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The quality of survival of 48 patients treated surgically for head and neck cancer was assessed using a problem-orientated self-administered questionnaire. The questionnaire was based on the European Organization for Research into the Treatment of Cancer (EORTC) core questionnaire to which a specific head and neck module was added. The following domains were studied: pain, fatigue, physical symptoms (gastrointestinal and 'other'), functional activity, psychological symptoms, overall physical condition and overall quality of life. For the analysis, five groups of patients were considered: laryngectomy (n = 15), pharyngolaryngoesophagectomy (n = 5), craniofacial procedure (n = 11), 'other operations' (n = 9) and patients with disease recurrence (n = 8). Each group identified different problem areas. Laryngectomees and 'other operation' patients reported relatively few problems, whereas patients with disease recurrence described difficulties in all of the domains examined. Symptoms of fatigue were common. Information collected in this way may facilitate improved rehabilitation and thus better quality of survival.

Background: Melanomas account for 4% of sinonasal malignancies. We present the largest single institution series reported thus far and analyze the outcome with reference to lymph node involvement, radiotherapy and endoscopic resection. Methodology: Survival and recurrence data were analyzed on sinonasal melanoma cases collected from 1963-2010 to compare treatment strategies and to ascertain factors predicting outcome. Results: 115 cases (mean age 65.9) were treated at our institution during this period. All underwent surgical resection of the tumour, 31 (27%) endoscopically, and 51 (44%) also received radiotherapy. Five year overall survival was 28% and disease-free survival was 23.7%. Local control was achieved for a median of 21 months, 5-year disease control rate of 27.7%. Endoscopically resected cases showed a significant overall survival advantage up to 5 years. Radiotherapy did not improve local control or survival. Cervical metastases conferred a dramatically worse outcome. Conclusions: Endoscopic resection of sinonasal melanoma does not prejudice outcome. The role of radiotherapy is unproven.

This study prospectively follows changes in quality of life (QoL) of 40 patients undergoing surgical treatment for head and neck malignancy over a 1-year period, using the University of Washington QoL questionnaire version 4.0. The tumour types included oral, oropharyngeal, hypopharyngeal, oesophageal, laryngeal, sinonasal and thyroid carcinomas. Mean overall QoL scores were significantly worse at 3 and 6 months (P < 0.05) and returned to around preoperative scores at 12 months (P = 0.11). Oropharyngeal, laryngeal, sinonasal and thyroid subsites all maintained QoL scores at each time point. QoL scores for hypopharyngeal and oral subsites dropped markedly at 3 and 6 months but returned to around preoperative levels at 12 months. The domains most affected by treatment varied depending on tumour subsite. For the population as a whole, their appearance, activity, speech, shoulder and saliva domains were all significantly less at 12 months. Anxiety scores were significantly better at 12 months.

was based on the average monthly salary in the UK. A conservative assumption was made about the increased risk of a productive day being lost -associated with level of patient satisfaction to their treatment -by calculating an approximate number of unscheduled hospitalisations that users of a new inhaler would experience in the previous 12 months relative to Spiriva® HandiHaler®. Patient satisfaction with their inhaler was based on inhaler features that relate to ease of use and ergonomics and compared Spiriva® HandiHaler® to an improved inhaler. Results: The frequency of unscheduled hospitalisations for the new inhaler and Spiriva® HandiHaler® users were calculated at 0.34 and 0.38, resulting in 68 and 76 productive days lost annually, respectively. The total annual societal cost per patient was € 9,851 with the new inhaler and € 10,891 with Spiriva® HandiHaler®. The new inhaler costs € 1,040 less per annum than Spiriva® Handihaler®. ConClusions: New inhalers with improved features have the potential to offer substantial societal cost savings in COPD compared with Spiriva® Handihaler®.