A structured review of journal articles reporting outcomes using the University of Washington Quality of Life Scale

The University of Washington Quality of Life Scale (UW-QoL) is one of the most frequently reported health-related quality of life (HR-QoL) questionnaires in head and neck cancer, and since its first publication in 1993 has been used in many different cohorts. There is a considerable amount of information to assimilate and, to date, we know of no attempt that has been made to summarise publications specific to its use in a peer review journal. The aim of this review was to systematically search published papers that report its use, identify common themes, and present a tabulated summary. Several search engines were used (PubMed, Medline, Medical-Journals.com, eMedicine), and 222 abstracts were found and hand searched. A total of 66 papers were eligible for inclusion, 21 on functional outcome, 25 on predictors of HR-QoL, 19 on development or validation of the questionnaire, and one clinical trial. The review includes a diversity of studies and a range of HR-QoL outcomes following head and neck cancer. It provides clinicians and their colleagues in multidisciplinary teams with a source of quick reference to relevant papers reporting the UW-QoL, and gives a short summary of the pertinent conclusions drawn from each paper.     

Development of the Greek version of the University of Washington Quality of Life questionnaire for patients with head and neck cancer

The University of Washington Quality of Life (UW-QOL) questionnaire, created in 1993 to evaluate health related quality of life, has been widely used in English-speaking populations and translated and validated in other languages. The aim of the present study was to carefully translate and psychometrically validate the UW-QOL questionnaire in Greek. The revised version of the questionnaire was obtained by forward and backward translation of the original English version, according to internationally accepted guidelines. Validation was performed in 120 patients with head and neck cancer treated in a Greek Anticancer Institute in Athens, during their follow-up visits. Eligible patients completed the Greek version of the questionnaire and two other previously validated quality of life questionnaires (EORTC QLQ H&N35 and C-30). Related data and the patients' demographics were extracted from the patient's notes. Strong internal consistency (mean Cronbach α value of 0.83) was shown, with good construct validity. Statistically significant differences were noted between tumour staging and treatment modality and global quality of life. Strong correlation was shown between previously validated EORTC questionnaires and the translated UW-QOL questionnaire. In conclusion, the Greek version of the UW-QOL questionnaire appears to be culturally appropriate and psychometrically valid.     

Evaluation of swallowing ability using swallowing sounds in maxillectomy patients

Maxillectomy for oral tumours often results in debilitating oral hypofunction, which markedly decreases quality of life. Dysphagia, in particular, is one of the most serious problems following maxillectomy. This study used swallowing sounds as a simple evaluation method to evaluate swallowing ability in maxillectomy patients with and without their obturator prosthesis placed. Twenty‐seven maxillectomy patients (15 men, 12 women; mean age 66.0 ± 12.1 years) and 30 healthy controls (14 men, 16 women; mean age 44.9 ± 21.3 years) were recruited for this study. Participants were asked to swallow 4 mL of water, and swallowing sounds were recorded using a throat microphone. Duration of the acoustic signal and duration of peak intensity (DPI) were measured. Duration of peak intensity was significantly longer in maxillectomy patients without their obturator than with it (P < .05) and was significantly longer in maxillectomy patients without their obturator than in healthy controls (P < .025 after Bonferroni correction). With the obturator placed, DPI was significantly longer in maxillectomy patients who had undergone soft palate resection than in those who had not (P < .05). These results suggest swallowing ability in maxillectomy patients could be improved by wearing an obturator prosthesis, particularly during the oral stage. However, it is difficult to improve the oral stage of swallowing in patients who have undergone soft palate resection even with obturator placement.     

Implications of the Quality of Life Metric in head and neck cancer

Across England the NHS (National Health Service) has set in place a national survey that invites cancer patients to report their quality of life around 18 months after their diagnosis. The two questionnaires are the EQ-5D-5L and EORTC C30. For head and neck cancer (HNC) several factors will affect patients’ characteristics and response rates at the 18-month window. There were three aims of this study: to account for drop-out over the first 18 months, to report the characteristics of responders in comparison with the whole cohort, and to summarise the health-related quality of life (HRQoL) outcomes (EQ-5D-5L and EORTC QLQ-C30). Patients treated with curative intent who were cancer-free at 15 months were sent a postal survey 16 months after diagnosis, with a second reminder at 18 months. Of the 256 patients analysed, 187 were alive at the 15-month follow-up window, 20 of whom were living with recurrence. Survival was related to tumour stage, treatment intent, and mode of treatment. A total of 109 (67%) responded and the response rate was better from older patients. Older patients reported better HRQoL across all measures apart from EQ-5D-5L mobility and EORTC physical functioning, while patients living in more deprived neighbourhoods reported worse HRQoL across all measures apart from loss of appetite. Other than a tendency for a worse HRQoL in patients having surgery with free-flap transfer, there were no obvious consistent differences by tumour stage, site, or treatment. In conclusion, when reflecting on the findings of the National QoL Metric (QoLM) in HNC, it will be important to consider the influence of survivorship and response rates.     

Evaluation of salivary cortisol levels in relation to dento-maxillary prosthesis adjustment

Purpose

The purpose of this study was to investigate the influence of dento-maxillary prosthesis adjustment procedure on levels of salivary cortisol.

21例儿童头颈部恶性肿瘤患者游离皮瓣修复临床分析

目的: 分析儿童头颈部肿瘤患者术区缺损游离皮瓣修复重建的临床特点。方法: 回顾2009—2011年于上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科接受头颈部恶性肿瘤切除以及游离皮瓣修复、年龄≤14岁患者的临床、病理及影像学资料。采用SPSS 17.0软件包对收集的数据进行统计学分析。结果: 最终纳入患者21例,其中男14例,女7例;17例为ASA Ⅰ级,4例为ASA Ⅱ级。中位手术时间480 min,中位术中出血量500 mL。6例患者接受气管切开。发生内科并发症7例,包括肺部感染4例,腹泻3例;外科并发症4例,包括皮瓣下血肿1例,创面裂开2例,腺瘘1例。气管切开术与内科并发症发生直接相关（P=0.035）,与总体并发症（P=0.064）发生具有潜在关联。结论: 游离皮瓣对于儿童头颈恶性肿瘤患者术区缺损修复具有极高价值,术后并发症是影响此类患者预后的主要负面因素,气管切开与术后并发症发生关系较大,需谨慎使用。     

Analysis of time taken to discuss new patients with head and neck cancer in multidisciplinary team meetings

Multidisciplinary team (MDT) meetings have an important role in the management of head and neck cancer. Increasing incidence of the disease and a drive towards centralised meetings on large numbers of patients mean that effective discussions are pertinent. We aimed to evaluate new cases within a single high volume head and neck cancer MDT and to explore the relation between the time taken to discuss each case, the number of discussants, and type of case. A total of 105 patients with a new diagnosis of head and neck malignancy or complex benign tumour were discussed at 10 head and neck cancer MDT meetings. A single observer timed each discussion using a stopwatch, and recorded the number of discussants and the diagnosis and characteristics of each patient. Timings ranged from 15 to 480 s (8 min) with a mean of 119 s (2 min), and the duration of discussion correlated closely with the number of discussants (r_s = 0.63, p < 0.001). The longest discussions concerned patients with advanced T stage (p = 0.006) and advanced N stage (p = 0.009) disease, the elderly (p = 0.02) and male patients (p = 0.05). Tumour site and histological findings were not significant factors in the duration of discussion. Most discussions on patients with early stage tumours were short (T1: 58% less than 60 s, mean 90) and fewer people contributed. Many patients, particularly those with early stage disease, require little discussion, and their treatment might reasonably be planned according to an agreed protocol, which would leave more time and resources for those that require greater multidisciplinary input. Further studies may highlight extended discussions on patients with head and neck cancer, which may prompt a review of protocols and current evidence.     

Internet use among head and neck cancer survivors in the North West of England

In general, use of the internet by patients in their healthcare is increasing. However, its use specifically among those with head and neck cancer in the UK has not been reported. The aims of this study were to report access to the internet by survivors of head and neck cancer, to indicate where it fits within their information sources, how they have used it, and how they might use it in future. A question on its use has been included in annual surveys of patients since 2006. Patient-reported access to the internet increased from 32% in 2006 to 54% in 2010. There were considerable differences in access by age; currently (2010) 83% of those under 55 years, and 40% of those aged 65-84 years. Binary logistic regression modelling involving age at survey (p<0.001), age leaving education (p<0.001), and sex (p=0.01), gave all three as independent predictors of access. In the 2010 survey 49% (234/473) never used the internet, 10% (49/473) used it rarely, 15% (70/473) used it occasionally, and 25% (120/473) used it often. The main reasons for its use for head and neck cancer were to find information, learn about treatment, side effects, and medication, and obtain advice from members of multidisciplinary teams. The findings of this study show that the internet has an important role for patients in providing information and support about their cancer, although other sources are still very important. Data from the study will help inform those promoting e-health about the type of resource that is wanted by patients.     

经皮咽造瘘术20例临床分析

目的：探讨经皮咽造瘘术在头颈部肿瘤切除和重建手术后提供肠内营养的临床效果。方法：2012年1月一2012年7月．20例行头颈部手术的患者存我科接受经皮咽造瘘术,由经皮咽造瘘胃管提供肠内营养支持。收集每例患者的相关资料．包括患者信息、诊断、治疗方法、安放胃管时间及出现的并发症,对治疗效果和并发症进行分析。结果：所有患者均能耐受经皮咽造瘘口留置的胃管,无营养不良表现。留置胃管时间最短6d,最长84d,平均43．8d。在随访期内．1例患者的胃管意外脱山,2例患者的造瘘口渗出物较多,1例患者诉说胃管异物感比较明显,1例患者因反流性食管炎于术后第6天拔除胃管,其余患者均未发现明显的并发症。拔管后造瘘口可白行愈合,瘢痕小,不影响美观,、结论：经皮咽造瘘术是安全可行的,具有美观、舒适的优点,简便、经济,容易推广,并发症少,是一项值得推荐的肠内营养方法。     

Sensitivity and specificity of sentinel lymph node biopsy in patients with oral squamous cell carcinomas using indocyanine green fluorescence imaging

Purpose

The purpose of this clinical study was to evaluate the sensitivity and specificity of cervical sentinel lymph node biopsy after mapping with indocyanine green fluorescence (ICG) for imaging early-stage oral cancer.

A synopsis of oncology and oncology-related papers published in the British Journal of Oral and Maxillofacial Surgery 2007–2008

This paper provides a summary of the 95 papers related to oncology that were published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) during 2007–2008. They include full length articles on clinical studies, radiology, basic science, and reconstruction in oral, and head and neck cancer. The journal also publishes technical notes and short communications. It encompasses the whole remit of the specialty and it is encouraging that authors choose to submit their work to BJOMS, but to improve the quality and status of the journal, we need to increase the ratio of full length articles to other submissions.Reviews of other subspecialties will be published in due course.     

Subset of patients with verrucous carcinoma of the oral cavity who benefit from treatment with methotrexate

Oral verrucous carcinoma (OVC) is a low-grade variant of squamous cell carcinoma (SCC) with a distinctive morphology and specific pattern of behaviour that is often diagnosed in elderly patients. Resection is the treatment of choice, with radiotherapy as a reasonable alternative. In this retrospective case review we present our experience and outcomes in a group of 12 patients with various stages of OVC who had not been treated conventionally because of the extent of their lesions and their poor general condition. All patients were given chemotherapy with methotrexate, which was given by various routes and in different doses during the period 1972-2010. In 11 patients treatment with methotrexate alone was beneficial. One patient failed to respond. Methotrexate used alone as chemotherapy may minimise morbidity and improve quality of life, particularly among elderly patients.     

Place and time of death in patients treated with palliative intent for oral cancer

Information about place and time of death can help patients, carers, general medical practitioners, and multi-professional teams to put palliation for oral cancer into context, particularly the aspirations of patients about where they die. Aintree Regional Maxillofacial Unit treated 487 consecutive patients for primary oral squamous cell carcinoma between 2006 and 2010. Mortality was ascertained from the Office for National Statistics. A total of 65 (13%) patients were treated with palliative intent, and median (IQR) survival was 4.3 months (2.1–8.0). The most common reasons for palliation were inoperability (33%) and extensive disease associated with serious comorbidity (18%). A total of 22 died in hospital, 14 in a hospice, 14 in their own home, 14 in a nursing, residential, or old people's home, and one elsewhere. Most patients given palliative care do not die in hospital and survival is short. Their needs and those of their carers can be better met through integrated care that is linked to the primary sector.     

Development of the clinical use of distant flaps for head and neck reconstruction

The reconstruction of hard and soft tissue defects, mainly after ablative oncologic surgery in the head and neck area, is an evolving field. The use of free flaps for reconstruction of the head and neck is considered to be the surgical standard. In our analysis of more than 1000 free flaps we give an overview of the development of the use of different types of free tissue transfer to the head and neck area over the last 25 years. We show that the evolving field of head and neck reconstruction raises new possibilities with new types of flaps, whereas other types of flaps disappear in the everyday clinical use. The spectrum of reconstruction possibilities broadens with the number of different flap types available to the head and neck surgeon.     

Prediction of post-treatment trismus in head and neck cancer patients

Our aim was to establish the incidence of trismus over time, together with risk factors (including quality of life (QoL)) for the prediction of trismus after treatment in patients with cancer of the head and neck. It was a longitudinal study of 152 patients accepted for primary operation who attended the head and neck cancer clinic of a tertiary referral cancer centre in the United Kingdom. A total of 87 patients was studied prospectively. Our results showed that 41/87 (47%) of patients presented with trismus, 57/80 (71%) had postoperative trismus, and 41/52 (79%) had trismus 6 months after operation or radiotherapy (trismus defined as a maximum mouth opening of ≤ 35 mm). Men and those who drank a lot of alcohol were less likely to have trismus after treatment. QoL variables showed that pain, eating, chewing, taste, saliva, social functioning, social contact, and dry mouth were significantly more impaired in the trismus group than among those without trismus. Postoperative differences in QoL between the two groups highlighted problems with social function and role-playing, fatigue, activity, recreation, and overall reduction in QoL. Women, and those who do not drink alcohol, are at particularly high risk of developing trismus, and, to prevent it and treat it, patients may benefit from multidisciplinary management at an early stage during treatment.     

Identification and characterization of novel human papillomaviruses in oral rinse samples from oral cavity and oropharyngeal cancer patients

ObjectivesThe objectives of this study were to: I) discover novel human papillomaviruses (HPVs) using next generation sequencing (NGS) technology in oral rinse samples collected from oral cavity cancer (OCC) and oropharyngeal cancer (OPC) patients; II) determine the prevalence of novel HPVs in archived OCC and OPC tissue samples; and III) examine the frequency of novel oncogenic HPVs in cancer and non-cancer oral rinse samples using real-time PCR.MethodsOral rinse samples were collected from 100 head and neck cancer patients, and 110 healthy individuals. NGS techniques were used to detect novel HPVs.ResultsThree potentially new types of HPV were discovered. Novel virus (NV) 14.4 was closely related to HPV76 with an 89% homology and is a member of the genus Beta-papillomavirus (β-PV); NV69.1 was distantly related to the genus Alpha-papillomavirus (α-PV), and NV95 was closely related to HPV147 with a 65–77% homology and is part of the genus Gamma-papillomavirus (γ-PV). In archived oral tissue samples, NV14.4 was detected in a single patient with OCC. Of the oral rinse samples, NV69.1 was more prevalent than the other two NVs.ConclusionsOur results demonstrated that there are novel HPVs present in oral rinse samples that may be associated with OCC and OPC. These novel HPVs can be identified and characterized using NGS techniques.     

let-7基因多态与中国汉族人群头颈癌易感性的关联研究

目的：探讨 let-7基因多态与中国汉族人群头颈癌易感性的关联。方法：采用病例-对照研究设计,以经确诊的503例头颈部癌患者作为病例组,选取900例健康人群作为对照组。对病例-对照进行流行病学调查,内容包括：一般人口学特征、疾病史、肿瘤家族史、吸烟、饮酒情况,并进行体格检查。收集研究对象血液标本5 mL,提取基因组 DNA。以 let-7 rs10877887和rs13293512为研究位点,应用TaqMan探针方法进行多态性检测,并用logistic 回归计算比值比（odds ratio,OR）及其95％可信区间（confidence interval,CI）,比较不同基因型与头颈癌患病风险的关系。结果：rs10877887位点3种基因型 TT、CT及 CC 在病例组分布频率分别为45．7％（227/503）、42．9％（213/503）及11．4％（57/503）;在对照组中分别为40．8％（361/900）、47．7％（422/900）及11．5％（101/900）。rsl3293512位点3种基因型 TT、CT 及 CC 在病例组分布频率分别为31．9％（157/503）、52．3％（257/503）及15．8％（78/503）,在对照组中分别为30．2％（270/900）、49．2％（439/900）及20．6％（194/900）。多因素 logistic 回归分析显示,携带 rs10877887位点至少1个突变等位基因 C 的个体与携带 TT基因型的个体相比,头颈部肿瘤患病风险差异无统计学意义（CC ＋CT/TT调整 OR＝0．82,95％ CI：0．90～1．23,P＝0．087）;与携带 TT＋CT基因型个体相比较,携带 rs13293512位点2个突变等位基因 C 的个体头颈部肿瘤患病风险显著降低（CC/TT＋CT 调整 OR＝0．73,95％ CI：0．55～0．98,P＝0．039）。结论：let-7 rs13293512位点多态可影响中国汉族人群的罹患头颈癌的风险。     

美国头颈癌患者生存资料分析

为使国内头颈癌生存分析的基本方法与国际一致，规范生存率分析的基本方法，以利于相互比较．本文以文字及表格方式，简述生存分析基本术语的概念、意义和应用，并介绍2002年第6版《美国头颈部肿瘤TNM分期》的1-5年观察生存率、相对生存率。