Quality of Life and Depression Symptoms After Therapy De-Escalation in HPV+ Oropharyngeal Squamous Cell Carcinoma: A Nonrandomized Controlled Trial.

Importance: Despite interest in therapy de-escalation for survivors of human papillomavirus-mediated oropharyngeal squamous cell carcinoma (HPV-positive OPSCC), the association of de-escalated therapy with patient-reported quality of life (QoL) outcomes and burden of depressive symptoms remains unclear. Objective: To identify associations between clinicopathologic and therapeutic variables with patient-reported QoL outcomes and depression symptom burden in patients with HPV-positive OPSCC, who were enrolled in a therapy de-escalation trial. Design, Setting, and Participants: In this nonrandomized controlled, open-label, curative-intent therapy de-escalation clinical trial in adults with stage I, II, and III HPV-positive OPSCC, patients were recruited from a high-volume head and neck oncology practice. Main Outcomes and Measures: The main outcomes of this study included quantitative, patient-reported QoL and depression symptoms per well-validated inventories. Patient-reported QoL was based on Functional Assessment of Cancer Therapy-Head & Neck (FACT-HN) scores (range, 0-148; lower score indicates inferior QoL). Patient-reported depression-related symptom burden was based on Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) scores (range, 0-27; a higher score indicates a higher burden of depression symptoms). Baseline clinicopathologic and treatment variables were paired with FACT-HN and QIDS-SR scores at baseline, 3, 6, 12, 24, and 36 months. Linear mixed-effect models with a random intercept were used for each participant and fixed effects for other measures. Regression coefficients are reported with 95% CIs. Results: A total of 95 patients were followed up for a median (IQR) of 2.2 (1.6-3.2) years. Of these, 93 patients (98%) were male with a mean (SD) age of 60.5 (8.2) years. Overall, 54 participants (57%) had a history of current or former smoking, 47 (50%) underwent curative-intent surgery (with or without adjuvant therapy), and 48 (50%) underwent primary radiotherapy (with or without chemotherapy). The median (IQR) radiotherapy dose was 60 (60-70) Gy. Five deaths and 2 recurrence events were observed (mean [SD] recurrence interval, 1.4 [1.5] years). A higher radiotherapy dose was the only modifiable factor associated with inferior patient-reported QoL (lower FACT-HN) (coefficient, -0.66 [95% CI, -1.09 to -0.23]) and greater burden of depression-related symptoms (higher QIDS-SR) (coefficient, 0.11 [95% CI, 0.04-0.19]). With the 70-Gy dose as reference, improvements in FACT-HN and QIDS-SR scores were identified when patients received 51 to 60 Gy (coefficient, 12.75 [95% CI, 4.58-20.92] and -2.17 [-3.49 to -0.85], respectively) and 50 Gy or lower (coefficient, 15.03 [4.36-25.69] and -2.80 [-4.55 to -1.04]). Conclusions and Relevance: In this nonrandomized controlled, open-label, curative-intent therapy de-escalation trial, a higher radiotherapy dose was associated with inferior patient-reported QoL and a greater burden of depression-related symptoms. This suggests opportunities for improved QoL outcomes and reduced depression symptom burden with a reduction in radiotherapy dose. Trial Registration: ClinicalTrials.gov Identifier: NCT04638465.

Gender-specific differences concerning psychosocial aspects and functional impairments that influence quality of life in oral cancer treatment.

PURPOSE: Patients with oral cancer have gender-specific differences with respect to health-related quality of life (HRQoL) and psychosocial variables (PV). The aim of the present study was to evaluate HRQoL and PV outcomes in patients treated for oral squamous cell carcinoma. METHODS: Data of 1234 patients were collected from a multicenter rehabilitation study of the German-Austrian-Swiss Cooperative Group on Tumours of the Maxillofacial Region (DÖSAK). Patient characteristics, oncological variables, post-treatment impairments, general quality of life (QoL), and PV (coping strategies, control beliefs, personal traits, perceived social support, depression, anxiety, and fear of tumor recurrence) were recorded. RESULTS: After treatment, HRQoL was similar between genders concerning general QoL, but men experienced significantly more treatment-related functional impairments influencing HRQoL. PV revealed gender-specific coping strategies, with women reporting significantly more "depressive coping," "religiosity," "fatalistic externality," and higher "social burden." Owing to their religious coping strategies, fatalistic attitude, and perceived higher social integration, women demonstrated superior disease acceptance, despite higher depression, anxiety, and lower psychosocial resilience. Conversely, men reported more introverted personal traits and lower social integration. CONCLUSION: Interventions during oral cancer treatment should address PV and have gender-specific elements to improve HRQoL after therapy.

Characteristics of patients diagnosed with cervical cancer in Brazil: preliminary results of the prospective cohort EVITA study (EVA001/LACOG 0215).

OBJECTIVES: Cervical cancer is the fourth most common cancer in women worldwide. Epidemiological and quality of life (QoL) data in patients with cervical cancer from low- and middle-income countries are scarce. We aimed to describe sociodemographic and clinicopathological characteristics and quality of life of patients with cervical cancer at diagnosis in Brazil. METHODS: EVITA is a prospective cohort study of newly diagnosed patients with cervical cancer from May 2016 to December 2017, stages I-IVB, from 16 Brazilian sites representing the five Brazilian regions. At baseline, medical evaluation was performed and European Organization for Research and Treatment of Cancer (EORTC) QLQ-CX24/C30 questionnaires were administered. RESULTS: A total of 631 patients were included. Mean±SD age was 49.3±13.9 years; skin color was non-white in 65.3%, and 68.0% had ≤8 years of formal education. In total, 85.1% of patients had a Pap smear. The main reasons reported by patients for not having a Pap smear were: lack of interest (46.9%), shame or embarrassment (19.7%), lack of knowledge (19.7%), and difficulty with access (9.1%). Most patients were diagnosed with locally advanced or metastatic disease (FIGO clinical stage II-IV in 81.8%- stage II in 35.2%, stage III in 36.1%, and stage IV in 10.5%). Patients with clinical stage III-IV had worse physical functioning and role functioning. CONCLUSIONS: Cervical cancer in Brazil is usually diagnosed at an advanced stage. Most patients have low formal education and are unemployed. Lack of interest was identified as a main reason for not having a screening test, and limited access was reported as a reason by <10% of the patients. Awareness campaigns must be a governmental priority, specially focused on the needy population, along with wide access to treatment.

Assessing Human Papillomavirus Awareness and the Role of Oropharyngeal Squamous Cell Carcinoma Education on Improving Intention to Vaccinate.

OBJECTIVES/HYPOTHESIS: The current state of the U.S. public's knowledge of the relationship between human papillomavirus (HPV) and HPV vaccinations to oropharyngeal squamous cell carcinoma (OPSCC) is unknown. Our objective was to 1) assess the general population's knowledge of human papillomavirus (HPV) and willingness to vaccinate, and 2) assess whether targeted education on HPV-related OPSCC can change intentions to vaccinate. STUDY DESIGN: Online cross-sectional survey. METHODS: An online, cross-sectional survey utilizing U.S. census-derived quotas to represent the U.S. population was distributed and analyzed to 517 adults in 2020. RESULTS: Exactly 72.7% of participants stated that they had or would vaccinate their child against HPV and were designated as "vaccinators." In multivariate regression, Black individuals were less likely to be vaccinators (OR 0.51 [95% CI 0.27-0.94]), but those who were aware of HPV's role in OPSCC were more likely to vaccinate (OR 2.56 [95% CI 1.47-4.46]). Knowledge about vaccination side-effects, eligibility, and mechanisms of HPV spread was low. Only 30.6% of the sample reported understanding the role of HPV in OPSCC. Of these, 43.0% gained this knowledge exclusively from nonhealthcare professional sources, like television. When presented with four short HPV-OPSCC-centered facts (HPV's role in OPSCC etiology, prevalence of infection, clinically silent course, and vaccine preventative effects), 54.0% of "nonvaccinators" indicated a willingness to change their minds. CONCLUSIONS: General knowledge about HPV, HPV's role in OPSCC, and the vaccine remains low in the general population. There are racial disparities in willingness to vaccinate within this sample, but these may be overcome by effective education on HPV-related OPSCC. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:528-537, 2022.

Risk of Suicidal Self-directed Violence Among US Veteran Survivors of Head and Neck Cancer.

Importance: Head and neck cancer (HNC) survivors are about twice as likely to die by suicide compared with other cancer survivors. Objective: To examine the associations between precancer mental health and pain and postcancer receipt of mental health, substance use disorder (SUD), or palliative care services with risk of suicidal self-directed violence (SSDV). Design, Setting, and Participants: This retrospective cohort study used the Veterans Health Administration data of 7803 veterans with a diagnosis of HNC (stage I-IVB) who received cancer treatment between January 1, 2012, and January 1, 2018. Data were analyzed between May 2020 and July 2021. Exposures: Presence of precancer chronic pain and SUD diagnoses, and postcancer SUD, mental health, or palliative care treatment. Exposures were defined using International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes in Veterans Health Administration administrative data. Main Outcomes and Measures: Documented SSDV event, including suicide attempt or death by suicide, after HNC diagnosis. Results: Among the cohort of 7803 veterans (7685 [98.4%] male; mean [SD] age, 65 [10.7] years), 72 (0.9%) had at least 1 documented SSDV event following their cancer diagnosis, and 51 (0.7%) died by suicide. Four adjusted modified Poisson regression analyses identified that precancer chronic pain (incidence rate ratio [IRR], 2.58; 95% CI 1.54-4.32) or mood disorder diagnoses (IRR, 1.95; 95% CI, 1.17-3.24) were associated with higher risk of postcancer SSDV. Those who had at least 1 documented mental health (IRR, 2.73; 95% CI, 1.24-6.03) or SUD (IRR, 3.92; 95% CI, 2.46-6.24) treatment encounter in the 90 days following HNC diagnosis were at higher risk for SSDV. A palliative care encounter within 90 days of postcancer diagnosis was associated with decreased risk of SSVD (IRR, 0.49; 95% CI, 0.31-0.78). Conclusions and Relevance: In this cohort study, a high proportion of HNC survivors with an SSVD event died from their injuries. Identification of risk factors for SSDV among HNC survivors may help direct additional resources to those who are at high risk. Referral to palliative care appears to be an important component of supportive oncologic care to reduce the risk of SSDV.

Oral Psychosomatic Disorders in Family Caregivers of Oral Squamous Cell Carcinoma Patients.

OBJECTIVE: To investigate the oral psychosomatic disorders (PSDs) in family caregivers (FCs) of oral cancer (OC) patients and to evaluate the correlation between these oral PSDs to severity of depression anxiety and stress. METHODS: A total of 50 participants were included each in first degree relative (FDR), second degree relative (SDR) and control group. All the participants completed DASS-21 questionnaire and were subjected to thorough clinical history and oral examination. RESULTS: All the FCs reported statistically significant higher mean levels of depression, anxiety and stress compared to controls (p˂0.001). A significantly greater number of FCs (40.00%) reported oral PSDs than control group (12.00%). Most prevalent oral PSD in FCs was aphthous stomatitis followed by oral lichen planus, bruxism, burning mouth syndrome and myofascial pain dysfunction syndrome. Moreover, there was a preponderance of these diseases in FDR (60.86%) compared to SDR (26.08%). FCs with moderate to very severe depression, anxiety and stress showed higher prevalence of these oral PSDs compared to the ones with mild depression, anxiety and stress. CONCLUSION: The observations of higher prevalence of oral PSDs in FCs with psychological alterations can enhance healthcare professionals' awareness to better understand FCs' oral healthcare needs.
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Patient-Reported Quality of Life After Resection With Primary Closure for Oral Tongue Carcinoma.

OBJECTIVES/HYPOTHESIS: For early-stage oral tongue carcinoma and carcinoma in situ (ESOTCCIS), we evaluated patient-reported quality-of-life (QOL) outcomes following resection with primary closure (R-PC). STUDY DESIGN: Retrospective review at an academic cancer center. METHODS: Thirty-nine ESOTCCIS patients (Tis, T1, T2) who underwent R-PC without radiation completed the University of Washington Quality of Life Questionnaire Version 4 (UW-QOL) at least 6 months since R-PC (mean = 2.39 years; range = 0.5-6.7 years). We compared UW-QOL scores for pain, swallowing, chewing, speech, and taste to established normative population scores. Multivariable regression analysis evaluated factors associated with QOL impairment. RESULTS: ESOTCCIS patients who underwent R-PC in comparison to the normative population reported significantly worse mean speech (87.7 vs. 98, P < .001) and taste (85.6 vs. 95, P = .002) scores and no significant differences in mean pain (91.7 vs. 86, P = .96), swallowing (100 vs. 98, P = .98), chewing (97.4 vs. 94, P = .98) scores. For speech and taste, 59% (23/39) reported no postoperative change from baseline, whereas 41% (16/39) and 35.9% (14/39) reported mild impairment, respectively. Overall, postoperative QOL was reported as good, very good, or outstanding by 87.2% (34/39). Higher American Society of Anesthesiologists class, cT1 compared to CIS, and ventral tongue involvement were independently associated with worse speech. Age < 60 years was independently associated with worse taste. CONCLUSIONS: ESOTCCIS patients who undergo R-PC without radiation can expect long-term swallowing, chewing, and pain to be in the normative range. Although a majority of patients can expect to achieve normative speech and taste outcomes, R-PC carries the risks of mild speech and/or taste impairments. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:312-318, 2021.

Penile cancer trends and economic burden in the Brazilian public health system.

OBJECTIVE: To gather information on penile cancer epidemiologic trends and its economic impact on the Brazilian Public Health System across the last 25 years. METHODS: The Brazilian Public Health System database was used as the primary source of data from January 1992 to December 2017. Mortality and incidence data from the Instituto Nacional de Câncer José Alencar Gomes da Silva was collected using the International Classification of Diseases ICD10 C60. Demographic data from the Brazilian population was obtained from the last census by the Brazilian Institute of Geography and Statistics, performed in 2010 and its 2017 review. RESULTS: There were 9,743 hospital admissions related to penile cancer from 1992 to 2017. There was a reduction (36%) in the absolute number of admissions per year related to penile cancer in 2017, as compared to 1992 (2.7versus 1.7 per 100,000; p<0.001). The expenses with admissions related to this condition in this period were US$ 3,002,705.73 (US$ 115,488.68/year). Approximately 38% of the total amount was spent in Northeast Region. In 1992, penile cancer costed US$ 193,502.05 to the public health system, while in 2017, it reduced to US$ 47,078.66 (p<0.02). Penile cancer incidence in 2017 was 0.43/100,000 male Brazilian, with the highest incidence rate found in the Northeast Region. From 1992 to 2017, the mortality rates of penile cancer in Brazil were 0.38/100,000 man, and 0.50/100,000 man in the North Region. CONCLUSION: Despite the decrease in admissions, penile cancer still imposes a significant economic and social burden to the Brazilian population and the Public Health System.

A radical change: A qualitative study of patients' experiences of eating and daily living through the first year after oesophageal resection.

PURPOSE: The purpose of this study is to explore the lived experiences of patients in terms of eating and consequences in everyday life in the first year after oesophageal cancer surgery. METHODS: Thirteen patients participated in qualitative interviews one year after surgery for oesophageal cancer. Descriptions capturing the meaning of the lived experiences of patients were then derived from subsequent analysis and interpretation of the interviews. A phenomenological hermeneutical approach comprised the epistemological stance, and theoretical perspectives were drawn from Schutz' theory of everyday life. RESULTS: Patient descriptions of their experiences with food, eating and everyday life in the first year after oesophageal cancer surgery fell into four themes: Adjusting to a different anatomy - food and eating as a dominant and difficult activity; changed body - food and eating as an underlying shadow; feeling different - social consequences of changed eating; a nutritional jungle - guidance and support in an uncertain time. CONCLUSION: The physical and social consequences of oesophageal cancer resection upend everyday structures, requiring patients to adopt a new, conscious and reflexive approach to food and eating as a social activity. Continuous support from healthcare professionals and patient-to-patient interaction can help redefine everyday life.

Quality of life in patients with cervical cancer after open versus minimally invasive radical hysterectomy (LACC): a secondary outcome of a multicentre, randomised, open-label, phase 3, non-inferiority trial.

BACKGROUND: In the phase 3 LACC trial and a subsequent population-level review, minimally invasive radical hysterectomy was shown to be associated with worse disease-free survival and higher recurrence rates than was open radical hysterectomy in patients with early stage cervical cancer. Here, we report the results of a secondary endpoint, quality of life, of the LACC trial. METHODS: The LACC trial was a randomised, open-label, phase 3, non-inferiority trial done in 33 centres worldwide. Eligible participants were women aged 18 years or older with International Federation of Gynaecology and Obstetrics (FIGO) stage IA1 with lymphovascular space invasion, IA2, or IB1 adenocarcinoma, squamous cell carcinoma, or adenosquamous carcinoma of the cervix, with an Eastern Cooperative Oncology Group performance status of 0 or 1, who were scheduled to have a type 2 or 3 radical hysterectomy. Participants were randomly assigned (1:1) to receive open or minimally invasive radical hysterectomy. Randomisation was done centrally using a computerised minimisation program, stratified by centre, disease stage according to FIGO guidelines, and age. Neither participants nor investigators were masked to treatment allocation. The primary endpoint of the LACC trial was disease-free survival at 4·5 years, and quality of life was a secondary endpoint. Eligible patients completed validated quality-of-life and symptom assessments (12-item Short Form Health Survey [SF-12], Functional Assessment of Cancer Therapy-Cervical [FACT-Cx], EuroQoL-5D [EQ-5D], and MD Anderson Symptom Inventory [MDASI]) before surgery and at 1 and 6 weeks and 3 and 6 months after surgery (FACT-Cx was also completed at additional timepoints up to 54 months after surgery). Differences in quality of life over time between treatment groups were assessed in the modified intention-to-treat population, which included all patients who had surgery and completed at least one baseline (pretreatment) and one follow-up (at any timepoint after surgery) questionnaire, using generalised estimating equations. The LACC trial is registered with ClinicalTrials.gov, NCT00614211. FINDINGS: Between Jan 31, 2008, and June 22, 2017, 631 patients were enrolled; 312 assigned to the open surgery group and 319 assigned to the minimally invasive surgery group. 496 (79%) of 631 patients had surgery completed at least one baseline and one follow-up quality-of-life survey and were included in the modified intention-to-treat analysis (244 [78%] of 312 patients in the open surgery group and 252 [79%] of 319 participants in the minimally invasive surgery group). Median follow-up was 3·0 years (IQR 1·7-4·5). At baseline, no differences in the mean FACT-Cx total score were identified between the open surgery (129·3 [SD 18·8]) and minimally invasive surgery groups (129·8 [19·8]). No differences in mean FACT-Cx total scores were identified between the groups 6 weeks after surgery (128·7 [SD 19·9] in the open surgery group vs 130·0 [19·8] in the minimally invasive surgery group) or 3 months after surgery (132·0 [21·7] vs 133·0 [22·1]). INTERPRETATION: Since recurrence rates are higher and disease-free survival is lower for minimally invasive radical hysterectomy than for open surgery, and postoperative quality of life is similar between the treatment groups, gynaecological oncologists should recommend open radical hysterectomy for patients with early stage cervical cancer. FUNDING: MD Anderson Cancer Center and Medtronic.

A surgical approach to squamous cell carcinoma of penis that also resolved the psychological dysfunction of the patient.

In this case study, we present an unusual case with squamous cell carcinoma surrounding the penis involving foreskin and glans of penis. In addition, multiple satellite nodules were noted in the pubis. A 57-year-old circumcised heterosexual male patient presented with a penile lesion existing for 10 years. At the same time, he was referred to an outpatient memory clinic because of persistent subjective memory complaints associated with depression and anxiety. The patient was operated under general anaesthesia. The lesion was resected circumferentially with macroscopic clearance, resulting in complete degloving of the penile shaft. Neurovascular bundles were preserved. Histopathological analysis of the lesion revealed an invasive and poorly differentiated squamous cell carcinoma, and the surgical margins were free from tumour. The patient was followed for 18 months. He did not have voiding difficulty. Pelvic tomographic and physical examination findings did not reveal any episode of recurrence or metastasis. Treatment of carcinoma resulted in a simultaneous full recovery of his memory decline and he remained free of depression and anxiety symptoms over time.

Effect of the sense of coherence and associated factors in the quality of life of head and neck cancer patients.

The sense of coherence (SOC) is a measure of global orientation regarding the ability of individuals to cope with stressful situations. The aim of the present study was to evaluate the association between SOC and quality of life (QoL) and clinical and sociodemographic characteristics among survivors of oral, oropharynx, hypopharynx, or larynx cancer. A cross-sectional study was conducted with 90 cancer patients in follow up at the Santa Maria University Hospital in southern Brazil who had completed conformal 3D radiotherapy at least three months earlier. QoL was assessed using the University of Washington Quality of Life (UW-QOL) questionnaire and SOC was measured using the Brazilian version of the SOC-13 questionnaire. Data on socio-demographic characteristics and the disease were obtained from patients' charts. Oral clinical conditions were also evaluated. Associations between exploratory variables and mean UW-QOL scores were evaluated through Poisson regression and the results were presented as rate ratios (RR) and 95% confidence intervals (CI). The mean overall UW-QOL score was 67.90 (± 18.71). Moderate and high SOC scores were associated with higher mean UW-QOL scores, that is, individuals with a stronger SOC demonstrated better QoL, (p < 0.05). Regarding the clinical variables, individuals with advanced stage cancer and those with hyposalivation and trismus had poorer QoL (p < 0.05). Patients with a greater SOC reported a better quality of life. Our findings show the importance of focusing on psychosocial factors, which can alleviate the impact caused by the disease and improve the QoL of these patients.

Factors associated with the quality of life for hospitalized patients with HPV-associated oropharyngeal squamous cell carcinoma.

PURPOSE: Oropharynx squamous cell cancer (OPSCC) is a type of head and neck squamous cell carcinoma. The raising OPSCC incidence is mainly attributed to human papillomavirus (HPV). HPV-related OPSCC has a relatively good prognosis, the concerns are focused on the improvement of quality-of-life (QOL). We aimed to figure out the factors which may affect the QOL of HPV-related OPSCC patients after treatment. METHODS: This study included patients with HPV-related OPSCC. The QOL of the patients were analyzed through the administration of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30)-Chinese version, the European Organization for Research and Treatment of Cancer Head and Neck Cancer Module-35 (EORTC QLQ-H&N-35)-Chinese version, and Eating Assessment Tool-10 (EAT-10). Multivariable regression analysis was employed to detect the influence of predictor variables on the QOL of patients. RESULTS: A total of 294 HPV-related OPSCC patients were involved in this research. The results of EORTC QLQ-C30, EORTC QLQ-H&N-35, and EAT-10 demonstrated that the treatment decreased the QOL of HPV-related OPSCC patients. Several different factors including marital status, consumption of tobacco and alcohol, tumor sites, clinical stages, therapeutic strategies, and neck dissection were proved to have influence on QOL of HPV-related OPSCC after treatment. CONCLUSION: Based on the analyzation of the QOL at baseline and after treatment, we demonstrated several factors which influenced the QOL of HPV-associated OPSCC patients after treatment. These results can make a great contribution to the improvement of the QOL after treatment.

Quality of Life in Patients with Surgically Removed Skin Tumors.

Background and Objectives: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected by the morbidity risk, surgery, and cosmetic or functional aspects. The aim of this study was to evaluate the quality of life of patients with skin cancer prior to and post surgical intervention. Material and methods: We performed a prospective study on 247 patients with skin tumors. Quality of life was evaluated through an initial questionnaire that was given to all consenting patients. This was used to determine patients' mobility, selfcare, normal activities, pain, and despair, using a five-point Likert scale. The general autoperceived health state was also recorded using a 100-point scale. The study included the responses of all patients at hospital admission, after one month of surgery, and after one year of surgery. Results: In patients with squamous cell carcinoma (SCC), the general health state indicator statistically significantly decreased one month after surgery and increased at one-year follow-up. In malignant melanoma (MM) patients, mobility, selfcare, normal activities, and discomfort presented a decrease in values one year after surgery, compared to the values registered at hospital admission. In patients with basal cell carcinoma (BCC), all indicators of quality of life presented an impaired value one year after surgery, after a decreasing trend. The general health state indicator statistically significantly increased one month after surgery and after one year. Conclusions: Surgery is one of the main steps in treating skin cancer. It has a great impact on patients' quality of life because of pain andthe effect on mobility and normal activities. Skin cancers influence the quality of life of patients both psychologicallyand physically.

Provider decision regret-a useful method for analysis of palliative thoracic re-irradiation for lung cancer?

BACKGROUND: The overall usefulness of palliative thoracic re-irradiation depends on the balance between efficacy, survival, and toxicity, and is difficult to judge from previous studies. In the absence of patient-reported data, we developed a method for provider decision regret that addresses the question "would we re-irradiate this patient again in light of the known outcome?" Furthermore, we analyzed different reasons for decision regret and defined a subgroup at increased risk. PATIENTS AND METHODS: A retrospective analysis of 33 patients with lung cancer re-irradiated with 17-45 Gy was performed. Reasons for decision regret included re-irradiation within the last 30 days of life, immediate radiological progression after re-irradiation (as opposed to stable disease or objective response), radiation myelopathy, any grade 4-5 toxicity, grade 3 pneumonitis, and other grade 3 toxicity in the absence of a symptomatic benefit or a time period of at least 3 months without worsening of the treated tumor. RESULTS: Median survival time was 5.2 months (95% confidence interval 3.4-7.0 months). Symptomatic and radiological responses were observed. Provider decision regret was declared in 12 patients (36%): 2 patients with grade 3 pneumonitis, 3 patients with a short survival (radiotherapy during the last 30 days of life), and 7 patients with progression. Decision regret was declared only in patients with Eastern Cooperative Oncology Group (ECOG) performance status (PS) 2 or 3 and was associated with a time interval to re-irradiation <6 months. CONCLUSION: Our data support the usefulness and acceptable side effects profile of palliative re-irradiation for lung cancer. Patients with reduced PS are at increased risk of futile treatment. Future research should aim at prediction of immediate disease progression (the prevailing cause of decision regret). Evaluation of provider decision regret has the potential to improve the way we learn from retrospective databases and should also be considered for other scenarios where high-quality prospective outcome data are lacking.

Validation of the English Basal and Squamous Cell Carcinoma Quality of Life (BaSQoL) Questionnaire.

BACKGROUND: Keratinocyte carcinomas (KC) impact patient quality of life (QoL). There is a need for validated QoL instruments specific to KC. The Basal and Squamous Cell Carcinoma QoL (BaSQoL) questionnaire was developed to comprehensively measure issues of importance to patients with KC. OBJECTIVE: To validate and characterize the BaSQoL questionnaire for QoL measurement after diagnosis and treatment of KC. METHODS: This was a prospective, observational study. Patients with basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) were asked to fill out BaSQoL, Skin Cancer Index (SCI), and Hospital Anxiety and Depression Scale (HADS) questionnaires. Descriptive statistics and classical test theory were used to assess validity. RESULTS: One hundred eighty-seven subjects enrolled in this study: 122 with BCC and 65 with SCC. One hundred seventy-one subjects (91.4%) completed questionnaires at all 3 time points; 16 patients (8.6%) were lost to follow-up. Overall performance using classical test theory was good, with good internal consistency (Cronbach's α 0.63-0.80). BaSQoL subscales were strongly correlated with subscales of the SCI, demonstrating convergent validity, and weakly correlated with HADS, showing divergent validity. CONCLUSION: The English language version of BaSQoL has good face, content, and construct validity. This study validates BaSQoL for use in English-speaking patients with BCC and SCC.

Campaign to Increase Awareness of Oral Cancer Risk Factors Among Preadolescents.

Oral squamous cell carcinoma (OSCC) represents one of the most common but scarcely known malignancies worldwide. The etiology of OSCC is strongly related to lifestyle habits and behavior, especially tobacco smoking and alcohol abuse. The mean age of individuals who start smoking and drinking alcohol is decreasing; thus, the aim of our campaign was to test the awareness and increase knowledge of oral cancer and its risk factors among young preadolescents. Six schools with 460 students aged 12-14 years were included in the campaign. A lecture about carcinogenesis and oral cancer was provided. Anonymous questionnaires were submitted to the students before and after the lecture, to test their knowledge, awareness, and understanding. Before the lecture, the students showed very little awareness of oral cancer (26.8%), although almost all of them identified tobacco smoking as a risk factor (92.2%). After the lecture, the students showed a significant understanding of the provided information, thus increasing their awareness. On scales of 1-10, the students rated the appropriateness of the campaign at 8.9 and their overall appreciation at 8.7. Social campaigns, especially among young students, seem to be appreciated and may represent a powerful strategy for increasing knowledge about cancer risk factors, especially when they are highly related to lifestyle habits and behavior.

COVID-19 Pandemic: Oral Repercussions and its Possible Impact on Oral Health

Abstract Many viral infections cause oral manifestations, including disorders in odontogenesis, resulting in dental malformations. In this review, based on current knowledge, we will discuss the likely dental and oral consequences of COVID-19. In this article, we review currently available data associated with vertical transmission of COVID-19 and odontogenesis, oral manifestations, and the impact of COVID-19 pandemic on a diagnosis of oral diseases. Owing to the severity of the pandemic, the population's anxiety and fear of becoming infected with COVID-19 may underestimate the signs and symptoms of serious illnesses, besides discourage patients from seeking health, medical or dental services to determine the diagnosis of oral lesions. Thus, the COVID-19 pandemic could be an additional and aggravating factor for the delay of serious illness diagnosis, such as oral squamous cell carcinoma resulting in higher morbidity and worse prognosis. Several changes and oral lesions have been described as oral manifestations of COVID-19, such as dysgeusia, oral ulcers, petechiae, reddish macules, desquamative gingivitis, among others. Besides, it can cause major systemic changes and predispose opportunistic infections. As with other viral infections, oral manifestations, including dental anomalies, can occur as a direct result of SARS-CoV-2 infection. However, further studies are needed to guide and clarify possible oral changes.

Penile cancer trends and economic burden in the Brazilian public health system / Tendências e carga econômica do câncer de pênis no sistema público de saúde brasileiro

ABSTRACT Objective: To gather information on penile cancer epidemiologic trends and its economic impact on the Brazilian Public Health System across the last 25 years. Methods: The Brazilian Public Health System database was used as the primary source of data from January 1992 to December 2017. Mortality and incidence data from the Instituto Nacional de Câncer José Alencar Gomes da Silva was collected using the International Classification of Diseases ICD10 C60. Demographic data from the Brazilian population was obtained from the last census by the Brazilian Institute of Geography and Statistics, performed in 2010 and its 2017 review. Results: There were 9,743 hospital admissions related to penile cancer from 1992 to 2017. There was a reduction (36%) in the absolute number of admissions per year related to penile cancer in 2017, as compared to 1992 (2.7versus 1.7 per 100,000; p<0.001). The expenses with admissions related to this condition in this period were US$ 3,002,705.73 (US$ 115,488.68/year). Approximately 38% of the total amount was spent in Northeast Region. In 1992, penile cancer costed US$ 193,502.05 to the public health system, while in 2017, it reduced to US$ 47,078.66 (p<0.02). Penile cancer incidence in 2017 was 0.43/100,000 male Brazilian, with the highest incidence rate found in the Northeast Region. From 1992 to 2017, the mortality rates of penile cancer in Brazil were 0.38/100,000 man, and 0.50/100,000 man in the North Region. Conclusion: Despite the decrease in admissions, penile cancer still imposes a significant economic and social burden to the Brazilian population and the Public Health System.

RESUMO Objetivo: Reunir informações sobre as tendências epidemiológicas do câncer de pênis e seu impacto econômico no Sistema Único de Saúde nos últimos 25 anos. Métodos: O banco de dados de informações do Sistema Único de Saúde foi utilizado como fonte primária de dados de janeiro 1992 a dezembro 2017. Os dados demortalidade e incidência do Instituto Nacional de Câncer José Alencar Gomes da Silva foram coletados usando a Classificação Internacional de Doença CID10 C60. Os dados demográficos da população brasileira foram obtidos do último censo do Instituto Brasileiro de Geografia e Estatística, realizado em 2010, e em sua revisão, de 2017. Resultados: Ocorreram 9.743 internações relacionadas ao câncer de pênis de 1992 a 2017. Houve redução (36%) nas internações anuais absolutas em 2017 em comparação com 1992 (2,7 versus 1,7 por 100.000; p<0,001). Os gastos com internações neste período foram de US$ 3,002,705.73 (US$ 115,488.68/ano). Cerca de 38% do valor total foi gasto na Região Nordeste. Em 1992, o câncer de pênis custou US$ 193,502.05 ao sistema público, enquanto em 2017 reduziu para US$ 47,078.66 (p<0,02). A incidência em 2017 foi de 0,43/100.000 brasileiro do sexo masculino, com a maior taxa de incidência encontrada na Região Nordeste. De 1992 a 2017, as taxas de mortalidade por câncer de pênis foram de 0,38/100.000 homem, sendo 0,50/100.000 homem na Região Norte. Conclusão: Apesar da diminuição nas hospitalizações, o câncer de pênis ainda impõe uma carga econômica e social significativa à população brasileira e ao Sistema Único de Saúde.