Quality of life score as a prognosticator for pharyngeal cancer patients treated with radiotherapy.

The purpose of this study was to evaluate the prognostic value of quality of life (QOL) scores acquired not only pre-treatment, but also 1 month after treatment for locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) in patients with pharyngeal cancer treated using radiotherapy. Data for 102 patients with naso-, oro-, or hypo-pharyngeal cancer treated between December 2008 and September 2017 were retrospectively analyzed. About 90% of the patients were male. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) was used for QOL assessments. Associations between QLQ-C30 scores before and 1 month after treatment and outcomes including LRC, DMFS, and OS were analyzed using Cox proportional hazard models. Median follow-up was 37 months (range, 5-117 months). Three-year LRC, DMFS, and OS rates were 77.8%, 60.0%, and 66.5%, respectively. Pre-treatment emotional functioning and diarrhea at 1 month after treatment were identified as significant predictors of LRC. Pre-treatment global QOL and diarrhea at 1 month after treatment were detected as significant predictors of DMFS. Pre-treatment emotional functioning, pre-treatment appetite loss, and diarrhea at 1 month after treatment were detected as significant predictors of OS. Diarrhea at 1 month after treatment was the most powerful QOL variable for predicting LRC, DMFS and OS. Our study revealed that several QOL scores not only before treatment but also 1 month after treatment correlated with LRC, DMFS and OS. In particular, the diarrhea domain of QOL at 1 month after treatment offered the most powerful prognosticator for pharyngeal cancer patients treated with radiotherapy.

Body image in head and neck cancer patients treated with radiotherapy: the impact of surgical procedures.

BACKGROUND: In this study, we aimed to investigate the impact of surgical procedures on the body image of head and neck cancer patients treated with radiotherapy and with or without radical surgery. METHODS: A cross-sectional survey of 150 patients with head and neck cancer was conducted. Sixty patients had nasopharyngeal cancer treated with definitive radiotherapy without surgery, and 90 patients had oral cavity cancer treated with radical surgery plus adjuvant radiotherapy. All participants completed a 10-item Body Image Scale (BIS) questionnaire to assess body image dissatisfaction. Among all patients, the socio-demographic and clinical variables were age, gender, partnership, education, employment, and radical surgery. In surgically-treated patients, the clinical variables were facial skin sacrificed, mouth angle sacrificed, glossectomy, maxillectomy, and mandibulectomy. ANOVAs, t-tests, and multiple regressions were used to evaluate the relationships between these variables and BIS results. RESULTS: In all patients, radical surgery was the strongest independent predictor of BIS scores. Surgically-treated patients had significantly worse BIS scores than the patients without surgery. In surgically-treated patients, facial skin sacrificed, mouth angle sacrificed, maxillectomy, and mandibulectomy were significantly associated with body image. According to multivariable analyses, inferior maxillectomy and segmental mandibulectomy were independent prognosticators of a poor BIS score in surgically-treated patients. CONCLUSION: Radical surgery for head and neck cancer patients has a significant impact on their body image, especially for those undergoing facial bone destructive surgery.

Awareness and Knowledge of Oral Cancer and Potentially Malignant Oral Disorders among Dental Patients in Far North Queensland, Australia.

BACKGROUND: Public awareness/knowledge on oral and pharyngeal cancer (OPC), potentially malignant disorders (PMODs) and their risk factors is crucial for prevention and early detection of OPC and PMODs. Yet, there are no published data available on the awareness and knowledge of OPC and PMODs among people living in Far North Queensland, Australia. MATERIALS AND METHODS: This study was conducted as a cross sectional survey. A self-administered questionnaire was designed and consisted of relevant questions to ascertain socio-demographic information, awareness and knowledge of OPC, PMODs and risk factors and questions on participant's exposure to risk factors and dietary history were also included. Survey was carried out at the Dental Clinic of the James Cook University School of Dentistry (JCU Dental), Cairns, Australia. Subjects above the age of 20 years (n=366) were randomly selected during the period from 31st July to 6th September 2013 and questionnaire was distributed to complete while they are waiting for treatment. Data analysis was carried out using SPSS version 21 and the chi -squared test was employed to compare groups. P<0.05 was considered statistically significant. RESULTS: The study revealed that 52.3% of the respondents were aware of the existence of OPC but only 19.0% were aware of PMODs. Of those who were aware of oral cancer, 92% agreed or strongly agreed that smoking is a strong risk factor for OPC. Similarly a relatively high proportion of the respondents agreed or strongly agreed that tobacco chewing (84%), tobacco chewing with areca nut (68%), chewing areca nut alone (51%) and exposure to actinic radiation (71%) as risk factors. However, the results for alcohol intake, age, and HPV infection were found to be relatively poor with proportions 33%, 34%, and 23% respectively. CONCLUSIONS: This study revealed an alarming lack of awareness and knowledge of OPC and PMODs.

Further analysis of the emotional consequences of head and neck cancer as reflected by the Patients' Concerns Inventory.

Patients with cancer of the head and neck can experience high levels of distress. The emotional burden of the disease must be recognised and important negative emotions assessed so that appropriate interventions can be provided. We obtained data from 1482 head and neck cancer Patients' Concerns Inventories (HNC-PCI) completed by 813 patients between 1 August 2007 and 9 January 2013, and particularly concentrated on the psychological, emotional, and spiritual well-being domain, which comprises 14 items. We also assessed health-related quality of life (HRQoL) using the University of Washington quality of life questionnaire version 4 (UWQoL). A total of 538 patients were male and the mean age of all patients on first completing the PCI was 64 years (range 20-94). Primary tumours were oral (n=392, 48%), oropharyngeal (n=196, 24%), laryngeal (n=142, 17%), other (n=74, 9%), or unknown (n=9, 1%). Fifty-one percent of patients (n=753) chose no items in the emotions category, 16% (n=236) identified fear of recurrence only, 16% (n=236) selected items other than fear of recurrence, and 17% (n=257) selected fear of recurrence and others. Patients who identified fear of recurrence with other issues had significantly worse scores for anxiety, mood, and overall quality of life (QoL). Fear of recurrence is common but patients with multiple emotional concerns need additional support, and further research is required to specify the practical details of the interventions needed at various points during and after treatment.

Effect of marriage on outcomes for elderly patients with head and neck cancer.

BACKGROUND: Beneficial effects of marriage on cancer outcomes have been observed for many cancers, but oral cavity and pharyngeal cancers have never been examined. METHODS: We used the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program linked with Medicare records to identify 9403 elderly patients (age ≥66 years) with oral cavity and pharyngeal cancers. We used a propensity score analysis to estimate differences in proportions (pd ) between married and unmarried patients on stage, treatment, and survival. RESULTS: For oral cavity cancers, a larger proportion of married patients presented with earlier stage (pd = 0.05; 95% confidence interval [CI], 0.02-0.08), were treated with surgery (pd = 0.06; 95% CI, 0.03-0.08), and survived 1 year (pd = 0.04; 95% CI, 0.01-0.06). Similar results were found for pharyngeal cancers for stage (pd = 0.04; 95% CI, 0.01-0.06), treatment with chemotherapy and radiation (pd = 0.04; 95% CI, 0.01-0.07), and 1-year survival (pd = 0.01; 95% CI, 0.08-0.16). CONCLUSION: Marriage is associated with earlier stage, aggressive treatment, and superior survival for patients with oral cavity and pharyngeal cancers.

Psychosocial factors associated with mouth and throat cancer examinations in rural Florida.

OBJECTIVES: We examined the knowledge and prevalence of mouth and throat cancer examinations in a sample drawn from rural populations in north Florida. METHODS: Telephone interviews were conducted across rural census tracts throughout north Florida in 2009 and 2010, in a survey that had been adapted for cultural appropriateness using cognitive interviews. The sample consisted of 2526 respondents (1132 men and 1394 women; 1797 Whites and 729 African Americans). RESULTS: Awareness of mouth and throat cancer examination (46%) and lifetime receipt (46%) were higher than reported in statewide studies performed over the past 15 years. Only 19% of the respondents were aware of their examination, whereas an additional 27% reported having the examination when a description was provided, suggesting a lack of communication between many caregivers and rural patients. Surprisingly, anticipated racial/ethnic differences were diminished when adjustments were made for health literacy and several measures of socioeconomic status. CONCLUSIONS: These findings support the notion that health disparities are multifactorial and include characteristics such as low health literacy, lack of access to care, and poor communication between patient and provider.

Knowledge and perceptions regarding oral and pharyngeal carcinoma among adult dental patients.

BACKGROUND: The aim of this study was to assess awareness and knowledge of oral and pharyngeal carcinoma and risk perception for developing the cancer among adult patients attending a major dental centre in Perth. Influence of socio-demographic factors on awareness, knowledge and perception was ascertained. METHODS: A random sample of 120 potential participants over the age of 18 who attended the Oral Health Centre of Western Australia between 14 and 18 June 2010 were invited to participate in the survey. A total of 100 participants completed a face-to-face interview guided by a questionnaire. RESULTS: Seventy-two per cent of the participants had heard of oral and pharyngeal carcinoma. Sixteen per cent knew that both smoking and drinking increased the risk of oral and pharyngeal carcinoma and 49% knew at least one sign or symptom of the cancer. Language spoken at home, education, and employment influenced cancer awareness and knowledge. Sixty-two per cent of the participants considered themselves not at risk of developing the cancer. CONCLUSIONS: The findings suggest that knowledge concerning oral and pharyngeal carcinoma in the community may be limited and educational strategies may be required to improve such knowledge.

Nutrient-based dietary patterns and the risk of oral and pharyngeal cancer.

The relationship between diet and oral and pharyngeal cancer has been rarely addressed considering dietary patterns. We examined this issue using data from a case-control study carried out between 1992 and 2005. Cases were 804 incident oral cancers hospitalized in 3 Italian areas. Controls were 2080 subjects hospitalized for non-neoplastic diseases. Dietary habits were investigated through a validated 78-item food-frequency questionnaire. Overall and individual measures of sampling adequacy were calculated to assess if applying a factor analysis or not. A posteriori dietary patterns were identified through a principal component factor analysis performed on a selected set of 29 nutrients. The internal reproducibility, robustness and reliability of the identified patterns were evaluated. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional multiple logistic regression models on quintiles of factor scores. The measures of sampling adequacy were generally satisfactory. We identified five major dietary patterns named Animal products, Starch-rich, Vitamins and fiber, Unsaturated fats and Retinol and niacin. The Animal products pattern was positively associated with oral cancer (OR=1.56, 95% CI: 1.13-2.15 for the highest vs. the lowest score quintile), whereas the Starch-rich pattern (OR=0.71, 95% CI: 0.50-0.99), the Vitamins and fiber pattern (OR=0.47, 95% CI: 0.34-0.65) and the Unsaturated fats pattern (OR=0.63, 95% CI: 0.45-0.86) were inversely associated with it. These findings confirm that diets rich in animal origin and animal fats are positively, and those rich in fruit and vegetables, and vegetable fats inversely related to oral and pharyngeal cancer risk.

Psychometric properties of the EORTC head and neck-specific quality of life questionnaire in disease-free Greek patients with cancer of pharynx and larynx.

PURPOSE: The purpose of our study was to formally translate to and determine the psychometric properties of QLQ-H&N35 in a group of Greek patients who had been successfully treated for laryngeal or pharyngeal cancer. METHOD: The Greek translation of the questionnaire was performed according to the instructions of EORTC Quality of Life group as described in the translation manual. The procedure included forward and backward translations followed by a pilot study and was reported and accepted by the EORTC Quality of Life group. In a cross-sectional study, the translated EORTC QLQ-H&N35 in conjunction with the core EORTC QLQC30 questionnaire was given to 116 patients who had been successfully treated for cancer of larynx or pharynx. RESULTS: The compliance was high, and the QLQ-H&H35 demonstrated acceptable reliability (internal consistency) and construct validity. The questionnaire had the ability to distinguish between patients with different performance status, site, treatment modality, and disease stage. CONCLUSION: The Greek version of EORTC H&N35 in conjunction with the EORTC C30 is a valid and informative tool in assessing quality of life in Greek patients with cancer of larynx and pharynx.

Perception of head and neck cancer quality of life within the medical world: a multicultural study.

BACKGROUND: Physician's perception of quality of life of patients with cancer is unclear. No reports have evaluated its influence on patient management. METHODS: Five hundred otolaryngologists completed a questionnaire regarding the quality of life of patients with head and neck cancer. RESULTS: Seventy-eight percent of responders thought that quality of life must be considered when choosing treatment, even if this meant decreased survival. Seventy-five percent thought it justified to withhold curative treatment if this would lead to impaired quality of life. Pain and breathing were the most important symptoms to consider. The perception was worse for physicians practicing in Latin culture, working in private practice, or with no personal acquaintance with a head and neck cancer victim and was better after radiotherapy than after surgery and chemotherapy. CONCLUSION: Quality of life is important for physicians and is considered as essential as survival by many physicians. The perception of patient's quality of life influences the treatment choice.

Predictors of quality of life after treatment for oral cavity and oropharyngeal carcinoma.

BACKGROUND: Treatment for head and neck cancer, including surgery, radiation, and chemotherapy, can impact quality of life. DESIGN: Patients seen at an academic institution and treated for oral cavity and oropharyngeal carcinoma were asked to participate. The standardized University of Michigan Head and Neck Specific Quality of Life questionnaire was distributed. RESULTS: Eighty-seven patients completed the questionnaire. The majority had squamous cell carcinoma (94%), stage III or IV disease (53%), and a history of tobacco or alcohol dependence (59%), and were male (62%). Eighteen percent had free-tissue transfer (fibula free flap in 8% and radial forearm free flap in 10%). Predictors of worse quality of life included advanced stage, gastrostomy-tube dependence, complication, or recurrence. CONCLUSION: Stage, gastrostomy-tube dependence, complication, recurrence, and treatment modality influence quality of life. A better understanding of the impact of oral cavity and oropharyngeal cancer treatment on quality of life will enable us to better advise our patients.

Hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer: quality of life in a prospective phase I/II trial.

BACKGROUND AND PURPOSE: Quality of life (QOL) was measured prospectively in a dose escalation study of twice daily hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer (HNC). MATERIALS AND METHODS: Patients with squamous cell HNC (TNM stage III/IV larynx or pharynx, or hypopharynx any stage) received 40 fractions of twice daily RT at 3 dose levels: (L1) 60Gy, 1.5Gy/fraction; (L2) 62Gy, 1.55Gy/fraction; and (L3) 64Gy, 1.6Gy/fraction. QOL was measured on the FACT-H&N at baseline, 6 and 12 months. RESULTS: Mean QOL scores were: baseline 104, 6 months 108, 12 months 112. At all time points, QOL scores were lower in patients with more advanced T-category. A mixed-model analysis of determinants of QOL showed no dose effect among L1 (n=22), L2 (n=26) or L3 (n=123). QOL improved significantly with time from diagnosis, however post-treatment QOL was lower and improved more slowly in patients who had feeding tubes. CONCLUSIONS: Post-RT QOL improved from baseline by a statistically and clinically significant amount. Hyperfractionated, accelerated RT provides favorable QOL outcomes, and is a viable alternative to chemoradiation for patients with locally advanced HNC.

Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters.

BACKGROUND AND PURPOSE: Dysphagia and swallowing problems are common in pharynx cancer patients treated with radiotherapy. Dysfunction of the upper aerodigestive tract may lead to reduced quality of life, malnutrition and aspiration pneumonia. The aim of the current study was to describe swallowing function after radiotherapy and examine its correlation with irradiated volume and dose. PATIENTS AND METHODS: All recurrence free patients treated for pharynx cancer with radical radiotherapy at our institution, between 1998 and 2002, were invited to participate, 35 (55% of eligible) agreed. Patients were examined with EORTC quality of life questionnaires and functional endoscopic evaluation of swallowing. Organs at risk were delineated on planning CT scans, available for 25 patients. RESULTS: Eighty-three percent of patients had some degree of dysphagia. Reduced sensitivity was observed in 94%, residues in 88%, penetration in 59% and aspiration in 18% of patients. Several significant correlations were found between both subjective and objective swallowing problems and DVH parameters of the upper aerodigestive tract. Doses less than 60 Gy to the supraglottic region, the larynx and upper esophageal sphincter resulted in a low risk of aspiration. DISCUSSION: Both subjective and objective swallowing problems were frequent and severe after radiotherapy for pharynx cancer. Swallowing dysfunction was correlated with dose and volume parameters of the upper aerodigestive tract.

Quality of life after free-flap reconstruction in patients with oral and pharyngeal cancer.

BACKGROUND: Our aim was to investigate quality of life and outcome after microvascular free-flap reconstruction after oncologic surgery. METHODS: Forty-four patients with a large carcinoma in the oral cavity, oral pharynx, or hypopharynx underwent free-flap surgery with or without radiotherapy. Patients completed the University of Washington Quality-of-Life Questionnaire preoperatively and four times during the 12 postoperative months. Survival rates and complications were analyzed. RESULTS: Postoperative composite quality-of-life scores were significantly lower than before treatment with no significant overall improvement during the follow-up. The scores for disfigurement, chewing, speech, and shoulder function remained significantly below the preoperative level throughout the follow-up. Sociodemographic factors predicted quality of life. Heavy drinking and unemployment caused a 2.4-fold and a 4.4-fold increase in risk of death, respectively. The rates for overall survival, tumor recurrence, flap success, and surgical complications were consistent with previous literature. CONCLUSION: Sociodemographic variables affect quality of life and patient survival in patients with oral cancer treated with microvascular free-flap reconstruction.

Health-related quality of life in patients with pharyngeal carcinoma: a five-year follow-up.

PURPOSE: The purpose was to evaluate the health-related quality of life (HRQL) of patients with pharyngeal carcinoma at diagnosis and after 1 and 5 years in relation to tumor location and treatment modality in a prospective multicenter study. METHODS: Eighty-nine patients with pharyngeal carcinoma (mean age, 60.0 years; 76% men) were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Cancer Module (EORTC QLQ-H&N35). RESULTS: Problems with dry mouth and teeth became worse between diagnosis and the 5-year follow-up. Problems with thick secretions and teeth increased between 1 and 5 years. The HRQL at diagnosis was associated with survival. Patients with oropharyngeal carcinoma reported better HRQL than patients with hypopharyngeal carcinoma. CONCLUSIONS: For patients with pharyngeal carcinoma, the HRQL at diagnosis seems to be an important factor for the prognosis of both HRQL over time and survival. Treatment of pharyngeal carcinoma often results in long-term side effects such as dry mouth, problems with teeth, and thick secretions.

Oral and pharyngeal cancer: analysis of patient delay at different tumor stages.

BACKGROUND: The aim of this study was to examine which factors are related to patient delay in a cohort of consecutive patients with pharyngeal cancer and oral cancer and to determine whether the different stages of patient delay (ie, appraisal, illness, behavioral, and scheduling) were related to different tumor stages. METHODS: Before treatment, 55 patients with pharyngeal cancer and 134 patients with oral cancer were interviewed about their prediagnostic period. To verify the data, a questionnaire was sent to the general practitioner and/or dentist and a close relative. RESULTS: Patients with a delay of more than 30 days were significantly more often diagnosed with late-stage (T3-T4) disease (pharynx, p = .01, odds ratio [OR] = 4.5; oral, p = .01, OR = 3.2). No sociodemographic characteristics were associated with patient delay. CONCLUSIONS: Prolonged patient delay was associated with late-stage disease for both patients with pharyngeal cancer and patients with oral cancer. Although for most patients the symptoms are vague or might look like a common cold or infection, the general public should be better informed about tumor symptoms. This may enhance earlier visits to a health care professional.

Oral and pharyngeal cancer: practices and opinions of dentists in British Columbia and Nova Scotia.

Oral and pharyngeal cancers are associated with high mortality rates, a situation usually attributed to late-stage diagnosis. Dentists in British Columbia and Nova Scotia were surveyed regarding their practices and opinions related to oral and pharyngeal cancer. In February 1998 a pretested, 41-item survey was mailed to a random sample of dentists in British Columbia (n = 817) and the population of dentists in Nova Scotia (N = 423). A reminder postcard and one additional mailing were sent to nonrespondents. Of the 670 dentists supplying usable responses (response rate 55.2%), only 56.7% agreed that their knowledge of the subject was current. Of 8 health history items, dentists assessed 5 on average, with most (88.0%) asking about the patients' current use of tobacco. A total of 72.7% of the responding dentists performed an oral cancer examination for all edentulous patients at every appointment, but 10.9% never did so. Similarly, 70.7% of the dentists always provided an oral cancer examination at the initial appointment for patients 40 years of age and older, but 9.8% never did so. Undergraduate training related to oral cancer examination was reported as good by only 52.2% of the dentists. About three-quarters of all dentists (77.0%) were interested in taking continuing education courses on this subject. Differences between the 2 provinces were not statistically significant (p > 0.01). Dentists in British Columbia and Nova Scotia could benefit from undergraduate and continuing education courses to increase their knowledge of health history assessment, examination for oral and pharyngeal cancers, and risk reduction strategies, such as counselling about tobacco cessation.