Purpose
Head and neck lymphedema (HNL) is common after head and neck cancer (HNC). This study aimed to explore quality of life (QoL) in patients with HNL to guide the development of a ...patient-reported QoL measure.
Methods
We conducted semi-structured interviews with 22 HNC survivors with HNL. Interviews explored participants’ experiences of living with HNL. Analysis of interview transcripts drew on qualitative content analysis to ensure themes were grounded in patient experience.
Results
Two main themes were established: “I want to live my life” and “It was like things were short-circuited.” These themes encompassed the substantial disruption patients attributed to the HNL and their desire to normalize life.
Conclusions
Understanding the impact of HNL on individual patients may be critical to optimizing treatment strategies to improve the physical burden of HNL and QoL. This study provides the framework for developing a patient-reported HNL QoL measure.
Implications for cancer survivors
The development of an HNL-specific QoL measure, grounded in the patient perspective, may provide cancer care teams with a tool to better understand HNL’s impact on each patient to tailor patient-centered care and optimize QoL outcomes.
Purpose
To develop a head and neck lymphoedema (HNL) specific quality of life (QoL) instrument to assess physical, functional, and social/emotional impacts of HNL.
Methods
Instrument candidate items ...were reviewed by patients with HNL and clinicians and rated for importance, clarity, and invasiveness. The Content Validity Ratio was applied for item reduction. Three‐step cognitive interviews were conducted with HNL patients to validate the items, survey format, and instructions.
Results
Initially, 130 candidate questions were developed. Following item reduction, 52 items progressed to three‐step cognitive interviews. Following cognitive interviews, the Comprehensive Assessment of Lymphoedema Impact in Head and Neck (CALI‐HaN) included 33 items; 1 global, 10 physical, 7 functional, and 15 emotional.
Conclusions
Physical, functional, and socioemotional effects need to be considered when measuring QoL in patients with HNL. This study describes initial development of the CALI‐HaN, an instrument that shows promise for clinical and research applications following future validation.
Purpose: While flexible endoscopic evaluation of swallowing (FEES) is a common clinical procedure used in the head and neck cancer (HNC) population, extant outcome measures for FEES such as ...bolus-level penetration-aspiration and residue scores are not well suited as global patient-level endpoint measures of dysphagia severity in cooperative group trials or clinical outcomes research. The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) was initially developed and validated for use during videofluoroscopic evaluations as a way to grade safety, efficiency, and overall pharyngeal swallowing impairment. The purpose of this study was to adapt and validate DIGEST for use with FEES. Method: A modified Delphi exercise was conducted for content validation, expert consensus, adaptation, and operationalization of DIGEST-FEES. Three blinded, expert raters then evaluated 100 de-identified post-HNC treatment FEES examinations. Intra- and interrater reliability were tested with quadratic weighted kappa. Criterion validity against the MD Anderson Dysphagia Inventory, Functional Oral Intake Scale, Secretion Severity Scale, and Yale Residue Rating Scale was assessed with Spearman correlation coefficients. Results: Interrater reliability was almost perfect for overall DIGEST-FEES grade (?subscript w = 0.83) and safety grade (?subscript w = 0.86) and substantial for efficiency grade (?subscript w = 0.74). Intrarater reliability was excellent for all raters (0.9-0.91). Overall DIGEST-FEES grade correlated with MD Anderson Dysphagia Inventory (r = -0.43, p < 0.0001), Functional Oral Intake Scale (r = -0.43, p < 0.0001), Secretion Severity Scale (r = 0.47, p < 0.0001), Yale Vallecular Residue (r = 0.73, p < 0.0001), and Yale Pyriform Sinus Residue (r = 0.65, p < 0.0001). Conclusion: DIGEST-FEES is a valid and reliable scale to describe the severity of pharyngeal dysphagia in patients with HNC.
Objectives/Hypothesis:
To determine the incidence of depression in head and neck cancer (HNCA) patients following definitive treatment and the relationship between depression and head and ...neck‐specific measures of quality of life and function.
Study Design:
Prospective cohort analysis.
Methods:
Two hundred forty‐six patients were evaluated with the Beck Depression Inventory Fast‐Screen (BDI‐FS), University of Washington Quality of Life (UW QOL), Voice Handicap Index (VHI), and MD Anderson Dysphagia Inventory (MDADI) questionnaires. Patients with a preexisting diagnosis of depression were excluded.
Results:
Complete 1‐year post‐treatment data were available for 46 HNCA patients, with depression identified in nine patients (20%). On multivariate analysis, depression was significantly associated with poorer global UW QOL (β = −40.3, P < .001) and overall MDADI scores (β = −21.8, P = .038), but not with VHI scores, after controlling for other clinical variables including initial treatment modality. BDI‐FS scores were significantly correlated with global UW QOL (r = −0.7, P < .001) and overall MDADI scores (r = −0.5, P = .0045), and global UW QOL correlated significantly with overall MDADI scores (r = 0.4, P = .0166). After controlling for clinical variables, MDADI, and VHI scores, only depression was associated with global UW QOL score (β = −30.5, P = .019).
Conclusions:
There is a high incidence of depressive symptoms in HNCA patients at 1 year following definitive therapy, which is independent of primary treatment modality and is associated with poorer global QOL and MDADI scores. Although depression and swallowing function are highly correlated, depression has a greater effect on QOL than swallowing scores, suggesting that early identification and aggressive treatment of patients with depressive symptoms is warranted to maximize post‐treatment QOL.
Objectives
The robotic retroauricular approach and transoral endoscopic thyroidectomy vestibular approach (TOETVA) have been employed to avoid anterior neck scarring in thyroidectomy with good ...success. However, outcomes have yet to be compared between techniques. We compare our initial clinical experience with these approaches for thyroid lobectomy at our institution.
Methods
A review of initial consecutive patients who underwent robotic facelift thyroidectomy (RFT) (August 2011–August 2016) at our institution was conducted. This was compared with the same number of initial consecutive patients who underwent TOETVA (September 2016–September 2017) at our institution. Demographics, operative time, pathology, complications, and learning curve were compared between cohorts. Learning curve was defined based on the slope of linear regression models of operative time versus case number.
Results
There were 20 patients in each cohort. There was no statistically significant difference in demographic data between cohorts. One hundred percent of RFT cases versus 95% TOETVA cases (P = .999) were completed without conversion to standard open technique with median operative times of 201 (124–293) minutes versus 188 (89–343) minutes with RFT and TOETVA, respectively (P = .36). There was no incidence of permanent recurrent laryngeal nerve injury in either cohort. The slopes of the regression models were 0.29 versus −8.32 (P = .005) for RFT and TOETVA, respectively.
Conclusion
RFT and TOETVA are safe and feasible options for patients motivated to avoid an anterior neck scar. However, the quicker learning curve without the need for a costly robotic system may make TOETVA the preferred technique for institutions wishing to perform anterior cervical incision‐sparing thyroidectomy.
Level of Evidence
4
Objective
This study aimed to compare outcomes in patients with head and neck lymphedema receiving either a home‐based lymphedema treatment program or a hybrid approach including both home‐based ...treatment and regular clinical visits.
Methods
Outcomes were assessed in patients receiving head and neck lymphedema rehabilitation. Baseline measures of neck, submental, and facial edema were obtained and repeated following treatment. A home program was recommended for all patients, and those receiving hybrid care received the same recommendations as well as a visit with the lymphedema therapist for additional treatment. Their outcomes were compared using standard statistical analysis.
Results
Fifty consecutive individuals were included, 25 in each group. Adherence to at least 50% of recommended treatment was reported in 68% of those receiving home‐based treatment and 84% of those receiving hybrid care. Significant improvement was demonstrated for 66% of patients. There was no statistically significant difference between treatment groups with regard to clinically significant improvement (P = .15). Patients receiving hybrid therapy demonstrated treatment advantages regarding facial edema (P = .037). Adherence to treatment was associated with clinical improvement (P = .047).
Conclusions
Comparable benefits were observed regardless of whether patients had a home‐based or hybrid lymphedema treatment approach. These data suggest a home‐based treatment approach may be appropriate for patients unable to participate in clinical sessions. However, for patients with significant facial edema, a hybrid approach may be preferable. Adherence was associated with better outcomes. Given these findings, future investigations should consider strategies to improve adherence to optimize the outcomes lymphedema treatment.
Level of Evidence
3b Laryngoscope, 2020
Objectives/Hypothesis
Based on current guidelines, surgical and nonsurgical therapies are viable frontline treatment for patients with locoregional oropharyngeal carcinoma (OPC). We sought to compare ...financial parameters between chemoradiation and transoral robotic surgery (TORS) in this patient population.
Study Design
Case‐control study.
Methods
In this study we identified patients with selected American Joint Committee on Cancer 7th Edition stage II to IVa OPC treated with TORS between January 2013 and December 2014. Fifteen patients who underwent TORS were stage matched with 15 patients treated with chemoradiation. Total charges and cost data for each patient were analyzed at 4‐month and 1‐year time points; functional and oncologic outcomes were assessed.
Results
There were no significant differences in functional and oncologic outcomes. Patients undergoing TORS had a longer inpatient hospital stay, and most required a nasogastric tube for an average of 3.5 days. There were no local or regional recurrences. Across all time points, the TORS group had lower charges and costs compared to the chemoradiation group, with 14% lower costs at 1 year. In the chemoradiation group, nearly two‐thirds of costs came from radiation therapy and pharmacy expenses. Chemotherapy accounted for most pharmacy costs. The costs of operating the surgical robot accounted for a about half of surgical costs.
Conclusions
Selected patients with stage II to IVa oropharyngeal carcinoma treated with TORS may incur lower costs than those treated nonsurgically. With rising healthcare spending, the financial impact of treatment might be considered for those patients eligible for treatment regimens with comparable functional and oncologic outcomes.
Level of Evidence
3b
Laryngoscope, 129:1604–1609, 2019
Background:
The Centers for Medicare and Medicaid Services has threatened to discontinue reimbursements for ventilator‐associated pneumonia (VAP) as a preventable “never event.” We sought to ...determine the relationship between pneumonia and in‐hospital mortality, complications, length of hospitalization and costs in head and neck cancer (HNCA) surgery.
Study Design:
Retrospective cross‐sectional study.
Methods:
Discharge data from the Nationwide Inpatient Sample for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm from 2003 to 2008 were analyzed using cross‐tabulations and multivariate regression modeling.
Results:
VAP was rarely coded. Infectious pneumonia was significantly associated with chronic pulmonary disease (odds ratio OR, 1.5; P < .001), while aspiration pneumonia was associated with dysphagia (OR, 2.0; P < .001). Pneumonia from any cause was associated with weight loss (OR, 3.3; P < .001), age >80 years (OR, 2.0; P = .007), comorbidity (OR, 2.3; P < .001), and major procedures (OR, 1.6; P < .001), with increased in‐hospital mortality for infectious (OR, 2.9; P < .001) and aspiration pneumonia (OR, 5.3; P < .001). Both infectious and aspiration pneumonia were associated with postoperative medical and surgical complications, increased length of hospitalization, and hospital‐related costs.
Conclusions:
Postoperative pneumonia is associated with increased mortality, complications, length of hospitalization, and hospital‐related costs in HNCA surgical patients. Variables associated with an increased risk of pneumonia are inherent comorbidities in HNCA and known risk factors for VAP, making this a high‐risk group for this never event. Caution must be used in the institution of reforms that threaten to inadequately reimburse the provision of care to this vulnerable population. Aggressive preoperative identification and treatment of underlying pulmonary disease, weight loss, and dysphagia may reduce morbidity and mortality. Laryngoscope, 2012
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