Patients concerns inventory highlights perceived needs and concerns in head and neck cancer survivors and its impact on health-related quality of life.

Currently, the head and neck cancer Patients' Concerns Inventory (HNC-PCI), a holistic, self-reported tool to help patients disclose needs and concerns during consultations, is not organised into domains. We used a Delphi approach to generate domains and applied them to an existing HNC-PCI database to assess association with health-related quality of life (HRQoL). The expert panel comprised 10 experts in head and neck cancer who were selected ad hoc. The HNC-PCI checklist was analysed and fed back to the panel for 3 rounds until consensus was achieved. Five domains were generated (A=Physical and functional; B=Psychological and emotional or spiritual well-being; C=Social care and well-being; D=Treatment-related; and E=Other) and were applied to a database compiled from 674 patients who had completed the PCI on 1276 occasions. On first completing the inventory (median 32 months after treatment) 81% selected items under domain A and 58% under domain B. Fewer items were selected/domain thereafter. Younger patients were more likely to select from domains B and C. Those treated by radiotherapy and adjuvant radiotherapy were more likely to select from domains A and C, respectively. Patients with laryngeal cancer tended to select from domain C, and those with poor HRQoL outcomes were significantly more likely to indicate more items of concern. The items selected under the HNC-PCI domains showed that certain clinical, pathological, and HRQoL factors were associated with specific patterns of needs or concerns.

Issues patients would like to discuss at their review consultation: variation by early and late stage oral, oropharyngeal and laryngeal subsites.

PURPOSE: The patient concerns inventory (PCI) was developed to help patients raise issues/concerns during routine follow-up and to indicate team members they want to see. This paper reports the use of the PCI across various H&N Cancer sub-sites (oral, oropharyngeal and laryngeal) and stages of disease (early and late) and describes the main concerns that patients want to discuss using a cross-sectional survey comprising the PCI with the University of Washington Quality of Life questionnaire. Patients treated for primary H&N squamous cell carcinoma, 1998-2009, were identified from the University Hospital Aintree H&N Cancer database. 447/775 (58 %) patients responded. Fear of recurrence concerns was common to all clinical groups (range 32-67 %). Speech issues were more common with laryngeal tumours, and saliva issues with oropharyngeal tumours (32 % early, 48 % late). Apart from early-stage laryngeal tumours, patients consistently reported issues concerning dental health/teeth and chewing. The median (IQR) number of concerns overall was 4 (2-7), with significant variation (p < 0.001) between clinical groups ranging from 2 (1-6) for early-stage oral to 6 (2-10) for late-stage oropharyngeal and 7 (5-9) late-stage laryngeal. The results indicated that PCI can be readily incorporated into managing HNC patients and supports a holistic multidisciplinary approach to clinic consultations. It accommodates difficult issues such as fear of recurrence and intimacy. Completion of the PCI by patients before consultation can highlight problems and concerns that doctors can target for discussion, thereby streamlining consultations, and ensuring that patient needs are better met, thus creating a more effective service.

Use of the Patient Concerns Inventory to identify speech and swallowing concerns following treatment for oral and oropharyngeal cancer.

BACKGROUND AND AIMS: The Patient Concerns Inventory is a holistic, self-reported screening tool for detecting unmet needs in head and neck cancer patients. This study aimed to assess its value in screening for self-perceived swallowing and speech concerns, and in facilitating multidisciplinary supportive care. METHODS: The Patient Concerns Inventory and the University of Washington Quality of Life questionnaire were completed by 204 post-treatment patients attending routine out-patient review clinics, and those with speech or swallowing issues were identified. RESULTS: Swallowing and speech issues were respectively reported by 21 and 7 per cent of University of Washington questionnaire respondents and by 17 and 13 per cent of Patient Concerns Inventory respondents. The two surveys combined indicated that speech or swallowing issues arose in 39 per cent of consultations (n = 178), involving 48 per cent of patients (n = 97). Of these 97 patients, 74 were known to the speech and language therapist. The remaining 23 patients had their concerns discussed in the clinic; three were referred on, and were assessed by the speech and language therapist and given appropriate interventions. CONCLUSION: The use of both surveys concurrently enabled all patients with swallowing or speech issues to discuss these concerns in the clinic and to access appropriate multidisciplinary interventions.

'I've got hay-fever and my mouth is stinging!'.

A case of oral allergy syndrome is presented. Crossreactivity of pollens with some fruit/vegetables causes immediate IgE-mediated symptoms localised to the mouth. Diagnosis is suspected from positive skin prick testing in the presence of a suggestive history. Management is by allergen avoidance. In serious and refractory cases, referral to a regional allergy clinic is recommended.