Functional outcomes and quality of life after a 6-month early intervention program for oral cancer survivors: a single-arm clinical trial.

Yueh-Hsia Chen,Yuan-Hung Chao,Chung-Yin Hsu,Shwu-Huei Lien,Wei-An Liang,Hsiao-Jung Tseng,Siang-Lan Guo

doi:10.7717/peerj.4419

Abstract

BackgroundAdvanced treatment of oral cancer increases survival rates; however, it also increases the risk of developing shoulder dysfunction, dysphagia, oral dysfunction, donor site morbidity and psychological issues. This single-arm preliminary pilot study aims to explore the effects of a six-month early intervention program following reconstructive surgery in oral cancer survivors.MethodsA total of 65 participants were analyzed following reconstructive surgery. Outcome measurements were taken during the first visit, and at one, three and six months after reconstructive surgery.ResultsScapular muscle strength and shoulder range of motion progressively improved during the 6-month follow-up. The mean Disability of the Arms, Shoulder and Hand (DASH) score showed significant improvement at 1 month (p < .001). Health related QoL showed significant differences between baseline and 6-months post-surgery scores on global health and on most of the function and symptom scales. The predicted return-to-work rate was 80% at one year after the operation. Return-to-work rate differs in different vocational types, with a higher rate of return in the skilled or semi-skilled (87.5%) and self-employed (86.7%). ConclusionsWe suggest that early integrated intervention program with a follow-up of at least six months following reconstructive surgery may help develop and identify intervention guidelines and goals in the initial six months of treatment following neck dissection in oral cancer survivors.

Highlights

Oral cavity cancer is the 11th most common cancer in the world
Though the modified radical and selective neck dissections aims to reduce the prevalence of shoulder dysfunction, a wide range of accessory nerve shoulder dysfunction (ANSD) incidence rates after neck dissection have been reported (Sheikh, Shallwani & Ghaffar, 2014; Umeda et al, 2010)
Apart from the disease-related variables, there were no significant differences in the demographic data of the early staged group and the advanced group

Summary

Introduction

Oral cavity cancer is the 11th most common cancer in the world. Its incidence rate is highly correlated with exposure to tobacco, betel nut chewing, and alcohol in developing nations, and the incidence of human papillomavirus (HPV) infection in developed countries (Krishna Rao et al, 2013; Marur & Forastiere, 2016; Sankaranarayanan et al, 2015). In the advanced stage of cancer, donor-site-related impairments often develop, such as accessory nerve shoulder dysfunction (ANSD) (Cappiello et al, 2005; Dijkstra et al, 2001; Stuiver et al, 2008; Van Wilgen et al, 2003). Advanced treatment of oral cancer increases survival rates; it increases the risk of developing shoulder dysfunction, dysphagia, oral dysfunction, donor site morbidity and psychological issues. This single-arm preliminary pilot study aims to explore the effects of a six-month early intervention program following reconstructive surgery in oral cancer survivors. We suggest that early integrated intervention program with a follow-up of at least six months following reconstructive surgery may help develop and identify intervention guidelines and goals in the initial six months of treatment following neck dissection in oral cancer survivors

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