Caregivers' burden and fatigue during and after patients' treatment with concomitant chemoradiotherapy for locally advanced head and neck cancer: a prospective, observational pilot study.

PURPOSE: Knowledge of caregivers' burden and fatigue before and after patients' treatment for locally advanced head and neck cancer is scarce. Therefore, we aimed to explore caregivers' fatigue and burden in relation to patients' fatigue, distress, and quality of life. METHODS: For caregivers, burden and fatigue were assessed. For patients, fatigue severity, distress, and health-related quality of life (HRQoL) were assessed. Measurements were conducted prior to treatment, 1 week, and 3 months after chemoradiotherapy. RESULTS: Caregivers' burden and fatigue followed patients' high peak in distress, fatigue, and diminished HRQoL as a consequence of treatment. Caregivers' baseline fatigue was a predictor for fatigue after chemoradiotherapy. Female spouses with higher baseline levels of fatigue and burden and caring for patients with lower levels of HRQoL seem risk factors for burden after chemoradiotherapy. CONCLUSIONS: Attention should be paid to caregivers' burden and fatigue before starting patients' intense treatment with chemoradiotherapy, as both burden and fatigue before starting treatment may contribute to burden and fatigue after chemoradiotherapy.

The value of routine follow-up in patients treated for carcinoma of the vulva.

BACKGROUND: Vulvar carcinoma patients traditionally are offered follow-up after their primary treatment because earlier diagnosis of recurrent disease is believed to improve chances for curative treatment. The objective of the current study was to determine the value of a strict routine follow-up protocol for the detection of recurrences in a large series of patients who were treated for carcinoma of the vulva. METHODS: Clinicopathologic data for patients with primary squamous cell carcinoma of the vulva who were treated between January 1990 and July 2000 were prospectively stored in a database. After treatment, patients visited the outpatient clinic at the study institution at gradually increasing intervals. When a recurrence was diagnosed, it was indicated whether the recurrence was local, occurred in the skin bridge, occurred in the inguinal region, or was distant, and this information was registered. Moreover, it was noted whether the diagnosis was made at a routinely scheduled or at an interval follow-up meeting and whether symptoms as noted by the patient herself led to the diagnosis. RESULTS: Data from 238 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage I-IV vulvar carcinoma were analyzed with a mean follow-up of 63 months (median, 58 months; range, 6-149 months). Sixty-five of 238 patients (27%) developed recurrent disease; 49 were local recurrences, 2 recurrences were found in the skin bridge, 6 were found in the inguinal region, and 8 were distant recurrences. Forty-two of these 65 recurrences (65%) were detected at a routinely scheduled follow-up meeting, at which time 21 of the 42 patients with recurrent disease (50%) reported symptoms or signs. Local recurrences diagnosed at a routinely scheduled follow-up meeting were found to have a smaller greater dimension (mean, 2.1 cm and median, 1.6 cm; range, 0.3-8.0 cm) compared with recurrences detected at an interval meeting (mean, 3.1 cm and median, 3.0 cm; range, 0.4-7.0 cm) (P = 0.04). CONCLUSIONS: The data from the current study indicated that routinely scheduled follow-up meetings with patients with carcinoma of the vulva result in the detection of smaller recurrences in a substantial proportion of patients compared with self-reported recurrences, without a measurable effect on morbidity or mortality.