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Howren MB, Pagedar NA. Prevalence of Pain and Associated Clinical Characteristics in 10-Year Survivors of Head and Neck Cancer. Otolaryngol Head Neck Surg 2025; 172:540-547. [PMID: 39575652 DOI: 10.1002/ohn.1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 10/18/2024] [Accepted: 11/09/2024] [Indexed: 01/29/2025]
Abstract
OBJECTIVE Pain prevalence in long-term head and neck cancer (HNC) survivors is important but understudied to date. The present investigation examined pain prevalence, associated clinical characteristics, and disease-specific health-related quality of life (HRQOL) in a cohort of survivors 10 years postdiagnosis (N = 187). STUDY DESIGN Retrospective cohort study. SETTING Single-institution tertiary care center. METHODS Pain was assessed using a single-item numeric rating scale. Clinical characteristics were abstracted from the patient medical record and HNC-specific HRQOL scores were measured using the Head and Neck Cancer Inventory (HNCI) and are presented by the pain subgroup. RESULTS At 10 years postdiagnosis, 56.7% reported no pain, 20.3% reported mild pain, 16.0% reported moderate pain, and 7.0% reported severe pain. Most patients with moderate or severe pain at the 10-year follow-up assessment also had advanced-stage disease at diagnosis. Multiple linear regression analyses indicated that advanced-stage disease at diagnosis was a significant predictor of pain at 10 years postdiagnosis controlling for age, sex, and comorbidity status (β = .184, t = 2.193, P = .030, sr2 = 0.025). Across all HNC-specific HRQOL domains, those reporting moderate/severe pain at 10 years postdiagnosis failed to reach a score of 70 which is indicative of high functioning on the HNCI in the areas of aesthetics, eating, speech, and social disruption. CONCLUSION Pain is a significant issue in long-term HNC survivors up to 10 years postdiagnosis. More research is needed to understand the correlates and types of long-term pain exhibited after treatment, including the implementation of screening and intervention into clinical workflow to improve outcomes and optimize HNC survivorship care.
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Affiliation(s)
- M Bryant Howren
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, Iowa, USA
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, Iowa, USA
| | - Nitin A Pagedar
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, Iowa, USA
- Department of Otolaryngology-Head and Neck Surgery, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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Howren MB, Christensen AJ, Pagedar NA. Prevalence of pain in a sample of long-term survivors of head and neck cancer. Am J Otolaryngol 2024; 45:104300. [PMID: 38640810 PMCID: PMC11168893 DOI: 10.1016/j.amjoto.2024.104300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/14/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE The experience of long-term pain in head and neck cancer (HNC) survivors is important but has received less attention in the HNC literature. The present study sought to examine the prevalence of pain from 2 to 5 years postdiagnosis and its association with HNC-specific health-related quality of life. MATERIALS & METHODS Prospective observational study at a single-institution tertiary care center. Pain was measured using a single item ranging from 0 to 10 with 0 representing no pain and 10 representing worst pain possible at 2 through 5 years postdiagnosis. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). RESULTS Pain reports were consistent across time. At 2 years postdiagnosis (N = 581), 27.6 % experienced at least some pain with 14.3 % reporting moderate or severe pain. At 3 years postdiagnosis (N = 417), 21.4 % experienced at least some pain with 14.2 % indicating moderate or severe pain. At 4 years postdiagnosis (N = 334), 26.7 % experienced at least some pain with 15.9 % reporting moderate or severe pain. At 5 years postdiagnosis (N = 399), 30.5 % experienced at least some pain with 17.5 % indicating moderate or severe pain. In general, across all four HNCI domains, those in the moderate and severe pain categories largely failed to reach 70 which is indicative of high functioning on the HNCI. CONCLUSIONS Pain is a considerable issue in long-term HNC survivors up to 5 years postdiagnosis. More research is needed to understand correlates of pain after treatment, including opportunities for screening and intervention, to improve outcomes and optimize recovery in HNC.
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Affiliation(s)
- M Bryant Howren
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Healthcare System, Iowa City, IA, United States of America; Department of Internal Medicine, The University of Iowa, Iowa City, IA, United States of America; Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America.
| | - Alan J Christensen
- Department of Psychology, East Carolina University, Greenville, NC, United States of America
| | - Nitin A Pagedar
- Holden Comprehensive Cancer Center, The University of Iowa, Iowa City, IA, United States of America; Department of Otolaryngology, Head and Neck Surgery, The University of Iowa, Iowa City, IA, United States of America
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O'Regan A, Fish LJ, Makarushka C, Somers T, Fitzgerald Jones K, Merlin JS, Dinan M, Oeffinger K, Check D. Managing Chronic Pain in Cancer Survivorship: Communication Challenges and Opportunities as Described by Cancer Survivors. Am J Hosp Palliat Care 2024; 41:78-86. [PMID: 36927121 DOI: 10.1177/10499091231164634] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES Many cancer survivors experience chronic pain after completing curative-intent treatment. Based on available data, chronic pain may be undertreated in this context; however, little is known about cancer survivors' experiences with clinical management of chronic pain. The purpose of this study was to better understand cancer survivors' pain management experiences after curative-intent treatment. METHODS We conducted 13 semi-structured interviews with a convenience sample of cancer survivors who had completed treatment for stage I-III breast, head/neck, lung or colorectal cancer. We used a thematic approach to qualitative data analysis. RESULTS Participants described that chronic pain often goes unrecognized by their providers, potentially due to limitations in how pain is assessed clinically and the tendency of both cancer survivors and providers to minimize or invalidate the pain experience. To improve communication, participants suggested that providers ask more open-ended questions about their pain, help them to establish functional goals, and provide patients with options for pain management. SIGNIFICANCE OF RESULTS This study demonstrates the importance of provider-initiated communication around pain management for cancer survivors to make them feel more supported in their care. Communication and shared decision-making interventions may improve cancer survivor-provider communication around chronic pain management, addressing an important gap in survivorship care.
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Affiliation(s)
- Amy O'Regan
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Laura J Fish
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke School of Medicine Durham, NC, USA
| | - Christina Makarushka
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Katie Fitzgerald Jones
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Jessica S Merlin
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michaela Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT, USA
| | - Kevin Oeffinger
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Devon Check
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
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Howren MB, Seaman A, Super GL, Christensen AJ, Pagedar NA. Examination of Predictors of Pain at 12 Months Postdiagnosis in Head and Neck Cancer Survivors. Otolaryngol Head Neck Surg 2023; 169:1506-1512. [PMID: 37403789 PMCID: PMC10766866 DOI: 10.1002/ohn.416] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Pain following the completion of treatment is important but has received less attention in the head and neck cancer (HNC) literature. The present study sought to examine the prevalence and predictors of pain measured 12 months postdiagnosis and its impact on HNC-specific health-related quality of life (HRQOL) in 1038 HNC survivors. STUDY DESIGN Prospective observational study. SETTING Single-institution tertiary care center. METHODS Pain was measured using a single item ranging from 0 to 10 with 0 representing no pain and 10 representing the worst pain possible. Self-reported depressive symptomatology was measured using the Beck Depression Inventory and self-reported problem alcohol use was measured by the Short Michigan Alcoholism Screening Test. HNC-specific HRQOL was measured using the Head and Neck Cancer Inventory (HNCI). RESULTS Hierarchical multivariable linear regression analyses indicated that in addition to pain at 3 months postdiagnosis (β = .145, t = 3.18, sr2 = .019, p = .002), both depressive symptomatology (β = .110, t = 2.49, sr2 = .011, p = .015) and problem alcohol use (β = .092, t = 2.07, sr2 = .008, p = .039) were significant predictors of pain at 12 months postdiagnosis. Subgroup analyses suggest that across all 4 HNCI domains, those in the moderate and severe pain groups at 12 months postdiagnosis failed to reach 70 which is indicative of high functioning. CONCLUSION Pain in patients with HNC is a considerable issue at 12 months postdiagnosis, deserving further attention. Behavioral factors such as depression and problem alcohol use may be associated with pain and require systematic screening over time to identify and treat issues that impact optimal long-term recovery from HNC, including disease-specific HRQOL.
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Affiliation(s)
- M. Bryant Howren
- Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University; Tallahassee, FL
- Florida Blue Center for Rural Health Research & Policy, College of Medicine, Florida State University; Tallahassee, FL
| | - Aaron Seaman
- Center for Access Delivery Research & Evaluation (CADRE), VA Iowa City Healthcare System; Iowa City, IA
- Department of Internal Medicine, The University of Iowa; Iowa City, IA
| | - Grace L. Super
- College of Medicine, Florida State University; Tallahassee, FL
| | | | - Nitin A. Pagedar
- Department of Otolaryngology—Head and Neck Surgery, Carver College of Medicine, The University of Iowa; Iowa City, IA
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Belcastro A, Smith BD, Heidel RE, Hechler BL. Incidence of pain complaints in oropharyngeal squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:626-632. [PMID: 33958314 DOI: 10.1016/j.oooo.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/27/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of throat pain and otalgia as presenting symptoms in patients with oropharyngeal squamous cell carcinoma (OPSCC) stratified by the cancer being their first or recurrent/second primary head and neck cancer (fHNC or rsHNC). STUDY DESIGN A retrospective analysis of patients operated on for OPSCC was performed. The primary predictor variable was HNC instance (fHNC/rsHNC) with outcome variables of throat pain and/or otalgia. Chi-square analysis was performed to test for significant associations between HNC instance and pain variables. Unadjusted odds ratios were calculated. RESULTS Eighty-nine patients met the inclusion criteria. Patients with OPSCC as an rsHNC had 4.67 times higher odds of throat pain (95% confidence interval [CI], 1.45-15.06) than those with OPSCC as an fHNC and had 20.22 times higher odds of simultaneous throat pain and otalgia (95% CI, 4.76-85.97) than those presenting with an fHNC. Current smoking status and human papillomavirus (HPV)-negative disease were also significantly predictive of rsHNC. HPV-negative disease was also predictive of pain. CONCLUSIONS In addition to the known associations of smoking and HPV status on recurrence and pain, there is a statistically significant association between cancer instance and pain in patients presenting with newly diagnosed, operable OPSCC.
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Affiliation(s)
- Alexandra Belcastro
- Resident, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - Blaine D Smith
- Resident, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | - R Eric Heidel
- Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Benjamin L Hechler
- Assistant Professor, Department of Surgery - Division of Plastic, Maxillofacial, and Oral Surgery, Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC, USA.
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Abstract
Oral cancer is the fifth most common form of cancer in Taiwan in terms of incidence and death rate and results in at least 2700 deaths each year.
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From an illusion of certainty into a reality of uncertainty: A longitudinal qualitative study of how people affected by laryngeal cancer use information over time. Eur J Oncol Nurs 2016; 23:15-23. [PMID: 27456371 DOI: 10.1016/j.ejon.2016.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 03/04/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Patients diagnosed with laryngeal cancer and their families face unique challenges. Providing information is an essential component of care. However little is known about the way in which they use information. This study aims to explore the different types of information used by laryngeal cancer patients and their carers from diagnosis into the follow up phase. METHOD The study adopted an interpretive longitudinal design using qualitative interviews at two specific time points. Twenty laryngeal cancer patients and 17 carers were interviewed. Data were analysed using Framework Analysis. RESULT Two main categories of information: professional and experiential, were found to be used, drawn from a range of sources. The information received at diagnosis appeared to contribute to an 'illusion of certainty' that life would return to normal at the end of treatment. However, as patients progressed into follow-up, many were propelled into a 'reality of uncertainty' due to the "disconnect" between the expectations both patient and carer developed from information received over the cancer trajectory. CONCLUSION The findings from this longitudinal study suggest that people affected by laryngeal cancer use two broad categories of information derived from a range of different sources and influenced by their own experiences. Health professionals need to situate information in the context of the individual's understanding and prior knowledge of health and illness to help generate more realistic expectations of treatment outcomes. The level of uncertainty experienced by both patients and their carers after treatment suggests a clear need for continued supportive care.
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Abstract
BACKGROUND The prevalence of head and neck cancers is lower (3.5% of total cancers in Australia) than for a number of other cancers. Treatment for head and neck cancer is often drastic and debilitating and patient outcomes are poorer. OBJECTIVE This qualitative study explored the experiences of cancer patients who underwent surgery for head and neck cancer. METHODS In-depth face-to-face interviews were conducted with 12 patients 7 to 26 months after surgery. Interviews were thematically analyzed to produce a rich description of patients' experiences from diagnosis through surgery and beyond. RESULTS Critical aspects of patients' experiences are described through the following themes: only having half the story, shocks and aftershocks, living with the aftermath, and being supported. Participants identified difficulties arising from receiving insufficient, confusing, and often untimely information. The persistent and traumatic nature of what patients endure challenges their physical, mental, and emotional coping capacity and, in some cases, their motivation to live. CONCLUSIONS There is a need to address gaps in support and education of patients and carers. Of particular concern is the problem related to information provision and comprehension. Critical examination of current practices, together with efforts toward coordinated care tailored to individual needs, is required, along with outreach services for patients in rural areas. IMPLICATIONS FOR PRACTICE The development and evaluation of targeted resources in a variety of forms such as DVD, Internet, and pamphlets are needed. Robust assessment strategies are required to inform supportive interventions matched to stages and significant events in patients' journeys.
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9
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The eating experience after treatment for head and neck cancer: A review of the literature. Oral Oncol 2015; 51:634-42. [PMID: 25935370 DOI: 10.1016/j.oraloncology.2015.04.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/13/2015] [Accepted: 04/18/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE Research has identified significant challenges that patients experience following treatment for head and neck cancer (HNC). These include the physical and emotional impacts of the diagnosis and treatment, which compound weight loss and negatively impact eating ability. There is limited research about the lived experience and the changed meaning of food, eating and the eating experience after treatment for patients with HNC. The purpose of this review was to explore available research pertinent to the lived experiences of patients in regards to the changed meaning of food, eating and the eating experience after treatment for HNC. PRINCIPAL RESULTS The review identified a limited number of studies that focused on the eating experience and/or the changed meaning of food after a HNC diagnosis. However, the findings do highlight that there are physical, psychological/emotional and social losses associated with the changed meaning of food and eating within the HNC population. CONCLUSIONS The eating experience is impacted after treatment for HNC. Physical, emotional and social losses in regards to the eating experience have been identified. Acknowledging the significance of eating challenges and the changed meaning of food is necessary to ensure patients receive the appropriate management and support to best manage these challenges in a timely manner.
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de Almeida JR, Vescan AD, Witterick IJ, Gullane PJ, Gentili F, Ringash J, Thoma A, Lohfeld L. Changes Experienced in Quality of Life for Skull Base Surgical Patients: A Qualitative Case Study. J Neurol Surg B Skull Base 2015; 76:129-144. [PMID: 28856080 DOI: 10.1055/s-0034-1371520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 12/28/2013] [Indexed: 10/24/2022] Open
Abstract
Objective Skull base tumors are associated with quality of life (QOL) changes. A qualitative case-study approach may help better understand patients' experiences. Methods A total of 34 skull base surgery patients were selected into focus groups using a criterion-based maximum variation sampling strategy from a sampling frame of 138 patients. Eight groups were organized based on a factorial design of surgical approach (endoscopic/pen) and tumor location (anterior/central). Data were analyzed using a conceptual framework. Qualitative analysis was performed on focus group transcripts to identify major themes and determine if surgical approach or tumor location had differential effects on QOL. Concepts were quantitatively tallied from written workbooks. Results The 34 participants (19 men, 15 women; mean age: 48 years, standard deviation: 14 years) had mixed reactions to their diagnosis ranging from relief to fear. Participants reported physical and nonphysical changes in QOL with some variation in physical complaints by tumor location. Several major themes emerged from the analysis. Skull base tumors are associated with fear and frustration, loss of physical senses and self-identity, social isolation, and coping mechanisms. Conclusions Skull base surgery may impact patients' lives. Qualitative study of patient experiences can provide rich information to better understand this disease.
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Affiliation(s)
- John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Allan D Vescan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Patrick J Gullane
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Fred Gentili
- Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Achilles Thoma
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Lynne Lohfeld
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Albornoz CR, Pusic AL, Reavey P, Scott AM, Klassen AF, Cano SJ, Cordeiro PG, Matros E. Measuring health-related quality of life outcomes in head and neck reconstruction. Clin Plast Surg 2012; 40:341-9. [PMID: 23506775 DOI: 10.1016/j.cps.2012.10.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A qualitative study was undertaken to understand the impact of omitted health concepts in existing patient-reported outcome (PRO) instruments for health-related quality of life (HR-QOL) evaluation following head and neck (H&N) cancer reconstruction. Twenty-six patients were interviewed. Patients described a broad range of symptoms. Oral competence, rhinorrhea, facial sensation, smile, vision and eye discharge are missing from existing PRO instruments. Altered appearance was a major stressor; both function and appearance changes had a negative psychosocial impact leading to social isolation and embarrassment. This framework is the foundation for development of a more complete PRO instrument, the FACE-Q Oncology.
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Affiliation(s)
- Claudia R Albornoz
- Plastic and Reconstructive Surgical Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, MRI 1007, New York, NY 10065, USA
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Rogers SN, Cleator AJ, Lowe D, Ghazali N. Identifying pain-related concerns in routine follow-up clinics following oral and oropharyngeal cancer. World J Clin Oncol 2012; 3:116-25. [PMID: 22905338 PMCID: PMC3421024 DOI: 10.5306/wjco.v3.i8.116] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 06/14/2012] [Accepted: 08/02/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To describe clinical characteristics of head and neck cancer (HNC) patients with pain and those wishing to discuss pain concerns during consultation.
METHODS: Cross-sectional, questionnaire study using University of Washington Quality of Life, version 4 (UW-QOL) and the Patients Concerns Inventory (PCI) in disease-free, post-treatment HNC cohort. Significant pain on UW-QOL and indicating “Pain in head and neck” and “Pain elsewhere” on PCI.
RESULTS: One hundred and seventy-seven patients completed UW-QOL and PCI. The prevalence of self-reported pain issues was 38% (67/177) comprising 25% (44/177) with significant problems despite medications and 13% (23/177) with lesser or no problems but wishing to discuss pain. Patients aged under 65 years and patients having treatment involving radiotherapy were more likely to have pain issues. Just over half, 55% (24/44) of patients with significant pain did not express a need to discuss this. Those with significant pain or others wanting to discuss pain in clinic had greater problems in physical and social-emotional functioning, reported suboptimal QOL, and also had more additional PCI items to discuss in clinic compared to those without significant pain and not wishing to discuss pain.
CONCLUSION: Significant HNC-related pain is prevalent in the disease-free, posttreatment cohort. Onward referral to a specialist pain team may be beneficial. The UW-QOL and PCI package is a valuable tool that may routinely screen for significant pain in outpatient clinics.
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Affiliation(s)
- Simon N Rogers
- Simon N Rogers, Derek Lowe, Naseem Ghazali, Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 7LN, United Kingdom
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Chen SC, Lai YH, Liao CT, Chang JTC, Lin CY, Fan KH, Huang BS. Supportive care needs in newly diagnosed oral cavity cancer patients receiving radiation therapy. Psychooncology 2012; 22:1220-8. [DOI: 10.1002/pon.3126] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 06/02/2012] [Accepted: 06/04/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Shu-Ching Chen
- Department of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
| | - Yeur-Hur Lai
- School of Nursing, College of Medicine; National Taiwan University; Taipei Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- College of Medicine; Chang Gung University; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
| | - Joseph Tung-Chien Chang
- College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Radiation Oncology, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
| | - Chien-Yu Lin
- College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Radiation Oncology, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
| | - Kang-Hsing Fan
- College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Radiation Oncology, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
| | - Bing-Shen Huang
- College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Radiation Oncology, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- Head and Neck Oncology Group, Chang Gung Medical Foundation; Chang Gung Memorial Hospital at LinKou; Taoyuan Taiwan
- Graduate Institute of Clinical Medicine; Chang Gung University; Taoyuan Taiwan
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14
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Chen SC. Life experiences of Taiwanese oral cancer patients during the postoperative period. Scand J Caring Sci 2011; 26:98-103. [DOI: 10.1111/j.1471-6712.2011.00914.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Prevalence and Correlates of Supportive Care Needs in Oral Cancer Patients With and Without Anxiety During the Diagnostic Period. Cancer Nurs 2010; 33:280-9. [DOI: 10.1097/ncc.0b013e3181d0b5ef] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Röing M, Hirsch JM, Holmström I, Schuster M. Making new meanings of being in the world after treatment for oral cancer. QUALITATIVE HEALTH RESEARCH 2009; 19:1076-1086. [PMID: 19638601 DOI: 10.1177/1049732309341192] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
When the mouth is affected by cancer, difficulties in satisfying basic human needs such as eating, tasting, swallowing, and speaking might arise, and the existential significance of the mouth might become obvious. How does it feel to live with these difficulties? What does it mean to be a human being living with the consequences of oral cancer? Five patients with oral cancer were interviewed a median time of 4 years after the beginning of treatment. A hermeneutic research approach was used to understand, explain, and interpret the transcribed interviews and showed how the consequences of oral cancer affected the being-in-the-world of the participants in three ways: existing as oneself, existing in the eyes of others, and existing with others. Against the background of the philosophy of Martin Heidegger, these findings illuminate how essential the mouth is to a human being's identity and existence.
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Lee EWC, Twinn S, Moore AP, Jones MP, Leung S. Clinical Encounter Experiences of Patients With Nasopharyngeal Carcinoma. Integr Cancer Ther 2008; 7:24-32. [DOI: 10.1177/1534735407313448] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a commonly occurring cancer among Hong Kong Chinese, especially in the relatively young population group. Since the disease carries a favorable prognosis, sequelae following treatment have become an important concern for patients suffering from NPC, particularly because of the strong interplay of psychological, social, and biological issues during their rehabilitation. In this qualitative study, in-depth, semistructured audiotaped interviews were undertaken with 32 patients receiving rehabilitation at the physiotherapy department of a regional teaching hospital in Hong Kong. The objective of the study was to examine the rehabilitation experiences of NPC survivors to identify factors that contributed to a satisfying clinical encounter experience. During the study, data collection and analysis using a grounded theory approach were concurrently conducted. The 3 main themes that shaped the rehabilitation experiences of NPC survivors were the patient-clinician relationship, participation in therapeutic alliance, and quality rehabilitation service provision. These, together with the identified needs of the participants, contributed to the participants' perceived health-related quality of life. A constructive clinical experience was perceived when their needs were met. The findings highlight the importance of patient-centeredness in the treatment delivery and a multifaceted role of clinicians in meeting the needs of this group of cancer survivors.
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Affiliation(s)
- Edwin W. C. Lee
- Department of Physiotherapy, Prince of Wales Hospital, Shatin, Hong Kong, edwinlee @cuhk.edu.hk
| | - Sheila Twinn
- Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong
| | - Ann P. Moore
- Clinical Research Centre for Health Professions, University of Brighton, United Kingdom
| | - Mark P. Jones
- School of Engineering, University of Brighton, United Kingdom
| | - S.F. Leung
- Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong
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Honorato B, Alcalde J, Martinez-Monge R, Zabalegui N, Garcia-Foncillas J. TAK1 mRNA Expression in the Tumor Tissue of Locally Advanced Head and Neck Cancer Patients. GENE REGULATION AND SYSTEMS BIOLOGY 2008. [DOI: 10.1177/117762500800200002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Resistance to radio and chemotherapy is one of the major drawbacks in the progression of head and neck squamous cell cancer (HNSCC) patients, evidencing the importance of finding optimum molecular prognosis markers to develop personalized treatment schedules. TGF-β effector TAK1 activity has been related to a greater aggressiveness in several types of cancer (Kondo et al. 1998; Edlund et al. 2003; Kaur et al. 2005) and, although there has been described no significant implication of TAK1 in HNSCC development, we have further examined the role of its mRNA expression as a marker of prognosis in HNSCC. Fifty-nine advanced HNSCC patients were recruited for the study. The tumor expression of TAK1 mRNA was analyzed with RT-PCR using Taqman technology and its relationship with the clinical outcome of the patients studied. TAK1 mRNA expression was lower in patients that relapsed than in those that did not, but the difference was only significant between the patients that showed response to treatment (p < 0.001). ROC curve analyses pointed a 0.5 expression ratio TAK1/B2M value as an optimum cut-off point for relapse and response. Our data suggest the TAK1 mRNA analysis by Taqman RT-PCR can predict the risk of relapse in HNSCC patients.
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Affiliation(s)
- Beatriz Honorato
- Clinical Genetics Unit and Oncology Department, University Clinic of Navarra, Pamplona, Spain
| | - Juan Alcalde
- Otolaringology Department, University Clinic of Navarra, Pamplona, Spain
| | | | - Natalia Zabalegui
- Immunotherapy Laboratory, CIMA University of Navarra, Pamplona, Spain
| | - Jesús Garcia-Foncillas
- Clinical Genetics Unit and Oncology Department, University Clinic of Navarra, Pamplona, Spain
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Abstract
AIM This paper reports a study to explore how cancer survivors talk about, experience and manage time in everyday life. BACKGROUND There is an increasing interest in specific physical and psychosocial aspects of life after cancer diagnosis and treatment, but hardly any research follows cancer survivors over time to explore how perceptions and experiences change. METHODS An exploratory study was carried out in 2002-2004 with a purposive sample of adults who had experienced various forms of cancer. Data collection included 9 weeks of participant observation at a Cancer Rehabilitation Centre and ethnographic interviews with 23 informants. Ten men and 13 women were interviewed twice: 2 weeks after their stay and 18 months later. FINDINGS Data were analysed from a culture-analytical perspective. Three main themes regarding the survivors' handling and perception of time were found: (1) cancer disrupts time and life; (2) awareness of time increases, time is verbalized and reflected; and (3) the informants appropriate time. A diagnosis of cancer, even for a survivor, means a confrontation with death. It means a disruption of continuous clock and calendar time. Survivors appropriate time, and prioritize how and with whom they want to spend their time. CONCLUSION With an increasing number of people being cured following a cancer diagnosis, nurses and oncology nurse specialists who work with cancer survivors must be aware of the fact that time is a central theme in understanding cancer survivors' lives, and they must know how to guide these survivors in their new lives and take care of their well-being.
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Affiliation(s)
- Dorte M Rasmussen
- Student Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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