Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients' views

Abstract

BackgroundAim of this study is to thoroughly assess pretreatment organ function in advanced head and neck cancer through various clinical outcome measures and patients' views.MethodsA comprehensive, multidimensional assessment was used, that included quality of life, swallowing, mouth opening, and weight changes. Fifty-five patients with stage III-IV disease were entered in this study prior to organ preserving (chemoradiation) treatment.ResultsAll patients showed pretreatment abnormalities or problems, identified by one or more of the outcome measures. Most frequent problems concerned swallowing, pain, and weight loss. Interestingly, clinical outcome measures and patients' perception did no always concur. E.g. videofluoroscopy identified aspiration and laryngeal penetration in 18% of the patients, whereas only 7 patients (13%) perceived this as problematic; only 2 out of 7 patients with objective trismus actually perceived trismus.ConclusionThe assessment identified several problems already pre-treatment, in this patient population. A thorough assessment of both clinical measures and patients' views appears to be necessary to gain insight in all (perceived) pre-existing functional and quality of life problems.

Examination of laryngoesophageal dysfunction‐free survival as an endpoint in nonsurgical treatment of squamous cell carcinomas of the larynx and hypopharynx

“…Additional tests, such as modified barium swallow or fiberoptic endoscopic evaluation of swallowing, also may improve this discrimination. 7 Alternatively, it may be possible to improve functional outcomes in this subset by identifying patients at risk, 4,8 assessing function pretreatment, 9 and Figure 1. Laryngoesophageal dysfunction-free survival is illustrated (Top) for the entire cohort and (Bottom) stratified according to the receipt of concurrent chemotherapy (CRT).…”

Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose–effect relationships for swallowing and mastication structures

“…To assess organ function before (baseline), at approximately 10-weeks, and 1-year after completing chemo-IMRT a multidimensional assessment protocol was used, which has been published previously [17]. In short, the protocol included standard videofluoroscopy (VFS) to evaluate swallowing function by using the Penetration and Aspiration Scale (PAS; score 1: material does not enter the airway, to score 8: material enters the airway, passes below the vocal folds, and no effort is made to eject) of Rosenbek et al [21].…”

“…Additionally, a structured, study-specific questionnaire was used, which was based on the EORTC C30 and HN35 but includes more detailed and symptom-specific questions relevant for this specific cancer group [17].…”

“…Restricted and/or painful mouth opening affect normal chewing and eating, and impair speech and oral hygiene [14,15] Studies that focused on radiation dose reduction and or structure avoidance, unfortunately, cannot easily be compared, because of their heterogeneity in tumor sites and treatment protocols, their overall retrospective nature, and their lack of objective assessments [1,16]. A systematic review of Roe et al [1] (papers published between January 1998 and December 2009) found only one prospective longitudinal study that consistently evaluated oropharyngeal swallow function, using both objective instrumental measures, as well as patient self-reports alongside established toxicity scores [17]. Three months after treatment with chemo-IMRT, the oropharyngeal cancer patients showed significant correlations between videofluoroscopy and patient-reported swallowing deterioration, and the dose to the pharyngeal constrictors.…”

Impact of Pain and Evaluation of Education and Self-Care in Patients with Head and Neck Cancer

“…Injury caused by compression or infiltration of soft tissues such as mucosa, musculature and nerve tissue, as well as bone tissue, can cause pain via nociceptive, inflammatory and neuropathic pain mechanisms [33]. Tumour-related pain has been reported in approximately 70% of patients with HNC at the time of diagnosis, although less than four on a numeric scale of zero to ten [26,[33][34][35].…”