Assessing the psychological predictors of benefit finding in patients with head and neck cancer.

BACKGROUND: Some individuals are able to gain psychological benefits from illness and adversity, such as a greater sense of purpose and closer relationships, termed 'benefit finding' (BF). The main aim of this study was to explore the extent to which BF is reported in patients with head and neck cancer (HNC). Secondary aims were to establish the relationships between BF, other patient-reported outcomes and predictive factors such as coping strategy and level of optimism. METHODS: This repeat measures study was conducted with 103 newly diagnosed patients with HNC. Self-completion questionnaires were used to assess BF pre-treatment and 6 months after treatment and pre-treatment coping, optimism, quality of life, anxiety and depression. Sixty-eight patients (66%) completed follow-ups. RESULTS: Moderate to high levels of BF were reported. Anxiety, depression and quality of life were not related to BF. Regression models of BF total score and three new factor analysed BF scales indicated that use of emotional support and active coping strategies were predictive of finding more positive consequences. Optimism, living with a partner and higher educational attainment were also found to have a protective effect. The amount of variance in BF explained by these five pre-treatment factors ranged from 32 to 46%. CONCLUSIONS: These findings demonstrate that both dispositional and potentially modifiable factors, in particular optimism and coping strategies, were associated with patients identifying positive consequences of a diagnosis of HNC. To maximise patient's longer-term resilience and adaptation, components of BF, either directly or via coping strategies, could be targeted for intervention.

"Cancer doesn't mean curtains": benefit finding in patients with head and neck cancer in remission.

There is an increasing awareness that there are often aspects of the experience of cancer that patients view as positive or beneficial despite substantial physical and psychological impacts. Individuals with head and neck cancer (HNC) are unique with respect to the possible facial disfigurement and functional limitations following disease and treatment. This qualitative study aimed to explore whether patients with HNC experience positive consequences posttreatment, and to investigate the nature of any benefit finding. Emerging master themes included a change in life priorities, greater closeness to family and friends, a greater awareness of self, for example, an increase in self-confidence and empowerment, and a greater awareness of faith and spirituality. Despite the adverse affects often associated with HNC, patients report some degree of positive growth following treatment.

Keratoprosthesis surgery.

PURPOSE: To survey current knowledge of use of keratoprostheses for visual rehabilitation in the dry eye. METHODS: Sections deal with: (1) when a keratoprosthesis is indicated; (2) classification of keratoprostheses; (3) the osteo-odonto-keratoprosthesis (OOKP), its history, indications and contraindications, patient assessment, surgical technique, results and complications, and (4) the AlphaCor, its design, indications, results and complications. RESULTS: The choice of keratoprosthesis in the severely dry eye is straightforward, as only one device - the OOKP - will work. With careful assessment, adequate technique, regular follow-up, and early recognition and management of complications, most patients can look forward to many years of sight with an OOKP. In the appropriately managed marginally dry eye, an AlphaCor keratoprosthesis may be considered, although the device should be seen as an alternative to high-risk keratoplasty in multiple graft rejection and vascularised corneae. CONCLUSIONS: KPro surgery is a complex and growing field. Those interested are invited to join the KPro Study Group (www.kpro.org), to add their contribution to the ongoing research and device evaluation.

Vitreoretinal complications of osteoodontokeratoprosthesis surgery.

PURPOSE: To describe the vitreoretinal complications in a cohort of patients with osteoodontokeratoprosthesis (OOKP) and discuss surgical management. METHODS: Review of notes of 35 OOKP cases performed at the Sussex Eye Hospital (Brighton, United Kingdom) between January 1999 and December 2005 was performed. RESULTS: The overall incidence of vitreoretinal complications was 22.8%, which included vitreous hemorrhage (3 patients), rhegmatogenous retinal detachment (3 patients), endophthalmitis with retinal detachment complicating lamina resorption and optic extrusion (2 patients), and intraoperative choroidal hemorrhage (1 patient). Preexisting aphakia was associated with rhegmatogenous retinal detachment (P < 0.05, chi2 = 4.36). Five patients required pars plana vitrectomy, which was performed either endoscopically (two cases) or using a binocular indirect viewing system (three cases) with one case requiring removal of the OOKP and insertion of a temporary keratoprosthesis. Retinal detachment repair was attempted on four of five patients but was successful for only one. Vitreous hemorrhage without retinal detachment required vitrectomy in one case, while two cases cleared spontaneously. CONCLUSIONS: Eyes receiving OOKP are prone to vitreoretinal complications, with retinal detachment associated with a poor prognosis. Thicker OOKP laminae and lamina bulk screening will hopefully reduce the risk of endophthalmitis due to unexpected resorption.

The osteo-odonto-keratoprosthesis (OOKP).

The osteo-odonto-keratoprosthesis (OOKP), although described over 40 years ago, remains the keratoprosthesis of choice for end-stage corneal blindness not amenable to penetrating keratoplasty. It is particularly resilient to a hostile environment such as the dry keratinized eye resulting from severe Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, and chemical injury. Its rigid optical cylinder gives excellent image resolution and quality. The desirable properties of the theoretical ideal keratoprosthesis is described. The indications, contraindications, and patient assessment (eye, tooth, buccal mucosa, psychology) for OOKP surgery are described. The surgical and anaesthetic techniques are described. Follow-up is life-long in order to detect and treat complications, which include oral, oculoplastic, glaucoma, vitreo-retinal complications and extrusion of the device. Resorption of the osteo-odonto-lamina is responsible for extrusion, and this is more pronounced in tooth allografts. Regular imaging with spiral-CT or electron beam tomography can help detect bone and dentine loss. The optical cylinder design is discussed. Preliminary work towards the development of a synthetic OOKP analogue is described. Finally, we describe how to set up an OOKP national referral center.

Mitomycin-C for mucous membrane overgrowth in OOKP eyes.

PURPOSE: The aim of this study was to report the use of mitomycin-C (MMC) in the treatment of mucous membrane overgrowth in eyes with osteo-odonto-keratoprosthesis (OOKP). METHODS: Records of 4 cases with mucous membrane overgrowth after stage 2 OOKP surgery were reviewed. RESULTS: All the patients had undergone a mucous membrane trimming procedure followed by MMC application. None of the patients had any episode of recurrence of the mucous membrane overgrowth after a single application of MMC in the follow-up period that ranged from 1 to 11 years. CONCLUSIONS: MMC can successfully arrest mucous membrane overgrowth in OOKP-implanted eyes including refractory cases.

Serial 3-dimensional computed tomography and a novel method of volumetric analysis for the evaluation of the osteo-odonto-keratoprosthesis.

PURPOSE: To assess the use of serial computed tomography (CT) in the detection of osteo-odonto-lamina resorption in osteo-odonto-keratoprosthesis (OOKP) and to investigate the use of new volumetric software, Advanced Lung Analysis software (3D-ALA; GE Healthcare), for detecting changes in OOKP laminar volume. METHODS: A retrospective assessment of the radiological databases and hospital records was performed for 22 OOKP patients treated at the National OOKP referral center in Brighton, United Kingdom. Three-dimensional surface reconstructions of the OOKP laminae were performed using stored CT data. For the 2-dimensional linear analysis, the linear dimensions of the reconstructed laminae were measured, compared with original measurements taken at the time of surgery, and then assigned a CT grade based on a predetermined resorption grading scale. The volumetric analysis involved calculating the laminar volumes using 3D-ALA. The effectiveness of 2-dimensional linear analysis, volumetric analysis, and clinical examination in detecting laminar resorption was compared. RESULTS: The mean change in laminar volume between the first and second scans was -6.67% (range, +10.13% to -24.86%). CT grades assigned to patients based on laminar dimension measurements remained the same, despite significant changes in laminar volumes. Clinical examination failed to identify 60% of patients who were found to have resorption on volumetric analysis. CONCLUSIONS: Currently, the detection of laminar resorption relies on clinical examination and the measurement of laminar dimensions on the 2- and 3-dimensional radiological images. Laminar volume measurement is a useful new addition to the armamentarium. It provides an objective tool that allows for a precise and reproducible assessment of laminar resorption.

Unusual variant of chorda tympani syndrome, its management, and a proposal on the nervous pathways involved.

Chorda tympani syndrome is an uncommon condition with similarities to Frey syndrome. We describe a variant of chorda tympani syndrome and its management, and put forward a hypothesis for the nervous pathways involved; something that seems to be lacking in published material.

Associations between quality of life, coping styles, optimism, and anxiety and depression in pretreatment patients with head and neck cancer.

BACKGROUND: Head and neck cancer is often diagnosed at a late stage and consequently radical treatment is necessary. The pretreatment phase is a time of high anxiety and depression for patients. This study aimed to investigate whether anxiety and depression are related to quality of life, coping styles, and dispositional optimism. METHODS: One hundred and three patients were recruited after diagnosis to a questionnaire study. Measures included the Hospital Anxiety and Depression Scale; SF12v2 Health Survey; Brief COPE, and the Revised Life Orientation Test. RESULTS: Quality of life, in particular emotional role explained a large proportion of the variance in pretreatment anxiety and depression. In addition, the use of negative coping styles was related to high anxiety levels and low levels of optimism were related to higher levels of depression. CONCLUSION: There are a small but significant proportion of pretreatment patients that may benefit from individualized support.