Psychosocial effects in long-term head and neck cancer survivors

BACKGROUND: To identify and rate the importance of several psychosocial and physiologic influences on quality of life (QOL) among a cohort of 5-year head and neck cancer survivors, we conducted a cross-sectional study of a convenience sample that used both questionnaires and physiologic evaluations. METHODS: QOL was assessed by the Functional Assessment of Cancer Therapy (FACT) and the FACT Head and Neck additional concerns (FACT-H&N) questionnaires. Psychosocial characteristics (or risk factors) potentially influencing QOL were measured by the Millon Behavioral Health Inventory (MBHI) and the Social Support Questionnaire (SSQSR). Physiologic risk factors were measured in examinations that included shoulder and neck range of motion, whole and stimulated saliva measurements, and oropharyngeal swallowing efficiency. We evaluated the association of selected QOL measures with three groups of potential risk factors: psychosocial factors, consisting of selected MBHI and SSQSR scales; physiologic factors, consisting of selected physical ability measures; and a combination of psychosocial/physiologic factors. RESULTS: The entire study population of 105 subjects completed the FACT and FACT-H&N questionnaires; 86 of these completed the physiologic tests as well. Combined psychosocial/physiologic models best predicted all QOL measures considered. Psychosocial models alone, compared with physiologic models alone, better predicted FACT physical and social/family well-being measures. Physiologic models alone, compared with psychosocial models alone, better predicted FACT-H&N additional concerns measures. Premorbid pessimism (MBHI) was consistently the best predictor of QOL measures. CONCLUSIONS: Both psychosocial and physiologic factors influence QOL in patients with head and neck cancer, but many QOL measures are most strongly influenced by psychosocial considerations. Physicians and surgeons caring for long-term head and neck cancer survivors should be cognizant of the importance of psychosocial risk factors in the QOL of their patients.     

Genitourinary long-term outcomes for childhood cancer survivors

The treatment of pediatric malignancies represents one of the success stories of modern medicine. As survival has increased, the focus is now on minimizing harmful effects of treatment. There continue to be late toxicities and secondary malignancies of the genitourinary (GU) system for childhood cancer survivors related to the specific therapeutic exposures. A systematic approach is important for prevention and treatment of these adverse late GU effects.     

Functional outcomes following chemoradiotherapy for head and neck cancer

OBJECTIVE: To study functional outcomes following concurrent chemoradiotherapy of head and neck cancer. METHODS: A retrospective chart review assessed diet, feeding tube use, and tracheotomy pretreatment and 3, 6, 12, and 24 months posttreatment. RESULTS: Of 196 patients who underwent chemoradiotherapy between 1990 and 2002, 148 (76%) required feeding tubes immediately posttreatment; 150 (77%) required nutritional support at 3 months. By 12 months, 92% were tube-free and 83% resumed near-normal diet. Of 17 patients (9%) with tracheotomy posttreatment, 71% were decannulated by 6 months. Stage IV disease strongly predicted prolonged feeding tube use and slow recovery of diet; age > or =60 also predicted slow recovery. Primary site, gender, and radiotherapy schedule did not predict functional recovery after adjusting for stage and age. CONCLUSION: Few patients required tracheotomy before or during chemoradiotherapy. Many patients required feeding tubes and nutritional support for several months following therapy, but most were tube-free and eating near-normal diets within 1 year. EBM RATING: C.     

Psychosocial adjustment of patients surgically treated for head and neck cancer.

Sixty-six patients, surgically treated for head and neck cancer and free of disease, were interviewed at the outpatient clinic from 6 months to 8 years after surgery. The patients were divided by the physician into two groups, according to the patients' degree of disfigurement, i.e., minor (24 patients, 36%, minor disfigurement group = MDG) or extensive (42 patients, 64%, extensive disfigurement group = EDG). Subsequently, the patients were interviewed with close-ended questions. The following subjective aspects were assessed: self-image; relationship with the partner, family, and friends; and the overall impact of the therapy. The results of the study showed a significantly higher impact in the EDG versus the MDG as regards a changed self-image (57% vs 25%, P less than 0.05), a worsened relationship with the partner (27% vs 0%, P less than 0.05), a reduced sexuality (74% vs 39%, P less than 0.01), and an increased social isolation (36% vs 12%, P less than 0.05). On the whole, 18% of the subjects stated that the disadvantages of therapy outweighed the advantages, and 30% fell that the difficulties encountered were "too harsh." In such cases, the opportunity of setting up a rehabilitation program offering psychosocial support should be considered.     

Quality of life of long-term survivors of surgically treated lung cancer

Quality of life (QOL) of long-term survivors (more than 3 years after surgery) of primary non-small cell lung cancer was studied. QOL was analyzed using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 30-Item version 3.0 (QLQ-C30) and Hospital Anxiety and Depression Scale (HADS). Sixty of 91 patients (66%) participated in this study 87 +/- 5 (38-172) months postoperatively. In QLQ-C30, calculated scores of physical (84.0 +/- 2.4), role (81.3 +/- 3.6), cognitive (79.7 +/- 2.6), emotional (86.8 +/- 1.9), and social (91.0 +/- 1.9) functioning, and global QOL (72.6 +/- 2.9) were obtained. Calculated HADS A (anxiety) was 3.3 +/- 0.3 and HADS D (depression) was 4.0 +/- 0.4. Postoperative follow-up duration was correlated with financial impact only. QOL of long-term survivors was influenced by gender histology, marital status, employment status, and academic carrier.     

Survival outcomes for second primary head and neck cancer: A matched analysis

Objectives: Determine if survival for second primary head and neck cancer is truly poorer than survival for first primaries.Methods: From the surveillance, epidemiology and end results database, 2 cohorts were constructed. One cohort consisted of patients with exactly 1 head and neck primary malignancy whereas the second cohort consisted of patients with exactly 2 head and neck primaries, restricted to second primaries of the tongue, tonsil, glottic larynx, and hypopharynx with squamous cell carcinoma histology. Demographic and extent of disease data were extracted. For each primary site, matched Kaplan-Meier survival analysis was conducted comparing overall survival between the 2 cohorts matching for primary site, year of diagnosis, age, sex, and cancer stage.Results: A total of 410 cases of second head neck primary were successfully matched to patients with single primary disease. Among 166 patients with oral tongue SCCA, mean (median) survival was 45.9 (28) months after the second primary diagnosis versus 63.9 (32) months for matched single primary patients (P = 0.266, log-rank test). Among 103 tonsillar carcinomas, mean survival was 46.5 (26) versus 78.0 (77) months for the second primary and single primary cohorts, respectively (P = 0.009). Among 68 matched glottic carcinomas, mean survival was 46.4 (27) versus 103.5 (102) months for the 2 cohorts, respectively (P = 0.001). Among 73 matched hypopharyngeal carcinomas, mean survival was 47.5 (21) versus 35.1 (19) months, respectively (P = 0.608).Conclusions: Survivals for second primary head and neck malignancies are not necessarily poorer than survivals for comparable first primaries. Second primary survival will vary from site to site.     

Swallowing outcomes after radiotherapy for head and neck cancer: a systematic review

BACKGROUND: A systematic review of the current data on swallowing function after radiotherapy or chemoradiotherapy is presented. METHODS: Electronic databases were searched for 1966-2005. Papers were categorized according to level of evidence, methodological quality, and the specific domain of swallowing being measured. RESULTS: Of 109 papers retrieved, 33 were identified and reviewed. Evidence was primarily classified as either level III.2 (cohort studies) or level IV (case series). Methodological quality was found to be compromised in most studies. Although many researchers had investigated swallowing impairment, a wide variety of measurement tools were employed. CONCLUSIONS: There are limited data on swallowing outcomes after radiotherapy or chemoradiotherapy for head and neck cancer. Further work is needed to ascertain which aspects of swallowing should be measured, and then to use such measures in well-designed clinical trials and prospective cohort studies of this under-researched population.     

Cryosurgery for head and neck cancer

We have used cryosurgical technics in the management of 106 malignant lesions of the head and neck region over the past six years. Morbidity has been minimal and short-term follow-up study indicates satisfactory tumor control. We currently use cryosurgery for the treatment of oral leukoplakia, for multiple small primary carcinomas, for widely spreading but superficially invading tumors, and for malignant lesions adjacent to but not deeply invading bone. For palliation and in patients too ill for resectional therapy, we have also found this modality to be advantageous. We are pleased with the minimal cosmetic defect engendered by the cryosurgical destruction of facial skin cancer.     

Prioritizing treatment outcomes: head and neck cancer patients versus nonpatients

BACKGROUND: Treatment decisions in head and neck cancer (HNC) might involve consideration of uncertain tradeoffs of one late effect against another or increasing toxicity or residual impairment for increased chance of survival. Understanding how patients prioritize potential outcomes, as well as whether these preferences are similar to those of nonpatients, is important to informed decision making and treatment planning. METHODS: Two hundred forty-seven newly diagnosed HNC patients from nine institutions and 131 nonpatients rank ordered a set of 12 potential treatment outcomes (eg, cure; being able to swallow; normal voice) from highest (1) to lowest (12). RESULTS: Patients and nonpatients were similar with respect to the three items most frequently ranked in the top three, that is, "being cured of cancer," "living as long as possible," and "having no pain" in that order. In contrast, patients more frequently ranked "cure" (90% vs 80%) and less frequently ranked "no pain" (34% vs 52%) in the top three. CONCLUSIONS: Survival seems to be of paramount importance to both patient and nonpatient groups, overshadowing associated toxicities and potential dysfunction. At the same time, patients might be more willing than nonpatients to undergo aggressive treatments and endure acute distress in the interest of potential long-term gains (ie, cure or longer survival).     

Patients with head and neck cancer cured by radiation therapy: a survey of the dry mouth syndrome in long-term survivors

BACKGROUND: Xerostomia can have a significant impact on the quality of life of patients treated by radiation therapy (RT) for cancer in the head and neck. The first aim of the study was to evaluate the degree of xerostomia in 39 long-term survivors treated between 1965-1995 by conventional two-dimensional radiation therapy and currently without evidence of disease. The second aim was to develop a concise instrument to evaluate the subjective aspects of xerostomia. METHODS: A newly developed questionnaire and a visual analog scale (VAS) were used in analyzing the degree of dry mouth and xerostomia-related problems. The radiation dose received by the major salivary glands was estimated by analyzing two-dimensional simulation films. RESULTS: Sixty-four percent of the patients experienced a moderate to severe degree of xerostomia. In the multivariate analysis, three questions regarding dry mouth, eating, and speech were particularly discriminatory for establishing the degree of xerostomia as expressed by the VAS score. CONCLUSIONS: In this survey, 64% of the long-term survivors, after treatment by conventional two-dimensional radiation therapy for a malignancy in the head and neck region, still experienced a moderate to severe degree of permanent xerostomia. A simplified instrument to evaluate xerostomia subjectively can consist of the VAS score and three graded questions.