Outcome and relative cost of transoral removal of submandibular calculi.

OBJECTIVE: To examine the outcomes and treatment cost of transoral removal of submandibular calculi, and to compare the outcomes and costs of other reported techniques. METHOD: Retrospective review of 60 consecutive patients undergoing transoral removal of submandibular calculi. All clinical, operative, post-operative and follow-up data were collated and outcomes analysed. RESULTS: A total of 61 submandibular glands were treated by the transoral approach. Patients with multiple stones (p = 0.034) and stones in the proximal submandibular duct (p = 0.0028) were at greater risk of requiring submandibular gland excision, compared with patients with single stones and stones in the distal duct, respectively. There was a significant difference between the gland preservation rate during the first versus the second half of the study (p = 0.028). Larger calculi were significantly more likely to be seen in the proximal duct (p < 0.001). The mean operating time (28 minutes) and length of hospital stay for transoral removal of submandibular calculi was much less than those for other treatment techniques.

A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group.

This study tests the reliability and validity of the European Organization for Research and Treatment of Cancer (EORTC) head and neck cancer module (QLQ-H&N35) and version 3.0 of the EORTC Core Questionnaire (QLQ-C30) in 622 head and neck cancer patients from 12 countries. The patients completed the QLQ-C30, the QLQ-H&N35 and a debriefing questionnaire before antineoplastic treatment or at a follow-up. 232 patients receiving treatment completed a second questionnaire after treatment. Compliance was high and the questionnaire was well accepted by the patients. Multitrait scaling analysis confirmed the proposed scale structure of the QLQ-H&N35. The QLQ-H&N35 was responsive to differences between disease status, site and patients with different Karnofsky performance status, and to changes over time. The new physical functioning scale (with a four-point response format) of version 3.0 of the QLQ-C30 was shown to be more reliable than previous versions. Thus, the QLQ-H&N35, in conjunction with the QLQ-C30, appears to be reliable, valid and applicable to broad multicultural samples of head and neck cancer patients.

Laryngeal cancer: quality-of-life and cost-effectiveness.

BACKGROUND: The need to account for the cost of care is being imposed on clinicians by the corporate purchasers of health care. The cost-effectiveness of treatment for laryngeal cancer should be based on measurable and relevant clinical outcomes. Quality-of-life (QL) is a very important outcome, especially if survival is similar between two treatments. METHODS: Using QL data gathered prospectively from a group of 46 patients with glottic cancer, the effects of radiotherapy (RT) are compared with those of surgery (total laryngectomy). RESULTS: Surgery results in greater measurable dysfunction, especially of speech, but with respect to psychological functioning and general well-being, there are no major QL differences between patients treated surgically and those receiving RT. CONCLUSIONS: Cost-effectiveness of surgery, from the perspective of patient-based QL outcome, is very similar to that for RT in advanced cancer of the larynx. Each center needs to carefully consider its outcomes and overall average costs per patient before deciding which treatment regimen is to be preferred. These results have implications for the organ-sparing regimens in the treatment of advanced laryngeal cancer.

Evolution of quality of life assessment in head and neck cancer.

Quality of life assessment as part of clinical practice in head and neck oncology began over 40 years ago. Early studies were narrative and cross-sectional; these were followed, at first, by simple quantitative measures of various parameters and later by longitudinal studies of greater complexity. More recently quality of life has been employed in a randomized clinical trial of head and neck cancer. Quality of life has evolved to become a standard means of assessing clinical outcomes, and an accepted end point measurement in clinical trials, to be considered alongside survivorship and side effects/complications.