Patient-Reported Quality of Life After Resection With Primary Closure for Oral Tongue Carcinoma.

OBJECTIVES/HYPOTHESIS: For early-stage oral tongue carcinoma and carcinoma in situ (ESOTCCIS), we evaluated patient-reported quality-of-life (QOL) outcomes following resection with primary closure (R-PC). STUDY DESIGN: Retrospective review at an academic cancer center. METHODS: Thirty-nine ESOTCCIS patients (Tis, T1, T2) who underwent R-PC without radiation completed the University of Washington Quality of Life Questionnaire Version 4 (UW-QOL) at least 6 months since R-PC (mean = 2.39 years; range = 0.5-6.7 years). We compared UW-QOL scores for pain, swallowing, chewing, speech, and taste to established normative population scores. Multivariable regression analysis evaluated factors associated with QOL impairment. RESULTS: ESOTCCIS patients who underwent R-PC in comparison to the normative population reported significantly worse mean speech (87.7 vs. 98, P < .001) and taste (85.6 vs. 95, P = .002) scores and no significant differences in mean pain (91.7 vs. 86, P = .96), swallowing (100 vs. 98, P = .98), chewing (97.4 vs. 94, P = .98) scores. For speech and taste, 59% (23/39) reported no postoperative change from baseline, whereas 41% (16/39) and 35.9% (14/39) reported mild impairment, respectively. Overall, postoperative QOL was reported as good, very good, or outstanding by 87.2% (34/39). Higher American Society of Anesthesiologists class, cT1 compared to CIS, and ventral tongue involvement were independently associated with worse speech. Age < 60 years was independently associated with worse taste. CONCLUSIONS: ESOTCCIS patients who undergo R-PC without radiation can expect long-term swallowing, chewing, and pain to be in the normative range. Although a majority of patients can expect to achieve normative speech and taste outcomes, R-PC carries the risks of mild speech and/or taste impairments. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:312-318, 2021.

Analysis of the Filipinos' Interest in Searching Online for Oral Cancer.

Objective: This study analyzed the health-seeking behavior of Filipinos using Google Trends tool to quantify relative search volume by term . Oral cancer, mouth cancer, tongue cancer, gum cancer, and lip cancer were used as predetermined search terms. Material and method: Comma-separated values file containing relative search volumes of search trends pertaining to oral cancer from 2009 to 2019 were assessed. Brown-Forsythe one-way ANOVA was used to measure differences with respect to oral cancer across different years and months. Two-way repeated measures ANOVA was applied to detect differences regarding mouth cancer, tongue cancer, gum cancer, and lip cancer across the years. Time series models were fitted and used to forecast search interests. Results: The results revealed that interest in oral cancer was significantly higher in 2019 (43.75±5.5, p<0.05) compared to 2009 (29.0 ± 6.7). In terms of months, searches were higher in February (45.0 ± 6.6) compared to May (24.8 ± 3.4, p=0.015), June (25.3 ± 4.4, p=0.020), and December (26.5 ± 4.0, p=0.038). Search interests for gum cancer and lip cancer remained significantly lower from 2011 to 2019, and tongue cancer from 2016 to 2018 but approximated mouth cancer in 2019. The forecast showed that mouth cancer (31.67%), tongue cancer (23.75%), and lip cancer (3.83%) would fluctuate through time pass, while gum cancer (8%) would remain steady in 2020. Conclusion: Health-seeking behavior through search trends showed an increased interest in oral cancer in 2019 and during February. It was anticipated that search interests would fluctuate in 2020, but at the end of the year would decrease for mouth cancer and tongue cancer, increase for lip cancer, and remain steady for gum cancer.

Non-curative treatment of patients with oral tongue squamous-cell carcinoma.

PURPOSE: Late-stage OTSCC is associated with poor overall survival (OS). Non-curative treatment approach aims to improve quality of life and prolong survival of patients deemed incurable. The purpose of this study was to investigate the used non-curative treatment modalities for OTSSC and patient survival. METHODS: All patients diagnosed with OTSCC and treated with non-curative intent at the HUS Helsinki University Hospital (Helsinki, Finland) during the 12-year period of 2005-2016 were included. Survival analysis after the non-curative treatment decision was conducted using the Kaplan-Meier method in this population-based study. RESULTS: Eighty-two patients were identified. A non-curative treatment decision was made at presentation without any previous treatment in 26 patients (7% of all patients diagnosed with OTSCC during the study period). Palliative radiotherapy was administered to 24% of all patients. The average survival time after the non-curative treatment decision was 3.7 months (median 2 and range 0-26). CONCLUSIONS: Due to the short mean survival time after decision for treatment with non-curative intent, and the notable symptom burden in this patient population, a prompt initiation of all non-curative measures is warranted.

Effects of palatal augmentation prosthesis in oropharyngeal dysphagia in Chilean patients with tongue cancer: Cases report

ABSTRACT: Therapy of malignant neoplasms of the tongue or oropharynx may cause dysphagia. Dysphagia in patients has negative significant social and psychological consequences. The six cases reports describe the effect of palatal augmentation prosthesis (PAP) on the management of dysphagia in patients with oral-pharyngeal cancer and as consequence of its treatment. The study also assesses PAP's effects on the quality of life of such patients.

Palliative Care Considerations for Patients With Head and Neck Cancer With Children at Home.

Adult patients diagnosed with head and neck cancer (HNC) who may have contact with children in the home setting are at risk of experiencing distress because of embarrassing and challenging oral symptoms often associated with an HNC diagnosis and the side effects of required treatments. This article features a case study involving a patient diagnosed with HNC and details how oncology nurses can provide patients with HNC and their caregivers with resources and support.

Reconstruction of Tongue Defects With the Contralateral Nasolabial Island Flap.

PURPOSE: Reconstruction of tongue defects after cancer resection is challenging for reconstructive surgeons. Conventional local flaps are usually compromised in patients with suspected ipsilateral neck metastasis. To extend the application of the nasolabial flap, especially in circumstances in which a free flap is unavailable, the contralateral nasolabial island flap was used, with favorable outcomes. PATIENTS AND METHODS: Seven patients presenting with tongue carcinoma underwent surgical resection and neck dissection. Tongue defects were simultaneously reconstructed using a contralateral nasolabial island flap. Clinical outcomes, including locoregional recurrence and distant metastasis, were recorded. Subjective functional outcomes were investigated using the University of Washington Quality of Life Questionnaire. RESULTS: All flaps survived without partial or complete necrosis. All patients survived without locoregional recurrence or distant metastasis during follow-up (6 months to 2 years). Functional outcomes were satisfactory, especially swallowing and speech functions. Donor-site morbidity was minimal and the scars were inconspicuously hidden in the nasolabial fold. CONCLUSIONS: The contralateral nasolabial island flap is technically feasible and can be an excellent option for tongue reconstruction without compromising oncologic safety.

The Use Of Anterolateral Thigh Flap (ALTF) For Functional Tongue Reconstruction With Postoperative Quality Of Live Evaluation.

UNLABELLED: The use of microsurgery for oral reconstruction of cancer patients, has become standard treatment in restoring oral function. The free anterolateral thigh flap is one of the most preferred options in reconstruction after total, subtotal or hemiresection of the tonque due to squamous cell cancer. The aim of the study was to present the reconstructive method using anterolateral thigh free flap with evaluation of quality of live. MATERIAL AND METHODS: Clinical material includes 46 consecutive patients with tongue cancer, who underwent complex surgical treatment between 2009 and 2011. There were 36 males and 10 females and the M: F ratio was 3.6: 1. All of them were reconstructed using the anterolateral thigh free flap. The quality of life was evaluated 6 months after completing the treatment, based on postoperative functional and aesthetic status. RESULTS: The overall flap survival rate was 96%. Surgical complications were observed in 8 patients (17%). Donor site was closed primarly in 42 cases and in remaining 4 skin graft was required. In all 46 cases understandable speech and return to unrestricted diet mastication and swallowing were achieved. The mean follow-up period after treatment was 32 months. Analysis of aesthetic effects evaluated in 23 cases and shows generally very good results. According to average transformed scores the QOL can be characterized as excellent for >90, very good for 76-90, good for 51-75, moderate for 25-50 and bad for <25 points. CONCLUSIONS: Anterolateral thigh flap, with its versatility in design, long pedicle with a suitable vessel diameter, low donor site morbidity, and very good aesthetic effects, could be the ideal flap for functional tongue reconstruction.

Quality of life and functional evaluation in patients with tongue base tumors treated exclusively with transoral robotic surgery: A 1-year follow-up study.

BACKGROUND: To evaluate quality-of-life (QoL), swallowing and voice in patients with base of tongue (BOT) tumors treated with transoral robotic surgery (TORS) alone without any adjuvant treatment. METHODS: The study was a prospective, single-center cohort trial. Swallowing, QoL and voice were evaluated in 13 patients with T1 or T2 oropharyngeal carcinomas of the BOT. Patients underwent evaluation using the following: a dysphagia score (DS); fiberoptic endoscopic evaluation-of-swallowing with the penetration aspiration scale (PAS); the MD Anderson Dysphagia Inventory (MDADI); and the Voice Handicap Index-10 (VHI-10). RESULTS: Subjective (DS) and objective (PAS) evaluation of swallowing produced mean scores of 1.08, 2.23 and 1.46 before surgery and at 6 and 12 months after surgery, respectively, for both tests. A significant difference was found when comparing DS and PAS data at baseline and 6 months after surgery; while no difference was observed between the baseline and 12 months after surgery. The mean values of the MDADI and VHI scores recorded before surgery, and at 6 and 12 months after surgery did not show any statistical difference. CONCLUSIONS: Objective swallowing deterioration in the first 6 months after TORS alone for BOT tumors was possible, but complete recovery of deglutition was observed within 12 months. No changes were reported in the patients' self-perceived status of swallowing and voice dysfunction, and related QoL after 1 year.

How will I be after my operation for oral cancer?

Validated health-related quality of life measures for patients with oral cancer have been available for over a decade. We used the Liverpool head and neck cancer database to identify 1060 patients who had curative operations for primary squamous cell carcinoma of the head and neck at the regional maxillofacial unit between 1995 and 2010. We then produced one-page summary tables for subsites of oral cancer by stage and common treatments based on patient-reported outcomes from the University of Washington quality of life (UWQoL) head and neck cancer questionnaire. Data had been collected in a series of annual surveys. Sites included were buccal and retromolar (n=189), oral tongue (n=358), floor of the mouth (n=321), and other oral sites (n=192). A total of 633 patients completed at least one questionnaire (total 1931) between 9 and 60 months after treatment (71% of those alive at 9 months). Only questionnaires completed around 2 years from diagnosis or operation were analysed. Data include crude survival at 1, 2, and 5 years, the 12 UWQoL domains, which comprise the number of patients who chose the best 2 responses for each, overall health-related QoL, and the number who chose the worst responses (based on an algorithm). The data are sufficiently detailed to be used in discussions with patients about likely outcomes. They can help patients to make decisions about the type of treatment, provide a reference for realistic expectations, and enable them to be better informed when they give their consent.

Health-related quality of life of patients treated with primary chemoradiotherapy for oral cavity squamous cell carcinoma: a comparison with surgery.

Our aim was to document the health-related quality of life (QoL) of patients with squamous cell carcinoma (SCC) of the oral cavity who were treated with chemoradiotherapy, and to compare it with that of patients treated with conventional surgery with or without adjuvant treatment. All patients who presented with SCC of the oral cavity treated with chemoradiotherapy alone at the Royal Brisbane & Women's Hospital between 2000 and 2011 and who were alive without disease were included. Health-related QoL was assessed by the University of Washington QoL questionnaire version 4, and the European Organisation for the Research and Treatment of Cancer (EORTC) QoL questionnaires C30 and HN35. The questionnaires were sent to all survivors. Those who responded to chemoradiotherapy were matched with patients who were treated by conventional surgery with or without adjuvant treatment by age, sex, subsite of tumour, and TNM stage. Sixteen patients completed the questionnaires (8 in each group). There was no significant difference between the 2 groups in any of the domains of any of the questionnaires. The overall outcome scores for both treatments in all 3 groups were reasonably high, which suggests that both treatments provided acceptable health-related QoL. The surgical group recorded higher scores than the chemoradiotherapy alone group in all domains of the UW-QoL except shoulder and anxiety. They recorded lower scores in all scales and items of EORTC HN35. There was no significant difference in health-related QoL between the 2 groups. Conventional surgery with or without adjuvant treatment recorded higher scores in most QoL domains including chewing, swallowing, saliva, and speech, issues most important to patients with SCC of the oral cavity.

Quality of life in patients younger than 40 years treated for anterior tongue squamous cell carcinoma.

This study investigated the quality of life in patients younger than 40 years with tongue squamous cell carcinoma. We used the University of Washington Head and Neck Quality of Life scale to compare the quality of life outcomes between young and old patients. Cases were patients younger than 40 years who were treated for anterior tongue squamous cell carcinoma. Controls were patients older than 40 years who were matched to the cases regarding diagnosis, sex, and TNM classification. Two controls were matched for each case; thus, 21 cases and 42 controls were selected. Twenty-one of 33 questionnaires (63.6%) were returned. The median follow-up duration was 3.7 years (range, 1-12 y). In the group of young patients, the best-scoring domains were pain, chewing, and swallowing, whereas the lowest scores were for appearance, mood, and anxiety. Young patients (40 years or younger) reported better function, notably regarding activity, recreation, shoulder, taste, and saliva compared with the old patients with anterior tongue squamous cell carcinoma. The patients younger than 40 years tend to have a good quality of life. Most of them were not significantly affected by pain. Quality of life should be used as part of our treatment of anterior tongue squamous cell carcinoma.

Living in limbo: Ethics and experience in a conversation about persistent oral lesions.

This case report presents a conversation that the authors had with a patient who is suffering from oral lichen planus and oral cancer. The reason that the authors approached the patient for an interview was to find out why he decided to enroll in an experimental study related to his oral cancer. The patient reported that it was "the waiting" that led him to enroll in this study--that is, the pressure of waiting for oral cancer to reemerge was simply unbearable, and enrolling in this experimental study enabled him to take a more proactive approach to his illness. The authors view this "waiting" as a "limbo experience" and reflect on the implications of this limbo experience for dental ethics and research ethics.

Quality of life in oral cancer patients-effects of tongue resection and sociocultural aspects.

BACKGROUND: The aims of this study were to evaluate postoperative quality of life in patients who have had resections of tongue cancer and reconstruction by flaps and to collect information about their sociocultural situation. METHODS: In this cross-sectional study, patients with primary tongue cancer treated with total and subtotal tongue resection in the First Affiliated Hospital of Zhengzhou University, between July 2008 and October 2011, were included. Quality of life was assessed by the 14-item Oral Health Impact Profile and the Medical Outcomes Study-Short Form 36 questionnaires 12 months postoperatively. Furthermore, a questionnaire about the sociocultural background of the patients was applied. RESULTS: Forty-six of the 62 questionnaires were returned (74.19%). In the Medical Outcomes Study-Short Form 36, the best-scoring domain was bodily pain, whereas the lowest scores were for social functioning and vitality. In the 14-item Oral Health Impact Profile, the lowest-scoring domain was psychological disability, followed by psychological discomfort and social disability. CONCLUSIONS: The postoperative quality of life in our patients was significantly influenced by tongue resection. This should be considered for surgical planning. The sociocultural data showed a rather low education level and life standard level for the majority of the patients.

Changes in the psychological characteristics of oral cancer patients in the perioperative period: a quantitative evaluation.

We examined the changes in psychological distress and quality of life (QOL) during the perioperative period in oral cancer patients undergoing surgery and investigated the relationship between patient's psychological distress and QOL. Methods. Fifty patients participated. The Hospital Anxiety and Depression Scale (HADS; Japanese version), as a psychological test and the Functional Assessment of Cancer Therapy General (FACT-G); and Head and Neck (FACT-H&N), as quality of life (QOL) surveys were administered preoperatively, after surgery, and 1 month after leaving the hospital. Results. Anxiety was highest pre-operation and depression was highest post-operation, but improvements in both were seen post-discharge. At the pre-operation time point, anxiety and depression low-score groups had significantly high scores on Emotional well-being and Functional well-being. At the post-operation time point, anxiety and depression low-score groups had significantly high scores on all QOL subscales. Conclusion. Providing psychological support while considering anxiety might be particularly useful preoperatively whereas providing psychological support while considering depression might be particularly useful postoperatively.

Quality of life outcome measures using UW-QOL questionnaire v4 in early oral cancer/squamous cell cancer resections of the tongue and floor of mouth with reconstruction solely using local methods.

Cancer treatment either by surgery alone or in a combination of surgery, radiotherapy±chemotherapy has significant consequences on the physical, mental, emotional and psychosocial wellbeing of the patient. Measurement of quality of life (QOL) is necessary to understand the patient's perception of their own treatment, as clinicians' views can be biased. Reconstruction of a cancerous defect with a free vascular flap is ideal in large, often composite defects, provided it is appropriate to the advanced stage and prognosis of the disease, medical condition of the patient, availability of surgical and financial resources and allows the prosthetic rehabilitation of the anatomic area. Using University of Washington Quality of life 4 questionnaire (UW-QOL4), we assessed the QOL of 38 patients, who underwent local surgical reconstructions after resection of T1/T2 tongue/floor of mouth squamous cell carcinoma defects. Objective assessment of speech and swallow function was also carried out using therapy outcome measure (TOM) scores by the speech and language therapy team (SALT) aiming to see the differences in the scores obtained in patients who underwent post-operative radiotherapy. Our study, conducted 6months after completion of all oncologic treatment for the primary disease, showed satisfactory levels of quality of life parameters with good function showing that local reconstructive methods are successful and may have benefits in the management of early oral cancers involving the tongue and floor of mouth. They are beneficial by providing a good quality in terms of function, by reducing the operating time, the surgical morbidity, simplifying post-operative care and thereby becoming an efficient, effective and a cost effective method.

Assessment of quality of life of patients with oral cavity cancer who have had defects reconstructed with free anterolateral thigh perforator flaps.

The aim of this study was to evaluate quality of life (QoL) in patients who have had resections of oral cancer and reconstruction by free anterolateral thigh perforator flaps. QoL was assessed by the 14-item Oral Health Impact Profile (OHIP-14) and the University of Washington Quality of Life (UW-QoL) questionnaires 12 months postoperatively. Fifty-one of the 69 questionnaires were returned (74%). In the UW-QoL the best-scoring domain was pain, whereas the lowest scores were for chewing, saliva, and taste. In the OHIP-14 the lowest-scoring domain was handicap, followed by psychological disability, and social disability. Free anterolateral thigh perforator flaps for reconstruction of defects of the head and neck after resection for cancer significantly influenced the patients' quality of life.

Assessing quality of life in patients with head and neck cancer in Spain by means of EORTC QLQ-C30 and QLQ-H&N35.

OBJECTIVES: The aim of this project was to evaluate the quality of life in patients undergoing treatment for head and neck cancer in the Murcia region (Spain). MATERIALS AND METHODS: The Quality of Life (QoL) of patients suffering head and neck cancer was assessed using Spanish translations of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Head and Neck Cancer Module (QLQ-H&N35). The questionnaires' scales and single items were compared according to age, sex, tumour location, stage of cancer and treatment type. RESULTS: Of the 109 patients who met the study's inclusion criteria, 94 completed the questionnaire. Quality of life was found to be associated with patient age (with patients <65 years obtaining higher scores) and also with tumour location. With regard to the stage of cancer, early stages obtained better scores than advanced ones. Patients who underwent surgical treatment combined with adjuvant radiotherapy and chemotherapy generally showed lower scores. CONCLUSIONS: The routine use of quality of life questionnaires among cancer patients enables health practitioners to discover in which areas and to what extent patients find their lives affected by the treatment they receive and its consequences. This allows health practitioners to provide information and treatments which are better adapted to patient needs. These results are similar to those obtained in populations from the north and centre of Europe.

Living in limbo: ethics and experience in a conversation about persistent oral lesions.

This case report presents a conversation that the authors had with a patient who is suffering from oral lichen planus and oral cancer. The reason that the authors approached the patient for an interview was to find out why he decided to enroll in an experimental study related to his oral cancer. The patient reported that it was "the waiting" that led him to enroll in this study--that is, the pressure of waiting for oral cancer to re-emerge was simply unbearable, and enrolling in this experimental study enabled him to take a more proactive approach to his illness. The authors view this "waiting" as a "limbo experience" and reflect on the implications of this limbo experience for dental ethics and research ethics.