Multimodal Guided Self-Help Exercise Program to Prevent Speech,Swallowing, and Shoulder Problems Among Head and Neck Cancer Patients: A Feasibility Study

Background

During a 6-week course of (chemo)radiation many head and neck cancer patients have to endure radiotherapy-induced toxicity, negatively affecting patients’ quality of life. Pretreatment counseling combined with self-help exercises could be provided to inform patients and possibly prevent them from having speech, swallowing, and shoulder problems during and after treatment.

Objective

Our goal was to investigate the feasibility of a multimodal guided self-help exercise program entitled Head Matters during (chemo)radiation in head and neck cancer patients.

Methods

Head and neck cancer patients treated with primary (chemo)radiation or after surgery were asked to perform Head Matters at home. This prophylactic exercise program, offered in three different formats, aims to reduce the risk of developing speech, swallowing, shoulder problems, and a stiff neck. Weekly coaching was provided by a speech and swallowing therapist. Patients filled out a diary to keep track of their exercise activity. To gain insight into possible barriers and facilitators to exercise adherence, reports of weekly coaching sessions were analyzed by 2 coders independently.

Results

Of 41 eligible patients, 34 patients were willing to participate (83% uptake). Of participating patients, 21 patients completed the program (64% adherence rate). The majority of participants (58%) had a moderate to high level of exercise performance. Exercise performance level was not significantly associated with age (P=.50), gender (P=.42), tumor subsite (P=1.00) or tumor stage (P=.20), treatment modality (P=.72), or Head Matters format (Web-based or paper) (P=1.00). Based on patients’ diaries and weekly coaching sessions, patients’ perceived barriers to exercise were a decreased physical condition, treatment-related barriers, emotional problems, lack of motivation, social barriers, and technical problems. Patients’ perceived facilitators included an increased physical condition, feeling motivated, and social and technical facilitators.

Conclusions

Head Matters, a multimodal guided self-help exercise program is feasible for head and neck cancer patients undergoing (chemo)radiation. Several barriers (decreased physical condition, treatment-related barriers) and facilitators (increased physical condition, feeling motivated) were identified providing directions for future studies. The next step is conducting a study investigating the (cost-)effectiveness of Head Matters on speech, swallowing, shoulder function, and quality of life.     

CASE STUDY Syntactic comprehension of reversible sentences in semantic dementia

Background: A patient with semantic dementia had difficulty comprehending semantically reversible passive sentences in the Test for the Reception of Grammar (TROG). Investigations of patients with semantic dementia have typically focused on the lexical and semantic components of language. Syntactic abilities have received less attention, presumably because these are reported to be preserved until later stages of the disease. Aim: To localise the possible functional sources of deficient comprehension of passives in a Dutch man (EGY) with semantic dementia. Methods & Procedures: Dutch written sentence picture–matching tasks were used to investigate whether EGY assigned the thematic role of agent on the basis of word order, the presence of auxiliary plus inflected verb morphology, the by phrase, the presence of a locative preposition (against and after), or the lexical‐semantic specifications of the verbs push and chase. Outcomes & Results: EGY was able to understand reversible active and truncated passive sentences. He was impaired when comprehension depended on understanding the agentive role of the by phrase, although his performance improved when a locative preposition was available to highlight the theme of the action. Conclusions: Intact performance on reversible active sentences indicated spared ability to process canonical word order. EGY's ability to understand truncated passives showed comprehension of the auxiliary and inflected verb, perhaps resulting in a conceptual representation of the passive as an adjectival construction (e.g., the cow is pushed = the pushed cow). EGY's deficit in comprehending full passive sentences is explained as a failure to process the syntactic and lexical information in the agentive by preposition. In semantic dementia, the division between lexicon and grammar may be more apparent than real.     

Benign and malignant sinonasal lesions with intracranial extension: differentiation with MR imaging

Most sinonasal lesions that extend into the anterior cranial fossa are malignant tumors. However, benign inflammatory polypoid disease can also rarely be manifested in this manner. Fourteen surgically proved cases of such benign and malignant disease were studied with magnetic resonance (MR) imaging. The appearances of the benign and the malignant lesions were quite different and allowed the seven chronic polypoid lesions to be distinguished from the tumors. The benign lesions had nonhomogeneous appearances on MR images due primarily to varying degrees of free-water resorption and protein concentration. The tumors had primarily homogeneous low-to-intermediate signal intensities due to their highly cellular composition.     

Verbal fluency in senile dementia: an analysis of search and knowledge

This investigation concerns the ability to decide on superordinate category membership as a determinant of retrieval failure in fluency tasks. Subjects were 24 normal elderly (mean age 83) and 66 senile dementia patients (mean age 80.5). Two tasks were presented. In the recall task subjects were asked to supply instances of articles of clothing and fruits. In a recognition task subjects were tested for their knowledge of category membership. Normative production frequencies of the items in the recognition task were systematically varied from intermediate to very low. Senile dementia patients generated significantly (P less than 0.001) less instances of both categories than normal elderly. In contrast, recognition of category exemplars was not impaired. These results present direct evidence for the hypothesis that senile dementia patients know far more category instances than they are able to produce.     

Deletion of the human retinoblastoma gene in primary leukemias

As an initial step in evaluating the role of tumor suppressor genes in leukemogenesis, we surveyed primary leukemia cells from 130 patients for possible deletion of the retinoblastoma susceptibility (Rb) gene by Southern blot analysis. Two of them clearly showed homozygous deletion of Rb alleles. The first patient was a pre-B acute lymphoid leukemia (ALL) associated with a cytogenetic translocation: t(14;16)(q24;q22). The deletion was located at the 3' portion of the Rb gene, very close to the site of Rb gene deletion recently identified in an ALL cell line. The absence of Rb110 protein was further confirmed by Western blot analysis. The second patient was a chronic myelomonocytic leukemia (CMMoL), terminated in acute blastic transformation. Deletion of the 5' portion of Rb gene was found in leukemic cells in the chronic stage. The results indicated that inactivation of the Rb gene occurred in certain cases of leukemia. Its significance warrants further study.     

Ultrastructural localization of nonspecific esterase activity in guinea pig and human monocytes, macrophages, and lymphocytes

Using either hexazotized pararosaniline or new fuchsin as coupling agents, we investigated the ultrastructural localization of alpha- naphthyl acetate esterase (ANAE) activity in guinea pig bone marrow and peritoneal exudates, and in human peripheral blood cells. DFP- inhibitable ANAE activity was present on the cell surface of lymphocytes, monocytes, macrophages, neutrophils, eosinophils, basophils, megakaryocytes, platelets, and blasts. Demarcation lines in megakaryocytes and the perinuclear cisternae in normoblasts were also positive. In addition, lymphocytes, monocytes, and macrophages displayed ANAE activity associated with cytoplasmic-vesicle clusters (CVC). Reaction product was always present on the cytoplasmic surfaces of these vesicles and in the adjacent cytoplasm; vesicle interiors were invariably ANAE-negative. Small lymphocytes generally had a single large paranuclear ANAE-positive CVC, whereas mononuclear phagocytes had multiple discrete foci of similar appearing ANAE-positive CVC that sometime became confluent. ANAE activity was also found in the Gall bodies of human lymphocytes and in coated vesicles of macrophages. Cytoplasmic ANAE activity was increased in oil-induced guinea pig peritoneal macrophages. Both surface and cytoplasmic esterase activities had a neutral pH optimum. An identical distribution of reaction product was observed when alpha-naphthyl butyrate was employed as substrate. The function of these esterases, and their relation to known surface and cytoplasmic neutral proteases, awaits further investigation.     

Minimal-exposure transfusion and the committed donor

Autologous blood (collected preoperatively or salvaged intraoperatively) is the safest blood available for transfusion, but its use is not always feasible. It may be possible to decrease a patient's exposure to homologous donors. Pediatric cardiac surgery patients frequently are unable to donate autologous blood preoperatively. Since 1984, attempts have been made to provide parental apheresis platelets and intraoperative blood salvage to such patients to decrease their donor exposure. Further decreases in donor exposure have been the object of a program of collecting from one committed donor all the blood a patient is anticipated to need. This article reviews the experience with 50 pediatric cardiac surgery patients on such a program, in whom the mean decrease in homologous-donor exposure was 57 percent (range, 12-93%). Thirteen of these patients received only homologous blood products from one committed donor, for a mean decrease in homologous-donor exposure of 80 percent (range, 50-93%). A comparison of 12 of these 13 recipients with a matched control group showed no significant difference in red cell transfusion practice but a significant difference in the number of homologous-donor exposures per m2 of body surface area (BSA) (mean donor exposures/m2 of BSA: patients = 1.5, controls = 10.5). The use of one committed donor and autologous blood can provide a minimal-exposure transfusion.