Translation, linguistic validation and reliability of FACT-H&N questionnaire in Oral Cancer patients in Sudan.

BACKGROUND: This study aimed to translate and validate an Arabic version of the Functional Assessment of Cancer Therapy Head and Neck Scale (FACT-H&N, v-4) for use among Sudanese oral cancer patients. METHODS: The instrument underwent translation and validation following the standard FACT translation methodology. The translated instrument was pre-tested for face validity and content validity using semi-structured, in-depth interviews with ten oral cancer patients to assess acceptability. The questionnaire was pilot tested with 60 patients; reliability was tested for internal consistency with Cronbach's alpha while construct validity was tested using 'known-group validity'. RESULTS: The pre-test study revealed no major issues, apart from a reluctance to answer questions on sexual satisfaction. The FACT-H&N demonstrated good internal consistency, it considered five particular constructs: PWB, SWB, EWB, FWB and FACT-H&N, their Cronbach's α values were positive and close to 1 with values of 0.85, 0.788, 0.86, 0.895 and 0.703 respectively, indicating that the questionnaire was valid and the responses consistent. Sixty patients were asked the global health-related quality of life item, 36.3% rated their QOL as very good or good (36.3%), while 41.7% rated it as average, and 21.7% as poor or very poor. Then FACT subscale mean scores were tabulated against three categories; patients with very poor/poor recorded significantly lower scores indicating construct validity. Some psychometric properties were consistent with other FACT-H&N translations such as the Chinese, French, Pakistani and Malaysian. CONCLUSIONS: This study validates the Arabic version of the FACT-H&N. It is a reliable tool and, will assist further QoL research in other Arabic-speaking countries.

While survival rates are routinely used to evaluate treatment outcomes in oral cancer, increased understanding of the human cost of this disease highlights the need to also consider the impact of the disease and therapy on patients' quality of life (QoL). Measurement of quality of life outcomes requires a validated QoL questionnaire with proven applicability in that specific context. Little research has been undertaken on the QoL of cancer patients in Sudan and no published research exists to date on the QoL of Sudanese oral cancer patients. While an Arabic version of the FACT-G general questionnaire exists, the FACT-H&N module was not previously available in Arabic. This paper describes the translation of the FACT-H&N from English into Arabic to suit Sudanese patients and other Arabic-speaking patients, with a detailed pre-test review by 10 patients, a pilot study with 60 patients and further validation with 130 patients. This study represents the first QoL research undertaken in oral cancer patients in Sudan and provides some insight into the impact of oral cancer on their lives. Findings from this study indicate that the Arabic version of the FACT-H&N questionnaire is a valid, reliable and acceptable method for assessing health related QoL in Arabic-speaking Sudanese oral cancer patients. This work will benefit future researchers working with Arabic-speaking oral cancer patients.

Headache Management in Community Pharmacies.

Many headache patients self-medicate and choose their preferred analgesic from a range of acute analgesics available on the high-street and from community pharmacies. Little is known about their presenting symptoms, headache diagnosis and their preferred treatments. A questionnaire was distributed to community pharmacies in the Munster region of Ireland and was administered to patients requesting treatment for headache. A total of 1023 completed questionnaires were received, 76.7% (n=765) were female and 51.8% were aged 18-39 years. 53.3% (n=542) were not previously diagnosed by a GP and 49.6% (n=502) had never sought advice from a pharmacist. According to the symptoms described, 32% (n=327) had episodic migraine and a further 15.2% (n=155) had probable episodic migraine. 30.3% (n=310) had tension type headache. 10.7% (n=105) had chronic daily headache. Codeine based products were the preferred treatment choice for 43.1% (n=441). Triptans were the most effective, 68.6% (n=166), in those for whom they were previously prescribed. 11.8% (n=121) had medication-overuse. The community pharmacist is an important resource in headache management. An expanded role incorporating best practice management guidelines has the potential to improve the outcomes for many headache sufferers.

Conceiving a national head and neck cancer screening programme.

BACKGROUND: This study was undertaken to determine the optimum approach to screening for head and neck cancer based on international experiences. OBJECTIVE: To determine whether or not head and neck cancer is suitable for screening, and, if so, what the ideal approach should be. METHODS: An electronic search of online databases up to and including May 2014 was conducted. Key search terms included 'head and neck', 'cancer', 'screening', 'larynx', 'oropharynx' and 'oral'. RESULTS: Subset analysis of high-risk cohorts showed statistically significant improvements in early detection of head and neck cancer via screening. CONCLUSION: Current levels of public awareness regarding head and neck cancers are suboptimal, despite increased incidence and mortality. Scheduled and opportunistic screening, coupled with efforts to enhance education and health behaviour modification, are highly recommended for pre-defined, high-risk, targeted populations. This can enable early detection and therefore improve morbidity and mortality.

'I'll continue as long as I can, and die when I can't help it': a qualitative exploration of the views of end-of-life care by those affected by head and neck cancer (HNC).

BACKGROUND: Evidence currently suggests that many people would prefer to die at home. However, optimal end-of-life homecare depends on the patient's ability to express their care preferences, prognostic awareness, complexity of care, concordance of patient/carer preferences and availability of appropriate services/support. This study explores Irish Head and Neck Cancer (HNC) patient and caregivers' views on end-of-life care (EoLC), an area hitherto little studied. METHODS: Qualitative data were collected using semistructured, one-to-one interviews with HNC patients with therapeutic experience and their nearest caregivers (n=10, 7 patients, 3 carers). Interview topic guide was developed from the PRISMA EoLC survey. Thematic content analysis was employed to interpret findings. RESULTS: Thematic analysis identified five broad EoLC themes: prognostication, decision making, preferred focus of care/advanced care planning (ACP), preferred place of care/death, perceived barriers/supports to home death. Participants were very willing to discuss most aspects of EoLC, exhibiting no signs of distress. Patients were reluctant to discuss preferred focus-of-care and ACP. This seemed linked to an overly optimistic view of aggressive medical intervention. While carers favoured full patient involvement in decision making, patients were divided between wanting autonomy and those preferring a more passive approach. All expressed a preference for homecare, and most felt they would ideally prefer to die at home. However, decision making was considered a complex process intertwined with risks, responsibilities and commitments to others. Carer burden and symptom control were major concerns. CONCLUSIONS: Normalising discussions on EoLC may benefit those affected by HNC. However, in HNC, this needs to be done alongside discussions regarding potentially life-extending treatment, symptom management and support.

Dental health of Irish alcohol/drug abuse treatment centre residents.

OBJECTIVES: This study examines the independent and combined impact of 'alcohol only' and 'alcohol plus drug' abuse on the dental health of Irish alcohol/drug abuse treatment centre residents, comparing their dental caries experience. METHODS: Four Irish treatment centres were visited periodically over a year. Data was collected on residents' alcohol, tobacco and drug habits. Participants underwent comprehensive oral examination. RESULTS: Of 210 participants (148 males and 62 females), 53% reported an 'alcohol plus drug' abuse; 44% had an 'alcohol-only' abuse. 'Drug-only' abusers (n = 7) were excluded. Ages ranged from 18-73 with 59% aged under 40. 'Alcohol-only' abusers were significantly older than "alcohol plus drugs" abusers (p < 0.001). Mean DMFT (14.4, sd 7.3) and MT scores (7.3, sd 6.8) were above the national averages. "Alcohol-only" abusers had higher DMFT scores (p < 0.001), more missing teeth (p < 0.001) and more filled teeth (p < 0.01) than "drugs plus alcohol" abusers. DT scores did not vary significantly between study groups. Multivariate analysis confirmed the significance of gender (males OR = 2.31, p = 0.009) on DT scores and highly significant influence of age (age < 36, OR = 0.08, p < 0.001) on MT status. However, study group was not a significant influence once age was taken into consideration. CONCLUSIONS: The study reveals a high level of dental disease among Irish alcohol/drug abusers. While some authors have suggested that 'alcohol-only' abusers may experience less decay than 'alcohol plus drug' abusers, this study found no significant difference in the caries experience of the two groups once age was taken into consideration.

Prevalence of oral mucosal abnormalities in addiction treatment centre residents in Southern Ireland.

This study examines the prevalence of oral mucosal lesions and conditions among Irish addiction treatment centre residents and explores the feasibility and acceptability of a targeted oral cancer screening programme for such individuals. Four alcohol addiction treatment centres were visited periodically over a 12-month period. Two hundred and twenty residents (78% of 283 targeted) were interviewed regarding their alcohol, tobacco and drug habits (type, quantity, duration), and attitudes to dental care. Comprehensive oral examinations were performed. All potentially sinister soft tissue lesions/symptoms were referred for further investigation. Data analysis utilised SPSS-18. Ten participants who denied a history of alcohol/drug addiction were excluded from the main study. Remaining 210 participants comprised 148 males (70%) and 62 females (30%), ranging from 18 to 73 years of age, (mean 37.65; S.D. 13.82); 60% were under 40. High rates of tobacco and alcohol usage were recorded, 53% reported dual addiction (drug+alcohol), 44% alcohol only, 3% drug only. The prevalence of mucosal abnormalities was 29% with 84 mucosal abnormalities/symptoms detected in 61 subjects, comprising 28 extra-oral lesions/symptoms and 56 intra-oral lesions. Residents with mucosal abnormalities were significantly older (mean 41.8 years; S.D. 14.3) than those without such lesions (mean 35.95; S.D. 13.3), (p<0.05). Highest prevalences were noted for candidiasis (3.8%), facial scaring/laceration (3.8%), intra-oral lumps/swellings (2.9%), lymphadenopathy (2.9%) and hoarseness (1.9%). Four red areas suggestive of erythroplasia and two leukoplakic lesions were detected. Study addresses the paucity of data on the prevalence of oral mucosal lesions in addicted persons in Southern Ireland. Thirteen extra-oral lesions/symptoms and 19 intra-oral lesions were potentially significant. Despite the relatively poor follow-up compliance rate (33%), two premalignant lesions were confirmed in the main study group, yielding a detection rate of 0.9%. Results suggest that an oral cancer screening programme targeted at individuals in addiction treatment centres may provide a feasible way to access persons with a history of tobacco and alcohol abuse. A high rate of untreated disease and emergency only attendance was seen in this study suggesting a lack of engagement with GDP services. Opportunistic screening in primary care is therefore unlikely to capture this cohort. Inclusion of oral cancer screening in the routine medical examination given to residents of addiction treatment centres may provide an efficient and effective way to detect potentially malignant lesions in these high-risk individuals.

Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review.

BACKGROUND: Irradiation-induced xerostomia seriously reduces quality of life for patients with head and neck cancer (HNC). Anecdotal evidence suggests that acupuncture may be beneficial. OBJECTIVE: To systematically review evidence on clinical effectiveness and safety of acupuncture in irradiation-induced xerostomia in patients with HNC. METHODS: A detailed search was performed to identify randomised controlled trials (RCTs) and systematic reviews of RCTs on acupuncture in irradiation-induced xerostomia, using AMED, BNIA, CINAHL, Cochrane, Embase, HPSI, PsycInfo and Medline. Grey literature was explored and 11 journals hand searched. Search terms included: acupuncture, xerostomia, salivary hypofunction, hyposalivation, dry mouth, radiotherapy, irradiation, brachytherapy, external beam. Two authors independently extracted data for analysis using predefined selection criteria and quality indicators. RESULTS: 43 of the 61 articles identified were excluded on title/abstract. 18 articles underwent full-text review; three were deemed eligible for inclusion. Two trials had moderate risk of bias; one had high risk. Two trials compared acupuncture with sham acupuncture; one control arm received 'usual care'. Outcome measurements included salivary flow rates (SFRs) in two trials and subjective questionnaires in three. All three trials reported significant reduction in xerostomia versus baseline SFR (p<0.05); one reported greater effect in the intervention group for stimulated SFR (p<0.01). Subjective assessment reported significant differences between real acupuncture and control in two trials (p<0.02-0.05). Insufficient evidence was presented to undertake risk/benefit assessment. CONCLUSIONS: Limited evidence suggests that acupuncture is beneficial for irradiation-induced xerostomia. Although current evidence is insufficient to recommend this intervention, it is sufficient to justify further studies. Highlighted methodological limitations must be dealt with.

A national study on the attitudes of Irish dental faculty members to faculty development.

INTRODUCTION: International studies suggest that dental faculty are resistant to the concept and practice of faculty development. This paper analyses the demographic and educational profile of Irish Dental Faculty, exploring their attitudes to educational initiatives. METHODS AND MATERIALS: Irish dental faculty were invited to participate in a national study on perceived educational needs. A custom-designed questionnaire was distributed using a 'mixed-method' approach, incorporating both quantitative and qualitative components. Overall response rate was 64.6%. RESULTS: Analysis of the demographic profile of Irish dental faculty reveals a male dominated regime (64%). Whilst faculty possess many professional qualifications and extensive clinical experience, most have little or no training in how to teach. Many had attended teacher training programmes; however, 92% merely attended infrequent, informal sessions. Less than a third (30%) of the part-time staff had attended teacher training (P

International variation in the incidence of oral and pharyngeal cancer.

OBJECTIVE: An accurate epidemiological profile is a crucial component of any cancer strategy. The ongoing development of population-based cancer registries provides an invaluable information resource in this regard. Examination of international incidence levels indicates substantial geographical variation. This study assesses the precise extent of such variation. BASIC RESEARCH DESIGN: The age-standardised rates (ASRs) for oral and pharyngeal cancer (OPC) were analysed for 183 registries in the IARC/WHO publication CIFC-Volume VII. RESULTS: The median annual age-standardised incidence rates were mouth (2.3 per 100,000), tongue (2.0), lip (1.2), and salivary gland (0.6); the corresponding female rates were mouth (0.8), tongue (0.7), salivary gland (0.4) and lip (0.2). A substantial level of heterogeneity existed between registries in most instances. In the case of males, the highest ASR and the inter-quartile range of ASRs were as follows--mouth (highest rate of 12.4 per 100,000; IQR 1.4 to 3.6), tongue (max. 8.0; IQR 1.1 to 2.9), lip (max. 13.5; IQR 0.3 to 2.4) and salivary gland (max. 4.2; IQR 0.4 to 0.8). Corresponding statistics for females were also recorded. Comb graphs are used to highlight the significance of specific geographical-based trends and putative aetiological factors explored. CONCLUSIONS: This study reveals substantial international variation in the incidence rates of OPC, with up to 20-fold variation between countries in annual incidence rates for individual sites. The novel presentational technique makes this information readily accessible to non-specialists and highlights the need for disaggregation in future OPC studies.

Oral and pharyngeal cancer in Ireland.

Early diagnosis and treatment of cancer are essential to achieving a good prognosis. This is particularly true for oral and pharyngeal cancer (OPC) which accounts for over half a million new cases and 200,000 deaths worldwide per annum. Despite the high mortality and high morbidity associated with OPC, it remains a relatively unknown disease. The lack of public awareness and the low profile of this disease, even among health care professionals, are considered among the main reasons for late presentation, with 60% of cases presenting at an advanced stage. Due to the age and general medical profile of the average oral cancer patient, many attend their general physician on a regular basis. An opportunity therefore exists to increase the rate of detection of early asymptomatic lesions by opportunistic screening particularly of "high risk individuals". Furthermore, prompt recognition of symptomatic lesions has the potential to greatly enhance the outcome for these patients. The aim of this paper is to increase awareness of OPC and to highlight the need for closer interdisciplinary links between medical and dental professionals.