Head Cancer Patients Research Articles

Revalidation of Proactive Gastrostomy Tube Placement Guidelines for Head and Neck Cancer Patients Receiving Helical Intensity-Modulated Radiotherapy

The Royal Brisbane and Women’s Hospital (RBWH) Swallowing and Nutrition Management Guidelines for Patients with Head and Neck Cancer were developed to enable evidence-based decision-making by the Head and Neck Multidisciplinary Team (H&N MDT) regarding enteral nutrition support options. The purpose of this study was to revalidate these guidelines in a cohort of patients receiving helical intensity-modulated radiotherapy (H-IMRT) compared to a historical cohort who received primarily 3D-conformal radiotherapy. Eligible patients attending the RBWH H&N MDT between 2013 and 2014 (n = 315) were assessed by the guidelines, with high-risk patients being recommended proactive gastrostomy tube placement. Data were collected on guideline adherence, gastrostomy tube insertions, the duration of enteral tube use and weight change. Sensitivity, specificity and positive predictive and negative predictive values were calculated and compared with the historical cohort. Overall guideline adherence was 84%, with 60% and 96% adherence to the high-risk and low-risk pathways, respectively. Seventy patients underwent proactive gastrostomy tube placement (n = 62 high-risk; n = 8 low-risk). Validation outcomes were sensitivity 73% (compared to 72%) and specificity 86% (compared to 96%). The guidelines yielded a high sensitivity and specificity, remaining valid in a cohort of patients treated with H-IMRT. Further studies are recommended to improve the sensitivity and understand the decrease in specificity in order to make ongoing guideline improvements.

Education of Dental Hygienists and Dental Therapists Working With Head and Neck Cancer Patients in Oral and Maxillofacial Surgery Departments in the United Kingdom-A Quantitative Study.

To investigate Dental Hygienists' (DHs) and Dental Therapists' (DTs) current undergraduate and postgraduate education with regard to the treatment of head and neck cancer (HANC) in Oral & Maxillofacial Surgery (OMFS) departments in the United Kingdom. A purposive sample of DHs and DTs, who were employed, or had been previously employed, in OMFS departments in the United Kingdom were asked to complete an online questionnaire about their education in the care and management of patients with HANC. The questionnaire was sent to members of the British Society of Dental Hygiene and Therapy (BSDHT), and the British Association of Dental Therapy (BADT) and was also posted via online forums. The questionnaire received 55 responses (response rate 83%): 54 female respondents and 1 male. Thirty-one (56%) respondents had not undertaken any HANC training. However, on starting work in an OMFS department, nine (16%) respondents reported being provided with HANC training. The results suggest that the UK review and standardise the provision of HANC training in the DH and DT educational curricula. Furthermore, it is recommended that the DH and DT curricula, at both undergraduate and postgraduate level, should include psychology training.

Impact of fast-track on recurrence and malignant transformation of patients with inverted papilloma

Background Inverted papilloma is a benign epithelial tumour located in the sinonasal tract with a high recurrence rate and a potential of malignant transformation. From 2017, patients with IP were included in our fast-track regime similar to head and neck cancer patients, including follow-up at 2, 6, 12, 18 and 24 months after surgery, then yearly for a total of 5 years. Aims/objectives This study aims to compare the recurrence rate and malignant transformation of patients with IP treated at a university centre following the implementation of a fast-track regime including a close follow-up. Methods A retrospective study was performed on all patients with IP diagnosed between 2018 and 2022. Results The study included 125 patients, all surgically treated for IP. Eight patients (6%) also presented with SCC at the time of diagnosis. The recurrence rate of benign IP was 17%. Most tumours originated in the maxillary sinus (48/117, 41%). No cases of metachronous cancer were seen during the follow-up. Conclusions and significance The majority of recurrences (90%) occurred within the first 2 years after treatment. No cases of malignant transformation were seen in the follow-up period. The rigorous follow-up program potentially contributed to the detection of recurrence before malignant transformation.

Pregabalin for Neuropathic Pain in Post-radiotherapy Head and Neck Cancer Patients: A Retrospective Study and Review of the Literature

Pregabalin for Neuropathic Pain in Post-radiotherapy Head and Neck Cancer Patients: A Retrospective Study and Review of the Literature

Prophylactic Swallowing Exercises in Patients with Laryngeal Cancer Who Underwent Total Laryngectomy—A Randomized Trial

Objectives: This study aims to determine the efficacy of prophylactic swallowing exercises on swallowing function in patients undergoing total laryngectomy for laryngeal cancer. Methods: The design was a randomized controlled trial set in one tertiary care academic medical center. A total of 92 patients undergoing total laryngectomy for stages III and IV laryngeal cancer performed five targeted swallowing exercises for a period of three months after their surgery, starting two weeks after the surgery. Weekly swallowing therapy sessions were held with the patients in order to encourage adherence and proper technique. The controls received no preventive exercise and were referred for swallowing treatment following the surgery, as well as radiation therapy if necessary. The Functional Oral Intake Scale (FOIS) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-H&N) were used to measure swallowing function at the baseline, one week following the surgery, and three, six, nine, and twelve months following the surgery. Results: Right after the surgery, there were no statistically significant variations between the intervention and control groups in the FOIS scores (p value = 0.64), the Eating in Public subscale scores (p value = 1) and Normalcy of Diet subscale scores (p = 0.33) of the PSS-H&N. The scores were significantly better among the intervention patients at months 3, 6, 9, and 12 for all the scores, with p values smaller than 0.000. Conclusions: Although not immediately following the surgery, the patients who engaged in prophylactic swallowing exercises showed improvements in their ability to swallow at 3, 6, 9, and 12 months following their procedure.

Minimal Clinically Important Differences in the Cancer Quality of Life Questionnaires in Patients with Head and Neck Cancer

Purpose: The purpose of this study is to determine the magnitude of change that is clinically meaningful in the EORTC QLQ-C30 and EORTC QLQ-HN35 instruments in head and neck cancer patients. Methods: Two hundred and twenty-two patients completed the EORTC QLQ-C30 and EORTC QLQ-HN35 at baseline and follow-up one to two months later. Minimal clinically important differences (MCIDs) were calculated through anchor- and distribution-based methods for improvement and deterioration. Karnofsky Performance status (KPS) was used as the anchor to determine meaningful change. Results: In the group of patients who deteriorated, more scales and symptoms demonstrated statistically significant meaningful change. EORTC QLQ-C30 meaningful change values for deterioration with KPS anchor ranged from 7.2 (physical functioning) to 16.7 units (Global Health Status), and for improvement ranged from 10.0 (role functioning) to 16.7 units (Global Health Status). Conclusions: We report—for the first time, to the best of our knowledge—MCID for EORTC QLQ-C30 and QLQ-HN35 in head and neck cancer patients. Knowledge of meaningful change in these questionnaires allows physicians to assess patient change over time, along with evaluating the impact of treatment on quality of life.

Impact of Artificial Intelligence-Based Autosegmentation of Organs at Risk in Low- and Middle-Income Countries

Radiation therapy (RT) processes require significant human resources and expertise, creating a barrier to rapid RT deployment in low- and middle-income countries (LMICs). Accurate segmentation of tumor targets and organs at risk (OARs) is crucial for optimal RT. This study assessed the impact of artificial intelligence (AI)-based autosegmentation of OARs in 2 LMICs. Ten patients, comprising 5 head and neck (HN) cancer patients and 5 prostate cancer patients, were randomly selected. Planning computed tomography images were subjected to autosegmentation using an Food and Drug Administration-approved AI software tool and manual segmentation by experienced radiation oncologists from 2 LMIC RT clinics. The control data, obtained from a large academic institution in the United States, consisted of contours obtained by an experienced radiation oncologist. The segmentation time, DICE similarity coefficient (DSC), Hausdorff distance, and mean surface distance were evaluated. AI significantly reduced segmentation time, averaging 2 minutes per patient, compared with 57 to 84 minutes for manual contouring in LMICs. Compared with the control data, the AI pelvic contours provided better agreement than did the LMIC manual contours (mean DSC of 0.834 vs 0.807 in LMIC1 and 0.844 vs 0.801 in LMIC2). For HN contours, AI provided better agreement for the majority of OAR contours than manual contours in LMIC1 (mean DSC: 0.823 vs 0.821) or LMIC2 (mean DSC: 0.792 vs 0.748). Neither the AI nor LMIC manual contours had good agreement with the control data (DSC < 0.600) for the optic nerves, chiasm, and cochlea. AI-based autosegmentation generates OAR contours of comparable quality to manual segmentation for both pelvic and HN cancer patients in LMICs, with substantial time savings.

Assessing the oral microbiome of head and neck cancer patients before and during radiotherapy.

To characterize the oral microbiome of patients with head and neck squamous cell carcinoma (HNSCC) before and during radiotherapy (RT), compared to healthy individuals. Evaluating the impact of oral microbiome in the clinical outcomes one year following the end of RT. Oral samples were collected from HNSCC patients who underwent RT using the following regimens: no dose received (T0), dose 12-16Gy (T1), dose 30-36Gy (T2) and dose ≥ 60Gy (T3). Samples from healthy individuals were also collected only once as a control group. Regions V1-V2 of the 16S rRNA were sequenced by Illumina and analyzed using Mothur. 49 patients with HNSCC and 25 healthy individuals were included. At T0, HNSCC patients showed a lower abundance of Firmicutes and Streptococcus (p = 0.011, p = 0.002) and a higher abundance of Bacteroidetes (p = 0.005) compared to healthy individuals. During RT, Fusobacterium (p = 0.017) and Porphyromonas (p = 0.0008) decreased, while Streptococcus increased at T1 (p = 0.001). By T3, the differences in Firmicutes, Bacteroidetes, and Streptococcus between the control and HNSCC groups were no longer significant (p > 0.3). Patients with higher initial abundances of Porphyromonas (p = 0.012) and Fusobacterium (p = 0.017) had poorer outcomes, including recurrence, metastasis, and death. In contrast, disease-free patients had a higher abundance of Streptococcus (p = 0.004). Oral microbiome dysbiosis was found in HNSCC patients. By the end of RT, the main initial differences in phylum and genus abundance observed at T0 between the control and HNSCC groups were no longer present. Higher abundances of Fusobacterium and Porphyromonas were associated with poor outcomes.

Incidence of head and neck cancer among Baquba Teaching Hospital Patients

Background: Squamous cells lining the tissues of the head and neck region, such as the nasal cavity, paranasal sinuses, oral cavity, lip, salivary glands, and hypopharynx, give growth to a group of malignancies together recognized as squamous cell carcinoma of the head and neck, which is the seventh utmost communal cancer diagnosis around the world. Objective: Determine the prevalence of head and neck cancer in Diyala province during 2022-2023 and their distribution according to age and gender of patients. In addition, this study aimed to identify the numbers of each type of head and neck cancer. Patients and Methods: A retrospective study achieved on the prevalence of head and neck cancer in the region accomplished in oncology center of Baquba teaching hospital in Diyala province, Iraq. Head and neck cancer patients recorded from 2022 to 2023. During this dated, a total of 172 patients were recorded. A search was accomplished on numerous databases, moreover, the information evaluated by age, gender and cancer type. Results: Regarding patients during 2022 (first group) which is contained of (94) patients with different head and neck cancer, 38(40.4%) were males and 56(59.6%) were females with statistically significant relationship. The patients during 2023 (second group) comprises of (78) patients with different head and neck cancer, 43(50.1%) were men and 35(44.9%) were women with statistically no significant correlation. Conclusion: Oral and pharyngeal cancer is more common in men than in women. The most common age group is 4th and 5th decade for head and neck cancer.

P-64830607-1086 - Second primary tumors in head and neck cancer patients. A literature review and case report

P-64830607-1086 - Second primary tumors in head and neck cancer patients. A literature review and case report

Head and Neck Cancer Survivors' Assessment of Mealtimes: Translation and Validation : Assessment and Rehabilitation of Dysphagia in Head and Neck Cancer Patients.

Dysphagia is a prevalent complication before, during and after treatment for head and neck cancer (HNC). Besides the medical and societal consequences, dysphagia has a negative impact on functioning, activity, participation and quality of life. These aspects are all affected by the environmental factors (EF). However, patient-reported outcome measures (PROMS) such as the Head-and-Neck Cancer Survivors' Assessment of Mealtimes (HNSAM), which thoroughly assess participation and EF in addition to function and activity, are rare. Therefore, this study aimed to translate and validate the HNSAM into Dutch (D-HNSAM). The HNSAM was translated according to the standardized procedure of translation & back-translation and according to the international cross-cultural adaptation process. A pilot study was then conducted with 10 HNC patients to assess the linguistic features and comprehensibility of the test items. Finally, the D-HNSAM was completed by 50 participants who were at least 6months post-treatment for HNC. The Performance Status Scale for Head and Neck cancer patients (PSS-HN)- subscales normalcy of diet and eating in public, the Dysphagia Handicap Index (DHI), the Functional Oral Intake scale (FOIS) and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) were used to examine the psychometric properties of the D-HNSAM. High correlations with related assessment tools and low correlations with unrelated assessment tools were expected. Internal consistency was found to be weak to good. Test-retest reliability, convergent validity and divergent validity were demonstrated except for the EF subscale. The D-HNSAM can detect differences in impact of dysphagia on daily functioning and quality of life. The D-HNSAM is a reliable and clinically valuable PROM for assessing the impact of dysphagia on daily functioning and quality of life in patients with HNC. The unique aspect of this PROM, the subscale EF, has unfortunately weak psychometric properties and requires further refinement.

The impact of nutritional intervention on quality of life and outcomes in patients with head and neck cancers undergoing chemoradiation.

Chemoradiotherapy in head and neck cancer patients has a curative intent but often deteriorates nutritional status leading to sarcopenia and cachexia. In this observational and single-centered study, a prospective evaluation of several biochemical and anthropometrical parameters, weight loss, handgrip strength, visual analogue scale of appetite, questionnaires associated with malnutrition & quality of life and body composition (obtained by Bioelectrical Impedance Vector Analysis) was performed before and after high-dose cisplatin chemotherapy combined with radiotherapy in 60 patients affected by head and neck cancer. Oral nutritional supplements were used to reach the correct number of daily calories and proteins. All patients completed radiotherapy as planned and the 96,4% of them did not interrupt chemotherapy for toxicity, reaching a total dose of at least 200mg/m2. Despite a rapid deterioration of body composition during treatment, nutritional support helped patients to maintain (or in some cases improve) anthropometric parameters from the end of chemoradiotherapy to the following 3 months. Low prealbumin and albumin pre-treatment led to higher risk of toxicities with consequent reduction of cisplatin dose intensity, whereas weight at the end of the treatment seems to be an interesting predicting factor for disease free and overall survival (p=0.007; p=0.015).

Effect of ionizing radiation on the shear bond strength of two different adhesive systems in primary teeth. in-vitro study

BackgroundRadiotherapy is a treatment modality used for head and neck cancer patients. It has a negative influence on bonding strength of adhesives. Little information is available about the effect of radiotherapy on bonding strength of adhesives in primary teeth. Therefore, this in vitro study aimed to detect the best adhesive system and ideal time to apply restorations in primary irradiated teeth regarding adhesive shear bond strength.MethodsDentin samples from primary teeth were randomly assigned to four groups based on restoration application time and radiation exposure, (G1: control, G2: preradiation, G3: 24 h postradiation, and G4: 6 months postradiation) with 20 samples per group. These groups were further divided into 2 subgroups according to the adhesive system used, with 10 samples per subgroup. (1) 3M™ Single Bond Universal Adhesive (SB), (2) 3M AdperSingle Bond 2 (AS). Samples were exposed to gamma radiation from a cobalt-60 machine. One shot of 60 Gy of radiation was delivered. Then samples were subjected to a shear bond strength test. The load was applied until failure and the maximum load was recorded. Numerical data are presented as mean and standard deviation values, then distributed according to Shapiro–Wilk test or Levene's test and analyzed via two-way ANOVA. The significance level was set at p < 0.05 for all tests. Statistical analysis was performed with R statistical analysis software version 4.4.1 for Windows (Team RC, R: A language and environment for statistical computing. R foundation for statistical computing, 2023).ResultsCompared with the AS subgroup, the SB subgroup presented significantly greater values (p < 0.001). For SB, there was no significant difference among the G1 and G4 groups (p > 0.001). However, there was a significant difference between G1, G2, and G3 (p < 0.001, P = 0.025, P = 0.265 ns respectively), and G3 presented the lowest values. For AS, there was no significant difference between groups G1 and G4 (p = < 0.001). Compared with the other groups, G3 presented a significant difference (p = 0.265 ns) and the lowest results.ConclusionRestorations performed 24 h after radiation had lower bond strength than those performed six months after radiation. Regardless of the adhesive system used, SB performed better than AS in terms of the shear bond strength.

Automating Dental Condition Detection on Panoramic Radiographs: Challenges, Pitfalls, and Opportunities.

Background/Objectives: The integration of AI into dentistry holds promise for improving diagnostic workflows, particularly in the detection of dental pathologies and pre-radiotherapy screening for head and neck cancer patients. This study aimed to develop and validate an AI model for detecting various dental conditions, with a focus on identifying teeth at risk prior to radiotherapy. Methods: A YOLOv8 model was trained on a dataset of 1628 annotated panoramic radiographs and externally validated on 180 radiographs from multiple centers. The model was designed to detect a variety of dental conditions, including periapical lesions, impacted teeth, root fragments, prosthetic restorations, and orthodontic devices. Results: The model showed strong performance in detecting implants, endodontic treatments, and surgical devices, with precision and recall values exceeding 0.8 for several conditions. However, performance declined during external validation, highlighting the need for improvements in generalizability. Conclusions: YOLOv8 demonstrated robust detection capabilities for several dental conditions, especially in training data. However, further refinement is needed to enhance generalizability in external datasets and improve performance for conditions like periapical lesions and bone loss.

Knowledge, Awareness, And Practice Of Multidisciplinary Team (MDT) Involved In The Rehabilitation Of Head And Neck Cancer Patients Regarding Post-Radiotherapy Prosthetic Options.

BACKGROUND: Head and neck cancer (HNC) patients require specialized multidisciplinary team care throughout the diagnosis, treatment, and survival. To achieve rehabilitation goals, a multidisciplinary team (MDT) should have adequate information regarding post-radiotherapy prosthetic options. This enables optimal rehabilitation and improves their quality of life. AIM: To assess the Knowledge, awareness, and practice of a multidisciplinary team involved in the rehabilitation of Head and Neck cancer patients regarding post-radiotherapy prosthetic options. SETTINGS AND DESIGN: Descriptive survey. MATERIALS AND METHODS: The URLs of the questionnaire consisting of fifteen closed-ended questions were shared via the web to the MDT team practicing in Tamilnadu and Pondicherry, to obtain a response of 119 which was the predetermined sample size. STATISTICAL ANALYSIS: Frequency and percentages and the results were further analysed statistically by the Chi square test. RESULT: Majority of the members in the multidisciplinary team were aware of few information on the impact of common treatment side effects on prosthetic rehabilitation and prosthetic options available, but were not practicing. CONCLUSION: Prosthetic options in postradiotherapy patients provides better results in terms of retention, stability, masticatory efficiency, comfort, and psychological well-being of the patient. Hence, the awareness of MDT should be increased regarding various available options of the prosthetic rehabilitation, advantages and disadvantages of prosthesis, and possibilities for retreatment in the case of failure for a successful treatment outcome.

Exploring dual energy CT synthesis in CBCT-based adaptive radiotherapy and proton therapy: application of denoising diffusion probabilistic models

Background.Adaptive radiotherapy (ART) requires precise tissue characterization to optimize treatment plans and enhance the efficacy of radiation delivery while minimizing exposure to organs at risk. Traditional imaging techniques such as cone beam computed tomography (CBCT) used in ART settings often lack the resolution and detail necessary for accurate dosimetry, especially in proton therapy.Purpose.This study aims to enhance ART by introducing an innovative approach that synthesizes dual-energy computed tomography (DECT) images from CBCT scans using a novel 3D conditional denoising diffusion probabilistic model (DDPM) multi-decoder. This method seeks to improve dose calculations in ART planning, enhancing tissue characterization.Methods.We utilized a paired CBCT-DECT dataset from 54 head and neck cancer patients to train and validate our DDPM model. The model employs a multi-decoder Swin-UNET architecture that synthesizes high-resolution DECT images by progressively reducing noise and artifacts in CBCT scans through a controlled diffusion process.Results.The proposed method demonstrated superior performance in synthesizing DECT images (High DECT MAE 39.582 ± 0.855 and Low DECT MAE 48.540± 1.833) with significantly enhanced signal-to-noise ratio and reduced artifacts compared to traditional GAN-based methods. It showed marked improvements in tissue characterization and anatomical structure similarity, critical for precise proton and radiation therapy planning.Conclusions.This research has opened a new avenue in CBCT-CT synthesis for ART/APT by generating DECT images using an enhanced DDPM approach. The demonstrated similarity between the synthesized DECT images and ground truth images suggests that these synthetic volumes can be used for accurate dose calculations, leading to better adaptation in treatment planning.

The Role of Oral Nutritional Supplements in Head and Neck Cancer Patients Undergoing Chemoradiotherapy.

This study aimed to assess the impact of oral nutritional supplements (ONS) on nutritional intake, body weight, and body composition in head and neck cancer (HNC) patients undergoing chemoradiotherapy. The study evaluated whether ONS could prevent treatment-related nutritional deterioration. This prospective observational pilot study included 30 HNC patients randomized into two groups: ONS (n = 15) and No ONS (n = 15). All participants underwent chemoradiotherapy, with the ONS group receiving 200 mL of a high-calorie, high-protein supplement twice daily. Nutritional status, including body weight, BMI, fat mass, fat-free mass, and bone mass, was assessed at three time points: baseline, mid-treatment, and end of treatment. Data were analyzed using the Mann-Whitney U test, with a p-value of ≤0.05 considered statistically significant. At baseline, there were no significant differences between the two groups in body weight, BMI, or body composition. By the end of radiotherapy, the No ONS group showed significant reductions in body weight (p < 0.001), BMI (p < 0.001), fat mass (p < 0.001), and fat-free mass (p < 0.001), while the ONS group maintained more stable nutritional parameters. Acute radiotherapy toxicities, including nausea, dysphagia, and oral mucositis, were not significantly different between the two groups. ONS effectively mitigates weight loss and preserves body composition in HNC patients undergoing chemoradiotherapy. While no significant reduction in radiation-induced toxicities was observed, the nutritional benefits of ONS support its use in preventing malnutrition in this patient population. Larger studies are needed to further validate these findings.

Cost-effectiveness of universal esophageal cancer screening for newly diagnosed oral cancer patients.

Oral and esophageal cancers are globally prevalent, especially in East Asia. Over half of head and neck cancer patients developing second primary esophageal cancer (SPEC) were initially diagnosed with oral cavity cancer (OCC). This study assessed the cost-effectiveness of universal endoscopic screening for early SPEC prevention in newly diagnosed OCC patients at different stages. This study employed Markov cohort models to evaluate the cost-effectiveness of endoscopic SPEC screening post-OCC diagnosis (stages 0 to IV) between screened and non-screened groups. Four surveillance frequencies were assessed: (i) one time, (ii) annual for 3years, (iii) annual for 10years, and (iv) annual for life. A hypothetical cohort of 100000 cases across stages was compared for costs and quality-adjusted life-years (QALYs), discounted annually at 3%. All four screening strategies were beneficial for all OCC stages, especially for early-stage patients, resulting in higher QALYs. Lifetime/annual screening from the payer's perspective proved most favorable, with incremental QALYs of 1.23 at stage 0 and 0.06 at stage IV. Incremental costs for this strategy ranged from NTD 121331 (USD 4044) at stage 0 to NTD 13032 (USD 434) at stage IV. Both incremental costs and incremental cost-effectiveness ratio (ICER) values indicated cost savings from a societal perspective. The ICER values ranged from NTD -626440 (USD -20881) at stage 0 and NTD -475021 (USD -15834) at stage IV. Overall, our study provided cost-effectiveness evidences to understanding the cost-effectiveness of endoscopic screening in OCC patients, particularly emphasizing the benefits of early and consistent screening.

The Use of Pharyngeal High-Resolution (Impedance) Manometry in Patients With Head and Neck Cancer: A Scoping Review.

This scoping review aims to summarize and explore current literature on the usefulness and clinical implications of pharyngeal high-resolution (impedance) manometry (HRM/HRIM) in head and neck cancer (HNC) patients. Three online databases (MEDLINE, Embase, Scopus, and additionally Google Scholar) were searched until December 2023. Studies using pharyngeal HRM/HRIM to assess swallowing or voicing in HNC patients, written in any language and published in peer-reviewed journals, were considered eligible. Quality check was performed using the Quality Assessment Tool for Quantitative Studies from the Effective Public Healthcare Practice Project. Information about the study population and HRM/HRIM data (equipment, protocol, analysis, and outcomes) were extracted. Eight papers met the inclusion criteria, six utilizing HRM and two HRIM. The study design consisted of case-series (five) and case-control (three). The quality assessment indicated a weak global rating for seven papers and a moderate rating for one for the remaining study. Findings suggest that HNC patients with dysphagia suffer from reduced pressures in the pharynx and upper esophageal sphincter compared to healthy individuals, potentially influenced by tumor characteristics and treatment. Decreased pressures may indicate poor functioning of swallowing musculature and mechanism. Pharyngeal HRM/HRIM is sparsely used for swallowing assessment in HNC patients. However, wider use seems warranted, as it can offer valuable insights into swallowing biomechanics. This can help quantifying the degree and timing of pressures involved in swallowing (problems) and holds potential for clinical applications, such as earlier diagnosis of radiation-induced therapy or surgery complications. Additionally, it can be beneficial in evaluating therapeutic swallowing strategies.

Prevalence and assessment of sleep-disordered breathing in head and neck cancer patients: a systematic review.

Sleep-disordered breathing (SDB) is a very common and underdiagnosed condition in head and neck cancers (HNC) patients. If untreated, SDB can lead to negative health consequences. The identification of SDB in HNC patients is crucial to ensure appropriate treatment and to improve outcomes. The purpose of the study was to investigate the incidence of coexisting SDB in HNC patients and to evaluate methods of assessing SDB in the population. A systematic search of PubMed, Embase, CINAHL, Cochrane Database, the Web of Science, and Scopus was performed for studies related to SDB in HNC patients. In total, 1713 articles were identified. 19 articles were selected for qualitative synthesis. The studies involved 584 subjects. The prevalence of SDB ranged from 57 to 90% before cancer treatment and from 12 to 96% after. When using an apnea-hypopnea index (AHI) cut-off ≥ 5/h to diagnosis SDB, the prevalence of SDB was 57-90% before cancer treatment and 12-94% after treatment. Sleep studies using polysomnography are the most commonly used assessment tools, but thresholds for diagnosis have been inconsistent. There is a high prevalence of SDB in HNC patients. However, the diagnostic and thresholds methods used for detecting SDB vary widely. To determine the accurate prevalence of SDB, prospective, systematic studies of SDB in unselected cohorts of HNC participants are required.