Head And Neck Cancer Survivors Research Articles

Efficacy of a brief telemedicine-based cognitive behavioral treatment (BRIGHT) versus attention control for head and neck cancer survivors with body image distress: A randomized trial.

212 Background: Nearly 1 in 3 head and neck cancer (HNC) survivors suffer from body image distress (BID), a source of devastating psychosocial morbidity that impairs quality of life. Evidence-based strategies to manage BID among HNC survivors are lacking. This trial evaluates the preliminary efficacy of BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment), a brief tele-cognitive behavioral intervention, relative to attention control (AC), at reducing BID among HNC survivors. Methods: HNC survivors with clinically significant BID were randomized to BRIGHT (n = 20) or AC (n = 24). BRIGHT was delivered by a psychologist in 5 weekly video tele-medicine sessions. AC consisted of dose- and delivery-matched survivorship education. Changes in HNC-related BID and cancer-related BID were assessed using the IMAGE-HN and Body Image Scale (BIS), respectively. The effect of BRIGHT vs AC was analyzed using generalized linear models. Clinical response (proportion of patients with a clinically meaningful change in IMAGE-HN and BIS scores) for BRIGHT vs AC was analyzed with logistic regression. Results: The median age was 63 years (range 41-80) and 61% had stage III/IV HNC. BRIGHT decreased HNC-related BID from baseline to 1- and 3-months post-intervention relative to AC (Table). At 3-months post intervention, the response rate of BRIGHT on HNC-related BID was 6.6-fold higher than AC (OR = 6.6; 90% CI 2.0 to 21.8). BRIGHT decreased cancer-related BID from baseline to 3-months post-intervention vs AC (Table). The improvement in HNC-related BID and cancer-related BID for BRIGHT vs AC at 3-months was clinically significant and the effect size was large (Cohen’s d = -0.9, 90% CI -1.4 to -0.4 for each). Conclusions: In this pilot RCT, BRIGHT results in clinically meaningful improvements in BID among HNC survivors. These promising preliminary data support conducting a large efficacy trial to establish BRIGHT as the first evidence-based treatment for HNC survivors with BID. Clinical trial information: NCT03831100. [Table: see text]

Neuropathic pain prevalence and risk factors in head and neck cancer survivors.

Neuropathic pain (NP) is a debilitating symptom among head and neck cancer (HNC) survivors although few large studies report its prevalence and associated risk factors. A cross-sectional survey assessing demographic, behavioral, and clinical risk factors for NP. NP was assessed using the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS). Forty-five percent (227/505) reported having pain including 13.7% (69/505) who were positive for S-LANSS. Reported pain sites were in the regions of the head and oral cavity (46.2%) and neck and throat (41.5%). Despite a higher self-reported use of analgesic medication (NP+=41.2%; NP-=27.4%; p=0.020) and alternative pain therapies (NP+=19.1%; NP-=8.4%; p=0.009), severe pain was more prevalent among those with NP (N+=23.2%; NP-=13.3%; p=0.004). Adjusted for opioid medications, ethnicity/race, age, surgery, depression, and comorbidities were risk factors for NP. NP remains prevalent in HNC survivors highlighting the importance of routine pain surveillance.

Smartphone-based follow-up of upper airway symptoms in head and neck cancer survivors one year after radiation therapy.

Improvements in treatment of head-and-neck cancer (HNC) have resulted in improved long-term survival rates so there is a growing interest in long-term consequences. The aim was to perform a smartphone-based assessment to analyse the upper airway dysfunction-related symptoms in HNC 1 year after radiotherapy (RT) during social distancing due to COVID-19. Smartphone-based assessment on upper airway function 1 year after RT was performed. Upper airway functions include perceived impact of voice on quality of life (Voice Handicap Index, VHI-30), swallowing (Functional Oral Intake, FOIS; and Swallowing Quality of Life questionnaire, SWAL-QOL) and sleep-disordered breathing (Pittsburgh Sleep Quality Index, PSQI) assessments. Additionally, quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The HNC group presented worse results in the VHI-30 scale, in the three subscales (p < 0.001). Swallowing function also presented worse results in the HNC group, with a lower score in the FOIS questionnaire (p < 0.001) and a poorer score in the SWAL-QOL (p < 0.001). Regarding to the sleep-disordered breathing, the HNC group presented poorer scores in all subscales (p < 0.05). The HNC group also presented worse scores in quality of life. Our findings showed that HNC survivors presented a poorer upper airway function and a worse quality of life. This population needs to be systematically screened for those function impairments. What is already known on the subject Head-and-neck cancer radiotherapy treatment is anatomically related to the upper airway, involved in several functions such as breathing, swallowing and speech that could be affected by the treatment. Public health restrictions caused by the COVID-19 pandemic have made it difficult, and in many cases impossible, to see patients in person and complete assessments that are often crucial to improve their approach. Telephone interviews appear to be largely equivalent to face-to-face interviews, which could solve these problems. What this paper adds to existing knowledge The aim of this study was to perform a smartphone-based assessment to analyse the upper airway dysfunction-related symptoms in head-and-neck cancer survivors 1 year after radiotherapy treatment. Our findings showed that head-and-neck cancer survivors who have been treated with radiotherapy presented a poorer upper airway function, with subjective speech and voice problems, swallowing and sleep-disordered breathing compared to a control group matched for age and sex 1 year after the treatment. What are the potential or actual clinical implications of this work? The results of this study will allow a better approach to treatment of head-and-neck cancer survivors.

708TiP BD4QoL: A multicenter randomized trial for monitoring quality of life (QoL) by intelligent tools in head and neck cancer (HNC) survivors after curative treatment

HNC survivors suffer from high physical, psychological and socioeconomic burdens. Achieving cancer-free survival with an optimal QoL is the primary goal for HNC patients (pts) management. Therefore, maintaining lifelong surveillance is critical. This can be carried out by advanced analysis of environmental, emotional and behavioral data unobtrusively collected from mobile devices. The aim of this clinical trial is to reduce, with specific non-invasive tools (i.e., their mobile devices), the proportion of HNC survivors experiencing a clinically meaningful reduction in QoL during post-treatment follow-up.

Return to work in head and neck cancer survivors: its relationship with functional, psychological, and disease-treatment factors.

Return to work (RTW) is important for survivors of head and neck cancer (HNC). The purposes of the study were to investigate the RTW ratio among HNC survivors and identify factors significantly affecting RTW in this population. A cross-sectional study with consecutive sampling was conducted in a medical center in Taiwan, with 111 patients with HNC who had completed major treatments within 5years and were employed before their cancer diagnosis enrolled as participants. Cervical range of motion (CROM) functionality, handgrip and hip flexor strength, maximal mouth opening (MMO), selected symptoms, depression, and disease/treatment-related factors were assessed. All of the factors were analyzed using t-test, chi-square test, and multiple logistic regression. Less than half (44.1%, n = 49) of the participants had returned to work. The t-test/chi-square test results showed the RTW group to be younger in age and better educated; have better handgrip/hip flexor strength, MMO, and CROM; have less speech difficulty and pain; and have less-advanced cancer than the non-RTW group. Further analysis of the above significant variables by logistic regression revealed early cancer stage, dominant handgrip strength, and less speech difficulty were the robust factors related to RTW. The RTW ratio is low in HNC survivors. RTW in HNC survivors is a multifactorial and complicated issue and needs to be further examined. Assessing the factors related to RTW systematically and developing comprehensive interventions and rehabilitation programs to reduce related dysfunctions are necessary to enhance RTW ability in HNC survivors.

Assessing radiation-induced carotid vasculopathy using ultrasound after unilateral irradiation: a cross-sectional study

BackgroundIncreased head and neck cancer (HNC) survival requires attention to long-term treatment sequelae. Irradiated HNC survivors have a higher ischemic stroke risk. However, the pathophysiology of radiation-induced vasculopathy is unclear. Arterial stiffness could be a biomarker. This study examined alterations in intima-media thickness (IMT) and stiffness-related parameters, shear wave (SWV) and pulse wave velocity (PWV), in irradiated compared to control carotids in unilateral irradiated patients.MethodsTwenty-six patients, median 40.5 years, 5–15 years after unilateral irradiation for head and neck neoplasms underwent a bilateral carotid ultrasound using an Aixplorer system with SL18-5 and SL10-2 probes. IMT, SWV, and PWV were assessed in the proximal, mid, and distal common (CCA) and internal carotid artery (ICA). Plaques were characterized with magnetic resonance imaging. Measurements were compared between irradiated and control sides, and radiation dose effects were explored.ResultsCCA-IMT was higher in irradiated than control carotids (0.54 [0.50–0.61] vs. 0.50 [0.44–0.54] mm, p = 0.001). For stiffness, only anterior mid-CCA and posterior ICA SWV were significantly higher in the irradiated side. A radiation dose–effect was only (weakly) apparent for PWV (R2: end-systolic = 0.067, begin-systolic = 0.155). Ultrasound measurements had good–excellent intra- and interobserver reproducibility. Plaques had similar characteristics but were more diffuse in the irradiated side.ConclusionsIncreased CCA-IMT and SWV in some segments were seen in irradiated carotids. These alterations, even in young patients, mark the need for surveillance of radiation-induced vasculopathy.Trial registration: clinicaltrials.gov (https://clinicaltrials.gov/ct2/show/NCT04257968).

Quantification of very late xerostomia in head and neck cancer patients after irradiation.

ObjectiveRadiation therapy (RT) for head and neck cancer (HNC) can result in severe xerostomia, or the subjective feeling of dry mouth. Characterizing xerostomia is critical to designing future clinical trials investigating how to improve HNC patients' quality of life (QoL). Few studies have investigated the very late (>5 years post‐RT) effects of RT for HNC. We undertook preliminary studies quantifying very late xerostomia.MethodsSix adults who underwent RT for HNC at least 5 years prior and reported xerostomia were enrolled. Five healthy adults without a self‐reported history of HNC or xerostomia were enrolled as controls. All participants completed three validated surveys to measure xerostomia‐related QoL. Salivary production rates were measured and compositional analysis of the saliva and oral microbiome was completed.ResultsThe QoL survey scores for the HNC participants were significantly worse as compared to the control participants. The HNC participants produced less unstimulated saliva (p = .02) but not less stimulated saliva. The median salivary mucin significantly higher in HNC participants than in control participants (p = .02). There was no significant difference between the pH, amylase, or total protein. Microbiome analysis revealed alpha diversity to be significantly lower in the HNC participants.ConclusionIn the survivors of HNC who suffer from late toxicities, multiple means of measuring toxicity may be useful. We found that in patients with radiation‐induced xerostomia over 5 years after therapy, not only were the QoL surveys significantly worse, as expected, but other measurements such as mucin and oral microbiome diversity were also significantly different.Level of evidence3.

Considerations for developing supportive care interventions for survivors of head and neck cancer: A qualitative study.

This study aimed to describe considerations for developing supportive care interventions targeted to head and neck cancer (HNC) survivors. One-time semi-structured interviews (N=33) were conducted with HNC survivors who had recently finished treatment (n=20) and HNC providers (e.g., physicians, nurses; n=13). Interviews were transcribed verbatim and coded using inductive applied thematic analysis techniques to identify themes. HNC survivors (75% male; M=61years old) and providers (54% physicians; 62% female) were unanimously supportive of developing HNC-specific supportive care interventions. Participants described potential benefits of offering interventions at various points throughout the HNC treatment and survivorship trajectory rather than at a single critical time. Many participants preferred group-based interventions because of the high value of peer-support. Others described how group interventions may not be appropriate for all HNC survivors due to risks for negative social comparisons and exacerbated anxiety. Participants suggested topics that should be addressed in HNC-specific interventions including education about acute and long-term side effects, symptom management, nutritional support, relationship/social role changes, grief/loss, and fear of recurrence. HNC-specific supportive care interventions are critically needed, as survivors experience persistent symptoms and distinct psychosocial concerns that impact quality of life. Findings from this study can inform the development of supportive care interventions targeted to the unique psychosocial concerns of HNC survivors.

Adherence to the American Cancer Society Head and Neck Cancer Survivorship Care Guideline According to Chart Review: A Nested Retrospective Cohort Pilot Study.

The purpose of this study was to explore adherence to the American Cancer Society (ACS) Head and Neck Cancer (HNC) Survivorship Care Guideline and their outlined 33 recommendations among posttreatment HNC survivors. A bi-institutional, retrospective, nested cohort study of mucosal or salivary gland HNC survivors diagnosed in 2018 was designed. Guideline adherence was assessed via retrospective chart review between 0 and 13 months after completion of oncologic treatment according to 4 categories: (1) problem assessed, (2) problem diagnosed, (3) management offered; (4) problem treated. Adherence was defined as meeting a recommendation subcategory at least once over the 13-month period. Among 60 randomly selected HNC survivors, a total of 38 were included in the final cohort after exclusion of individuals with ineligible cancers and those who died or were lost to follow-up over the study period. Approximately 95% of HNC survivors were assessed for HNC recurrence and screened for lung cancer. Certain common problems such as xerostomia, dysphagia, and hypothyroidism were screened for and managed in ≥70% of eligible survivors. Conversely, screening for other second primary cancers and assessment of a majority of other physical and psychosocial harms occurred in <70% of survivors, and in many cases none to a slim minority of survivors (eg, sleep apnea and sleep disturbance, body and self-image concerns). Only 5% of survivors received a survivorship care plan. Overall adherence to the ACS HNC Survivorship Care Guideline in early posttreatment survivors was suboptimal. Interventions are needed to better implement and operationalize these guideline recommendations.

Long-term Survivorship and Non-cancer Competing Mortality in Head and Neck Cancer: A Nationwide Population-Based Study in South Korea.

As the survival of head and neck cancer (HNC) improves, survivors increasingly confront non-cancer-related deaths. This nationwide population-based study aimed to investigate non-cancer-related deaths in HNC survivors. Data from the Korean Central Cancer Registry were obtained to characterize causes of death, mortality patterns, and survival in patients with HNC between 2006 and 2016 (n=40,890). Non-cancer-related mortality relative to the general population was evaluated using standardized mortality ratios (SMRs). The 5- and 10-year cause-specific competing risks probabilities of death (cumulative incidence function, CIF) and subdistribution hazards ratios (sHR) from the Fine-Gray models were estimated. Comorbidity-related mortality was frequent in older patients, whereas suicide was predominant in younger patients. The risk of suicide was greater in patients with HNC than in the general population (SMR, 3.1; 95% confidence interval [CI], 2.7 to 3.5). The probability of HNC deaths reached a plateau at 5 years (5-year CIF, 33.9%; 10-year CIF, 39.5%), whereas the probability of non-HNC deaths showed a long-term linear increase (5-year, CIF 5.6%; 10-year CIF, 11.9%). Patients who were male (sHR, 1.56; 95% CI, 1.41 to 1.72), diagnosed with early-stage HNC (localized vs. distant: sHR, 1.86; 95% CI, 1.58 to 2.21) and older age (65-74 vs. 0-44: sHR, 6.20; 95% CI, 4.92 to 7.82; ≥ 75 vs. 0-44: sHR, 9.81; 95% CI, 7.76 to 12.39) had an increased risk of non-cancer mortality. Non-HNC-related deaths continue increasing. HNC survivors are at increased risk of suicide in the younger and comorbidity-related death in the older. Better population-specific surveillance awareness and survivorship plans for HNC survivors are warranted.

Self-care for head and neck cancer survivors with lymphedema and fibrosis: A pilot randomized clinical trial.

6094 Background: Lymphedema and fibrosis (LEF) are debilitating late effects in head and neck cancer survivors (HNCS). Initial therapy is usually directed by therapists following which patients undertake a LEF self-care program (SCP). No evidence based LEF-SCP are available. We report on the feasibility and preliminary efficacy data of a multifaceted LEF-SCP. Methods: 59 HNCS with LEF were randomized to: Usual care (n = 20), usual care + LEF-SCP (n = 20), and usual care + LEF-SCP + routine follow-up with a lymphedema therapist (n = 19). Assessments were conducted at baseline, 3-, 6-, 9-, and 12-months. Outcome measures include feasibility and preliminary efficacy (LEF progression, symptom burden, and jaw range of motion [ROM]). Multivariate covariance pattern model analysis was used to test for difference between arms. Results: 1) Feasibility: LEF-SCP training sessions - 80% completion rate; 90% satisfaction with the LEF-SCP; self-care adherence was similar between arms; no adverse event. 2) Preliminary Efficacy: Compared to usual care, participants randomized to LEF-SCP (+/- follow-up) showed a decrease in LEF severity (p &lt; 0.05), reduction in symptom burden (p &lt; 0.05), without significant improvement in jaw ROM. No significant differences were noted between the patients +/- follow-up with a lymphedema therapist. There was a trend to improved self-efficacy in patients participating in the LEF-SCP. Conclusions: The LEF-SCP is feasible and potentially efficacious for HNCS. Further testing is warranted. Clinical trial information: NCT03030859.

Barriers to accessing psycho-oncological support in head and neck cancer: A qualitative exploration of healthcare professionals' perspectives.

Disease- and treatment-related consequences in Head and Neck Cancer (HNC) can result in psychological issues for which specialist psychological support, dubbed psycho-oncology, is recommended. Health and Social Care Professionals (HSCPs) function as a crucial link between survivors and these services, through onward referral pathways. However, little is known about these HSCPs' perspectives on barriers to accessing psycho-oncology in HNC. The current study sought to investigate such perspectives. Eleven HSCPs from national cancer centres across Ireland were recruited using purposive sampling. A qualitative, cross-sectional research design was implemented utilising virtual semi-structured interviews. Interviews were audio-recorded, transcribed, and analysed using inductive, reflexive thematic analysis. The researcher identified four themes relating to barriers to psycho-oncology access: Lack of Access and Perceived Elitism in Onward Referral; Communication Barriers; Stigma Associated with Mental Illness and Psychological Services, and Inadequate Signposting and Advertising of Existing Psycho-Oncology Services. These findings indicate that HSCPs face multiple barriers when attempting to refer HNC survivors to psycho-oncology services. Some of these barriers relate to survivors, others to HSCPs themselves, and some to professionals within psycho-oncology services. By removing barriers in onward referral faced by HSCPs, HNC survivors may more readily link in with pre-existing psycho-oncology services in the future. The following may assist with removing such barriers: increased inter-professional dialogue between HSCPs and psycho-oncology services and communication skills training; mental health stigma reduction campaigns targeted at survivors, HSCPs, and wider society; and increased signposting of available psycho-oncology services and in-service training for HSCPs.

Interventions for head and neck cancer survivors: A systematic review.

e24042 Background: Quality survivorship care includes cancer-related and general health care domains, including cancer surveillance and prevention of new cancers, management of psychosocial and physical late effects, health promotion/disease prevention, and management of chronic conditions. Survivors of head and neck cancer (HNC) have particularly complex unmet needs across all of these domains. We systematically reviewed interventions for HNC survivors to identify existing evidence and gaps in HNC survivorship care research. Methods: We performed a systemic review (PROSPERO ID: CRD42021269566) using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched MEDLINE, Embase, Emcare and PsycINFO for primary studies published in English between 2000 and 2021 to identify prospective studies for which interventions began after completion of cancer treatment and had a study endpoint ≥1 year after treatment completion. The population included adults treated with for HNC We used Covidence systematic review software to facilitate article screening and study selection. Two reviewers independently screened titles and abstracts followed by full texts for eligibility. Disagreements were resolved by consensus. Two reviewers critically appraised each selected study. Reviewers evaluated risk of bias with the Cochrane RoB 2.0 tool for randomized trials and the ROBINS-I tool for non-randomized studies. Due to the anticipated heterogeneity of included studies, narrative synthesis was used to summarize data. Results: The literature search identified 7395 studies; after applying inclusion and exclusion criteria, 28 studies were identified for critical appraisal: 13 randomized trials and 15 non-randomized studies. Most study interventions (n = 25) focused on surveillance and management of physical effects, including 13 studies that also targeted management of psychosocial effects. Four studies targeted the prevention and surveillance for recurrence and new cancers, and only one study addressed health promotion and disease prevention. Among the 13 randomized studies, 12 had a medium to high risk of bias, and 1 with a low risk of bias. The 15 non-randomized studies included 12 with a high risk and 3 with a medium risk of bias. Common sources of bias included lack of pre-planned sample size and power, lack of blinding of patients or assessors, heterogeneity in population, and attrition with incomplete follow-up. Conclusions: This systematic review and critical appraisal identified gaps in HNC survivorship intervention research targeting under-represented domains of the survivorship framework, and common challenges in study design that introduce risk of bias. To promote quality survivorship care for HNC survivors, scientifically rigorous intervention studies must address broader areas of focus.

Nutrition Impact Symptoms in Relation to Head and Neck Cancer Survivor’s Vegetable Intake and Use of Seasoning

Background: Most head and neck cancer (HNC) patients undergoing aggressive treatments with chemoradiotherapy and surgical resection of tumors suffer from symptoms long after treatment is completed that hinder adequate oral food intake, collectively known as Nutrition Impact Symptoms (NIS). Our aim was to examine the correlations between NIS and HNC survivors’ vegetable intake and use of seasoning. Methods: We conducted a 29-item telephone administrated survey to collect vegetable intake and seasoning habits among HNC survivors (n=22, age 61.4 ± 9.8 years, mean ± standard deviation) who received radiation therapy between 6 months and 10 years before recruitment identified through the cancer registry at Carle Foundation Hospital. Treatment-related side-effects (11 items) including difficulty swallowing, dry mouth, and mouth sores reflected NIS. A mean composite score was created for all the symptoms where higher scores indicated greater NIS. Spearman correlations examined the relationships between NIS, vegetable intake, and seasoning. Results: Half (50%) of the participants reported no change in their vegetable intake since diagnosis of cancer, and on average, ate 1 cup/day of total vegetables. Higher NIS scores associated with higher pumpkin and sweet potatoes intake (r (20) = .43, p&lt;0.05), and there was a trend for higher scores of difficulties swallowing to be associated with lower corn and peas intake (r (20) =-.37, p=0.08). Participants with higher scores of problems with teeth and gums were less likely to use seasoning (r (20) = -.42, p&lt;0.05). Conclusion: The findings support that HNC treatment can affect vegetable intake long after completion of radiotherapy. However, it would be premature for any recommendations to be derived from the present study for health professionals. A larger, observational study with a longer follow-up is therefore needed to examine these correlations.

Oral health related quality of life in long-term survivors of head and neck cancer compared to a general population from the seventh Troms\xf8 study

BackgroundBoth the incidence and survival rate of head and neck cancer (HNC) is increasing, making quality of life of HNC survivors an important issue.MethodsIn this cross-sectional study we compared the oral health related quality of life (OHRQoL) of long-term HNC survivors to that of a general population cohort from the seventh survey of the Tromsø study with the Oral Impact on Daily Performances questionnaire. Comparisons were done with frequency analyses and cross tabulation. We also assessed OHRQoL’s association to sociodemographic and oral health related variables in both cohorts as well as with cancer related variables in the HNC cohort with regression analyses.ResultsThe HNC survivors had four times the risk of reporting problems with daily performances compared with the general population cohort. The ability to eat and enjoy food was most frequently affected in both cohorts. Moderate-poor self-rated dental health and general health as well as high frequency of dental visits were significantly associated with poorer OHRQoL. To have a history of oral or pharyngeal cancer was associated with more problems than having a history of laryngeal cancer.ConclusionsOur study shows that HNC treatment is associated with a strong and lasting impairment of OHRQoL, highlighting the need to find less toxic, yet effective ways to treat the disease, and to provide easy access to expert dental care at all stages of the disease to minimize morbidity. Given the widespread side effects of cancer treatment, a multidisciplinary approach might be required to improve the OHRQoL of HNC survivors.

Hearing screening and amplifier uptake results in a multidisciplinary head and neck cancer survivorship clinic.

Hearing loss and tinnitus are prevalent among survivors of head and neck cancer (HNC), but auditory issues are under-addressed in the survivorship literature. The purpose of this study was to describe the hearing loss and management experience of a group of survivors provided with a hearing screening and amplifier assistance if needed during their visit. A retrospective chart review of 1176 individuals seen in the HNC Survivorship Clinic between December 2016 and October 2020 who interacted with audiology was performed. Of these survivors, 72% failed the 30-dB HL hearing screening at one or more frequencies. Thirty-three percent of the sample reported tinnitus. Consistent with the general population, this group has a low prevalence of hearing aid use. In this clinic, individuals who fail the hearing screening at all frequencies are offered a simple, non-custom amplifier for use during their visit. Thirty-one percent of individuals offered the amplifier used it during their Survivorship Clinic visit to enhance communication and reduce listening effort. Only 54% of individuals who failed the hearing screening self-reported hearing loss. The poor sensitivity and specificity associated with the self-perception of hearing loss data support the need for hearing screening that consists of responding to tones. Of individuals who received a recommendation for a comprehensive hearing test, 21% received a hearing test with 68% of these individuals receiving the hearing test the same day of their Survivorship Clinic visit. The data from 1176 survivors of HNC seen by audiology over the past few years as part of the UPMC HNC Survivorship Clinic support the need for hearing management in this population to improve communication during and after the Survivorship Clinic visit. Survivors of HNC have a high prevalence of greater than mild hearing loss and tinnitus (both issues known to negatively impact health-related communication and quality of life). This manuscript describes a hearing screening program within a Survivorship Clinic that identifies individuals in need of non-custom amplification during their appointment to support effective communication. Survivors should be referred to audiologists for evaluation and management of treatment-related issues of hearing.

Manual Therapy for Patients With Radiation-Associated Trismus After Head and Neck Cancer

Trismus is highly prevalent in head and neck cancer (HNC) survivorship. Current standards for trismus treatment include various stretch-based exercise protocols as a primary and single treatment modality with limited evidence regarding the role of manual therapy (MT) for this indication. To assess the effect size and associations of response to MT to increase oral opening in the setting of radiation-associated trismus. This retrospective case series was conducted at the University of Texas MD Anderson Cancer Center between 2016 and March 2020 (before COVID-19 interruption) and included 49 disease-free survivors of HNC who were referred for treatment of radiation-associated trismus. Intraoral MT (including or excluding external head and neck) targeting the muscles of mastication. Maximum interincisal opening (MIO) before and after the initial MT session compared with serial MT sessions. Covariates were examined to determine the association with response to MT for trismus. A total of 49 survivors of HNC (13 women [27%]; 24 [49%] 64 years or younger; 25 [51%] 65 years or older; mean [range] of 6.6 [0-33] years postradiotherapy were included, 9 [18.4%] of whom underwent a single MT session; 40 [81.6%] who underwent multiple sessions [mean, 6; median (range), 3 (2-48)]). The MIO improved after a single session by a mean (SD) of 4.1 (1.9) mm (0.45 effect size) and after serial MT sessions by a mean (SD) of 6.4 (4.8) mm with an effect size of 0.7. No covariates were found to be clinically meaningfully associated with MIO improvement following MT. The findings of this case series study suggest that MT improved MIO with a medium to large effect size in survivors of HNC with radiation-associated trismus. The results suggest that the largest increase in oral opening was achieved after the initial treatment and although gains were more modest, oral opening continued to improve with serial treatment. Covariates were not associated with MT response, suggesting that patients with clinical features often considered treatment refractory (eg, advanced disease, multiple lines of oncology treatment, ≥5 years posttreatment) may benefit from treatment with MT. Manual therapy may be a beneficial frontline or adjuvant treatment when combined with traditional stretching therapy. A clinically meaningful increase in oral opening has the potential to improve swallow function, speech, pain, and quality of life.

State of Rehabilitation Research in the Head and Neck Cancer Population: Functional Impact vs. Impairment-Focused Outcomes.

Management of head and neck cancer (HNC) typically involves a morbid combination of surgery, radiation, and systemic therapy. As the number of HNC survivors grows, there is growing interest in rehabilitation strategies to manage HNC-related comorbidity. In this review, we summarize the current state of HNC rehabilitation research. We have organized our review using the World Health Organization's International Classification of Function (ICF) model of impairment, activity, and participation. Specifically, we describe the current research on rehabilitation strategies to prevent and treat impairments including dysphagia, xerostomia, dysgeusia, dysosmia, odynophagia, trismus, first bite syndrome, dysarthria, dysphonia, lymphedema, shoulder syndrome, cervicalgia, cervical dystonia and dropped head syndrome, deconditioning, and fatigue. We also discuss the broader impact of HNC-related impairment by exploring the state of rehabilitation literature on activity, participation, psychosocial distress, and suicidality in HNC survivors. We demonstrate that research in HNC rehabilitation continues to focus primarily on impairment-driven interventions. There remains a dearth of HNC rehabilitation studies directly examining the impact of rehabilitation interventions on outcomes related to activity and participation. More high-quality interventional studies and reviews are needed to guide prevention and treatment of functional loss in HNC survivors.

Silenced: Patients’ experiences of voicelessness in head and neck cancer

ObjectivesThe objective of this qualitative study was to explore patients’ experiences of communicating with health professionals following a diagnosis of head and neck cancer (HNC). MethodsA qualitative research approach based on social constructionist theory was used. A total of 21 in-depth semi-structured interviews were conducted with people diagnosed with HNC. Thematic analysis was used to identify themes. ResultsThe experience of losing the capacity for speech was experienced by survivors of HNC as distressing and traumatic. Voicelessness was not just a loss of physical speech, but a holistic experience of silencing. A number of tensions emerged including patients’ experiences of losing their voice and then finding different ways to verbally express themselves; in interactions with health professionals there was a tension between abrupt, hurried communication and a slower, more mindful communication style. Sub-themes around communication style emerged where disparities between levels of health literacy were unaddressed, and patients’ experienced a lack of empathy. Another tension experienced was between an old style medical model and the ideal of person-centred care and the biopsychosocial model of health. ConclusionWhether HNC patients lose their voice temporarily, have periods of voicelessness, or are able to speak, but feel unheard, the treatment experience is too often one of disempowerment and silencing of their perspectives. Practice ImplicationsHealth professionals are challenged to find creative communication methods, to practice mindful listening, source speech pathology and adaptive technologies, and to facilitate communication that supports patients in expressing their values, preferences and needs.

Alcohol and Head and Neck Cancer: Updates on the Role of Oxidative Stress, Genetic, Epigenetics, Oral Microbiota, Antioxidants, and Alkylating Agents.

Head and neck cancer (HNC) concerns more than 890,000 patients worldwide annually and is associated with the advanced stage at presentation and heavy outcomes. Alcohol drinking, together with tobacco smoking, and human papillomavirus infection are the main recognized risk factors. The tumorigenesis of HNC represents an intricate sequential process that implicates a gradual acquisition of genetic and epigenetics alterations targeting crucial pathways regulating cell growth, motility, and stromal interactions. Tumor microenvironment and growth factors also play a major role in HNC. Alcohol toxicity is caused both directly by ethanol and indirectly by its metabolic products, with the involvement of the oral microbiota and oxidative stress; alcohol might enhance the exposure of epithelial cells to carcinogens, causing epigenetic modifications, DNA damage, and inaccurate DNA repair with the formation of DNA adducts. Long-term markers of alcohol consumption, especially those detected in the hair, may provide crucial information on the real alcohol drinking of HNC patients. Strategies for prevention could include food supplements as polyphenols, and alkylating drugs as therapy that play a key role in HNC management. Indeed, polyphenols throughout their antioxidant and anti-inflammatory actions may counteract or limit the toxic effect of alcohol whereas alkylating agents inhibiting cancer cells’ growth could reduce the carcinogenic damage induced by alcohol. Despite the established association between alcohol and HNC, a concerning pattern of alcohol consumption in survivors of HNC has been shown. It is of primary importance to increase the awareness of cancer risks associated with alcohol consumption, both in oncologic patients and the general population, to provide advice for reducing HNC prevalence and complications.