Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer

Abstract

Head and neck squamous cell carcinoma (HNSCC) is the most common cancer involving the mucosal surfaces of the head and neck and is associated with a number of etiological factors, including cigarette smoking, alcohol and betel nut consumption and exposure to high-risk human papillomavirus. The risk of HNSCC increases with age, peaking in the seventh and eighth decade, but this varies by anatomical and histological subtype. While several advancements have been made in the treatment of head and neck cancer (HNC) in recent decades, undertaking curative treatment still subjects the majority of HNSCC patients to substantial treatment-related toxicity requiring patients to tolerate a gamut of physical, psychological, and emotional demands on their reserves. In conjunction with other patient-related factors, clinicians involved in treating patients with HNSCC may incorporate advancing chronological age into their decision-making process when determining treatment recommendations. While advancing chronological age may be associated with increased concerns regarding physical treatment tolerability, clinicians may also be concerned about heightened vulnerability in various health and wellbeing outcomes. The available literature, however, does not provide evidence of this vulnerability in patients with advancing age, and, in many instances, older patients self-report greater resilience compared to their younger counterparts. While this data is reassuring it is limited by selection bias and heterogeneity in trial and study design and the absence of a consistent definition of the elderly patient with HNSCC. This narrative review article also includes a review of the measures used to assess HRQL, psychosocial outcomes and unmet needs in elderly or older patients with HNSCC.

Utilization and Impact of a Radiation Nursing Clinic to Address Acute Care Needs for Patients with Gynecologic Cancers

“…For patients receiving CCR, we identified important psychosocial risk factors associated with RNC utilization, including unpartnered marital status and referral for psychosocial oncology assessment. Previous work has shown that caregivers play a crucial role in promoting self-care and supporting patient needs, not only for cancer patients but also for those with other chronic diseases; indeed, a lack of social support is a predictor of poor outcomes [ 24 , 25 , 26 , 27 , 28 ]. The concept of psychosocial vulnerability has not been previously identified as a risk factor for acute care utilization, specifically within oncology populations.…”

Widespread distribution and altered pain processing in head and neck cancer survivors at long-term after treatment

“…When considering Qol 1 year after RT treatment, pain presence is still severe and can interfere in patients QoL. Additionally, other pain-related aspects in cancer patients have been proposed as relevant when exploring Qol like medication intake and psychoemotional distress [ 27 , 28 ].…”

The role of the soft palate dose regarding normal tissue toxicities in older adults with head and neck cancer undergoing definitive radiotherapy

“…Although a matter of debate in the older HNSCC population [ 6 – 8 ], concomitant chemotherapy is commonly applied simultaneously to definitive radiotherapy for locoregionally advanced HNSCCs. Radiotherapy can result in considerable both acute and chronic toxicities in HNSCC patients, severely impacting patients’ quality of life (QoL) [ 9 , 10 ], conformal treatment techniques such as intensity-modulated radiotherapy (IMRT) have been shown to reduce treatment-related toxicities, as relevant organs at risks (OARs) such as the parotid glands or the pharyngeal constrictor muscles (PCMs) can be spared [ 11 , 12 ]. Proton IMRT may further reduce the risk of treatment-induced normal tissue injuries in HNSCC patients and is currently investigated in clinical trials [ 13 , 14 ].…”