Is social inequality related to different patient concerns in routine oral cancer follow-up clinics?

Abstract

Oral cancer has a higher incidence in the lower social strata, and these patients are less likely to engage in supportive interventions and report a poorer quality of life (QoL). The aim of this paper is to compare the Patient Concerns Inventory (PCI) responses across social groups attending routine oral cancer follow-up clinics with particular focus on the deprivation lower quartile. The PCI package is completed by patients as part of their routine review consultation with SNR. Patients were those diagnosed between 2008 and 2012. Deprivation was stratified using the IMD 2010 from postcode. Of the 106 eligible patients, 85 % used the PCI. Just over half (54 %) were living in the most deprived quartile, with two-thirds (68 %) of males in the most deprived quartile, compared with 35 % of females (p = 0.004). In regard to number and type of PCI items selected by patients at their first PCI clinic, there were no notable differences in respect of IMD classification. The two commonest concerns were fear of recurrence (43 %) and sore mouth (43 %). The most deprived quartile reported significant problems in regard to mood (p = 0.004) and recreation (p = 0.02), and a non-significant trend (36 vs 18 %, p = 0.09) in stating their overall QoL as being less than good. It is possible to identify the concerns of patients from lower socioeconomic strata as part of routine follow-up clinics. This allows for targeted multi-professional intervention and supports to improve the outcome in this hard to reach group.

Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: baseline results in a cluster preference randomised controlled trial

“…(6). ACE 27 comorbidities were mild for 33% (95), moderate for 17% (48), and severe for 3% (8). Most patients had smoked with 13% (37/280) currently smoking at the time of the baseline questionnaire, 58% (163/280) being former smokers and 29% (80/280) having never smoked.…”

“…It consists of 56 items, which patients select from before their appointment, to help guide the outpatient consultation, which covers a range of symptoms and potential problems individuals may confront after treatment. The PCI helps to focus the consultation, to aid doctor-patient communication, and to signpost patients to other professionals for advice and support [8]. It is a tool that can be integrated into routine clinical practice [9].…”

Free Flap Reconstruction of the Maxilla

“…The Patient Concerns Inventory (PCI) is a survey tool developed to help patients express their concerns; it has been successfully used in head and neck cancer patients, and it suggests that patients of lower socioeconomic status are more likely to: (1) develop oral cancer and (2) have more difficulty coping with the treatment. 21 The University of Washington Quality of Life (UWQOL) questionnaire is another validated tool to help assess patients' overall quality of life after head and neck cancer treatment. 21 Also, the European Organization for Research and Treatment of Cancer (EORTC) Core QOL questionnaire is a validated questionnaire elucidating various facets of oral and pharyngeal function and quality of life after head and neck surgery.…”

“…21 The University of Washington Quality of Life (UWQOL) questionnaire is another validated tool to help assess patients' overall quality of life after head and neck cancer treatment. 21 Also, the European Organization for Research and Treatment of Cancer (EORTC) Core QOL questionnaire is a validated questionnaire elucidating various facets of oral and pharyngeal function and quality of life after head and neck surgery. 12 These and other tools can potentially improve surgeon-patient communication by helping patients express their biggest concerns and helping surgeons learn what issues matter the most to their patients.…”

Patient Concerns Inventory (at diagnosis) and intention to treat

“…Treatment of head and neck cancer is often radical, with patients suffering from high levels of emotional distress at some point prior to, during or after treatment. The disease and the treatment can affect adversely the health-related quality of life (HRQOL) of patients 2 . In order for them to be involved with decision making about their care, it is crucial they are able to communicate their diverse needs and concerns effectively 3 .…”