Functional and quality of life outcomes after partial glossectomy: a multi-institutional longitudinal study of the head and neck research network.

BACKGROUND: While aggressive treatment for oral cancer may optimize survival, decrements in speech and swallowing function and quality of life often result. This exploratory study investigated how patients recover their communicative function, swallowing ability, and quality of life after primary surgery [with or without adjuvant (chemo)radiation therapy] for tongue cancer over the course of the first year post-operation. METHODS: Patients treated for oral cancer at three institutions (University of Alberta Hospital, Mount Sinai Beth Israel Medical Center, and Turku University Hospital) were administered patient-reported outcomes assessing speech [Speech Handicap Index (SHI)], swallowing [(M.D. Anderson Dysphagia Inventory (MDADI)] and quality of life [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC-H&N35)]. Outcome measures were completed pre-operatively and at 1-, 6-, and 12-months post-operatively. RESULTS: One hundred and seventeen patients undergoing partial glossectomy with reconstruction participated in this study. Results indicated no significant differences in swallowing function (MDADI and EORTC-H&N35 subscales) between baseline and 6 months post-surgery and no significant differences in speech function (SHI subscales) between baseline and 1 year post-surgery. Most quality of life domains (EORTC-H&N35 subscales) returned to baseline levels by 1 year post-operation, while difficulties with dry mouth and sticky saliva persisted. A clear time trend of adjuvant (chemo)radiation therapy negatively affecting dry mouth scores over time was identified in this study, while negative independent effects of chemoradiation on MDADI swallowing, and EORTC-H&N35 swallowing, eating, and opening mouth subscales were found. CONCLUSIONS: Assessment time influenced patient-reported speech, swallowing, and quality of life outcomes, while treatment (by time) effects were found for only swallowing and quality of life outcomes. Results of the present study will help guide clinical care and will be useful for patient counseling on expected short and long-term functional and quality of life outcomes of surgical and adjuvant treatment for oral cavity cancer.

Investigation of factor affecting health-related quality of life in head and neck cancer patients.

OBJECTIVES: Head and neck cancer (HNC) patients have profound illness of physical, social and psychological factors that affects quality of life (QOL). The purpose of this study is to investigate the factors affecting HRQL in patients with intra-oral prostheses. BACKGROUND: Some cross-sectional studies have been performed to investigate HRQL in patients with HNC, but these studies did not report in detail how factors affect the HRQL of maxillectomy and mandibulectomy and/or glossectomy patients. MATERIALS AND METHODS: The University of Washington Quality of Life version 4 questionnaires (Japanese version) was administered to 50 maxillectomy and 50 mandibulectomy and/or glossectomy patients with intra-oral prostheses who were selected according to inclusion and exclusion criteria. Gathered data were statistically analyzed to investigate how a number of factors, namely, age, sex, pathologic diagnosis, neck dissection, resection size, radiotherapy and dental condition affect HRQL. RESULTS: In the maxillectomy patients, there were no significant differences between malignant and benign tumor in pathological diagnosis or between dentate and edentulous in dental condition. Age, sex, neck dissection and radiotherapy affected HRQL. In the mandibulectomy and/or glossectomy patients, there was no significant difference between dentate and edentulous in dental condition. Age, sex, glossectomy, neck dissection and radiotherapy affected HRQL. CONCLUSIONS: The factors affecting HRQL in the maxillectomy patients were different from those in the mandibulectomy and/or glossectomy patients. Though they wore stable prostheses; we were still able to show that resection size, radiotherapy and neck dissection affected HRQL.

Quality of life outcome measures following partial glossectomy: assessment using the UW-QOL scale.

BACKGROUND: The consequences of a diagnosis of head and neck cancer and the impact of treatment have a clear and direct influence on well-being and associated quality of life (QOL) in these patients. AIMS: To determine the QOL in head and neck cancer patients following a partial glossectomy operation. DESIGN AND SETTING: Cross-sectional cohort study; Head and Neck Oncology Unit, tertiary referral center. MATERIALS AND METHODS: 38 patients with partial glossectomy were assessed with the University of Washington head and neck quality of life (UW-QOL) scale, version 4. STATISTICAL ANALYSIS: Statistical analysis was performed using the Statistical Package for Social Sciences 10.0 (SPSS Inc, Chicago version III). Information from the scale was correlated using the Mann Whitney test. A P value less than/equal to 0.05 was considered as significant. RESULTS: The mean (sd) composite score of the QOL in our series was 73.6 (16.1). The majority (71.8%) quoted their QOL as good or very good. Swallowing (n = 16, 47.1%), speech (n = 15, 44.1%) and saliva (n = 15, 44.1%) were most commonly cited issues over the last 7 days. On the other hand, the groups with reconstruction, neck dissection, complications and radiotherapy demonstrated a significant reduction of quality of life scores (Mann Whitney test, P < 0.005). CONCLUSION: The composite score and overall QOL as assessed using the UW-QOL scale (version 4) were modestly high in our series of partial glossectomy patients. Swallowing, speech, and saliva are regarded as the most important issues. Stage of the disease, neck dissection, reconstruction, complications, radiotherapy and time since operation were seen to significantly affect domain scores.

[Psychological responses of patients after partial or total glossectomy due to carcinoma of the oral cavity]. / Psychologiczne reakcje chorych po czésciowym lub calkowitym wycieciu jezyka z powodu nowotworu jamy ustnej.

The necessity of partial or total glossectomy due to carcinoma of the oral cavity means that the patient suffers from severe and life-threatening disease and the medical team aims at eliminating that threat. The major goal of surgical intervention is to stop the growth of the cancer. However, it can be associated with considerable injury of the ill person. After the operation, the patient goes through the rehabilitation process during which he or she may experience suffering and various limitations resulting from injury. The patient also tries to adjust to the new situation in life. It is the time for the patient when the threat of death is no longer present or at least it has been averted and now the patient must challenge the process of adaptation associated with the loss of the tongue. The rehabilitation undertaken by the patient with the assistance of the medical team has two major goals. The first goal is to restore the function to the greatest possible extent, that is to learn to swallow and speak again. The second aim is psychological and sociological adaptation. In order to bring the patient into the process of acquiring new skills necessary for the realisation of basic life functions, as well as those needed for the fulfilment of substitutive forms of self-realisation and the achievement of satisfaction in life, the medical personnel should aim at understanding psychological and sociological conditions of the patient which may facilitate or impede patient's rehabilitation process and adaptation to illness. The examination and analysis of psychological dimensions characteristic of people struggling with cancer helps in understanding the patient, but first of all in learning individual experiences, problems and ways of coping with disability resulting from the particular form of injury. Research on the quality of life of patients after partial or total glossectomy is mostly concerned with functional aspects of the loss of the tongue and less attention is being paid to the subjective perspective of a patient. Although most patients suffer from significant functional impairments in swallowing, sensation and speech, as well as from difficulties in adaptation resulting from disability, some research shows that good quality of life can be maintained in patients who are highly motivated, have emotional support from their family and friends, maintain close contact with their physician, and have access to a rehabilitation team consisting of specialists of various disciplines.

A psychosocial perspective on the glossectomy experience.

This analysis of the glossectomy experience based on Goffman's concepts of the preservation of self and of stigma management suggests several helpful responses for speech-language pathologists and other clinicians. Attention to psychosocial dimensions of recovery. In the face of life-threatening illness and necessarily radical treatment, the patient and others may trivialize or overlook psychosocial needs. The importance of specific social behaviors--talking on a telephone or eating in a restaurant--can only be understood in terms of the patient's own self-definition. The psychological impact is more than frustration at lost or inadequate functioning. It may be profound grief, a response to threats to aspects of self-definition most valued by the patient. Help in the presentation and preservation of self. While helping to improve speech intelligibility by reinforcing different compensatory mechanisms, clinicians can assist with other compensations in social performance. More attention to nonverbal cues, including dress and physical appearance, may be helpful. Increased use of written communication can facilitate social interactions and reinforce the sense of linguistic competence until intelligibility and fluency are regained. From the perspective of Goffman's analyses, the individual who selectively manipulates social cues to counteract a stigma need not feel "fake." The intent of more conscious manipulations is not to invent a new self or to fool others but to preserve the integrity of the self. More information about stereotypes may help the glossectomee cope with others' inappropriate reactions and evaluate the relative importance of stigmas in different social interactions (e.g., stereotypes expressed by one's employer or family members deserve more attention than those expressed by strangers).(ABSTRACT TRUNCATED AT 250 WORDS)