Head And Neck Cancer Population Research Articles

Feasibility and impact of a dedicated multidisciplinary rehabilitation program on health-related quality of life in advanced head and neck cancer patients.

In an observational prospective study, feasibility and outcomes of a dedicated multidisciplinary rehabilitation program (HNR) for head and neck cancer (HNC) patients were evaluated. HRQoL was assessed before and after HNR with EORTC C30 and H&N-35 QoL questionnaires in 52 consecutive patients. Initial HRQoL scores were compared with EORTC reference scores for HNC patients and post-HNR with those available for the general healthy population. Distress was assessed before and after HNR with the distress thermometer (DT). At completion of HNR with a mean duration of 7months, overall HRQoL was significantly improved (p<0.001). Role, Emotional, and Social function scales and most EORTC C30 and H&N35 symptom scale items showed a statistically significant (p<0.01) and clinically relevant improvement. Mean distress score before HNR was above the cutoff value of 5, suggesting the need for referral to rehabilitation. After completing HNR, distress decreased significantly to 3.0 (p<0.001). HRQoL pretreatment was poorer than that of the EORTC reference HNC population, whereas at the completion of the HNR program, the HRQoL was comparable to that of the general population reference level. We conclude that a dedicated multidisciplinary HNR program is feasible and suggest that it has a positive impact on HRQoL. The multidisciplinary approach may have added value over mono-disciplinary interventions. However, our results should be judged cautiously due to the observational nature of the study.

Prevalence and management of pulmonary comorbidity in patients with lung and head and neck cancer

Background. The simultaneous presence of cancer and other medical conditions (comorbidity) is frequent. Cigarette smoking is the major risk factor for as well head and neck cancer (HNC) and lung cancer (LC) as chronic obstructive pulmonary disease (COPD). COPD is the most common comorbidity in LC patients, and presence of COPD worsens the prognosis of HNC and LC. COPD is under-diagnosed and under-treated in the Danish population. The aims of this study were to determine the prevalence of COPD in a HNC and LC population, and to determine the need and feasibility of a randomized controlled phase II trial comparing usual care with optimized medical treatment of COPD in cancer patients.Material and methods. All patients with HNC or LC referred for oncologic treatment in a university hospital during a 10-month period were invited to attend a pulmonary clinic for evaluation of lung function. Patients who were found to have concomitant COPD were randomized to intervention or usual care. Primary endpoints were prevalence of COPD among the referred patients with either LC or HNC, and further whether the patients that were diagnosed with COPD already received treatment in accordance with Danish COPD guidelines. Secondary outcome was feasibility, i.e. the proportion of eligible patients that accepted follow-up in the pulmonary clinic for 24 weeks in addition to oncological treatment. The design of the randomized trail is described in detail.Results. In total 130 patients of whom 65% had LC and 35% HNC have been screened during the first seven months of this ongoing trial. Sixty-eight percent of LC patients and 22% of HNC patients had COPD. All but one of 68 eligible patients accepted randomization. Nearly one third (31%) of the LC and HNC patients with COPD were diagnosed prior to study entry, and of these, only 33% were receiving correct treatment according to current guidelines.Conclusion. For patients with LC, and to a lesser extend HNC, there is a need for improved diagnosis and treatment of concomitant COPD. Furthermore, patients found it acceptable to be scheduled for a 24-week follow-up in a pulmonary clinic along with their oncological treatment.

Coping with an altered mouth and perceived supportive care needs following head and neck cancer treatment.

Oral health is essential to general health and well-being and is severely impacted by head and neck cancer (HNC) and its treatment. This study aimed to describe how people who have been treated for HNC cope with altered oral health and function and to identify their supportive care needs. A qualitative, descriptive approach was used. Data was collected from individual interviews with six participants 6 months after treatment. Data analysis was performed by qualitative content analysis involving inductive and directed approaches. Directed content analysis was guided by the Stress, Appraisal and Coping Model. Three themes describing changed oral health were identified from the data: dimensions of eating, maintaining oral health after treatment and adapting to the chronic side effects of treatment. A strong use of problem-focussed coping was described, in addition to the importance of peer support in adapting to the psychosocial outcomes of treatment. Support needs identified related to increased access to specialist dental oncology services post treatment, information needs and a need for more psychological support. The study findings describe the experience of a sample of people who have received treatment for HNC. Due to a demographically homogenous sample and the strong use of positive coping strategies, the results presented may not describe the experience of the wider HNC population; however, these results provide insight into factors that may influence positive coping.

EDGE Task Force on Head and Neck Cancer Outcomes: A Systematic Review of Outcome Measures for Temporomandibular-related Dysfunction

Background: Patients with head and neck cancer (HNC) often experience significant postoperative limitations in temporomandibular joint (TMJ) function, facial pain, reduced nutritional intake, speech impairments, and compromised activities of daily living due to side effects of cancer treatment. Physical therapists treating these individuals must use valid and reliable patientreported outcome measures to quantify change related to physical therapy intervention for the TMJ. Purpose: As part of the activities of the Oncology Section EDGE Task Force on Head and Neck Cancer Outcomes, we report evidence-based recommendations for patient-reported outcome measures for individuals with HNC-related temporomandibular dysfunction (TMD). Methods: A systematic literature review of TMD-related patient-reported outcome measures that are clinically feasible and relevant to the HNC patient population was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model. Recommendations are based on the quality of psychometric properties, clinical utility, and previous use in HNC-related research. Twenty-two outcome measures were selected for review; 4 received a rating of 3, “recommended” for use in the HNC population. Conclusions: A variety of outcome measures have been reported in the literature for individuals with HNC-related TMD. Four measures, the Graded Chronic Pain Scale, 8 and 20-item Jaw Functional Limitation Scale and TMD Pain Screener, are recommended for clinical use by the researchers on this task force although it is important to note psychometric properties specific to the HNC population are lacking. Systematic Review Registration Number: PROSPERO CRD42013004898

Designing a survivorship program for head and neck cancer patients.

e17007 Background: Our institution receives approximately 700 new patients with head and neck cancer (HNC) annually. A need was identified to develop, provide and evaluate services for the unique needs of HNC patients and their families. Methods: A dual leadership model was established, involving two HNC specialists: an advanced practice nurse and a radiation oncologist. After a literature search and environmental survey, we contacted identified H&amp;N survivorship programs. Internal participants were identified from the HNC clinical team and existing institutional survivorship program. We established interdisciplinary Steering (focused on development and oversight of clinical &amp; education programs) and Research (tasked with assessing needs and outcomes) committees. We sought consensus on program principles, scope, a definition of survivorship, and a theoretical model of the HNC journey. A half-day retreat including community partners and patient/family representatives was held to set 5-year priorities. Results: Little published literature on survivorship initiatives specific to HNC exists. Three HNC survivorship clinical or research programs were identified; the largest (established in 2009) was visited, while telephone contact was made with investigators at the others. Principles guiding program development included interdisciplinary collaboration, grass-roots expertise, and a holistic scope. We defined survivors as all HNC patients and their families, from diagnosis through death. Program scope includes physical, emotional, social, financial, functional and psychosocial needs. A theoretical map of the cancer journey and evolving challenges was developed. The retreat included 50 participants, representing 20 different roles. We identified these top priorities: 1) Establish a post-treatment team; 2) Make survivorship a (mandatory) standard of care; 3) Optimize patient navigation; 4) Match services to specific patient groups (eg. men); 5) Expand access to allied health services; and 6) Develop a clinical care pathway. Conclusions: Survivorship is a complex and evolving area of research and care delivery. A team-based, comprehensive approach has been developed to address the needs of the highly specialized HNC population.

1057 - Pharmacokinetic and Pharmacodynamic Analysis of 5-Fluorouracil in Chinese Head and Neck Cancer (HNC) Patients

ABSTRACT Background Pharmacokinetic (PK) variability of 5-fluorouracil (5-FU) has been demonstrated for +30 years and a significant link between exposure and therapeutic response has been identified. A maximum tolerated exposure (MTE) from the area under curve (AUC) has been characterized for various regimens and therapeutic dose management (TDM) has been used to optimize dosing. Objective The objective of this study was to characterize the PK variability of 5-FU in the Chinese HNC population and examine the relationship between AUC, toxicity and efficacy. The 5-FU MTE in this population was compared with MTE identified for European HNC patients. Methods 89 treatment naive patients with HNC were administered cisplatin (80mg/m2, d1) and 5-FU (4g/m2, 120h IV). Blood samples were collected at steady state after the first 18h of 5-FU infusion. Plasma was analyzed by a 5-FU immunoassay and AUC was calculated. Relationship between 5-FU AUC and 5-FU related toxicities was examined. Preliminary efficacy results were evaluated for 5-FU related toxicity. Results The patient 5-FU AUC values varied widely: from 15 to 103 mg · h/L. 33% of patients were within the target range of 25-35 mg· h/L; 18% were below and 49% were above . Toxicity was recorded for 89 patients. Among the 44 patients with AUC above the target range, severe mucositis or mylesupression was experienced by 32 patients. By comparison, among the 45 patients within or below target range, only 3 experienced severe toxicities. ROC analysis for 5-FU AUC and severe mucositis identified a cut-point of 36 mg· h/L (p Incidence of severe mucositis and myelosuppression with 5-FU AUC AUC ≤35 mghr/L >35 mghr/L Grade 3 3% 36% Grade 0 - 2 47% 13% Conclusion Results of this study demonstrate wide PK-variability of 5-FU exposure and a significant relationship between severe toxicity and AUC in HNC cancer patients. The study confirms that the MTE in this population is similar to a European HNC population treated with cisplatin/5-FU. TDM using the target range of 25-35 mg· h/L may have benefit in lowering toxicity in HNC patients. Disclosure All authors have declared no conflicts of interest.

Survey of Usual Practice: Dysphagia Therapy in Head and Neck Cancer Patients

There is no standardized dysphagia therapy for head and neck cancer patients and scant evidence to support any particular protocol, leaving institutions and individual speech-language pathologists (SLPs) to determine their own protocols based on "typical" practices or anecdotal evidence. To gain an understanding of current usual practices, a national internet-based survey was developed and disseminated to SLPs who treat head and neck cancer (HNC) patients. From a random sample of 4,000 ASHA SID13 members, 1,931 fit the inclusion criteria, and 759 complete responses were recorded for a 39.3% response rate. Results were analyzed by institution type as well as by individual clinical experience. While some interesting trends emerged from the data, a lack of uniformity and consensus regarding best practices was apparent. This is undoubtedly due to a paucity of research adequately addressing the efficacy of any one therapy for dysphagia in the HNC population.

Targeting epidermal growth factor receptor in head and neck cancer: lessons learned from cetuximab

As early detection strategies have not been successful, most patients with head and neck cancer (HNC) present with advanced (stages III and IV) disease. Oral cavity tumors are treated primarily with surgical resection and advanced tumors of the pharynx and larynx are generally treated with combined modality therapy (chemoradiation). The major advances in the management of HNC have evolved from the integration of targeted therapeutics into treatment regimens. Presently, the most important target for new therapeutic strategies in HNC is the epidermal growth factor receptor (EGFR) and so far only cetuximab, a monoclonal antibody targeting EGFR, has been approved by the United States Food and Drug Administration in the HNC population as a radiation-sensitizing agent for patients undergoing primary radiation-based treatment and for patients with recurrent or metastatic disease. Other receptor and non-receptor kinase targeting strategies are under active clinical investigation as well. The increasing number of molecular targeting strategies in clinical development underscores the need to identify which HNC patients will respond to specific therapies. This article focuses on the current preclinical and clinical evidence of monoclonal antibodies targeting EGFR in HNC. We will first review the mechanisms of action of cetuximab, its clinical trials and side-effect profiles, and its present clinical application. Then, the current development status of other molecular antibodies and two molecular inhibitors, gefitinib and erlotinib, will be examined. Finally, by focusing on cetuximab, the current issues in EGFR targeting will be reviewed and we propose future directions of EGFR targeting. We hope that this review will provide further insight into the future directions of targeted therapy in the management of advanced HNC.