Long‐term patient‐reported outcomes after reconstructive surgery for head and neck cancer: A systematic review

Abstract

Current literature on reconstruction after head and neck cancer (HNC) focusses on short‐term patient‐reported outcomes (PROs), while there is a need for knowledge on long‐term consequences. Embase, Medline, Web of Science, and Cochrane were searched for studies on health‐related quality of life (HRQoL) after HNC reconstruction, using validated PROMs in at least 50 patients, and a follow‐up of more than 1 year. Thirty studies were included, comprising 2358 patients with a follow‐up between one and 10 years. The most used questionnaire was the UW‐QoL v4. Reconstructive surgery was generally followed by diminished oral function, worsened by radiotherapy. Patients experienced anxiety and fear of cancer recurrence. However, there was a progressive decrease in pain over time with some flaps having more favorable HRQoL outcomes. Age and bony tumor involvement were not related to postoperative HRQoL. These results may lead to better patient counseling and expectation management of HNC patients.

Views of health care professionals on the implementation of preoperative advance care planning in older patients with head and neck cancer: Q methodology

“…Participants who held this view supported discussions with patients before surgery, which may be explained by the fact that of all cancer surgeries, surgery has the greatest impact on the patient’s language function, and communication-related problems are more common in the postoperative period [ 32 ]. When patients experience serious adverse postoperative complications such as bleeding and infection, they may not be able to directly express their wishes for treatment, resulting in them being forced to undergo treatments that are inconsistent with their values [ 33 ]. Presurgical ACP discussions can be effective in helping patients to fully express their wishes and in promoting understanding of the patient’s treatment wishes among HCPs and family members.…”

Current and Emerging Diagnostic, Prognostic, and Predictive Biomarkers in Head and Neck Cancer

“…Despite advances in treatment, there has been a gradual increase in overall mortality, with five-year survival rates of approximately 50-85%, depending on the type and location of the tumor [1,5,6]. Treatment of HNC confers significant morbidity and impacts the quality of life [9][10][11][12].…”

“…Current therapies for HNC require a multimodal approach that may include surgical resection, radiation therapy, and/or systemic therapy [2,9,13]. With the growing understanding of the mechanisms behind HNC, there has been interest in more accurate prognostic indicators and effective post-treatment surveillance, as well as alternative individualized treatments.…”

Evaluating Head and Neck Reconstruction Outcomes Proves Difficult—Seeking Improvement in Reporting

“…In tongue cancer reconstruction alone there have been many reports that include terms such as hemiglossectomy, partial glossectomy and total glossectomy. However, within these studies, it is not always clear if the floor of the mouth or other adjacent structures, such as extrinsic tongue muscles, suprahyoid muscles, mandible, maxilla, or retromolar trigone, were involved in the ablation (Box) . Without a clear description of what is removed, it is impossible for the reconstructive surgeon to fully evaluate the results presented in the study (Box).…”

“…It is arguable that patient-reported outcome measures (PROMS) and quality of life are most important when evaluating the success of a reconstruction. The patient-driven creation of the FACE-Q survey was a valiant attempt to improve and standardize PROMS; unfortunately, a recent systematic review included 30 journal articles that used 14 different surveys for PROMS, which forces the reconstructive surgeon to learn the contents of a new survey for each evaluation of a new study . While the importance of a core outcome set has previously been discussed, as a field, we have clearly been unable to agree on which way forward is best …”