Patient Concerns Inventory for head and neck cancer: Brazilian cultural adaptation.

OBJECTIVE:: The purpose of this study was to translate, culturally validate and evaluate the Patients Concerns Inventory - Head and Neck (PCI-H&N) in a consecutive series of Brazilian patients. METHOD:: This study included adult patients treated for upper aerodigestive tract (UADT) cancer. The translation and cultural adaptation of the PCI-H&N followed internationally accepted guidelines and included a pretest sample of patients that completed the first Brazilian Portuguese version of the PCI. Use, feasibility and acceptability of the PCI were tested subsequently in a consecutive series of UADT cancer patients that completed the final Brazilian Portuguese version of the PCI and a Brazilian Portuguese version of the University of Washington Quality of Life Questionnaire (UW-QOL). Associations between physical and socio-emotional composite scores from the UW-QOL and the PCI were analyzed. RESULTS:: Twenty (20) patients participated in the pretest survey (translation and cultural adaptation process), and 84 patients were analyzed in the cultural validation study. Issues most selected were: fear of cancer returning, dry mouth, chewing/eating, speech/voice/being understood, swallowing, dental health/teeth, anxiety, fatigue/tiredness, taste, and fear of adverse events. The three specialists most selected by the patients for further consultation were speech therapist, dentist and psychologist. Statistically significant relationships between PCI and UW-QOL were found. CONCLUSION:: The translation and cultural adaptation of the PCI into Brazilian Portuguese language was successful, and the results demonstrate its feasibility and usefulness, making this a valuable tool for use among the Brazilian head and neck cancer population.

Does elective neck dissection in T1/T2 carcinoma of the oral tongue and floor of the mouth influence recurrence and survival rates?

The aim of this study was to evaluate the results of elective neck dissection compared with observation (control group) in selected cases of early carcinoma of the oral tongue and floor of the mouth. It was a retrospective analysis of 222 patients who had the tumour resected (161 also had elective neck dissection). Occult lymph node metastases were detected in 33/161 (21%), and neck recurrences were diagnosed in 10 of the 61 patients in the control group (16%). Occult lymph node metastases reduced the 5-year disease-specific survival from 90% to 65% (p=0.001) and it was 96% among the controls. The 5-year disease-specific survival was 85% in the group treated by neck dissection and 96% in the observation group (p=0.09). Rigorous follow-up of selected low risk patients is associated with high rates of salvage, and overall survival was similar to the observed survival in patients treated by elective neck dissection. Observation is a reasonable option in the treatment of selected patients.

Patient Concerns Inventory for head and neck cancer: Brazilian cultural adaptation / Inventário de Preocupações dos Pacientes com câncer de cabeça e pescoço: adaptação cultural brasileira

Summary Objective: The purpose of this study was to translate, culturally validate and evaluate the Patients Concerns Inventory - Head and Neck (PCI-H&N) in a consecutive series of Brazilian patients. Method: This study included adult patients treated for upper aerodigestive tract (UADT) cancer. The translation and cultural adaptation of the PCI-H&N followed internationally accepted guidelines and included a pretest sample of patients that completed the first Brazilian Portuguese version of the PCI. Use, feasibility and acceptability of the PCI were tested subsequently in a consecutive series of UADT cancer patients that completed the final Brazilian Portuguese version of the PCI and a Brazilian Portuguese version of the University of Washington Quality of Life Questionnaire (UW-QOL). Associations between physical and socio-emotional composite scores from the UW-QOL and the PCI were analyzed. Results: Twenty (20) patients participated in the pretest survey (translation and cultural adaptation process), and 84 patients were analyzed in the cultural validation study. Issues most selected were: fear of cancer returning, dry mouth, chewing/eating, speech/voice/being understood, swallowing, dental health/teeth, anxiety, fatigue/tiredness, taste, and fear of adverse events. The three specialists most selected by the patients for further consultation were speech therapist, dentist and psychologist. Statistically significant relationships between PCI and UW-QOL were found. Conclusion: The translation and cultural adaptation of the PCI into Brazilian Portuguese language was successful, and the results demonstrate its feasibility and usefulness, making this a valuable tool for use among the Brazilian head and neck cancer population.

Resumo Objetivo: O objetivo deste estudo foi traduzir, adaptar culturalmente e avaliar o Inventário de Preocupações dos Pacientes - Cabeça e Pescoço (IPP-CP) em uma série consecutiva de pacientes brasileiros. Método: Este estudo incluiu pacientes adultos tratados por câncer do trato aerodigestivo superior (TADS). A tradução e a adaptação cultural do IPP-CP seguiram diretrizes internacionalmente aceitas e incluíram uma amostra piloto de pacientes que completaram a primeira versão em português do IPP-CP. O uso, a viabilidade e a aceitabilidade do IPP-CP foram testados posteriormente, em uma série consecutiva de pacientes com câncer do TADS que completaram a versão final em português do PCI e uma versão em português do questionário de qualidade de vida da Universidade de Washington (UW-QOL). As associações entre os escores físicos e socioemocionais do UW-QOL e do IPP foram analisadas. Resultados: Vinte pacientes participaram da pesquisa piloto (processo de adaptação cultural e tradução), e 84 pacientes foram analisados no estudo de validação cultural. As questões mais selecionadas foram: medo de o câncer voltar, boca seca, mastigação/comer, fala/voz/ser compreendido, deglutição, saúde dental/dentes, ansiedade, fadiga/cansaço, paladar e medo de eventos adversos. Os três especialistas mais selecionados foram fonoaudiólogo, dentista e psicólogo. Relações estatisticamente significativas entre IPP e UW-QOL foram encontradas. Conclusão: A tradução e a adaptação cultural do IPP para o português foram bem-sucedidas, e os resultados demonstram a viabilidade e a utilidade da ferramenta, tornando-a valiosa para uso na população brasileira com câncer de CP.

Quality of life related to swallowing after tongue cancer treatment.

The surgical treatment of tongue cancer, with or without reconstruction and/or radiotherapy, leads to different levels of voice, speech, and deglutition disorders. Evaluating the quality of life related to these swallowing alterations is important to further our knowledge about the impact of such alterations from the patient's point of view. Our objective was to describe the quality of life related to swallowing in patients treated for tongue cancer, using specific questionnaires. Twenty-nine patients participated in the study for a minimum of one year after oncologic treatment. Patients with advanced disease who underwent radiotherapy had significantly worse scores in most domains. The aspects related to how to deal with deglutition problems, time taken for meal consumption, pleasure in eating, chewing problems, food sticking in throat and mouth, choking, and the knowledge of feeding restrictions, which were evaluated by different domains of SWAL-QOL, were factors that contributed to a negative impact for patients with advanced-stage tumors who underwent radiotherapy.

Analysis of Swallowing After Retromolar or Oropharynx and Reconstruction with Myocutaneos or Microvascular Free Flaps

Objective: Evaluate swallowing in retromolar or oropharyngeal cancer patients submitted to surgical resection and microvascular free flap (MFF) or pedicled myocutaneous flap (MC) reconstruction. Study: Retrospective case series. Patients and methods:Eighteen previously untreated patients with squamous cell carcinoma of the retromolar area or oropharynx submitted to surgical treatment and reconstruction between January. 2000 and July, 2003, were submitted to videofluoroscopic evaluation.The reconstruction was performed with MFF in 12 cases and MC in 6 cases. Parameters analyzed were: oropharyngeal motility alterations, stasis, laryngeal penetration and/or aspiration and dysphagia severity. Results: Oral phase was worsefor MC than for MFF patients, with premature bolus leakage (66.7% and 16.7%), increased oral transit time (66.7% and 16.7%), reduced anterior-posterior tongue movement (66.7% and 25%), nasal regurgitation (50% and 0%) and oral stasis (83.3% and 41.6%), respectively. In pharyngeal phase, results were similar in both groups. Main alterations in MFF andMC were, respectively, pharyngeal swallowing delay (83.3% and 100%), nasal regurgitation (58.3% and 83.3%), increased pharyngeal transit time (50% and 83.3%), reduced laryngeal elevation (41.7% and 66.7%), pharyngeal stasis (50% and16.7%) and laryngeal aspiration (50% and 66.7%). Conclusion: Oropharyngeal swallowing after retromolar or oropharyngeal cancer surgery seems to differ depending on the type of reconstruction. Microvascular free flaps seemed to allow a more efficient oropharyngeal deglutition.