Health-related quality of life of Brazilian children and adolescents with benign and malignant solid tumours: A prospective cohort study during the first year after hospital admission.

INTRODUCTION: This study aims to assess the impact of paediatric benign and malignant solid tumours and its treatment on the health-related quality of life of children and adolescents who were followed up in a Reference Center in Pediatric Oncology in Rio de Janeiro. METHODS: It is a prospective cohort study. Quality of life assessment was performed using the PedsQL™ 4.0 Generic Core Scales and PedsQL™ 3.0 Cancer Module protocols three times: during hospital admission (T1), 6 months after admission (T2) and 1 year after admission (T3). RESULTS: We evaluated 132 patients, 59 men and 73 women, aged 2-17 years. In PedsQL™4.0, the Emotional Functioning scale was the one with the worst scores, while the scores on the Social Functioning scale was the best. In PedsQL™ 3.0, the worst domains were Procedural Anxiety and Worry. Patients with malignant bone tumours had the worst health-related quality of life. The group who received only surgery had better results. Total scores of PedsQL™4.0 and PedsQL™ 3.0 improved between T1 and T3. CONCLUSION: Children and adolescents with malignant and benign neoplasms undergo changes in quality of life as a result of the disease and treatment, but an improvement has been observed over time.

Sinais, sintomas e função vocal em indivíduos com disfagia tratados de câncer de cabeça e pescoço / Signs, symptoms and vocal function in individuals with dysphagia treated for head and neck cancer

RESUMO Objetivos Avaliar a presença de sinais e sintomas vocais e função vocal em indivíduos com disfagia, tratados de câncer de cabeça e pescoço - CCP e identificar os valores de corte dos respectivos instrumentos. Métodos Estudo prospectivo com 96 indivíduos (68 homens e 28 mulheres), divididos em grupo experimental - GE (pacientes tratados de CCP com disfagia, independente de queixa vocal) e grupo controle - GC (sem queixas autorrelatadas de voz e deglutição, pareados em média de idade e sexo com GE), que responderam a um questionário com dados de identificação e caracterização da amostra, Lista de Sinais e Sintomas Vocais - LSS, e dois protocolos de avaliação vocal (Índice de Função Glótica - IFG e Escala de Sintomas Vocais - ESV). Por fim, as notas de corte dos protocolos foram identificadas por meio da curva ROC (Receiver Operating Characteristic). Resultados Indivíduos do GE apresentaram mais sinais e sintomas vocais e maiores escores no IFG e ESV que os indivíduos do GC, além de pior autoavaliação vocal. Os três instrumentos apresentaram máxima área sob a curva ROC, com valores de corte ESV=17, IFG=4 e LSS=6 pontos. Conclusão Indivíduos tratados de CCP com disfagia apresentam mais sinais e sintomas vocais, pior autopercepção da disfunção vocal e maior prejuízo nos aspectos de limitação, emocional e físico da voz, que indivíduos vocalmente saudáveis. Os três instrumentos evidenciaram sensibilidade e especificidade máximas, podendo ser utilizados como ferramentas de triagem.

ABSTRACT Purpose To evaluate the presence of vocal signs and symptoms and the vocal function in patients with dysphagia treated for head and neck cancer - HNC and identify the cutoff values of these instruments. Methods Prospective study with 96 individuals (68 men and 28 women) divided into an experimental group - EG (HNC patients with dysphagia, independently of their vocal complaints) and control group - CG (without self-reported vocal or swallowing complaints, with age and sex-matched to the EG). They all answered a questionnaire with identification and characterization of the sample data, the Vocal Signs and Symptoms List - SSL and the protocols: Glottal Function Index - GFI and Voice Symptom Scale - VoiSS. The protocols cutoff values were identified by the ROC curve. Results Individuals from the EG had more vocal signs and symptoms and higher scores in the GFI and the VoiSS than individuals from the CG, they also had worst vocal self-assessment. The three instruments showed maximum area under the ROC curve, with cutoff values of VoiSS=17, GFI=4 and SSL=6. Conclusions Individuals treated for HNC with dysphagia presented more vocal signs and symptoms, poorer perception of their vocal dysfunction and greater loss in vocal aspects of impairment, emotional and physical than the vocally healthy individuals. The three instruments showed maximum sensitivity and specificity and can be used as screening tools.

Practice of laryngectomy rehabilitation interventions: a perspective from South America.

PURPOSE OF REVIEW: Treatment of laryngeal cancer will depend on several factors, including tumor factors, patient factors, as well as the technical resource and expertise of the surgical team and treatment center. In developing countries, most patients have their diagnosis performed at advanced stages, with a significant proportion at very advanced locoregionally, which results in a limitation to the use of organ-preserving approaches. A total laryngectomy is still the most frequent treatment for larynx cancer patients. The rehabilitation in such scenarios can be more demanding and can cost more compared with developed countries. RECENT FINDINGS: For early-stage tumors, function-preserving strategies are mandatory, and can include partial laryngectomies and radiation therapy. In such cases, functional rehabilitation usually is easily achieved, with lower negative impact on the patient's daily life. For advanced tumor stages, a treatment shift toward a more conservative management has been observed. However, the success rates of organ-preserving strategies, mainly with chemoradiation approaches, will rely on a rigorous patient selection process. SUMMARY: The rehabilitation of laryngectomy patients in developing countries can be more demanding and can cost more compared with developed countries. In such scenarios, some strategies can be employed by the multidisciplinary team, mainly by the surgical and speech-pathology teams, aiming to decrease the costs involved in the rehabilitation of total laryngectomy patients in developing countries.

Swallowing, speech and quality of life in patients undergoing resection of soft palate.

The aim of this study was to evaluate swallowing, speech and quality of life in patients undergoing surgery for malignant tumors involving soft palate. We performed a cross sectional study of 23 patients (aged 32-80 years), submitted to soft palate resection, free of disease for at least 1 year. Primary closure of the surgical defect was performed in 5 patients (21.7 %), adaptation of a palatal obturator prosthesis in 2 (8.7 %), myocutaneous flap in 5 (21.7 %), local flap in 2 (8.7 %) and microsurgical free flap in 9 (39.1 %). All patients were submitted to fibreoptic endoscopic evaluation and completed functional and quality of life questionnaires. Functional evaluation of swallowing showed higher prevalence of pooling of food in the nasopharynx in patients submitted to regional flap reconstruction or primary closure (53.9 %). Swallowing difficulties were predominantly related to solid foods (54.5 %) and were associated with more extensive palatal resections. Most individuals submitted to reconstruction with microsurgical flaps had satisfactory velopharyngeal mobility (87 %). The presence of nasal air escape or velopharyngeal gap was minimal in most of the sample. Hypernasality contributed minimally to imprecisions in speech articulation or intelligibility. Vocal alteration did not impact patients' quality of life. Pharyngeal phase of swallowing was satisfactory in most patients. However, nasal reflux and penetration were present in a few patients. Most patients had minimal phono-articulatory alterations as a global outcome. Scores of swallowing and speech parameters regarding the questionnaires used were high, demonstrating minor impact on quality of life.

Prevalence of upper aerodigestive symptoms in patients who underwent thyroidectomy with and without the use of intraoperative laryngeal nerve monitoring.

BACKGROUND: Upper aerodigestive symptoms (UADS) have been reported by patients who have had thyroidectomies. This study evaluated the long-term prevalence of UADS after thyroidectomy in patients who did and who did not have intraoperative neuromonitoring (IONM). METHODS: This was a cross-sectional study of patients with normal vocal fold mobility who had a thyroidectomy. It included patients who did and did not have this surgery with IONM. All patients answered a questionnaire regarding UADS occurring one or more years after thyroidectomy. The questionnaire dealt with UADS relating to voice and swallowing symptoms and sought to quantify their severity. The 208 patients who underwent thyroidectomy without IONM were designated the control group (CG). The 100 patients who underwent thyroidectomy with IONM were designated the neuromonitored group (NMG). RESULTS: The proportion of patients in the CG who reported UADS was 45%; 25.9% of these patients reported voice symptoms, and 33.6% reported swallowing symptoms. The proportion of patients in the NMG who reported UADS was 39%; 27% of these patients reported voice symptoms, and 22% reported swallowing symptoms. Thus, patients in the CG had more swallowing symptoms and a greater severity of UADS-related symptoms than patients in the NMG. CONCLUSIONS: In this study, IONM had a favorable effect in terms of decreasing the prevalence and severity of UADS occurring one year or more after thyroidectomy.

Vocal handicap and quality of life after treatment of advanced squamous carcinoma of the larynx and/or hypopharynx.

OBJECTIVE/HYPOTHESIS: To evaluate and correlate voice-specific quality of life (QOL) and health-related QOL (HR-QOL) after treatment for advanced cancer of the larynx and/or hypopharynx. STUDY DESIGN: Cross-sectional study. METHODS: Patients submitted to partial laryngectomy (PL), salvage PL (sPL), concomitant radiotherapy and chemotherapy (RT+Chemo), total laryngectomy (TL), salvage TL (sTL), total pharyngolaryngectomy (TP) and salvage total pharyngolaryngectomy (sTP). The following questionnaires were used: (1) Voice Handicap Index (VHI) and (2) University of Washington Quality of Life Questionnaire (UW-QOL; version 4). RESULTS: Eighty-four patients participated in the study. All the patients PL (10), sPL (1), and RT+Chemo (24) communicated by laryngeal voice. Of the 49 patients submitted to total removal of the larynx, 30 communicated with alaryngeal phonation, the major part being tracheoesophageal prosthesis (17). The worst subscale of VHI for the total patient group was functional (mean=13.15), and the value of the total score was 31. Patients submitted to PL, RT+Chemo, and TL presented slight handicap (medians of 27, 14, and 21.5, respectively). Patients treated with sTL, TP, and sTP presented moderate handicap (medians of 45, 37.5, and 31.5, respectively). HR-QOL was considered between good and excellent for 78.6% of the patients, and poor for 21.4%. The correlation between voice-specific QOL and HR-QOL was significant (P=0.0001). CONCLUSION: Patients treated for advanced cancer of the larynx/hypopharynx present slight to moderate voice handicap and good/excellent HR-QOL. Stricter analysis of both the VHI and UW-QOL data suggests that more attention be given to the vocal handicap of the individual patient.

Early and long-term effects of physiotherapy for trismus in patients treated for oral and oropharyngeal cancer

OBJECTIVE: Study aim was to analyze early and late effects of physical therapy in the mouth opening of patients with trismus after treatment for oral and oropharyngeal cancer. METHODS: This was an ambispective cohort study, including 29 patients with oral and oropharyngeal squamous cell carcinomas treated by surgery and/or adjuvant radiotherapy. Physical therapy including an active range of motion exercises, manual stretching and CRAC (contract-relax, antagonistcontract) technique were applied. Information about tumor, cancer treatment, physical therapy and mouth opening was obtained from the medical or physical therapy records. Assessment of mouth opening was performed at three moments: pre-physical therapy, at the end of the last session of treatment (early results) and when patients were invited for a new functional evaluation (long-term results).RESULTS: Mouth opening increased significantly in both early and long-term evaluations (p < 0.001). The initial mouth opening measurements (23.2mm) were significantly smaller than the post-physical therapy (33.9 mm) and long-term measurements (38.1 mm) (p < 0.001). Effect size was 1.0 and 1.4, related to early and late results, respectively. Surgically treated patients seem to have a better long-term response than those treated with adjuvant radiotherapy (p = 0.053). CONCLUSIONS: Mouth opening increased significantly after physical therapy in patients with trismus, and these results were sustained after therapy had been concluded. There seems to be a larger increase in mouth opening in patients treated exclusively by surgery than in patients treated with adjuvant radiotherapy

Caracterização da fonoarticulação e sua relação com a disfagia em pacientes com disartrofonia em um hospital oncológico / Characterization of phonoarticulation and its relationship with dysphagia in patients with dysarthrophonia in an oncological hospital

Tema: A disartrofonia caracteriza-se por sintomas motores que influenciam o padrão vocal, articulatório e de deglutição que trazem um impacto negativo na qualidade de vida dos indivíduos, principalmente, em seu contexto social. Objetivo: Descrever os achados da fonoarticulação e da deglutição em pacientes com disartrofonia atendidos em um hospital oncológico. Método: Trata-se de um estudo clínico-qualitativo, descritivo, retrospectivo, envolvendo 12 pacientes (7 mulheres e 5 homens), idade média de 50 anos (10-88 anos), com diagnóstico clínico de disartrofonia. Foram analisadas amostras de gravações com vogal sustentada, fala encadeada, fala espontânea e provas de diadococinesia fonoartiulatória na caracterização das disartrofonias. A deglutição foi avaliada por meio do diagnóstico videofluoroscópico, de acordo com o grau de severidade da disfagia. Resultados: Com relação às habilidades comunicativas, 42% dos pacientes apresentaram qualidade vocal tensa, 50% redução da velocidade de fala, 83% alteração na naturalidade, 50% comprometimento na inteligibilidade de fala, 58% alteração da fluência. Observou-se alta taxa de incoordenação pneumofonoarticulatória (67%), presença de hipernasalidade (42%) e severa imprecisão articulatória, nos casos analisados. A maior incidência da disfagia foi encontrada em pacientes com disartrofonia hipocinética e mista moderada (com componentes hipocinéticos e atáxicos), sendo 34% com disfagia orofaríngea neurogênica discreta. Conclusão: As características vocais dos pacientes com disartrofonia em um hospital oncológico são decorrentes de diferentes etiologias e demonstram grande variação de apresentação. Os distúrbios de deglutição também se fizeram presentes e demonstram alta variabilidade em relação aos seus achados videofluoroscópicos.

Background: Dysartrophonia is characterized by symptoms infl uencing the standard of voice, articulation and swallowing which, consequently, bring a negative impact on quality-of-life of individuals, mainly in their social context. Aim: To describe voice and deglutition of patients with dysartrophonia. Method: This is a clinical-qualitative descriptive retrospective study, in which 12 patients were analyzed (7 female and 5 male), ranging in age from 10 to 88 (mean 50), diagnosed with dysartrophonia. We analyzed recorded samples of vowel prolongations, automatism, contextual speech and diadochokinesia rates, relating these samples to the videofl uoroscopic evaluation results, according to the degree of severity of dysartrophonia and dysphagia. Results: Regarding comunication skills, 42% of patients had strained vocal quality, 50% had slowed speech, 88% had alterations in naturality speech, 50% had compromised speech intelligibility ranging from intelligible upon attentive listening to unintelligible 58% had fl uency alteration. Additional fi ndings were a high level of lack of coordination among respiration, phonation and articulation, presence of hypernasality (42%) and severe articulatory inaccuracy. In this study the highest incidence of mild and moderate neurogenic oropharyngeal dysphagia was found mainly in patients with hypokinetic and moderate mixed dysartrophonia (with hypokinetic and ataxic components) and only one case of mild fl accid dysartrophonia; 34% of patients had mild neurogenic oropharyngeal dysphagia. Conclusion: Vocal characteristics of patients with dysartrophonia in cancer hospitals result from different etiologies and show many presentation. Deglutition disorders were also observed and showed high variability regarding videofluoroscopic findings.

Introducción: La disartrofonía se caracteriza por síntomas motores que influencian el patrón vocal, articulatorio y de deglución que traen un impacto negativo a la cualidad de vida de los individuos, principalmente, en su contexto social. Objetivo: Describir los allados de la fonoarticulación y la deglución de los pacientes con disartrofonía. Metodo: Trátase de un estudio clinico-cualitativo, descriptivo, retrospectivo, envolviendo 12 pacientes (7 del sexo femenino, 5 del sexo masculino), con média de edad de 50 años (10-88 años), con diagnóstico clinico de disartrofonia. Fueron analizados amuestras de grabaciones con vocal sustentada, habla concatenada, habla espontánea y pruebas de diadococinesia fonoarticulatória para la caracterización de las disartrofonias. La deglutición fue evaluada por medio de diagnóstico videofl uoroscopico, de acuerdo con el grado de severidad de la disfagia. Resultados:Con relación a las habilidades comunicativas, 42% de los pacientes presentan cualidad vocal tensa, 50% reduccion de la velocidad del habla, 83% alteración en la naturalidad, 50% inteligibilidad de habla comprometida y 58% alteración de la fl uidez. Se observó alta tasa de incoordinación pneumofonoarticulatoria (67%), presencia de hipernasalidad (42%) y severa imprecisión articulatoria en los casos analizados. La incidencia maior de disfagia se encontró en pacientes con disartrofonia hipocinética y mista moderada (con componientes hipocinéticos y atáxicos), de estos el 34% tenian disfagia orofaríngea neurogénica discreta. Conclusión: Las características vocales de los pacientes con disartrofonia en un hospital oncológico son decorrientes de diferentes etiologías, y demonstran grande variación de presentación. Los distúrbios de deglución también estuvieron presentes y demuestran alta variabilidad en relación a los sus allados videofluoroscopicos.