnourished (weight loss >10%) head and neck cancer patients who were included in a nutrition intervention trial were randomized to receive either no preoperative and standard postoperative tube-feeding (group I), standard preoperative and postoperative tube-feeding (group II) or arginine-supplemented preoperative and postoperative tube-feeding (group III). Of these patients, 31 completed a full QOL assessment on the first day of preoperative nutritional support, one day before surgery, and 6 months after surgery. Both a disease-specific (EORTC QLQ-C30) and a generic questionnaire (COOP-WONCA) were used. One way analysis of variance (ANOVA) and the Kruskal-Wallis test were applied for testing differences in scores between groups. RESULTS: Between baseline and the day before surgery, both preoperatively fed groups revealed a positive change for the dimensions physical and emotional functioning and dyspnea (with significance in group II, P=0.050,0.031,0.045 respectively). Group III showed a negative change in appetite (P=0.049). Between baseline and 6 months after surgery, there were no differences between group I and both pre-fed groups. There were no differences in favour of group III compared to group II. CONCLUSION: Enteral nutrition improves QOL of severely malnourished head and neck cancer patients in the period preceding surgery. No benefit of preoperative enteral feeding on QOL could be demonstrated 6 months after surgery.     

Costs and quality of life of multiple sclerosis in Spain

This cost-of-illness analysis is based on information from 1.848 patients in Spain and is part of a Europe-wide study on the costs of multiple sclerosis. The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity and progression. Patients were identified by the Asociación Española de Esclerosis Múltiple (AEDEM) and participated in the survey by answering a mail questionnaire (response rate 31.8%). In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all resource consumption, medical, non-medical, work absence and informal care, as well as utility (QOL). The mean age of the cohort was 45 years, and only 5.5% of patients were 65 years of age or more. Approximately 36% of patients had mild disease (Expanded Disability Status Scale [EDSS] score of 0–3), 44.8% had moderate disease (EDSS score of 4–6.5) and 17.7% had severe disease (EDSS score ≥7). The mean EDSS score in the sample was 4.5 (median 5.0), with a utility of 0.554. Costs and utility are highly correlated with disease severity. Workforce participation decreases from around 70% in early disease to less than 5% in the very late stages. Hospitalization is very infrequent in early disease, representing less than € 1.300 per patient per year for patients at EDSS scores <6, but increases steeply for patients at scores ≥7. Ambulatory care increases fivefold between early and late disease, while investments and services increase from basically no cost to just over € 6.000 at EDSS scores ≥7. Productivity losses increase more than eightfold, and informal care increases from € 593 at EDSS scores of 0–1 to nearly € 34.228 at scores of 8–9. Hence, total mean costs per patient are driven by the distribution of the severity levels in the sample, increasing from € 10.425 at EDSS scores of 0–1 to € 45.264 at a score of 7, and € 65.693 at scores of 8–9. The same is true for utility, which decreases from 0.865 to 0.084 as patients progress from the mildest to the most severe disability levels. However, the utility loss compared to the age- and gender-matched general population is high at all levels of the disease (～0.25 in patients below 30 years of age with an EDSS score of 2–3, and ～0.4 in patients over 60 years of age and a score of ≥6), leading to an estimated annual loss of 0.276 quality-adjusted life-year per patient. Relapses for patients with an EDSS score below 5 are associated with a cost of approximately € 2.750 and a utility loss of 0.1 during the quarter in which they occur.     

Costs and quality of life in multiple sclerosis in The Netherlands

This cost-of-illness analysis based on information from 1.549 patients in The Netherlands is part of a Europe-wide study on the costs of multiple sclerosis (MS). The objective was to analyze the costs and quality of life (QOL) related to the level of disease severity and progression. Patients from three specialized MS centres participated in the survey by answering a mail questionnaire (response rate, 52%). In addition to details on the disease (type of disease, relapses, level of functional disability), the questionnaire asked for information on all resource consumption, medical, non-medical, work absence, early retirement and informal care as well as QOL (expressed as utility). The mean age of the cohort was 47 years, and 7.6% of patients were 65 years of age or more. Forty-eight percent of patients had mild disease [Expanded Disability Status Scale (EDSS) score of 0–3], 40% moderate disease (EDSS score of 4–6.5) and 11% severe disease (EDSS score of 7 and above). The mean EDSS score in the sample was 3.9 (median 4.0), with a utility of 0.61. Costs and utility are highly correlated with disease severity. Workforce participation decreases from around 75 to 80% in early disease to less than 5% in the very late stages. Hospitalization is very infrequent in early disease, representing less than € 500 per year for patients at EDSS scores below 6, but increases steeply for patients at an EDSS score of 7 and above. Ambulatory care increases fivefold between early and late disease, while services rise from basically no cost to almost € 8.000 per year at an EDSS score of 7 and € 19.000 per year at EDSS scores of 8–9. Productivity losses are multiplied by 10 in late disease, while informal care increases from € 300 per year at EDSS scores of 0–1 to nearly € 15.000 per year at EDSS scores of 8–9. Hence, total mean costs per patient are driven essentially by the distribution of the severity levels in the sample, increasing from € 9.300 per year at EDSS scores of 0–1 to € 50.000 per year at an EDSS score of 7 and € 78.000 per year at EDSS scores of 8–9. The same is true for utility, which decreases from 0.85 to 0.05 as the disease becomes severe. However, the utility loss compared to the age- and gender-matched general population is high at all levels of the disease (0.25 at an EDSS score of 2 to 0.4 at EDSS scores of 5–6), leading to an estimated annual loss of 0.24 quality-adjusted life-years (QALYs) per patient. Relapses for patients with an EDSS score below 5 are associated with a cost of around € 2.800 and a utility loss of 0.15 during the quarter in which they occur.     

Efficacy of Glutamine in the Prevention of Oral Mucositis and Acute Radiation-Induced Esophagitis: A Retrospective Study

Glutamine is a nutraceutic with antioxidant and immune functions that can protect from adverse effects associated with radiation therapy (RT). The aim of this study was to test whether oral glutamine prevents oral mucositis (OM) or acute radiation-induced esophagitis (ARIE) and favors nutritional status. This retrospective, cohort study included patients treated with RT for cancer on head and neck (HN) or chest areas during the 2008–2010 period. Data on glutamine treatment (initiated before RT, during RT, or no glutamine), appearance of mucositis (according to World Health Organization criteria), weight loss (WL) during RT, moderate [body mass index (BMI) <20.5 kg/m² or WL > 5%) or severe (BMI < 18.5 kg/m² or WL > 10%) malnutrition, and nutritional support were collected. Quantitative data were compared using Student's t-test and analysis of variance, and qualitative data using the chi-square test. The risk difference was calculated with its 95% confidence interval (95% CI). The sample included 117 patients. Overall, glutamine was associated with a significant reduction of mucositis, WL, and enteral nutrition. The risk difference for developing OM in patients receiving glutamine when compared with controls was -9.0% (95% CI = ?18.0% to ?1.0%), and for ARIE it was ?14.0% (95% CI = ?26.0% to ?1.0%). More of the patients not receiving glutamine developed severe malnutrition when compared with those receiving this supplement, but there were no differences in other outcomes such as interruption of RT, hospitalization, use of opioid analgesics, or death during RT. Glutamine may have a protective effect during RT, reducing the risk and severity of OM and ARIE, preventing weight loss, and reducing the need for nutritional support. Prospective trials are required.     

营养干预对头颈部肿瘤急性放射性口腔粘膜反应的影响

目的:探讨营养干预对头颈部肿瘤放疗病人营养状态及急性放射性口腔粘膜反应的影响。方法:68例接受放疗的头颈部恶性肿瘤病人随机分为营养干预组(33例)和对照组(35例),分析比较两组在放疗前、放疗结束时、放疗后1个月的营养状况评分、平均体质量、体质指数和急性粘膜反应分级。结果:放疗前两组营养评估分数无统计学差别(P0.05)。在放疗结束,放疗结束后1个月时,营养干预组的营养评估分数明显低于相应时间点的对照组(P0.001,P0.05);对照组的评估分数明显高于放疗前(P0.001,P0.05)。放疗开始后营养干预组体质量基本保持稳定;在放疗结束时,营养干预组平均体质量明显高于相应时间点的对照组(P0.001);对照组的平均体质量明显低于放疗前(P0.001)。营养干预组体质指数基本保持稳定;在放疗结束,放疗结束后1个月时,营养干预组体质指数明显高于对照组(P0.001,P0.05);对照组的体质指数明显低于放疗前(P0.001,P0.05)。在放疗中两组严重急性放射性口腔粘膜反应(Ⅲ+Ⅳ级)发生率比较差异无显著意义(P0.05);而放疗结束后1个月时,营养干预组总的急性放射性口腔粘膜反应(Ⅰ+Ⅱ+Ⅲ+Ⅳ级)发生率明显低于对照组(χ2=4.556,P0.05,P0.05),严重反应(Ⅲ+Ⅳ级)发生率也明显低于对照组(χ2=4.712,P=0.030,P0.05)。结论:营养干预可以有效维持头颈部肿瘤放疗病人的营养状态,促进急性放射性口腔粘膜反应的恢复。     

Elevated Burden for Caregivers of Children with Persistent Asthma and a Developmental Disability

To evaluate how having a child with both persistent asthma and a developmental disability (DD) affects caregiver burden and quality of life (QOL). 3–10 year old children with persistent asthma in urban Rochester, NY. Cross-sectional baseline survey (2006–2009). Parent report of autism spectrum disorder or other behavioral disorder requiring medication. Caregiver burden and QOL as measured by scores on previously validated depression, parenting confidence, and asthma-related QOL scales as well as an assessment of competing demands on the caregiver. Bivariate and multivariate regression analyses controlling for caregiver age, education, marital status, race, ethnicity, and child asthma symptom severity. We enrolled 530 children as part of a larger study (response rate: 74; 63 % Black, 73 % Medicaid). Of this sample, 70 children (13 %) were defined as having a DD. There were no differences in asthma symptom severity between children with and without a DD diagnosis. However, even after adjusting for potential confounders, caregivers of children with a DD reported worse scores on the depression (p = .003), parenting confidence (p < .001), and competing demands (p = .013) scales and worse asthma-related QOL (p = .035) compared to caregivers of typically developing children with asthma. Despite having similar asthma symptom severity, caregivers of children with both persistent asthma and a DD diagnosis report more burden and lower QOL compared to that of caregivers of typically developing children and persistent asthma. Further attention to this subgroup is needed to promote optimal support for caregivers.     

Weight loss during radiotherapy for head and neck malignancies: what factors impact it?

Radiotherapy (RT) is an important treatment modality in head and neck cancers. Loss of weight during RT due to various factors is a matter of concern. This study was conducted to see the pattern of weight loss and the causative factors involved. One hundred forty patients with head and neck cancer treated with radical RT, concurrent chemoradiation, or postoperative RT were retrospectively studied. A dose of 70 Gy was given in the radical and in the chemoradiation schedule. In postoperative RT, a dose of 60-64 Gy was delivered. During the weekly review of the patients, serial recording of their weight was done along with measurement of other parameters. Analysis was done to see which factors were causative in patients having a weight loss of >5 kg and of >10%. Three variables were found to be significant for the >5-kg weight loss. These were a low initial Karnofsky performance score (KPS; P < 0.001), use of chemoradiation (P < 0.001), and a total dose of >60 Gy (P = 0.04). For the >10% weight loss, the significant factors were low initial KPS (P < 0.001) and use of chemoradiation (P < 0.001). Therefore, it is important to take care of the nutrition of those patients who have a low KPS, are on chemoradiation, or will be delivered a dose of >60 Gy. The role of prophylactic Ryle's tube placement or agents such as megestrol acetate in such patients should be further investigated.     

Discriminative aspects of two generic and two asthma-specific instruments: relation with symptoms, bronchodilator use and lung function in patients with mild asthma

The objective of this study was to compare the two most frequently used asthma-specific quality of life (QOL) questionnaires and two generic QOL questionnaires with clinical data in order to establish their ability to discriminate in asthma severity, also referred to as cross-sectional construct validity. We conducted a multicentre, randomized, placebo-controlled study investigating the long-term effects of the long-acting ß2-agonist formoterol in asthma patients using inhaled corticosteroids and short-acting ß2-agonists. Before randomization, the peak expiratory flow (PEF) and use of ß2-agonists for relief of symptoms were recorded twice daily for 1 month. At the end of the run-in period, the forced expiratory volume in 1s (FEV1), airway hyper-responsiveness (PC20 methacholine) and QOL were measured, using two asthma-specific questionnaires, the Asthma Quality of Life Questionnaire (AQLQ) and the Living with Asthma Quality of Life Questionnaire (LWAQ), as well as two generic questionnaires, the Short Form 36 (SF-36) and the Psychological General Well Being (PGWB) index. The quality of life of the patients (n=110) was only mildly impaired. The mean symptom score was 3.6 on a scale of 0-21 and the mean FEV1 was 65% of that predicted. The correlations between the QOL parameters and objective measures of asthma severity, such as the FEV1, PEF and PC20, were low (0.01-0.37). The correlations between the QOL parameters and subjective measures of asthma severity, such as symptom scores (range 0.26-0.65) and ß2-agonist use for the relief of symptoms (0.09-0.39), were higher. The correlations of the activity and symptoms domains of the AQLQ with diary-obtained symptom scores were r=0.50 (p[lessthan]0.0001) and r=0.65 (p[lessthan]0.0001), respectively. The correlation between the physical construct of the LWAQ and symptom scores was r=0.42 (p[lessthan]0.001) and that between the physical sumscore of the SF-36 and symptom scores was r=0.50 (p[lessthan]0.001). The correlation between the PGWB and symptom scores was r=0.41 (p[lessthan]0.001). The relation between the FEV1, PEF and PC20 and QOL was very low. The QOL measurements related well to the symptom scores. The AQLQ had a better cross-sectional construct validity than the LWAQ. The cross-sectional construct validity of the SF-36 was surprisingly high for this group of patients and the SF-36 performed better than the PGWB and LWAQ.     

Costs and quality of life of multiple sclerosis in Austria

This cost-of-illness analysis is part of a Europe-wide study on the costs of multiple sclerosis (MS) and is based on information from patients in Austria. The objective was to estimate the costs and quality of life (QOL) related to the level of disease severity and progression. Questionnaires were sent to 2995 patients registered with a nationwide patient organization. Patients were asked to provide details regarding the type of disease, relapses, level of functional disability, resource consumption (medical and non-medical), work absence, sick leave and informal care, as well as QOL. Surveys from a total of 1.019 (34.0%) patients were used in the analysis, of which the mean (standard deviation [SD]) age was 50 (12.2) years; 70% of patients were female. Patients with mild disease (Expanded Disability Status Scale [EDSS] score 0–3) represented 41% of patients, 36% had moderate disease (EDSS score 4–6.5) and 22% had severe disease (EDSS score ≥7). The mean (SD) EDSS score in the sample was 4.4 (2.4), with a mean (SD) utility of 0.55 (0.32).Costs are presented from the societal perspective as well as from the viewpoint of payers of care and invalidity. Mean total annual costs for an average patient in the sample were estimated at € 40.300 in the societal perspective, whereas payers’ costs were estimated at only half of this. Disease-modifying drugs represented a quarter of all costs in the payer perspective, but only 12% of societal costs. For society, the highest cost was the loss of productivity (36%), while payments for this loss (invalidity pensions and sick-leave compensation) accounted for only 21% of total costs to payers. Costs are highly correlated with disease progression, increasing four-fold from early disease to very severe disease (€ 16.000 to € 63.800). Mean annual costs per patient reported are thus determined by the distribution of disease severity in the sample. Workforce participation decreases from roughly 75% in early disease to less than 10% in the late stages, despite the fact that 70% of patients with an EDSS score of 8 or 9 are still below the official retirement age. Consequently, productivity losses increase over fivefold. In parallel, costs of informal care increase from € 325 per year at an EDSS score of 0–1 to over € 20.000 at an EDSS score of 8–9. Hospitalization is very infrequent in early disease, representing less than € 1.000 for patients with an EDSS score of 0–1, but increases steeply for patients with an EDSS score ≥5. QOL, measured as utility scores, decreases rapidly from almost 0.90 to 0.05 as disability becomes severe. However, the loss of utility is evident at all disease levels. Young patients with an EDSS score of approximately 2 have a utility that is 0.15 lower than matched individuals from the general population. This loss increases to approximately 0.4 for patients over 60 years of age with an average EDSS score of 6.0–6.5. Patients with a recent relapse had lower utility (–0.1) and higher costs (+ € 4.750).     

Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation.

Twenty-three patients with head and neck cancer were randomly allocated, regardless of pretreatment nutrition status, to receive either radiotherapy alone (12 patients) or radiotherapy plus nutritional oral supplementation (11 patients) with high-protein nutritional powder of balanced nutrient content (Ensure). Nutrition status was assessed subjectively and objectively for all patients before and at weekly intervals during the course of irradiation. All patients who received nutritional supplementation experienced an increase in body weight and in triceps skin-fold thickness, whereas 58% of the other group had weight loss (p = 0.001). Irradiation had to be suspended in 5 of the 12 patients who received no nutritional support because of severe mucosal reaction and/or poor performance status. All patients who received nutritional supplementation during radiotherapy had their course of irradiation without interruption.     

Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status

Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.     

Nutritional Intervention for Nonsurgical Head and Neck Cancer Patients Treated with Radiation Therapy: Results from a Prospective Stepped-Wedge Clinical Protocol

Aim: To evaluate the impact on weight loss (WL) of a standardized nutritional stepped-wedge protocol on consecutive head and neck cancer (HNC) patients treated with curative radiotherapy (RT).

Methods: We prospectively collected data of patients followed by a trained dietitian and treated according to a pre-defined stepped-wedge protocol. Patients with swallowing defect at the baseline and WL >10% 3 months prior to the beginning of RT were excluded from the analysis. Nutritional status was assessed at the baseline and weekly during the course of RT. Fluid and caloric intake were assessed through a 24-h recall.

Results: Between May 2010 and March 2011, 42 patients treated were evaluated. Median overall treatment time was 52.5 days. WL per CTCAE 4.03 was G0, G1 and G2 in 23 (55%), 14 (33%) and 5 (12%) patients, respectively. Thirty-five (83%) patients did not require enteral nutrition. About 90% of patients completed RT without interruption of oral feeding.

Conclusions: Despite the high toxicity profile of curative RT in HN, we proposed a standardized stepped-wedge protocol allowing to prevent severe WL in most of our patients. Further larger prospective studies are warranted to validate our approach and to achieve consensus on nutritional intervention in this subset of patients.     

The impact of concurrent granulocyte–macrophage colony-stimulating factor on quality of life in head and neck cancer patients: results of the randomized,placebo-controlled Radiation Therapy Oncology Group 9901 trial

Purpose

The Radiation Therapy Oncology Group (RTOG) conducted a randomized, placebo-controlled trial evaluating the efficacy of GM-CSF in reducing mucosal injury and symptom burden from curative radiotherapy for head and neck (H&N) cancer.

Methods

Eligible patients with H&N cancer receiving radiation encompassing ≥50 % of the oral cavity or oropharynx received subcutaneous GM-CSF or placebo. Quality of life (QoL) was assessed using the RTOG-modified University of Washington H&N Symptom Questionnaire at baseline 4, 13, 26, and 48 weeks from radiation initiation.

Results

Of 125 eligible patients, 114 were evaluable for QoL (58 GM-CSF, 56 placebo). Patient demographics, clinical characteristics, and baseline symptom scores were well balanced between the treatment arms. At the end of the acute period (13 weeks), patients in both arms reported negative change in total symptom score indicating increase in symptom burden relative to baseline (mean ?18.4 GM-CSF, ?20.8 placebo). There was no difference in change in total symptom score (p > 0.05) or change in mucous, pain, eating, or activity domain scores (p > 0.01) between patients in the GM-CSF and placebo arms. Analysis limited to patients treated per protocol or with an acceptable protocol deviation also found no difference in change in total symptom score (p > 0.05) or change in domain scores (p > 0.01) between treatment arms. Provider assessment of acute mucositis during treatment did not correlate with patient-reported mucous domain and total symptom scores (p > 0.05).

Conclusion

GM-CSF administered concurrently during head and neck radiation does not appear to significantly improve patient-reported QoL symptom burden.     

Electronic patient-reported outcomes and toxicities during radiotherapy for head-and-neck cancer

Purpose

To characterize quality of life (QOL) using real-time, electronic patient-reported outcomes (ePROs) and to evaluate adverse events (AEs) and supportive care during head-and-neck radiotherapy (RT) and concurrent chemoradiotherapy (CCRT).

Methods

Sixty-five patients undergoing head-and-neck RT completed electronic, real-time, 12-item linear analog self-assessments (LASA) at baseline, before biweekly appointments, and at the last week of RT. Changes in QOL domains between time points were calculated. Clinical data were collected from the institutional medical record. AEs were recorded at the same time points as the LASA and graded.

Results

During head-and-neck RT, most patients had clinically meaningful decreases in all QOL domains except level of support, financial concerns, and legal concerns. QOL domains with the most prevalent, clinically meaningful decreases were fatigue (75.4% of patients; 95% CI, 62.9–84.9%), social activity (70.8%; 95% CI, 58.0–81.1%), and overall QOL (70.8%; 95% CI, 58.0–81.1%). All patients had grade 2 AEs; 35.4% had grade 3 (50.0%, CCRT; 12.0%, RT; P?=?.002). Weight loss averaged 5.5 kg (6.9 kg, CCRT; 2.8 kg, RT; P?<?.001). Intravenous hydration was needed in 52.3% (77.5%, CCRT; 12.0%, RT; P?<?.001); feeding tube placement 40.0% (57.5%, CCRT; 12.0%, RT; P?=?.001); emergency department visits without hospitalization, 10.8%; and emergent hospitalization, 27.7% (37.5%, CCRT; 12.0%, RT; P?=?.04).

Conclusions

Head-and-neck RT, particularly CCRT, negatively impacts patients’ overall QOL, social activity, and fatigue, with frequent grade 3 AEs, weight loss, intravenous hydration, feeding tube placement, ED visits, and hospitalization. Real-time ePROs allow providers to monitor QOL at multiple time points during RT, potentially allowing early intervention to improve QOL and mitigate AEs.

     

Gastrostomy tube placement in head and neck cancer patients undergoing radiotherapy

Background: In head and neck cancer (HNC) patients, the side effects of radiotherapy (RT) often lead to patients being unable to consume adequate nutrition and fluid (Chencharick and Mossman, 1983). Gastrostomy tube placement prior to RT can reduce incidence of severe weight loss and hospitalization during treatment (Beaver et al., 2001). However, gastrostomy tube usage is dependant upon HNC site and area of RT. The aims of the study were to identify the characteristics of those HNC patients who will require gastrostomy tube feeding during RT and utilize these data to target future patients for prophylactic tube placement prior to commencing RT and to write guidelines for the placement of feeding tubes. Method: Data were collected retrospectively regarding diagnosis, surgery and area of RT on all HNC patients who had had a prophylactic gastrostomy placed prior to RT between April 2000 and April 2002. Outcome measurements in terms of utilization of gastrostomy, body weight and nutrition related emergency admissions were recorded. Results: Thirty‐five patients had a prophylactic gastrostomy placed [26 male, nine female; mean age 62 (range 26–84) years]. Of these, 26 utilized their tube for feeding or fluids during RT. The sites of radiotherapy were: bilateral RT to the oro‐ or nasopharynx and neck (20 patients), bilateral RT to the neck (five) and RT to the left oropharynx and neck (one). The mean weight loss during RT in patients who utilized their prophylactic gastrostomy was 3.3 (range 0–11.5%) compared to 8 (5.5–12.0%) in patients who did not have a prophylactic gastrostomy. Only one of the patients with a prophylactic gastrostomy had a hospital admission (length of stay 11 days) compared to four patients who did not [mean length of stay 21 days (range 14–29)]. Six of the nine patients who did not utilize their gastrostomy for feeding and were able to maintain their nutrition orally, received bilateral RT to the neck only. Discussion: Most of the patients who received bilateral RT to the oro‐ or nasopharynx required gastrostomy feeding during RT, which is consistent with findings of Beaver et al. (2001) who reported the highest incidence of weight loss in patients receiving RT to the nasopharynx or base of the tongue. Conclusion: In view of the association between the site of RT and gastrostomy utilization, hospital admissions, length of stay and weight loss, HNC patients with planned bilateral RT to the oro‐ or nasopharynx or with existing dysphagia should be targeted for gastrostomy tube placement prior to starting treatment. References: Beaver, M.E., Matheny, K.E., Roberts, D.B. & Myers, J.N.(2001) Predictors of weight loss during radiation therapy. Otolaryngol. Head Neck Surg. 125 , 645–648. Chencharick, J.D. & Mossman, K.L. (1983) Nutritionalconsequences of the radiotherapy of head and neck cancer. Cancer 51 , 811–815.     

Intravenous ω‐3 Fatty Acids Plus Gemcitabine

Background: Marine‐derived ω‐3 fatty acids (ω‐3FAs) have proven antitumor activity in vivo and in vitro and improve quality of life (QOL) in clinical cancer studies. These changes may be mediated by reduction in circulating proangiogenic and proinflammatory factors. In this first study of intravenous ω‐3FAs as a therapy in cancer patients, we aimed to assess if it could augment the antitumor activity of gemcitabine in patients with advanced pancreatic cancer and improve QOL. Materials and Methods: Patients were administered gemcitabine 1000 mg/m³ weekly followed by up to 100 g (200 mg/mL) of ω‐3 rich lipid emulsion for 3 weeks followed by a rest week. This was continued for up to 6 cycles, progression, unacceptable toxicity, patient request, or death. The primary outcome measure was objective response rate, with secondary outcome measures of overall and progression free survival, QOL scores, and adverse events. Results: Fifty patients were recruited. Response rate was 14.3% and disease control rate was 85.7%. Overall and progression free survival were 5.9 and 4.8 months, respectively. Increase in global health of > 10% over baseline was seen in 47.2% of patients. More than 50% of patients had > 10% increase in QOL scores in generic symptom scores and both disease‐specific domains. Grade 3/4 adverse events were thrombocytopenia (8%), neutropenia (12%), nausea or vomiting (4%), and chills (6%). Conclusion: Intravenous ω‐3FAs in combination with gemcitabine shows evidence of improved activity and benefit to QOL in patients with advanced pancreas cancer and is worthy of investigation in a randomized phase III trial.     

Evaluation of quality of life in patients with allergic rhinitis

Nasal symptoms of allergic rhinitis, such as watery rhinorrhea, sneezing and nasal obstruction, are thought to result in reduction in quality of life (QOL). In this study, we evaluated the QOL scores of patients suffering from allergic rhinitis, using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and the Short Form-36 (SF-36). One hundred twenty six patients with allergic rhinitis who visited the department of otolaryngology of UOEH and affiliated hospitals from April, 2003 to March, 2004 were enrolled in this study. Each symptom of allergic rhinitis was shown to degrade the RQLQ scores. In particular, nasal obstruction and severity of the disease strongly related to the RQLQ scores. All the SF-36 scores of allergic rhinitis patients were lower than those of standard Japanese. Nasal obstruction was severer, and ocular symptoms were milder in the perennial group than in the seasonal group. The QOL scores of emotional aspects were significantly different between generations. The QOL score of social functioning increased, and that of mental health decreased with age. These results clearly indicate that nasal symptoms of allergic rhinitis cause degradation of QOL in daily and social lives. It would be interesting and necessary to evaluate QOL disturbance and loss of working efficiency in workers with allergic rhinitis in further studies.     

Association Between Preoperative Nutritional Status and Postoperative Outcome in Head and Neck Cancer Patients

Head and neck cancer patients treated with surgery often experience significant postoperative morbidities. Administering preoperative nutritional intervention may improve surgical outcomes, but there is currently a paucity of data reviewing the association between preoperative nutritional status and postoperative outcome. It is therefore of importance to investigate this association among head and neck cancer patients. To assess the association between preoperative nutritional status and postoperative outcome in head and neck cancer patients treated with surgery, a retrospective study of 70 head and neck cancer patients who were surgically treated between 2013 and 2014 in a tertiary referral head and neck surgery center in Hong Kong was conducted. Clinical data regarding preoperative nutritional status and postoperative outcome were retrieved from a computer record system. Logistic and linear regressions were used to analyze the appropriate parameters. A higher preoperative albumin level was associated with lower rates of postoperative complications and better wound healing (P < 0.05). In contrast, preoperative body mass index, hemoglobin level, and absolute lymphocyte count did not demonstrate significant associations with postoperative outcome. As high albumin levels are associated with better surgical outcome in head and neck cancer patients, preoperative intervention strategies that boost albumin levels could be considered for improving surgical outcome.     

麻风病患者抑郁状态与生存质量关系的多重线性回归分析

目的 分析麻风病患者抑郁状态与生存质量各维度间的相关关系。方法 采用流行病调查用抑郁自评量表（center for epidemiologic studies depression scale,CES-D）和世界卫生组织生存质量简表（world health organization's quality of life questionnaire-brief version,WHOQOL-bref）对广东省麻风病患者进行抑郁程度和生存质量调查,用多重线性回归方法分析抑郁程度得分与生存质量各维度间的关系和强度。结果 共263名麻风病患者完成了调查,其中男性177名（67.3%）,女性86名（32.7%）。131名（49.8%）调查对象有抑郁症状,有抑郁症状调查对象生存质量各维度评分均低于无抑郁症状对象,差异均具有统计学意义（均有P<0.05）。在各维度中,生存质量总评、生理健康、心理健康、社会关系和环境因素得分与抑郁症状的回归系数分别为-0.340、-0.322、-0.644、-0.424和0.244,除生存质量总评外,其他回归系数差异均具有统计学意义（均有P<0.05）。结论 广东省麻风病患者的抑郁症状发生率高,生存质量得分与CES-D得分有关联,应采用多层次的干预措施防止麻风病患者抑郁症的发生。