The impact of taste and smell alterations on quality of life in head and neck cancer patients.

PURPOSE: Taste and smell alterations (TSAs) are among the most frequent and troublesome symptoms reported by head and neck cancer (HNC) patients after treatment. Little is known about the relationship between TSAs and quality of life (QoL) among HNC patients. The aim of this study was to determine the effect of TSAs on overall QoL among tube-fed and orally fed HNC patients before treatment, at end of treatment and at 2.5-month follow-up. METHODS: Data were collected in a longitudinal study prior to treatment (n = 126), at end of treatment (n = 100) and at 2.5-month follow-up (n = 85). Chemosensory Complaint Score (CCS) and the University of Washington Quality of Life Questionnaire version 3 were used to assess TSAs and QoL, respectively. Generalized estimated equation modeling was used to estimate the effect of CCS on QoL. RESULTS: At end of treatment, QoL and CCS had declined for both tube-fed and orally fed patients and thereafter improved, but not to pre-treatment levels. Neither QoL nor CCS mean scores were different between the two groups at any time point. CCS was a significant predictor of overall QoL (ß = -1.82, p < 0.0001), social-emotional (ß = -1.76, p < 0.0001), physical (ß = -1.12, p < 0.0001) and overall functions (ß = -1.15, p < 0.0001) at a multivariate level. Taste was reported as an important symptom for both tube-fed and orally fed groups at end of treatment and follow-up. CONCLUSIONS: TSAs are an important symptom and an independent predictor of QoL for both tube-fed and orally fed HNC patients. HNC patients need support to manage TSAs, regardless of the method of nutritional intake.

Physical symptom burden of post-treatment head and neck cancer patients influences their characterization of food: Findings of a repertory grid study.

BACKGROUND AND AIM: Dietary advice for post treatment head and neck cancer (HNC) patients emphasizes food characteristics of nutritional value and texture, and not patients' characterization of food. The aim of this study was to determine patients' characterization of food. METHODS: Repertory grid interviews were conducted with 19 orally-fed HNC patients between 4 and 10 months post-treatment to characterize foods commonly eaten, avoided and eaten sometimes. Patients compared and rated 12 foods using their own descriptors. Data were analyzed by General Procrustes Analysis (GPA). Socio-demographic status, taste and smell alterations, appetite and food intake data were also collected. Patient physical symptom burden was defined by University of Washington-Quality of Life Physical Function domain scores and used to stratify patients with "less physical symptom burden" (n = 11, score ≥ 61.7) or "greater physical symptom burden" (n = 8, score < 61.7). RESULTS: All patients used descriptors of taste, ease of eating, convenience, texture, potential to worsen symptoms and liking to characterize foods. Overall, avoided foods were characterized as having dry texture, while foods commonly eaten were characterized by their ease of eating and low potential to worsen symptoms. Descriptors of nutrition and smell were significant only for patients with greater physical symptom burden. CONCLUSIONS: Physical symptom burden influenced the characterization of foods among post-treatment HNC patients. Nutrition counseling must consider patients' physical symptom burden and the subsequent characterization of food that drive food selection or avoidance to facilitate dietary advice for adequate, appropriate and enjoyable food intake.

Socioeconomic status, human papillomavirus, and overall survival in head and neck squamous cell carcinomas in Toronto, Canada.

BACKGROUND: Despite universal healthcare in some countries, lower socioeconomic status (SES) has been associated with worse cancer survival. The influence of SES on head and neck cancer (HNC) survival is of immense interest, since SES is associated with the risk and prognostic factors associated with this disease. PATIENTS AND METHODS: Newly diagnosed HNC patients from 2003 to 2010 (n=2124) were identified at Toronto's Princess Margaret Cancer Centre. Principal component analysis was used to calculate a composite score using neighbourhood-level SES variables obtained from the 2006 Canada Census. Associations of SES with overall survival were evaluated in HNC subsets and by p16 status (surrogate for human papillomavirus). RESULTS: SES score was higher for oral cavity (n=423) and p16-positive oropharyngeal cancer (OPC, n=404) patients compared with other disease sites. Lower SES was associated with worse survival [HR 1.14 (1.06-1.22), p=0.0002], larger tumor staging (p<0.001), current smoking (p<0.0001), heavier alcohol consumption (p<0.0001), and greater comorbidity (p<0.0002), but not with treatment regimen (p>0.20). After adjusting for age, sex, and stage, the lowest SES quintile was associated with the worst survival only for OPC patients [HR 1.66 (1.09-2.53), n=832], primarily in the p16-negative subset [HR 1.63 (0.96-2.79)]. The predictive ability of the prognostic models improved when smoking/alcohol was added to the model (c-index 0.71 vs. 0.69), but addition of SES did not (c-index 0.69). CONCLUSION: SES was associated with survival, but this effect was lost after accounting for other factors (age, sex, TNM stage, smoking/alcohol). Lower SES was associated with greater smoking, alcohol consumption, comorbidity, and stage.

Poorly differentiated "insular" carcinoma of the thyroid: a case report.

Poorly differentiated "insular" carcinoma of the thyroid is a rare type of thyroid malignancy, situated morphologically and biologically in an intermediate position between well-differentiated (papillary and follicular) and undifferentiated (anaplastic) carcinoma. Here we report a case of a 56-year-old woman who developed a mass over the left thyroid gland in 1988, and received a thyroid operation in 1990 which was reported as benign lesion. Three years later, a mass recurred over the right lobe of the thyroid, and another thyroid operation was performed. The pathological report was medullary carcinoma. Four months later, recurrent mass over the right thyroid bed developed. Fine-needle aspiration biopsy of the mass showed moderately high cellularity with moderate pleomorphism, and multinucleated giant cells. Distinct cytoplasmic blue granules were also found in Liu's stain. She received total thyroidectomy and right neck radical dissection. Pathology examination showed well-defined nests of tumor cells ('insulae'), and immunohistochemical study showed positive stain for calcitonin. Pathologic diagnosis was poorly differentiated "insular" carcinoma of the thyroid. Four months after operation, recurrent neck mass over the suprasternal notch developed. Computerized tomography of neck and chest showed tumor mass over left thyroid bed with extension to anterior mediastinum. Whole body 131I scan showed mediastinum involvement and multiple bony metastases. Ablative 131I treatments (150 mCi and 200 mCi) were given twice, but in vain. The patient died 14 months after her last operation.

Relationship of self-reported oral health and nutritional risk among hospitalized older adults.

Oral health and nutritional risk were assessed in 300 hospitalized older adults using self-reported instruments. Patients who self-reported poor oral health status were at greatest nutritional risk. Study results suggest that self reported oral health and nutritional risk are multidimensional and that screening instruments may help identify patients who could benefit from a dental referral. The combination of nutritional and oral health screening methods may be an efficient and cost-effective method for nondental health care providers to identify and refer older adults for oral health care.