University Of Washington Quality Of Life Research Articles

University of Washington Quality of Life subdomain outcomes after treatment of sinonasal malignancy: A prospective, multicenter study.

Sinonasal malignancies (SNMs) adversely impact patients' quality of life (QOL) and are frequently identified at an advanced stage. Because these tumors are rare, there are few studies that examine the specific QOL areas that are impacted. This knowledge would help improve the care of these patients. In this prospective, multi-institutional study, 273 patients with SNMs who underwent definitive treatment with curative intent were evaluated. We used the University of Washington Quality of Life (UWQOL) instrument over 5 years from diagnosis to identify demographic, treatment, and disease-related factors that influence each of the 12 UWQOL subdomains from baseline to 5 -years post-treatment. Multivariate models found endoscopic resection predicted improved pain (vs. nonsurgical treatment CI 2.4, 19.4, p=0.01) and appearance versus open (CI 27.0, 35.0, p<0.001) or combined (CI 10.4, 17.1, p<0.001). Pterygopalatine fossa involvement predicted worse swallow (CI -10.8, -2.4, p=0.01) and pain (CI -17.0, -4.0, p<0.001). Neck dissection predicted worse swallow (CI -14.8, -2.8, p<0.001), taste (CI -31.7, -1.5, p=0.02), and salivary symptoms (CI -28.4, -8.6, p<0.001). Maxillary involvement predicted worse chewing (CI 9.8, 33.2; p<0.001) and speech (CI -21.8, -5.4, p<0.001) relative to other sites. Advanced T stage predicted worse anxiety (CI -13.0, -2.0, p=0.03). Surgical approach, management of cervical disease, tumor extent, and site of involvement impacted variable UWQOL symptom areas. Endoscopic resection predicted better pain, appearance, and chewing compared with open. These results may aid in counseling patients regarding potential QOL expectations in their SNM treatment and recovery course.

Assessing Long-Term Quality of Life Concerns Through Survivorship Clinic in Head and Neck Cancer Patients.

To characterize the concerns of head and neck cancer (HNC) patients and discern changes in quality-of-life (QoL) during long-term follow-up. Retrospective review. Survivorship clinic at a tertiary academic center. A retrospective review was conducted on HNC patients seen in our survivorship clinic between 1/2020 and 1/2024 using the University of Washington Quality of Life (UW-QOL) Questionnaire. Three hundred and forty-two patients were seen for 914 encounters. Patients were divided into 4 groups: pretreatment (n = 326), 0 to 12 months posttreatment (n = 247), 1 to 3 years posttreatment (n = 248), and more than 3 years posttreatment (n = 64). The average follow-up after treatment was 459 days (range: 0-5.2 years). Multivariable analysis revealed significant improvements in overall QoL, health-related QoL, social-emotional composite scores, activity, anxiety, appearance, chewing, mood, pain, speech, and recreation at more than 1-year posttreatment compared to less than 1-year posttreatment. However, declines were noted in saliva and taste scores. No differences in scores were observed between patients 1 to 3 years posttreatment and those >3 years posttreatment. At all timepoints before and after treatment, top concerns were pain, activity, and swallowing. Patients with oral cancer followed for more than 1-year posttreatment had worse scores in appearance, chewing, pain, and speech compared to those with oropharyngeal cancer. Understanding the evolving concerns of HNC patients is imperative for enhancing care. Most QoL domains improve at 1-year posttreatment except for saliva, taste, swallowing, and shoulder function. QoL scores stabilize after 1-year post-treatment. Pain, activity, and swallowing remain the top concerns at all time points.

Patient-reported outcomes after oral cancer reconstructions with radial and ulnar forearm-free flaps.

This study aimed to evaluate patient-reported quality of life and incidence of decision regret in patients undergoing radial (RFFF) and ulnar forearm-free flaps (UFFF) reconstruction. Patients undergoing either RFFF or UFFF were assessed with the University of Washington Quality of Life (UW-QOL) and Oral Health Impact Profile (OHIP-14) questionnaires, and the Decision Regret Scale (DRS), both before and at least 12 months post-reconstruction. In total, 40 RFFF and 40 UFFF were included. Harvesting time was longer in RFFF (p = 0.043), and the donor-site defect was significantly larger in RFFF than in UFFF (p = 0.044). Patients with UFFF scored better UW-QOL in the appearance, pain, activity, mood, and social functioning domains (p < 0.05). However, the RFFF group excelled in swallowing and chewing domains. The DRS score revealed a significant difference between RFFF and UFFF, with scores of 36.26 versus 27.36, respectively. Moreover, the mean DRS score reduced at 12 months compared with 6 months, significantly superior for UFFF. Oral cancer patients reconstructed with UFFF exhibited a better appearance, social domain, and mild decision regret compared with RFFF, indicating that the UFFF may contribute to improving postoperative quality of life in oral cancer patients.

Sequential free fibula transfers: Quality of life and systematic review.

Successive osteoseptocutaneous fibula transfers for jaws reconstruction are rare but important options. This study contributes patient-reported and clinical outcomes, as well as systematically reviews all existing reports. All sequential fibula transfers performed by the senior author were reviewed from a prospectively managed database, including University of Washington quality of life (UWQoL). Systematic review was conducted in PubMed and Cochrane databases for similar publications. Eighteen patients (average age 51.5 years) received sequential fibulas (mean 4.7 years between reconstructions). Secondary fibulas more often had benign indications (72.2% vs. 33.3%, p = .04), most commonly osteoradionecrosis (38.9%). At a mean follow-up of 30.5 months, the average interincisal distance increased from 21.8 to 27.6 mm, and 92.3% tolerated an oral diet following the second fibula. Eight patients completed the UW-QoL before and after the second fibula, and three prior to the first fibula. Composite physical function was significantly decreased from 96.7 prefibula reconstruction to 63.3 following the first (p < .001) and 64.2 after the second fibula (p < .001). There were no differences in other domains. The systematic review yielded six articles reporting 56 patients (mean 39 months between fibulas). Secondary fibulas were performed for repeat malignancy (45%) and osteoreadionecrosis (39%), resulting in elevated tube feeding from 20% following the first to 39% following the second, but overall high quality of life in two studies. Sequential osteoseptocutaneous fibula reconstructions of jaws are often performed for benign indications such as osteoradionecrosis. Overall function and QoL are comparable with those following the first fibula transfer.

Translation, transcultural adaptation, and validation of the serbian version of the University of Washington Quality of Life questionnaire (UW-QoL) - a pilot study

Background/Aim. The University of Washington Quality of Life (UW-QoL) questionnaire is one of the most frequently applied instruments for the evaluation of the health-related quality of life of head and neck cancer patients worldwide. The aim of this study was to perform a formal translation of the original version into the Serbian language, assess its psychometric properties, and validate it for use in the Serbian-speaking population. Methods. The study was designed as pilot research and conducted between August and October 2023. The internal consistency of the questionnaire was established by calculating Cronbach?s alpha coefficient (CA). The intraclass correlation coefficient (ICC) was a measure of temporal stability. The construct validity of the instrument was assessed by correlating its total scores with Oral Health Impact Profile-14 (OHIP-14) and Emotion Regulation Questionnaire results. Results. A total of 30 patients (23 males and 7 females) with a mean age of 58.07 ? 13.59 years were enrolled in the research. Mean values of the physical function and social-emotional function subscales were 59.50 ? 12.68 and 55.39 ? 15.26 (the researchers interviewed the participants) and 58.78 ? 12.57 and 57.72 ? 14.91 (the patients completed the questionnaire by themselves). CA value of the Serbian version of the UW-QoL questionnaire was 0.816 (the questionnaire was filled out by the researchers) and 0.802 (the subjects completed it on their own). ICC was 0.797. There was a statistically significant strong correlation between the UW-QoL questionnaire and OHIP-14 total scores. The obtained results showed a weak, non-significant correlation between the UW-QoL questionnaire and the Emotion Regulation Questionnaire. Conclusion. Our pilot research showed that the Serbian version of the UW-QoL questionnaire appears as psychometrically valid and reliable as the original English version.

Potential Dosimetric Predictors of Patient-Reported Quality of Life for Head and Neck Cancer Following Chemoradiation IMRT

This study aims to identify both acute and late patient patient-reported salivary quality of life outcomes in patients with head and neck cancer treated with chemoradiation therapy on a prospective trial. A cohort of 40 patients with head and neck cancers were included in the study. All patients underwent concurrent chemoradiation therapy using IMRT delivery (1 patient on one Linac, 24 patients on a different Linac, and 15 on a helical delivery machine). All patients were asked to complete the University of Washington Quality of Life (UOW-QOL) questionnaire at baseline, immediately after treatment, as well as at 1 month, 3 months, 6 months, 12 month and 18 months post-treatment. For the salivary quality of life (QOL) outcome scores, the possible responses were scored on a discreet scale of 100, 70, 30, and 0, with 100 as normal and 0 as dysfunctional. Dosimetric endpoints achieved based on the treatment plan, such as maximum/mean/minimum doses, V30 (percent volume receiving 30 Gy dose), and Dy (dose received to y percent volume) were collected for the bilateral salivary glands, bilateral temporomandibular joint and bilateral submandibular glands. The associations between these dosimetric parameters and the corresponding salivary QOL scores at each time point were analyzed. A Wilcoxon test was performed to identify any differences in the dosimetry and salivary QOL scores among the four different responses. At short-term follow-up including 1- and 6-month, the distribution of the mean dose received by the right parotid was significantly different between the patients that reported a salivary QOL score of 30 and those that reported 100, with p-values of 0.007 for the 1-month comparison and 0.006 for the 6-month comparison. This was also seen for the V30, with p-values of 0.027 for the 1-month comparison and 0.013 for the 6-month comparison. At 3 months, the maximum dose received by the left temporomandibular joint was significantly different between the patients that reported 30 and those that reported 70, with a p-value of 0.038. At 6 months, the average dose distribution of the right submandibular gland received between the patients that reported a score of 30 and 100 was also significantly different, with a p-value of 0.006. At the long-term follow-up time points of 12 and 18 months, no significant differences were found. The significant differences seen in the data suggest that the dosimetry may have effects on patient reported salivary QOL at short-term follow-up but not long-term. This provides a new perspective into how a patient's QOL over a period of time could be affected by the amount of dose to critical organs. These results also serve as the basis for further investigation into the actual delivered dose, which could differ from the planned dose due to daily anatomic changes over the course of head and neck radiotherapy delivery. These daily volumetric and dosimetric changes may guide early adaptive treatment to improve patient-reported QOL outcomes.

Decisional regret, symptom burden, and quality of life following transoral robotic surgery for oropharyngeal cancer

BackgroundTransoral robotic surgery (TORS) has equivalent oncologic control to radiotherapy with potential for improved quality of life (QOL) and lower patient-reported decisional regret. MethodsCross-sectional study between 2016 and 2021 of TORS patients with early-stage oropharyngeal squamous cell carcinoma who completed the Decision Regret Scale (DRS), M. D. Anderson Dysphagia Inventory (MDADI), and University of Washington Quality of Life (UW-QOL). The median time from treatment to questionnaire completion was 1.8 years (IQR 1.4–3.3, range 1.0–5.6). ResultsOf 65 patients, 84.6% expressed no or mild decisional regret. Regret was not associated with clinical parameters or adjuvant treatment but was correlated with MDADI (τavg = −0.23, p < 0.001) and UW-QOL (τavg = −0.27, p < 0.001). Worse MDADI was associated with older age and worse UW-QOL was associated with multi-site operation and shorter time to survey. ConclusionsOverall, the TORS cohort expressed very limited decisional regret. DRS scores were unaffected by clinicodemographics or additional adjuvant therapies, but decision regret was correlated with worse QOL and worse swallowing.

Quality of Life after Mandibular Reconstruction Using Free Fibula Flap and Customized Plates: A Case Series and Comparison with the Literature.

A single-center retrospective study was conducted to assess health-related quality of life (HRQoL) in 23 consecutive patients undergoing mandibular reconstruction using the computer-aided design (CAD) and computer-aided manufacturing (CAM) technology, free fibula flap, and titanium patient-specific implants (PSIs). HRQoL was evaluated after at least 12 months of surgery using the University of Washington Quality of Life (UW-QOL) questionnaire for head and neck cancer patients. In the 12 single question domains, the highest mean scores were found for "taste" (92.9), "shoulder" (90.9), "anxiety" (87.5), and "pain" (86.4), whereas the lowest scores were observed for "chewing" (57.1), "appearance" (67.9), and "saliva" (78.1). In the three global questions of the UW-QOL questionnaire, 80% of patients considered that their HRQoL was as good as or even better than it was compared to their HRQoL before cancer, and only 20% reported that their HRQoL had worsened after the presence of the disease. Overall QoL during the past 7 days was rated as good, very good or outstanding by 81% of patients, respectively. No patient reported poor or very poor QoL. In the present study, restoring mandibular continuity with free fibula flap and patient-specific titanium implants designed with the CAD-CAM technology improved HRQoL.

Assessment of quality of life after soft tissue resection of head and neck carcinoma and reconstruction with double-paddle peroneal artery perforator free flap

We aimed to assess the quality of life for head and neck carcinoma (HNC) patients who underwent soft tissue resection and reconstruction with double-paddle peroneal artery perforator (DPAP) free flap. The quality of life was assessed by means of the University of Washington quality of life (UW-QOL) and the 14-item Oral Health Impact Profile (OHIP-14) questionnaires at 12 months postoperatively. Data from 57 patients were retrospectively analysed. Out of these, 51 patients were at TNM stage III or IV. Finally, 48 patients finished and returned the two questionnaires. In the UW-QOL questionnaire, the mean (SD) higher scores were pain 76.5 (6.4), shoulder 74.3 (9.6), and activity 71.6 (6.1), whereas the lower scores were chewing 49.7 (5.2), taste 51.1 (7.7), and saliva (56.7 (7.4). In the OHIP-14 questionnaire, the higher-scoring domains were psychological discomfort (69.3 (9.6) and psychological disability 65.2 (5.8), whereas the lower-scoring domains were handicap 28.7 (4.3) and physical pain 30.4 (8.1). The DPAP free flap significantly improved appearance, activity, shoulder, mood, psychological discomfort, and handicap compared with pedicled pectoralis major myocutaneous flap reconstruction. In conclusion, DPAP free flap for reconstruction of tissue defects after soft tissue resection of HNC significantly improved the patients' QOL compared to pedicled pectoralis major myocutaneous flap reconstruction.

Health-related quality of life in patients with noma (cancrum oris): Case series

Introduction and importanceCancrum oris (noma) is a destructive disease of orofacial tissues and adjacent structures that progress rapidly, causing functional and cosmetic problems to the patient and ultimately affecting their health-related quality of life. This case series focuses on the impact of the cancrum oris on the health-related quality of life of patients which has been underreported in literature. Case presentationHerein, we present 3 cases (1 pediatric and 2 adult patients) of cancrum oris. One adult male succumbed to the disease while the remaining two are undergoing treatment. We used the modified versions of the Early Childhood Oral Health Impact Scale (ECOHIS) and the University of Washington-Quality of Life (UWQoL) questionnaire for pediatric and adult patients respectively. Clinical discussionThe sequela of cancrum oris affects negatively the quality of life of the patients even after definitive management. Despite this, there is no validated questionnaire to assess the quality of life. The modified versions of the ECOHIS and the UWQoL questionnaires that were used in this case report can be used effectively to assess the HRQoL of the patients. ConclusionCancrum oris is a neglected disease that affects negatively the health-related quality of life of patients who suffer from it, despite medical intervention.

Patient-reported outcomes and morbidity after head and neck reconstructions: An evaluation of fibular and scapular free flaps

BackgroundFibular (FFF) and scapular free flaps (SFF) are versatile tissue transfers for head and neck reconstruction. However, their relative morbidity has been sparsely studied. The primary goal of this study was to evaluate the morbidity and patient-reported outcome measures of these two reconstructive options. Materials and MethodsCase series of patients from 2017 to 2020 who underwent a FFF or SFF for head and neck ablation. Demographic and surgical outcome measures, such as Charlson Comorbidity Index (CCI), anesthetic time, donor site morbidity, and perioperative morbidity score (POMs) were extracted. Patients were contacted to complete the Decision Regret Scale (DRS), University of Washington Quality of Life (UW-QoL), Oral Health Impact-14, and limb specific functional outcome measures. Statistical analyses included a linear regression. ResultsIn total, 97 FFF (mean age 58.5, 62.9% male) and 55 SFF (mean age 64.8, 63.6% male) were included. Total surgical time was higher in the SFF group (p < 0.05) and they had more comorbidities (p < 0.01). SFF patients had lower POM scores on post-operative day three (p < 0.05) while FFF patients scored better on the UW-QoL Physical Domain (p < 0.01). The DRS for both groups (FFF mean DRS 22.7, SFF mean DRS 19.2) was similar. When adjusted for patient morbidity, however, the SFF group had less decisional regret (p < 0.05). ConclusionThis is the largest comprehensive evaluation of patient-reported outcome measures for FFF and SFFs. SFFs required longer surgical times but had less early morbidity than FFFs. Patients who underwent either reconstructions reported mild decisional regret, proving these are generally well tolerated procedures.

Translation and Validation of the Filipino Version of the University of Washington Quality of Life Questionnaire (UW-QOL) for Patients with Head and Neck Cancer

ABSTRACT Objective: To translate the University of Washington Quality of Life (UW-QOL) questionnaire into Filipino and to validate it among a sample of patients with head and neck cancer. Methods: Design: Cross-sectional study Setting: Tertiary Government Training Hospital Participants: 33 patients Results: A total of 33 patients were recruited in this study. Eighteen (54.5%) were male, and 15 (45.5%) were female aged 24-79 years old (mean age 52.85 ± 11.81 years old) completed the study. All items in the Filipino translation of the UW-QOL had a content validity index. The raters in face validation had 100% agreement in almost all items except for the appropriateness of font size and space of the questionnaire. The Cronbach’s alpha of the Filipino version of the questionnaire was 0.8596. The alpha score when each of the items was deleted remained within the range of 0.83 – 0.86. The intraclass correlation coefficients of all items were greater than 0.9. For all items, there were no significant difference observed between the test and retest scores. Conclusion: This study showed that the Filipino translation of the UW-QOL is culturally adapted, internally consistent and stable. It is as reliable as the original English version in assessing health related QOL, and valid for assessing HR-QOL among patients with head and neck cancers.

Comparison between the radial forearm and groin soft tissue free flaps for reconstruction in patients with oral cavity cancer: a quality of life analysis

The purpose of this study was to compare the effects of the radial forearm free flap (RFFF) and groin soft tissue free flap (GSFF) on the quality of life (QoL) of patients undergoing reconstructive surgery after resection for oral cancer. A retrospective analysis of 48 patients was performed. The Vancouver Scar Scale (VSS), University of Washington Quality of Life (UW-QOL) questionnaire, and 14-item Oral Health Impact Profile (OHIP-14) questionnaire were used to evaluate the donor site scars and QoL of the patients. The postoperative hospital stay was significantly longer in the RFFF group than in the GSFF group (P = 0.001). Furthermore, the total VSS score (P = 0.011), VSS score for pigmentation (P < 0.001), and OHIP-14 scores for psychological discomfort (P = 0.026) and social disability (P = 0.044) were all significantly higher in the RFFF group than in the GSFF group, while the UW-QOL scores for appearance (P = 0.037) and mood (P = 0.036) were significantly lower in the RFFF group than in the GSFF group. Compared with the RFFF, the GSFF scar is more concealed, with better aesthetics at the donor site, and this flap can result in improved postoperative QoL for patients with oral cancer.

Quality of Life in Patients With Recurrent and Second Primary Head and Neck Cancer.

In the setting of similar outcomes, quality of life (QOL) measures can be utilized to compare treatment modalities in head and neck squamous cell carcinoma (HNSCC). We evaluate QOL and symptoms in patients treated for primary, second primary, and recurrent HNSCC. Retrospective cohort study. Head and neck cancer survivorship clinic. We identified patients seen between 2016 and 2019. QOL and symptoms were assessed with the University of Washington Quality of Life (UW-QOL) questionnaire, 10-item Eating Assessment Tool, 8-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder, and Neck Disability Index. Regression analysis was utilized to explore associations and compare QOL outcomes. Our cohort comprised 662 patients: 546 with primary HNSCC, 34 with second primary HNSCC, and 82 with recurrent HNSCC. Multimodality therapy was associated with lower UW-QOL Physical Subscale (UW-QOL-PS) vs single modality: chemoradiation therapy (-12.17 [95% CI, -16.57 to -7.78]) and surgery + postadjuvant treatment (-12.11 [-16.06 to -8.16]). Multimodality therapy was also associated with lower UW-QOL Social-Emotional Subscale (UW-QOL-SS): chemoradiation therapy (-6.70 [-11.41 to -1.99]) and surgery + postadjuvant treatment (-7.41 [-11.63 to -3.19]). Recurrence (-14.42 [-18.80 to -10.04]) and second primary (-11.15 [-17.71 to -4.59]) demonstrated lower UW-QOL-PS vs primary. Radiation for recurrence or second primary had worse UW-QOL-PS (-10.43 [-19.27 to -1.59]) and UW-QOL-SS (-10.58 [-18.76 to -1.54]) and higher Eating Assessment Tool (6.08 [1.39-10.77]) than surgery alone. Surgery + postadjuvant treatment showed worse UW-QOL-PS (-12.65 [-23.76 to -1.54]) and UW-QOL-SS (-12.20 [-22.38 to -2.03]). Multimodality therapy, particularly with recurrent and second primary HNSCC, is more likely to contribute to diminished QOL and symptoms. This important consideration should play a role in framing informed discussions with patients regarding treatment.

Quality of life following photodynamic therapy for head and neck pathologies: An exploratory study

IntroductionHealthcare related quality of life (QoL) is defined as the impact one's level of health and wellbeing has on a number of domains, including physical, mental, spiritual and social functions. Photodynamic therapy (PDT), a cancer treatment modality, is increasingly used to treat or palliate head and neck pathologies. Due to the complex nature of this area of the body, both the pathology and the treatment of it can severely affect the quality of life. Thus far, no questionnaire has been developed which focuses on quality-of-life post-PDT of head and neck pathologies. Patients and methodsWe have developed the University College London Quality of Life Questionnaire for Patients undergoing PDT in the Head and Neck, using meta-tetra(hydroxyphenyl)chlorin (mTHPC) as the photosensitiser. This was modified from the University of Washington quality of life (UW-QOL) questionnaire. Thirty-eight patients who received mTHPC-PDT for various head and neck pathologies completed the questionnaire, with a mean follow-up of 56 days. ResultsAll patients reported improved QoL following mTHPC-PDT. The main problem that was reported was post-PDT pain, which is a common side effect. Visual symptoms, breathing, speaking and swallowing problems improved significantly in the 4th week following treatment and significant improvement in activities of daily living, social life, mood and anxiety were reported in the subsequent weeks. ConclusionsmTHPC-PDT confers improvement in QoL score in selected head and neck cancer patients with figures comparable to other treatment modalities. This exploratory study demonstrated patterns of QoL outcome. Further work needs to be done for survey validation and inclusion of a larger cohort which will allow optimal sub-group analysis and help guide further interventions.

Adaptation and validation of the Latin-American Spanish version of the VHI-10 (LASVHI-10)

PurposeTo generate a cross-cultural adaptation of the Voice Handicap Index-10 (VHI-10) in the Latin-American Spanish language and to assess its psychometric properties. MethodsThis is a descriptive and prospective cross-sectional study. The Voice Handicap Index-10 (VHI-10) was translated and back-translated and then adapted to the Latin-American Spanish language (LASVHI-10). It was then applied to adult patients with clinical findings of dysphonia made by a physician. A psychometric validation consisting of a principal components exploratory factor analysis with varimax rotation, concurrent validation comparing the visual analog scale performed by the patient and two relevant questions of the Spanish version of the University of Washington Quality of Life (UWQOL) scale, known group validity assessment and test–retest reliability assessment was performed. ResultsA total of 119 patients were included. The mean score for the LASVHI-10 scale was 18.4±10.7 (median 18, range 0–40). A principal component factor analysis showed a two-factor solution with good diagnostic test results. The Cronbach's alpha value for the global scale was .92. The comparison between the LASVHI-10 and the visual analog scale demonstrated a high correlation (rho=.82), and the coefficient for test–retest was .80. ConclusionThe results of this study provide evidence of a reliable and objective instrument to be used in clinical practice and for research objectives in Spanish-speaking patients.

Application of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma

To investigate the effectiveness of free peroneal artery chimeric perforator flap in repairing the defect after advanced local lesions resection in parotid gland carcinoma (PGC). Between June 2010 and June 2020, 32 patients with advanced local lesions of PGC were treated with extended radical resection. After that, 17 patients were repaired with the free peroneal artery chimeric perforator flaps (trial group) and another 15 patients were repaired with the pedicled pectoralis major myocutaneous flaps (control group). There was no significant difference in gender, age, disease type, histopathological classification, clinical stage, and pathological stage between groups ( P>0.05). The size of skin flap in trial group ranged from 7 cm×6 cm to 12 cm×8 cm and the size of soleus muscle flap ranged from 5 cm×3 cm to 6 cm×4 cm. The donor sites were repaired with skin grafting. The size of the pedicled pectoralis major myocutaneous flaps in control group ranged from 9 cm×6 cm to 14 cm×7 cm. The donor sites were sutured directly. The operation time, survival rate of flap, and postoperative survival of patients were recorded and compared between groups. At 1 year after operation, the University of Washington quality of life (UW-QOL) questionnaire was used to evaluate the quality of life of patients in the two groups, including appearance, shoulder movement, sociability, masticatory function, speech function, and mood. The operations completed successfully. The operation time was (6.19±0.72) hours in trial group and (6.41±0.71) hours in control group, showing no significant difference between groups ( t=-0.863, P=0.395). The survival rate of flap in trial group was 94.1% (16/17); and 1 patient suffered from vascular crisis after operation and was replaced with the pedicled pectoralis major myocutaneous flap. The survival rate of flap in control group was 100%. All grafts survived and the incisions healed by first intention in the two groups. All patients were followed up. The follow-up time was 6-60 months (median, 60 months) in trial group and 7-60 months (median, 60 months) in control group. Cumulative survival rates of patients at 1, 3, and 5 years after operation were 94.1%, 64.7%, and 58.8% in trial group, respectively; 86.7%, 66.7%, and 53.3% in control group, respectively. There was no significant difference in the cumulative survival rate between groups ( χ 2=0.090, P=0.762). According to the UW-QOL questionnaire at 1 year after operation, the scores of appearance, shoulder movement, sociability, and mood in trial group were significantly higher than those in control group ( P<0.05); and there was no significant difference in masticatory function and speech function scores between groups ( P>0.05). The peroneal artery perforator has an invariable anatomical relationship. Each perforator emits the muscular branch that nourishes the soleus muscle. Therefore, personalized free peroneal artery chimeric perforator flap can be designed according to the tissue defect, and used to repair the defect after advanced local lesions resection in PGC.

Surgical factors associated with patient-reported quality of life outcomes after free flap reconstruction of the oral cavity

ObjectivesTo determine which surgical factors are associated with quality-of-life (QOL) outcomes in oral cavity cancer survivors after free flap reconstruction of the oral cavity. Patients and MethodsA cross-sectional study was conducted from a multidisciplinary head and neck cancer (HNC) survivorship clinic. Oral cavity cancer survivors with at least 6-months of postoperative follow-up from ablation and free flap reconstruction were included. Primary outcome measures were validated patient-reported outcome measures (PROMs) including the Eating Assessment Tool-10 (EAT-10) measure of swallowing-specific QOL, University of Washington Quality of Life (UW-QOL) physical and social-emotional subscale scores and feeding tube dependence. ResultsExtent of tongue resection was associated with EAT-10 and the UW-QOL Physical subscale scores. Patients with oral tongue defects reported worse scores than with composite defects in the EAT-10 and UW-QOL physical domain (p = 0.0004, 0.0025, respectively). This association no longer applies when controlling for differences in extent of tongue resection. Patients with anterior composite resections reported worse EAT-10 scores than lateral resections (p = 0.024). This association no longer applies when controlling for extent of tongue resection (p = 0.46). Gastric tube dependence demonstrates similar trends to PROMs. ConclusionExtent of tongue resection was strongly associated with poor QOL outcomes after free tissue reconstruction of the oral cavity and mediates the associations between other defect characteristics and QOL. These findings demonstrate the need for emphasis on expected oral tongue defects when counseling patients and highlight the need to address QOL in a multidisciplinary fashion post-operatively.

Patient-Reported Quality of Life Outcomes After Integrating Exclusive Liquid Meal Replacement in Patients With Head and Neck Cancer Undergoing Chemoradiation: Results From a Phase II Study

<h3>Purpose/Objective(s)</h3> Preventing malnutrition during chemoradiation (CRT) for head and neck cancer (HNC) is crucial for treatment adherence, minimizing treatment-related complications, and maximizing quality of life (QOL). We sought to assess patient-reported QOL outcomes after integrating exclusive liquid meal replacement with Soylent, a novel meal replacement agent, in patients with HNC undergoing CRT. <h3>Materials/Methods</h3> Patients undergoing definitive or adjuvant concurrent CRT for locally advanced HNC enrolled on our single-institution, prospective phase II protocol evaluating nutritional replacement with Soylent. Patients who reached 5% body weight loss during CRT were transitioned to Soylent meal replacement for all nutritional needs. Patients who reached 10% body weight loss were recommended for gastrostomy tube placement. The University of Washington QOL (UW-QOL) and the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) questionnaires were used to assess patient-reported QOL prior to the receipt of CRT (baseline), as well as at 1, 3, 6, 12, and 18 months following conclusion of CRT. Higher scores indicated better QOL for both assessments. Paired t-test or Wilcoxon signed-rank test was applied to assess whether differences between scores at each time point and baseline exist. Multiple testing was addressed via Benjamini-Hochberg procedure with a false discovery rate threshold of 0.2. <h3>Results</h3> Of the 41 patients who completed evaluable QOL surveys, 33/41 (80%) reached the 5% weight loss threshold and 32/33 (97%) were transitioned to Soylent. Subsequently, 11/33 (33%) on Soylent reached the 10% weight loss threshold, but only 1/11 (9%) received a gastrostomy tube. The nadirs for overall and health-related UW-QOL were reached at 1 month and rebounded to exceed baseline by 6 months. The mean overall UW-QOL score was 71 at baseline compared with 62, 69, 77, 73, and 80 at 1, 3, 6, 12, and 18 months, respectively. Comparing individual UW-QOL domains from baseline to 18 months, significant differences were found in only two domains. Saliva scores decreased from 91 to 73 (adjusted <i>P</i> = 0.02) whereas anxiety scores increased from 51 to 81 (adjusted <i>P</i> = 0.11). FACT-H&N survey scores were reduced from 32 at baseline to 20 at 1 month (adjusted <i>P</i> < 0.001) and 26 at 3 months (adjusted <i>P</i> < 0.001), but increased to 29, 30, and 27 at 6, 12, and 18 months, without significant differences as compared to baseline (adjusted <i>P</i> > 0.57 for all). <h3>Conclusion</h3> This study's results reveal encouraging QOL outcomes from exclusive liquid meal replacement with Soylent, which appear potentially comparable with QOL outcomes from contemporary de-escalation trials in HNC pending further direct comparison. Soylent liquid meal replacement with aggressive dietary monitoring appears to be a promising approach for maximizing patient-reported QOL after conventional, concurrent CRT.

Functional outcomes after submandibular gland-sparing neck dissection in patients with oral squamous cell carcinoma

The feasibility of submandibular gland (SMG) preservation during neck dissection has been described. The aim of this study was to analyse the functional outcomes in patients undergoing SMG preservation during neck dissection for cT1–2N0 oral squamous cell carcinoma. Consecutive patients were divided into two groups based on the management of the SMG, and underwent a saliva flow test before surgery, 7 days after surgery, and at 3, 6, 9, and 12 months after surgery. All enrolled patients completed the fourth version of the University of Washington Quality of Life (UWQOL) questionnaire at 12 months after surgery. In patients who underwent SMG preservation during neck dissection, the flow rate at 7 days after surgery was significantly lower than that preoperative; however, it gradually returned to baseline at 9 months after surgery. The saliva flow rate at 9 months after surgery was similar to that at 12 months after surgery. Further, patients with SMG preservation had higher scores for the activity, swallowing, chewing, and saliva domains than patients without SMG preservation. The results of the study suggest that saliva secretion ability can be preserved following SMG-sparing neck dissection, and that SMG preservation improves postoperative quality of life.