Patient-reported outcomes and morbidity after head and neck reconstructions: An evaluation of fibular and scapular free flaps

Liu, Alice; Deane, Emily C.; Heffernan, Austin; Ji, Yunqi; Durham, J.S.; Prisman, Eitan

doi:10.1016/j.oraloncology.2022.106019

Cited by 10 publications

(20 citation statements)

References 38 publications

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“…Of the 28 included studies, 5 had a qualitative design (3 for DC, 1 for DR, and 1 for DC and DR) and 23 were quantitative (3 for DC, 19 for DR, and 1 for DC and DR). Publication dates ranged from 1980 to 2022, and 12 studies were less than 5 years old.…”

Section: Resultsmentioning

confidence: 99%

“…One study by Shaverdian et al considered DR of a deescalation treatment instead of regular treatment, and we excluded this study from the meta-analysis on grounds of clinical heterogeneity. Hence, meta-analyses were performed on 16 articles, using 3 different instruments (eAppendix 2 in Supplement 1): study-specific questionnaires, the Shame and Stigma Scale (SSS), and the Decision Regret Scale (DRS).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies used prevalence to report DR, of which 1 study examined the level of DR after choosing deescalation treatment instead of regular treatment and found that no participants experienced regret. Upon our request, 5 authors of the 8 we approached provided additional data for calculating prevalence estimates. With exclusion of the deescalation treatment study, the prevalence of DR varied from 14.2% to 85.5% (median, 61.4%).…”

Section: Resultsmentioning

confidence: 99%

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Decisional Conflict and Decision Regret in Head and Neck Oncology

Heirman,

Arends,

de Jel

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceHead and neck cancer (HNC) often requires treatment with a major impact on quality of life. Treatment decision-making is often challenging, as it involves balancing survival against the preservation of quality of life and choosing among treatments with comparable outcomes but variation in morbidity and adverse events; consequently, the potential for decisional conflict (DC) and decision regret (DR) is high.ObjectivesTo summarize the literature on DC and DR in HNC, to give an overview of its prevalence and extent, and to advise on clinical practice and future research.Data SourcesEmbase, Web of Science, MEDLINE, and PsycINFO were searched up to February 24, 2023, including all years of publication.Study SelectionEligible studies addressed DC and/or DR as primary or secondary outcomes with any instrument in HNC, except cutaneous tumors. Two mutually blinded researchers conducted screening and inclusion with support of an artificial intelligence assistant and conducted risk of bias (ROB) assessment.Data Extraction and SynthesisThe Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed for data extraction. ROB assessments were done using Critical Appraisal Skills Programme (qualitative) and CLARITY (quantitative). Meta-analysis with a random-effects model was used to obtain pooled prevalence estimates for DC and DR when at least 4 sufficiently clinically homogeneous studies were available.Main Outcomes and MeasuresPrevalence of DC (qualitative, Decisional Conflict Scale, SURE questionnaire) and DR (qualitative, study-specific questionnaires, Decision Regret Scale, Shame and Stigma Scale).ResultsOverall, 28 studies were included, with 16 included in meta-analyses for DR prevalence. The pooled prevalence of clinically relevant DR above the cutoff score for validated questionnaires (11 studies; 2053 participants) was 71% (95% CI, 58%-82%; I2 = 94%), while for study-specific questionnaires (5 studies; 674 participants) it was 11% (95% CI, 5%-22%; I2 = 92%). Only 4 studies investigated DC, showing a prevalence of 22.6% to 47.5% above cutoff values. Derived overarching themes found in qualitative studies were preparation, shared decision-making roles, information, time pressure, stress of diagnosis, and consequences.Conclusions and RelevanceAlthough limited data on DC and DR were available, the studies performed indicated that DC and DR are highly prevalent issues in HNC. Results suggest that study-specific questionnaires underestimated DR. The findings underscore the rationale to improve counseling and shared decision-making for this patient population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Decisional Conflict and Decision Regret in Head and Neck Oncology

Heirman,

Arends,

de Jel

et al. 2024

JAMA Otolaryngol Head Neck Surg

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“…[35][36][37] Although this article focused primarily on DASH results for upper trunk free flaps, other studies have utilized lower-extremity-specific PROMs such as the Lower Limb Core Scale 38 or Foot and Ankle Outcome Score 39 to assess lower extremity flaps such as the fibular free flap (FFF). [40][41][42] Future studies using standardized PROMs across donor sites are necessary to enable surgeons to compare the morbidity of upper and lower extremity flaps and accurately tailor donor site selection to patient function, lifestyle, and hobbies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of patient‐reported upper extremity disability following free flaps in head and neck reconstruction: A systematic review and meta‐analysis

et al. 2023

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Background Comparisons of patient‐reported donor site morbidity based on the Disabilities in Arm, Shoulder, and Hand (DASH) instrument across upper trunk free flaps in head and neck surgery, including radial forearm (RFFF), osteocutaneous radial forearm (OCRFF), scapular tip (STFF), and serratus anterior (SAFF) free flaps, may help inform donor tissue selection. Methods In this meta‐analysis, 12 studies were included and the primary outcome was average DASH score. Results The pooled DASH scores were 12.14 (95% CI: 7.40–16.88) for RFFF (5 studies), 17.99 (11.87–24.12) for OCRFF (2 studies), 12.19 (8.74–15.64) for STFF (3 studies), and 16.49 (5.92–27.05) for SAFF (2 studies) and were not significantly different. Conclusions Results suggest that patients generally function well, with minimal to mild donor site morbidity, when assessed at an average of 20 months after flap harvest. These results are based on few effects from primarily retrospective studies of fair quality, and further research is needed.

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“…In four of these studies, over a quarter of all their head and neck patients expressed moderate to strong regret (26.7%-37.3%) after surgical treatments that ranged from upper aerodigestive cancer interventions to major head and neck free flaps. 17,19,21,23 The only exception was Kwon et al's study assessing transoral robotic surgery, where 15% of their patients report moderate to strong regret, 26 There was significant variation when authors analyzed DRS relative to the treatment modalities patients received. For example, Goepfert et al 18 found that their patients with oropharyngeal cancer treated with surgery alone had a mean DRS of 1.3 while those who underwent surgery and radiation therapy/systemic therapy had a mean DRS of 24.4.…”

Section: Decision Regret Scale Analysismentioning

confidence: 99%

Patient‐Reported Decisional Regret After Operative Otolaryngology Procedures: A Scoping Review

Liu,

McNeely,

Prisman

et al. 2023

The Laryngoscope

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ObjectiveTo review the published literature on decisional regret in adult patients undergoing operative otolaryngology procedures. The primary outcome was decisional regret scale (DRS) scores. DRS scores of 0 indicate no regret, 1–25 mild regret, and >25 moderate to strong/severe regret.Data SourcesA comprehensive librarian‐designed strategy was used to search MEDLINE, Embase, and CINAHL from inception to September 2023.Review MethodsInclusion criteria consisted of English‐language studies of adult patients who underwent operative otolaryngology treatments and reported DRS scores. Data was extracted by two independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta‐analyses Extension for Scoping Reviews (PRISMA‐ScR) guidelines were followed. Oxford Centre's Levels of Evidence were used for quality assessment.ResultsIn total, 6306 studies were screened by two independent reviewers; 13 studies were included after full‐text analysis. Subspecialties comprised: Head and neck (10), endocrine (1), general (1), and rhinology (1). The DRS results of the included studies spanned a mean range of 10.1–23.9 or a median range of 0–20.0. There was a trend toward more decisional regret after large head and neck procedures or when patients underwent multiple treatment modalities. Depression, anxiety, and patient‐reported quality of life measures were all correlated with decisional regret. Oxford Centre's Levels of Evidence ranged from 2 to 4.ConclusionThis is the first comprehensive review of decisional regret in otolaryngology. The majority of patients had no or mild (DRS <25) decisional regret after otolaryngology treatments. Future research on pre‐operative counseling and shared decision‐making to further minimize patient decisional regret is warranted.Level of EvidenceN/A Laryngoscope, 2023

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Patient-reported outcomes and morbidity after head and neck reconstructions: An evaluation of fibular and scapular free flaps

Cited by 10 publications

References 38 publications

Decisional Conflict and Decision Regret in Head and Neck Oncology

Decisional Conflict and Decision Regret in Head and Neck Oncology

Comparison of patient‐reported upper extremity disability following free flaps in head and neck reconstruction: A systematic review and meta‐analysis

Patient‐Reported Decisional Regret After Operative Otolaryngology Procedures: A Scoping Review

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