2b Laryngoscope, 126:1567-1571, 2016.

Patients who receive ≥ 3 units of blood after free tissue transfer for HNC had a significantly increased risk of death after controlling for age, preoperative hemoglobin and albumin, cancer stage, and adverse pathologic features. Increased transfusions are also associated with higher wound infection rates. The increased tendency to transfuse free flap patients in order to maintain a threshold hematocrit may have a detrimental impact on survival and wound infections and should be revisited.

Brain tumors can cause any type of psychiatric symptoms. Rarely, brain tumors can present without any localizing signs but with psychiatric symptoms. A review of the literature indicates that there is no association between psychiatric symptoms and tumor location or histological type. Hence, it is important for clinicians to have an index of suspicion of brain tumor in patients with new-onset psychiatric symptoms, atypical presentations and treatment resistance and, as a result, consider neuroimaging. Early detection is of paramount importance for treatment and quality of life of patients. Mood symptoms may herald a brain tumor. For example, anorexia can be a presenting symptom of hypothalamic tumors. A prospective controlled study will be of benefit to further assess the association between psychiatric symptoms and brain tumor locations. New developments in the diagnostic and treatment area of brain tumors would be of help in undertaking such a prospective study.

A meta-analytic study of reports of brain tumors and psychiatric symptoms for the past 50 years was conducted to examine potential associations between tumor location and psychiatric symptoms. Results demonstrated that there is a statistically significant association between anorexia symptoms and hypothalamic tumors. For the rest of the brain regions a statistically significant association could not be definitively determined. However, several of the regions demonstrated an increased likelihood of associated symptoms when compared with other regions. The methodological limitations of this analysis are discussed.

Objectives/Hypothesis Head and neck cancer pain is a prevalent problem, and the current opioid crisis has highlighted concerns raised in chronic pain management. This study assessed the characteristics of opioid use in patients undergoing treatment for oropharynx cancer and identified risk factors associated with chronic opioid use. Study Design Retrospective cohort study. Methods A study was conducted of 198 eligible patients who underwent radiotherapy as part of their treatment for oropharynx cancer at a single institution from 2012 to 2017. p16/human papillomavirus (HPV) status was determined by pathology report review. Opioid use was recorded. Statistical analysis was performed to assess risk factors for chronic opioid use and effect on overall survival. Results The average age was 62 years, and the mean follow‐up was 38 months. Eighty‐three percent of patients had stage III/IV disease, and 73% received chemoradiotherapy. Sixty‐nine percent were HPV/p16 positive. Fifty‐seven (29%) patients had preexisting chronic pain conditions. Chronic opioid use was observed in 53% of the patients. Age ≤ 62 years (P < .0001), history of depression (P = .0356), p16 negative status (P = .0097), opioid use at pretreatment visit (P = .0021), and presence of a preexisting chronic pain condition at time of diagnosis (P = .0181) were associated with chronic opioid use using univariate analysis. On multivariate analysis, T stage and anxiety/depression were associated with chronic opioid use. Overall survival was worse for patients who had chronic opioid use, but was not significant when recurrence was taken into consideration. Conclusions More than 50% of the patients treated for oropharynx squamous cell carcinoma in this cohort were chronic opioid users after treatment. Identifying patients at greatest risk for chronic opioid use prior to treatment may help with long‐term pain management in this patient population. Level of Evidence 4 Laryngoscope, 129:2087–2093, 2019