The incidence, severity, and location of pain was evaluated in 30 head and neck cancer patients prior to treatment after the first phase of their treatment and upon the completion of treatment. The incidence of pain was relatively high (40%-70%) and tended to increase slightly over treatment. Patients having advanced disease (stage III or IV) had a higher incidence of pain. Pain severity ratings were stable over treatment. Pain was located close to tumor or incision sites, and a trend for patients to report a greater number of pain sites over treatment was noted. While medical status variables (disease stage and site) were found to predict pain status after the initial phase of cancer treatment, initial pain measurements were more likely to predict pain status at the completion of treatment.
Behavioral evaluations of pain were carried out on a sample of 30 head and neck cancer patients before, at the midpoint, and at the end of their treatment. Observations of patients' behavior as they carried out functional activities revealed that patients tended to display their pain primarily through facial expression and to a lesser extent through guarded movement. During the period of treatment there were significant increases in the number of simple daily activities that increased pain, in the time spent sitting each day, and in the number of patients using narcotics. There was also a strong tendency for patients to lose weight and to use a greater number of pain relieving methods. A behavioral dysfunction index based on scores on each of the behavioral measures was clearly related to pain ratings. Measures of pain taken before treatment were highly predictive of behavioral dysfunction index scores recorded at the completion of cancer treatments.
Twenty-one patients with adenoid cystic carcinoma of the head and neck were treated with intravenous boluses of cyclophosphamide and vincristine and 5-day continuous intravenous infusions of 5-fluorouracil (CVF) every 4 weeks. Eight patients received CVF as palliation for recurrent or metastatic disease. A sustained complete response (107+ months) was observed in one patient; one partial response and one mixed response each also were observed. In four patients disease stabilized, and in one disease progressed. Thirteen patients received six courses of CVF in the adjuvant setting after surgery and radiation for either primary or locoregional recurrent disease. Recurrences developed in two of seven patients with primary disease and three of six patients with recurrent disease with a median follow-up 45 months (range, 20-108+). Recurrence rate and time interval to recurrence were comparable to those of well-matched historical controls. Distant metastases have not developed in patients treated with CVF in the adjuvant setting, whereas distant metastases had developed in historical controls within comparable periods of follow-up. Serious toxicities were not encountered in any patient. The authors conclude that CVF is a well-tolerated combination chemotherapy program with activity in adenoid cystic carcinoma of the head and neck. This regimen, however, has not had a major impact in the adjuvant setting in preventing recurrent disease.
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