Surgical Procedures to Enhance Prosthetic Prognosis in the Rehabilitation of a Maxillectomy Defect Due to Sinonasal Carcinoma: A Case Report

BackgroundThe consequences of treatment for Head and Neck cancer (HNC) patients has profound detrimental impacts such as impaired QOL, emotional distress, delayed recovery and frequent use of healthcare. The aim of this trial is to determine if the routine use of the Patients Concerns Inventory (PCI) package in review clinics during the first year following treatment can improve overall quality of life, reduce the social-emotional impact of cancer and reduce levels of distress. Furthermore, we aim to describe the economic costs and benefits of using the PCI.MethodsThis will be a cluster preference randomised control trial with consultants either ‘using’ or ‘not using’ the PCI package at clinic. It will involve two centres Leeds and Liverpool. 416 eligible patients from at least 10 consultant clusters are required to show a clinically meaningful difference in the primary outcome. The primary outcome is the percentage of participants with less than good overall quality of life at the final one-year clinic as measured by the University of Washington QOL questionnaire version 4 (UWQOLv4). Secondary outcomes at one-year are the mean social-emotional subscale (UWQOLv4) score, Distress Thermometer (DT) score ≥ 4, and key health economic measures (QALY-EQ-5D-5 L; CSRI).DiscussionThis trial will provide knowledge on the effectiveness of a consultation intervention package based around the PCI used at routine follow-up clinics following treatment of head and neck cancer with curative intent. If this intervention is (cost) effective for patients, the next step will be to promote wider use of this approach as standard care in clinical practice.Trial registration32,382. Clinical Trials Identifier, NCT03086629. Protocol: Version 3.0, 1st July 2017.

Statement of the Problem: Head and neck cancer treatment has provided better cure and survival rates but the patient’s quality of life is still an issue. Purpose: To verify the correlation between the three most used instruments for evaluating the quality of life of head and neck cancer patients. Materials and Method: This cross-sectional study evaluated patients treated for head and neck cancer at the Mato Grosso Cancer Hospital, Cuiabá, MT, Brazil. The variables age, gender, cohabitation status, education, religion, smoking, ethnicity, tumor location and histological type and treatment modality were collected. The patients quality of life was assessed by the Functional Assessment of Cancer Therapy Quality of Life Measurement System (FACT-H&N), University of Washington Quality of Life Questionnaire (UW-QOL), and EORTC QLQ-C30/EORTC QLQ-H&N35 of the European Organization for Research and Treatment of Cancer. Results: The study population consisted of 33 individuals with a mean age of 63.42±11.25 years; 69.70% were males; 54.55% had no partner; 45.45% had only elementary education; 87.9% followed a religion; 84.38% were smokers and 87.50% alcoholics. Squamous cell carcinoma responded for 78.79% of the cases and palate/oropharynx and mouth floor (21.21% each) were the most affected sites. All patients underwent radiotherapy, 90.91% chemotherapy and 63.64% surgery. On the analysis of quality of life, shoulder (UW-QOL), social performance (EORTC QLQ-C30/QLQ-H&N35) and overall well-being (FACT-H&N) had the highest scores while saliva (UW-QOL), nausea and vomiting (EORTC QLQ-C30/QLQ-H&N35) and emotional well-being (FACT-H&N) had the lowest scores. A positive correlation was found between the questionnaires for the patient's overall quality of life and the domains Pain, Appearan-ce, Activity, Deglutition, Chewing, Speech, Taste, Saliva, Mood and Anxiety. Conclusion: Given the correlation between the questionnaires, the selection of the instrument for future research involving head and neck cancer patients’ quality of life should consider the specific aspects to be evaluated.

Quality of life is a concept referring to the physical, psychological and emotional well-being of individuals. It is affected by various aspects of one’s life including physical health, interpersonal relationships, psychological well-being and other environmental factors. Head and neck cancer patients undergo surgery and chemotherapy which could lead to changes in their facial appearance as well as voice and speech, resulting in self-image anxiety. It impacts the patients’ self-esteem, perception and confidence negatively. This research aims to study how facial disfiguration and self-image anxiety affects the overall quality of life of head and neck cancer patients. The relationship between cancer and the quality of life of cancer patients is complex, as they face various challenges such as the disease itself, its treatment and the impact it has on their self-image. The existing literature related to the subject was examined, including various articles, review papers and research papers. Altogether, we identified and reviewed 20 articles. The inclusion criteria focused on papers on the quality of life of cancer patients, facial disfigurement post-surgery, self-image anxiety among head and neck cancer patients. The studies indicate that head and neck cancer patients experienced negative body image due to facial disfigurement from surgery and chemotherapy. This resulted in increased self-image anxiety among the cancer patients. It is observed that the physical pain, distress, facial disfiguration and self-image anxiety impacted their quality of life and overall well-being negatively.

Introduction: A number of studies published by the World Trade Center Health Registry (Registry) document the prevalence of injuries sustained by victims of the World Trade Center Disaster (WTCD) on 9/11. Injury occurrence during or in the immediate aftermath of this event has been shown to be a risk factor for long-term adverse physical and mental health status. More recent reports of ongoing physical health and mental health problems and overall poor quality of life among survivors led us to undertake this qualitative study to explore the long-term impact of having both disaster-related injuries and peri-event traumatic exposure on quality of life in disaster survivors. Methods: Semi-structured, in-depth individual telephone interviews were conducted with 33 Registry enrollees who reported being injured on 9/11/01. Topics included: extent and circumstance of the injury(ies), description of medical treatment for injury, current health and functional status, and lifestyle changes resulting from the WTCD. The interviews were recorded, transcribed, and inductively open-coded for thematic analysis.Results: Six themes emerged with respect to long term recovery and quality of life: concurrent experience of injury with exposure to peri-event traumatic exposure (e.g., witnessing death or destruction, perceived life threat, etc.); sub-optimal quality and timeliness of short- and long-term medical care for the injury reported and mental health care; poor ongoing health status, functional limitations, and disabilities; adverse impact on lifestyle; lack of social support; and adverse economic impact. Many study participants, especially those reporting more serious injuries, also reported self-imposed social isolation, an inability to participate in or take enjoyment from previously enjoyable leisure and social activities and greatly diminished overall quality of life.Discussion: This study provided unique insight into the long-term impact of disasters on survivors. Long after physical injuries have healed, some injured disaster survivors report having serious health and mental health problems, economic problems due to loss of livelihood, limited sources of social support, and profound social isolation. Strategies for addressing the long-term health problems of disaster survivors are needed in order to support recovery.

PurposeThe patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics for one year after treatment on health-related QOL (HRQOL).MethodsA pragmatic cluster preference randomised control trial with 15 consultants, 8 ‘using’ and 7 ‘not using’ the PCI intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible.ResultsConsultants saw a median (inter-quartile range) 16 (13–26) patients, with 140 PCI and 148 control patients. Of the pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) social-emotional subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (− 2.9%, 12.9%) but without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected decreased over time.ConclusionThis novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.

Update a previous review examining associations between psycho-social factors and survival in head and neck cancer patients. Searched Cochrane, Psych info and Embase for the period from 1 January 1995 to 1 June 2007, as well as personal and article reference lists and article archives. Identified articles assessed by consensus for eligibility using following criteria: survival as outcome measure; psycho-social factors as prognostic indicators; results specifically for head and neck cancer patients, not including oesophageal or thyroid cancer. Seven of 64 articles fulfilled criteria. Data abstracted independently by two reviewers using pre-determined proformas. Quality also rated using Scottish Intercollegiate Guidelines Network 50 tool. At baseline, expression of intense psycho-social complaints, higher self-perceived physical ability and self-reported high physical functioning were significantly associated with increased survival. Uncertainty about the diagnosis and treatment was found to be a negative prognostic indicator, as was being single, poor cognitive function, baseline fatigue and alcoholism. Overall quality of life and head and neck pain 12 months after date of diagnosis were found to be significantly associated with survival in one study. However, overall quality of life and depression at the time of diagnosis were not. There appears to be some association between selected psycho-social factors and long-term survival from head and neck cancer. However this relationship is currently neither strong nor proven, requiring examination by multi centred trials with standardisation of research definitions and methodologies, and examination of post-treatment psycho-social factors.

Understandability of Speech Predicts Quality of Life Among Maxillectomy Patients Restored With Obturator Prosthesis

Identifying Potential Associations Between Patient Reported Outcomes and Normal Structure Dose Metrics in Head and Neck Cancer Patients Using a Big Data Approach

Salivary gland tumors account for only 3%–5% of all tumors in the head and neck, 10%–15% of which originate from minor salivary glands. Pleomorphic adenoma is a benign lesion of the salivary gland, most commonly occurring in the region of the hard and soft palates. The treatment of choice for pleomorphic adenomas is with the partial or total function of the extension of the lesion, and placing palatal obturators are one method of reestablishing masticatory function and facial esthetics. This study aimed to rehabilitate a patient using a palatal implant following partial maxillectomy for the removal of a pleomorphic adenoma. A young patient with pleomorphic adenoma of the hard palate underwent a partial right-sided maxillectomy procedure which removed the hard palate and alveolar regions of the molars. Prior to surgery, the patient was assessed to make a surgical guide for resection of the tumor, as well as a provisional obturator plate using orthodontic wire clasps. After healing, the patient was rehabilitated using a palatal obturator which had been incorporated into a removable partial denture. The clinical sequence used to fabricate the final prosthesis was as follows: initial molding after surgery, prosthesis design, preparation of the mouth, work molding, structure testing and orientation planning, teeth testing and installation, and periodic maintenance. Thus, we can conclude that the palatal obturator is an excellent means of restoring a patient’s oral function, facial esthetics, and overall quality of life.

Aim: The aim of this study was to assess the magnitude of various oral health indicators. Further, to identify the oral health indicators as a predictive factor for the quality of life among head and neck cancer patients. Methods: A cross-sectional study was conducted among 400 head and neck cancer patients attending tertiary cancer center. The European Organization for Research and Treatment of Cancer and Head and Neck specific (EORTCQLQH&N35) module was used to assess the patient's quality of life. Oral health indicators (oral hygiene practices, oral complication, dental visits, oral rehabilitation) were recorded through oral examination and personal interviews. Spearman's correlation coefficient was used to assess the correlation between oral health indicators and different scales of QoL. Multivariate linear regression by a backward stepwise method was applied to assess the influence of oral health indicators as a predictive factor for QoL. Results: Out of 400 patients, 54.25% of patients reported having one or another form of oral complication. Periodontal problems were the common oral complication among the patients. There was a weak correlation between oral health indicators and most of the scales of EORTC QLQ-H&N35. Theoretically, linked oral health indicators were found to be significant predictive factors. Conclusion: The results show that there was a high magnitude of poor oral health indicators. Oral health indicators also acted as a significant predictor of quality of life. A multi-disciplinary approach is desirable for the improvement in oral health thus improving the overall quality of life among head and neck cancer patients.

The effectiveness of thyme honey for the management of treatment-induced xerostomia in head and neck cancer patients: Afeasibility randomized control trial.

The objective of the study was to examine the association between overall and health-related quality of life and smoking in men and women of discrete smoking groups in Finland. The design was a Health 2000 Survey, conducted in Finland 2000--2001. The setting and participants were a two-stage, stratified, nationally representative cluster sample that comprised 8,028 persons aged 30 or over living in mainland Finland. Health-related quality of life was measured by the 15D questionnaire; and overall quality of life was assessed by a single question measure capturing the respondent's own perception and estimation of his/her quality of life. The present study showed that daily smokers had both lower health-related and overall quality of life than never-smokers among the Finnish adult population. Health-related quality of life profiles showed that daily smokers did worse than never-smokers in a considerable number of the health dimensions. The effects of smoking were observed not only through health: the daily smokers registered significantly lower ratings of overall quality of life compared with never-smokers, too. Both the health-related and overall quality of life of ex-smokers approached those of never-smokers. The results of the present study suggest that improved health is not the only benefit of smoking cessation; better quality of life and more fulfilling everyday living can also be expected. As the major health consequences of smoking usually manifest themselves only after several years of smoking, both health-related and overall quality of life measurements could be used as an intervention tool for motivating people to quit.

Introduction: Cancers affecting the parts of head and neck hugely impact the patients. Among Head and Neck Cancer (HNC) patients, the visible signs and symptoms of the disease or the side effects of treatment modalities can cause various degrees of functional impairment such as mastication, swallowing and communication or disfigurement. Aim: To study the relationship between self-image and quality of life among head and neck cancer patients. Materials and Methods: This was a descriptive cross sectional survey conducted among 54 head and neck cancer patients. Data were collected through self- dministered demographic proforma, disease related proforma, self-image scale and Functional Assessment of Head and Neck Cancer (FACT; H&N).Association between self-image and demographic and disease related variables were assessed by computing Chi-square.Kruskal Wallis was computed to find the association between quality of life and demographic and disease related variables.Results: Majority of patients i.e., 36 out of 54 (66.7 %) were above 50 years, 43 (79.6%) were men, 47 (87%) were married, 46 (85.18%) had the disease duration of less than six months, 43 (79.6%) were receiving both radiation therapy and chemotherapy as a mode of treatment, 49 (90.7%) of them did not have any co-morbidity, 16 (29.6%) had a mode of feeding other than oral (ryles tube and PEG feeding) and six (11.1%) had undergone tracheostomy. There was a significant association between self-image and monthly income, treatment modality and radiotherapy dose with p =0.013, 0.006 and 0.046 respectively. Kruskal Wallis test value for mode of feeding (4.881) was also statistically significant (0.027) with quality of life. There is positive correlation (r=0.613, p=0.001) between self-image and quality of life of head and neck cancer patients.Conclusion: HNC patients suffer with the disease 24 hours a day. Self-image and quality of life of these patients is interrelated.As the self-image improves, the quality of life will be better and vice versa.

Cancers affecting the parts of the head and neck significantly impact patients. Among head and neck cancer (HNC) patients, the visible signs and symptoms of the disease or the side effects of treatment modalities can cause various degrees of functional impairment such as mastication, swallowing, communication, and disfigurement. To assess psychological distress and quality of life in head and neck cancer patients after 3 and 6 months' post-treatment. A hospital-based follow-up study was conducted among head and neck cancer patients who came for routine follow-up after treatment in five cancer hospitals in Hyderabad City. Patients were categorized based on the treatment into surgery, chemotherapy, radiotherapy, and combination of all and the same subjects were followed; after 3 months, psychological distress and quality of life were assessed by distress thermometer and functional assessment of cancer therapy head and neck (FACT H and N). A total of 235 participants were included in the study. Mean age was 58.2 ± 8.7 years. The mean scores of psychological distress at baseline were 4.6 ± 1.2, and after follow-up, it was 3.4 ± 1.2 and the mean scores of quality of life at baseline were 76.4 ± 15.6, and after follow-up, it was 75.5 ± 12.5. The mean scores of psychological distress had reduced from baseline to follow-up with negligible improvement in the quality of life.

Quality of life in prostate cancer patients.