Comparison of psychosocial outcomes in head and neck cancer patients receiving a coping strategies intervention and control subjects receiving no intervention. Development and evaluation of a problem-focused psychosocial intervention for patients with head and neck cancer Health-related quality of life in head and neck cancer survivors: impact of pretreatment depressive symptoms. Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer. Long-term health-related quality of life in survivors of head and neck cancer. Long-term effect of a nurse-led psychosocial intervention on health-related quality of life in patients with head and neck cancer: a randomised controlled trial First year after head and neck cancer: quality of life. Development of a new head and neck cancer-specific comorbidity index. Predictors of poor sleep quality among head and neck cancer patients. Early self-care rehabilitation of head and neck cancer patients Can a person-centred-care intervention improve health-related quality of life in patients with head and neck cancer? A randomized, controlled study Effects of psychosocial intervention on quality of life in patients with head and neck cancer. Prediction of survival by pretreatment health-related quality-of-life scores in a prospective cohort of patients with head and neck squamous cell carcinoma. Psychosocial and physical correlates of survival and recurrence in patients with head and neck carcinoma: results of a 6-year longitudinal study. Patient‐reported outcomes, body composition, and nutrition status in patients with head and neck cancer: Results from an exploratory randomized controlled exercise trial Results of a feasibility study for a psycho-educational intervention in head and neck cancer. Development and preliminary evaluation of a rehabilitation consult for survivors of head and neck cancer: an intervention mapping protocol
This feasibility study aim ed at comparing psychosocial outcomes in head and neck cancer patients receiving the Nucare program  with a group of control subjects receiving no intervention .  A prospect i ve , nonr and omized study design was used . The Nucare program , a short-term psychoeducational coping strategies intervention , was the test intervention . Control subjects were matched to intervention subjects by cancer stage and time since cancer diagnosis . Outcomes were quality of life and depressive symptoms evaluated at baseline and 3 to 4 months later . One hundred thirty-eight subjects were recruited , and outcome data were available on 101 subjects . At outcome evaluation , compared with their baseline scores , the intervention group had improved physical and social functioning , global quality of life , fatigue , sleep disturbance , and depressive symptoms ; the control group showed no changes in quality of life or depressive symptoms . The results suggest that the Nucare program may improve quality of life and reduce depressive symptoms in head and neck cancer patients Goals of the work Patients with head and neck cancer have complex needs that affect many basic functions of life and contribute to substantial psychosocial problems . The aim of this study was to evaluate the effectiveness of a problem-focused intervention for patients with psychosocial dysfunction who had completed treatment for head and neck cancer . Patients and methods Using a quasi-experimental design , 54 participants who were above pre-determined cutoff points for psychosocial dysfunction ( hospital and depression scale , work and social adjustment scale ) were given the opportunity to self-select into either the experimental group for the psychosocial intervention programme which was delivered in an individualised format , with bibliotherapy as an adjunct , or the control group for usual care . Main results Analysis of covariance results demonstrated a reduction in psychological distress ( anxiety , p = 0.001 ; depression , p = 0.005 ) , improving social functioning ( p = 0.048 ) and quality of life scores ( p = < 0.05 ) for the experimental group , all of which were sustained into the 3-month follow-up period . No such improvements were evident for the control group . Conclusions This study suggests that head and neck cancer patients with post-treatment psychosocial dysfunction  can benefit from a problem-focused psychosocial intervention . Such evidence can inform practice , policy and future research , aim ed at improving post-treatment quality of life for patients with head and neck cancer OBJECTIVE Symptoms of depression are common in those with cancer . The authors investigated whether depressive symptoms assessed before the initiation of cancer treatment predicted diminished health-related quality of life ( HRQOL ) at follow-up . DESIGN As part of a large , prospect i ve study of oncologic outcomes , 306 patients with head and neck cancer ( HNC ) were assessed on several clinical and psychosocial characteristics during a pretreatment clinic visit and then at 3- and 12-month follow-up appointments . MAIN OUTCOME MEASURES Depressive symptomatology was assessed with the  Beck Depression Inventory  and HNC-specific HRQOL ( main outcome measure ) was assessed with the  Head and Neck Cancer Inventory .  RESULTS Controlling for age , gender , marital status , cancer site , stage of disease , alcohol and tobacco use , comorbidity status , and pretreatment HRQOL , simultaneous multiple regression analyses revealed that depressive symptoms present at study enrollment , before the initiation of cancer treatment , significantly predicted lower HRQOL at 3- and 12-month follow-up assessment s across the 4 HNC-specific domains of speech , eating , aesthetics , and social disruption ( all ps < or= .01 ) . CONCLUSION Results suggest that depressive symptomatology present near the time of diagnosis can have a significant , deleterious impact on HRQOL over time in HNC survivors . Thus , it may be useful to assess depression at diagnosis to identify individuals at greater risk for poor HRQOL outcomes OBJECTIVE To assess toxicities , functional outcomes , and health-related quality of life associated with concurrent chemoradiation therapy ( CRT ) in patients with head and neck cancer . DESIGN Prospect i ve and retrospective outcomes study . SETTING Tertiary care institution . PATIENTS Participants in the longitudinal Outcomes Assessment Project whose head and neck cancer was treated with CRT between February 1 , 2000 , and March 1 , 2007 ( n = 104 ) . INTERVENTIONS Patients prospect ively provided functional and health-related quality of life information , including data from the 1-year and most current follow-up visits . Medical records were review ed to determine toxicity and survival rates . MAIN OUTCOME MEASURES Well-defined acute and late toxicities ; functional outcomes ( diet , dentition , tracheostomies ) ; head and neck cancer-specific , general health , and depression outcomes ; and survival rates . RESULTS Most patients had oropharyngeal or laryngeal tumors ( 87.5 % ) and advanced-stage disease ( 75.0 % ) . Approximately one-half had hematologic toxicities and toxicity-related treatment delays . Approximately one-quarter had neurotoxicities and /or ototoxicites , moist desquamation , pneumonia , nausea and vomiting requiring hospitalization or intravenous fluids , dehydration or malnutrition requiring hospitalization , and mild or moderate fever . Although patients receiving the current intensity-modulated radiation therapy ( IMRT ) protocol using the Pinnacle(3 ) planning system had more toxicity-related treatment delays , they had fewer toxicities and better functional and health-related quality of life outcomes compared with those receiving conventional lateral opposing-field radiation or the initial IMRT protocol using the Best nomos PEACOCK planning system . CONCLUSIONS Patients receiving CRT  experience a substantial number of treatment-related adverse events , primarily affecting oropharyngeal and laryngeal function , with improvement noted for the current IMRT protocol . Improving dental prosthetic rehabilitation and including evaluations with speech and swallowing pathologists before and during treatment may enhance patient outcomes OBJECTIVE To examine health-related quality of life ( HRQOL ) reported by 5-year head and neck cancer survivors and factors that predicted these long-term scores . DESIGN Prospect i ve , observational outcomes study . SETTING Tertiary care institution . PATIENTS A total of 337 patients diagnosed as having head and neck carcinoma between January 1995 and December 2004 , who enrolled in the Outcomes Assessment Project and survived at least 5 years . INTERVENTIONS While participating in the longitudinal Outcomes Assessment Project , patients filled out surveys measuring HRQOL at numerous points in time . MAIN OUTCOME MEASURES Outcomes included 5-year scores in eating , speech , aesthetics , social disruption , physical and mental health , depressive symptoms , and overall quality of life ( QOL ) . In addition to analyzing patients ' 5-year HRQOL outcomes , multivariate analyses were performed to determine which patient , clinical , treatment , and 1-year HRQOL factors independently predicted these 5-year outcomes . RESULTS Overall , the cohort 's long-term general health was similar to that to age-matched norms from the general population . But over 50 % of these survivors had problems eating , 28.5 % reported depressive symptoms , and 17.3 % reported substantial pain . At long-term follow-up , 13.6 % continued to smoke , and 38.9 % used alcohol . Multivariate analyses demonstrated that 1-year pain and diet were the strongest independent predictors of 5-year HRQOL outcomes . CONCLUSIONS Eating problems due to poor oropharyngeal functioning and persistent pain are the most prevalent problems that these survivors face . Early interventions addressing eating issues , swallowing problems , and pain management will be a crucial component in improving this patient population 's long-term QOL , especially in those who are functioning poorly 1 year after diagnosis Background : Head and neck cancer ( HNC ) patients are prone to have a poor health-related quality of life after cancer treatment . This study investigated the effect of the nurse counselling and after intervention ( NUCAI ) on the health-related quality of life and depressive symptoms of HNC patients between 12 and 24 months after cancer treatment . Methods : Two hundred and five HNC patients were r and omly allocated to NUCAI ( N=103 ) or usual care ( N=102 ) . The 12-month nurse-led NUCAI is problem-focused and patient-driven and aims to help HNC patients manage with the physical , psychological and social consequences of their disease and its treatment . Health-related quality of life was evaluated with the EORTC QLQ-C30 and QLQ H&N35 . Depressive symptoms were evaluated with the CES-D. Results : At 12 months the intervention group showed a significant ( P<0.05 ) improvement in emotional and physical functioning , pain , swallowing , social contact , mouth opening and depressive symptoms . At 18 months , global quality of life , role and emotional functioning , pain , swallowing , mouth opening and depressive symptoms were significantly better in the intervention group than in the control group , and at 24 months emotional functioning and fatigue were significantly better in the intervention group . Conclusion : The NUCAI effectively improved several domains of health-related quality of life and depressive symptoms in HNC patients and would seem a promising intervention for implementation in daily clinical practice PURPOSE Treatment regimens for head and neck cancer patients profoundly affect several quality -of-life domains . Rehabilitative needs have been identified through cross-sectional analyses ; however , few studies have prospect ively assessed quality of life , included assessment of psychosocial variables , and identified predictors of long-term follow-up . PARTICIPANTS AND METHODS The present study addresses these limitations through a prospect i ve assessment of 105 patients with a newly diagnosed first primary squamous cell carcinoma of the oral cavity , pharynx , or larynx . Participants were enrolled onto a larger r and omized controlled trial comparing a provider-delivered smoking cessation intervention with a usual-care-advice control condition . Participants completed a battery of self-report measures after diagnosis and before treatment and additional quality -of-life instruments  at 1 and 12 months after initial smoking cessation advice . RESULTS Participants displayed improvements at 12 months in functional status ( P = .006 ) and in the areas of eating , diet , and speech ; however , the latter three represent areas of continued dysfunction , and the changes were not statistically significant . Despite these improvements , patients reported a decline in certain quality -of-life domains , including marital ( P = .002 ) and sexual functioning ( P = .017 ) , as well as an increase in alcohol use ( P < .001 ) . Predictors of quality of life at 12 months included treatment type , the Vigor subscale of the Profile of Mood States instrument , and quality -of-life scores obtained 1 month after initial smoking cessation advice . CONCLUSION Results reinforce the need for rehabilitation management through the integration of psychologic and behavioral interventions in medical follow-up BACKGROUND Most patients with head and neck squamous cell carcinoma are older and may have coexistent or comorbid diseases . OBJECTIVES To determine the prognostic impact of individual comorbid conditions in patients with head and neck cancer , to combine the individual comorbid conditions to form a new a head and neck-specific comorbidity instrument , and to compare it with the Modified Kaplan-Feinstein Index to determine if the new disease-specific instrument offers any improvement in survival prediction over a general comorbidity index . DESIGN Retrospective review of medical records . POPULATION The study population comprised 1153 patients with biopsy-proven , newly diagnosed squamous cell carcinoma of the oral cavity , oropharynx , or larynx . RESULTS Seven comorbid conditions ( congestive heart disease , cardiac arrhythmia , peripheral vascular disease , pulmonary disease , renal disease , cancer controlled , and cancer uncontrolled ) were significantly related to survival . These comorbid conditions were assigned integer weights to reflect their relative prognostic importance and combined to create the new Washington University Head and Neck Comorbidity Index ( WUHNCI ) . Survival was significantly related to levels of comorbidity severity as defined by the WUHNCI . The WUHNCI predicted survival better than the Modified Kaplan-Feinstein Index despite containing far fewer ailments . CONCLUSIONS Comorbidity is an important feature of the patient with head and neck cancer . The WUHNCI can be used for retrospective review or prospect i ve outcomes research OBJECTIVES /HYPOTHESIS The objective of this study was to determine the predictors of sleep quality among head and neck cancer patients 1 year after diagnosis . STUDY DESIGN This was a prospect i ve , multisite cohort study of head and neck cancer patients ( N = 457 ) . METHODS Patients were surveyed at baseline and 1 year after diagnosis . Chart audits were also conducted . The dependent variable was a self-assessed sleep score 1 year after diagnosis . The independent variables were a 1 year pain score , xerostomia , treatment received ( radiation , chemotherapy , and /or surgery ) , presence of a feeding tube and /or tracheotomy , tumor site and stage , comorbidities , depression , smoking , problem drinking , age , and sex . RESULTS Both baseline ( 67.1 ) and 1-year postdiagnosis ( 69.3 ) sleep scores were slightly lower than population means ( 72 ) . Multivariate analyses showed that pain , xerostomia , depression , presence of a tracheotomy tube , comorbidities , and younger age were statistically significant predictors of poor sleep 1 year after diagnosis of head and neck cancer ( P < .05 ) . Smoking , problem drinking , and female sex were marginally significant ( P < .09 ) . Type of treatment ( surgery , radiation and /or chemotherapy ) , primary tumor site , and cancer stage were not significantly associated with 1-year sleep scores . CONCLUSIONS Many factors adversely affecting sleep in head and neck cancer patients are potentially modifiable and appear to contribute to decreased quality of life . Strategies to reduce pain , xerostomia , depression , smoking , and problem drinking may be warranted , not only for their own inherent value , but also for improvement of sleep and the enhancement of quality of life Abstract Conclusions : No positive effects of early preventive rehabilitation could be identified . The results do not contradict the proposition that rehabilitation based on self-care can be effective but it is important to establish evidence -based training programs and identify proper instruments for selection of patients and evaluation of intervention . Objectives : Patients with head and neck cancer suffer from functional impairments due to intense treatment . In this study , we investigated the effectiveness of an experimental early preventive rehabilitation using hard , objective end points in a nonselective , longitudinal , prospect i ve cohort study . Methods : In all , 190 patients were included in the program and received instructions for training before the start of treatment with the aim of reducing swallowing problems and reducing mouth opening and stiffness in the neck .  A control group of 184 patients was recruited . Results : There was no difference in weight loss and 2-year survival between the two groups . No positive effects concerning functional impairments were found in patient-reported outcome measures Background The incidence of head and neck cancer is increasing slightly . Head and neck cancer but also it ’s necessary and often successful treatment may affect general domains of health-related quality of life and provoke a variety of adverse symptoms and side effects , both during and after treatment . The objective of this study was to compare a person-centred care intervention in terms of health-related quality of life , disease-specific symptoms or problems , with traditional care as a control group for patients with head and neck cancer . Methods In this r and omized controlled trial ,  person – centred-care intervention and traditional care ( control ) groups comprised 54 and 42 patients , respectively . Outcome measures used were : the EORTC QLQ-C30 and the EORTC QLQ-C35 . Both groups answered the question naires at baseline and after 4 , 10 , 18 and 52 weeks from start of treatment . The question naires ’ scores were compared between groups by using independent sample s test and non-parametric test for continuous variables . For categorical data , Fisher ’s exact test was used . Longitudinal data were analysed using generalized linear models for normally distributed repeated measures data . Results At baseline , the intervention and control groups were comparable in terms of medical and sociodemographic variables , clinical characteristics , health-related quality of life and disease-specific symptoms or problems . At all the follow-up points , even during the worst period for the patients , the person-centred-care group consistently reported better scores than the control group . The differences were numerically but not always statistically significant . When testing longitudinal data , statistically significant results were found for head and neck cancer-specific problems , swallowing ( p = 0.014 ) , social eating ( p = 0.048 ) and feeling ill ( p = 0.021 ) . Conclusions The results from this study suggest that adopting the person-centred-care concept practice d here could be a way to improve function and wellbeing in patients with head and neck cancer . Trial registration The study was retrospectively registered in 2016 - 12 - 05 in Clinical Trials gov . “ Can a Person-centred-care Intervention Improve Health-related Quality of Life in Patients With Head and Neck Cancer ” registration number : NCT02982746 BACKGROUND A longitudinal , prospect i ve , case-control study evaluated if a psychosocial support program improved health-related quality of life ( HRQL ) in head and neck ( H&N ) cancer patients . METHODS One hundred forty-four H&N cancer patients were included : 52 study patients and 92 controls . The study group met the support team repeatedly throughout the first year after diagnosis . HRQL was assessed three times during the first year and after 3 years using the EORTC QLQ-C30 , EORTC QLQ-H&N35 , and HADS . RESULTS A few statistically significant differences were found , all favoring the controls . Controls reported better global quality of life after 1 year and felt less ill after 3 years . Depression and treatment-related side effects were prevalent in both groups . CONCLUSIONS Our psychosocial support program did not improve HRQL in H&N cancer patients . Its effectiveness may be improved by evaluating and actively integrating HRQL assessment s during the program , thereby enabling rapid and adequate symptomatic treatment and /or psychologic intervention OBJECTIVE To evaluate the association between pretreatment health-related quality -of-life ( HRQOL ) scores and survival in a heterogeneous cohort of patients with newly diagnosed head and neck squamous cell carcinoma ( HNSCC ) . DESIGN Prospect i ve cohort study . SETTING University hospital and referral center in Western Norway . PATIENTS A total of 106 patients with intact cognitive functioning who were younger than 78 years , were diagnosed as having HNSCC , and underwent treatment with curative intent from November 1 , 2002 , through June 30 , 2005 . MAIN OUTCOME MEASURES Overall survival and HRQOL scores obtained at the time of diagnosis . RESULTS All dichotomized HRQOL sum scores except the functional score ( P = .20 ) were significantly predictive of survival in univariate analyses . The hazard ratios of the dichotomized general symptom , global quality -of-life , and head and neck sum score were 3.66 , 0.31 , and 2.28 , respectively . All sum scores except the dichotomized functional score remained predictive of survival after sequential adjustment for sociodemographic and clinical characteristics , neuroticism , choice of psychological coping , current smoking and alcohol consumption , and comorbidities . Similar findings were found for specific HRQOL indices of physical functioning , dyspnea , sleep disturbance , appetite loss , swallowing , and social eating from the European Organization for Research and Treatment of Cancer 30-Item Core Quality of Life Question naire , version 3.0 , and the Quality of Life-Head and Neck Cancer Module . Moreover , patients in the highest scoring quartiles for the symptom sum scores and /or the lowest scoring quartile for the global score had overall mortality rates of 50 % to 64 % compared with 23 % to 26 % among the other patients . CONCLUSION The HRQOL sum scores and specific indices among HNSCC patients predict survival independently of established known prognostic factors BACKGROUND Studies that have examined correlations between psychosocial factors and survival in cancer patients do not permit any definitive conclusions . To the authors ' knowledge , to date no study has examined the relation between medical as well as quality of life variables and survival in head and neck carcinoma patients . The current study focused on the complex interactions among psychosocial , medical , behavioral , and demographic variables as they relate to prognosis in these patients . METHODS A total of 133 consecutive head and neck carcinoma patients were included in a prospect i ve study at pretreatment . In addition to clinical variables , psychosocial and physical functioning was assessed by means of a self-report question naire . RESULTS During the observation period 57 patients died whereas 76 were still alive at 6 years after treatment . Results of the multivariate survival analysis indicated that patients without head and neck metastasis had a better prognosis than patients with positive cervical lymph nodes . Pretreatment smoking showed a negative correlation with overall survival . Patients who were more physically self-efficacious ( i.e. , higher perceived physical abilities ) were more likely to survive and less likely to develop a recurrence . In addition , patients who expressed intense psychosocial complaints prior to treatment had a better prognosis than had those who did not express such negative feelings . CONCLUSIONS The current findings linking physical self-efficacy and prognosis are promising , but clinical trials are necessary to examine the direct and indirect mediational pathways of the variables that underlie physical efficacy and influence survival and recurrence . Also , the negative correlation between pretreatment smoking and survival suggests a need for increased efforts to address smoking in newly diagnosed patients Patients with head and neck cancer experience  loss of weight and muscle mass , decreased functioning , malnutrition , depression , and declines in quality of life during and after treatment . The purpose of this exploratory r and omized study was to determine the optimal timing for the initiation of a lifestyle and progressive resistance exercise training intervention ( during or after radiation therapy ) , as determined by intervention adherence and by comparing between‐group outcomes across 24 weeks BACKGROUND With survival rates for people with head and neck ( H&N ) cancers static during the past 30 years and the enormous burden of psychosocial impacts they suffer well documented , the testing of psychosocial interventions in this group is a priority . OBJECTIVE To test the feasibility of providing a psycho-educational intervention for people with H&N cancer . METHODOLOGY A prospect i ve non-r and omised design was used . Subjects were patients with H&N cancer . They were offered the Nucare coping strategies program in one of three formats : small group and one-to-one formats with therapists ; and a home format , with material for home use , without a therapist . Outcomes measures ( quality of life ( QOL ) and anxiety and depression ) were collected at baseline and following the intervention . Analyses were performed using non-parametric statistics . RESULTS Of 128 people invited to participate , 66 agreed , 59 completed the intervention and 50 had outcomes data . Following the intervention , there were significant improvements in physical and social functioning and global QOL , and reduced fatigue , sleep disturbance and depressive symptoms . CONCLUSIONS These data suggest that the intervention is desired by the target group , feasible to deliver after cancer therapy and may have some beneficial effects , although an appropriately design ed study is required to confirm this Background Evidence suggests that rehabilitation interventions can improve function and quality of life in survivors of head and neck cancer ( HNC ) , but there is a lack of coordinated , integrated services , and those offered are inconsistent . To address these gaps , we will develop and conduct preliminary evaluation of a rehabilitation consult , built on the theoretical foundations of goal setting and self-management , and composed of a brief functional evaluation , a re source compendium , and collaborative goal - setting and action planning processes . Methods / design The development of the rehabilitation consult will be guided by intervention mapping , which consists of six steps : 1 . Needs assessment ; 2 . Definition of program objectives ; 3 . Selection of theory-based intervention methods ; 4 . Production and pretesting ; 5 . Adoption , implementation and sustainability planning ; 6 . Process and effect evaluation . Within the intervention mapping framework , an iterative process of constructing drafts and mini-evaluations with consumers and experts will be used , modifying the rehabilitation consult intervention until a version suitable for formal evaluation is established . The rehabilitation consult will then be evaluated using a prospect i ve , mixed method , single group design with 30 survivors of head and neck cancer . Outcomes will be assessed pre- and post-intervention and at 6-month follow-up . Discussion Survivors of head and neck cancer have among the most complex rehabilitation needs of all cancer patients . The rehabilitation consult is expected to improve knowledge and uptake of rehabilitation re sources and strategies in survivors of head and neck cancer and thereby improve long-term function and quality of life . If the rehabilitation consult is effective in cancer patients with such high and diverse needs , this project will produce a toolkit that will be adaptable for other types of cancer in other jurisdictions
Functional and cognitive impairment , depressive symptoms and social isolation are highly prevalent in head and neck cancer patients and associate with high risk of adverse health outcomes .
OBJECTIVES Older head and neck cancer patients are at increased risk for adverse health outcomes , but little is known about which geriatric assessment associates with poor outcome .
The aim is to study the association of functional or cognitive impairment , social environment and frailty with adverse health outcomes in patients with head and neck cancer .