Developing Supportive Care Services Within a Multidisciplinary Head and Neck Cancer Program

Abstract

43 (47%) patients were still alive. The median prior irradiation dose to the skull base region was 6360 cGy for those without TLN and 6760 cGy for those with TLN (PZ.055). Median re-irradiation proton dose was 60 CGE without TLN and 7 0CGE with TLN (PZ.419). Twelve patients (13%) were found to have temporal lobe necrosis with median time to development of 8 months. Of these patients, 6 patients had right-sided TLN, 5 had left-sided, and 1 patient had bilateral TLN. The median total mean dose to 2 cc to the right temporal lobe was 51.87 CGE for those without TLN and 75.10 CGE for those with TLN (PZ.057); median max pixel dose to the right was 68.80 CGE without TLN and 110.13 CGE with TLN (PZ.040). On the left side, median total mean dose to 2 cc was 32.29 CGE with no TLN and 59 CGE with TLN (PZ.211) and median max pixel dose was 55.19 CGE without TLN and 71.34 CGE with TLN (PZ.560). All patients were determined to have grade 1 TLN per CTCAE 4.0 with only radiographic evidence and were clinically asymptomatic except for one patient with grade 2 toxicity requiring medical management with steroids. Conclusion: Among patients treated in the re-irradiation setting with proton therapy, 13% of patients developed TLN that was only apparent radiographically except for one who was treated medically. Analysis of more detailed dosimetric data with longer follow-up data are underway to better ascertain the significance of these findings.

Implementing a Tailored Psychosocial Distress Screening Protocol in a Head and Neck Cancer Program

“…[5][6][7][8][9] The elevated rates observed in HNC patients have been attributed to significant treatment side effects, functional impairment and loss (e.g., speech and swallowing), [10][11][12] disfigurement, 13 and persistent pain and fatigue. 14,15 Prior studies in patients with HNCs have identified distress as an important predictor of a range of negative medical outcomes, 16,17 such as delays in seeking treatment, 17,18 poor adherence to treatment, 19 increased costs, 20 increased health care utilization, 21 longer hospital stays, poorer quality of life, 22 and decreased survival. 23,24 Despite the high prevalence of distress in HNC patients and its negative impact on clinical outcomes, the implementation of distress screening and management in routine care is not widespread.…”