BACKGROUND: After definitive cancer treatment, survivors of head and neck cancer (HNC) are commonly recommended to participate in therapies aimed at reducing the burden of treatment-related side effects. OBJECTIVE: In this study, we evaluated whether adherence to referral to physical therapy (PT) and speech-language pathology therapy (SLPT) is related to patient health literacy (HL). METHODS: This is a retrospective cohort analysis of patients attending a multidisciplinary HNC survivorship clinic between 2017 and 2019. HL was measured using the Brief Health Literacy Screen, with scores below 10 indicating inadequate HL. Chi-square and logistic regression were used to evaluate the association between HL and adherence to PT or SLPT referral. KEY RESULTS: From the overall cohort (N = 454), 80 patients (18%) had inadequate HL. Compared to those with adequate HL, patients with inadequate HL were significantly less likely to complete initial PT evaluation (74% vs. 58%, p = .034) but were not significantly less likely to complete initial SLPT evaluation (70% vs. 61%, p = .37). After adjusting for age, primary tumor site, and treatment stage, we found that patients with inadequate HL were half as likely to follow up for initial PT evaluation (odds ratio 0.45, p = .032). CONCLUSION: Overall, inadequate HL is associated with reduced adherence to PT but is not associated with adherence to SLPT among HNC survivors. These results highlight the clinical importance of HL and underscore the need for interventions to facilitate adherence to treatment for patients with inadequate HL. [HLRP: Health Literacy Research and Practice. 2023;7(1):e52–e60.] PLAIN LANGUAGE SUMMARY: We sought to understand whether health literacy plays a role in patient adherence to treatment recommendations. We found that patients with inadequate health literacy were less likely to follow up with physical therapy evaluations. These findings highlight the importance of health literacy among head and neck cancer patients and provides clues for developing patient-centered interventions to facilitate adherence to treatment recommendations.
Fifty-four persons with serious mental illness who were living below the poverty line were randomly divided into two groups. Members of one group received allowances and forgivable loans to raise them above the poverty line for one year. The others received some funds, but not enough to raise them above the poverty line. All participants selected one staff member from a consortium of supporting agencies to serve as a sponsor and another person to serve as an adviser to help them function better. For both groups hospitalization rates were significantly reduced, and quality of life in some domains improved.
Background There is a growing cohort of head and neck cancer (HNC) patients affected by late‐ and long‐term posttreatment side effects. Our study evaluates the relationship between the demographics, clinical characteristics, and posttreatment symptom burden with the subjective sense of flourishing among HNC survivors. Methods A cross‐sectional, single‐center study of adult survivors of squamous cell cancer of the oral cavity, oropharynx, and larynx/hypopharynx who completed the Secure Flourishing Index (SFI) and patient‐reported outcomes related to depression, anxiety, swallowing dysfunction, neck disability, and insomnia between November 2020 and April 2021. Results A total of 100, predominantly male (86%), survivors with an average age of 63.0 ± 9.6 were included in the study. Univariable analysis showed a significant association between higher flourishing scores and advanced age (95% CI: [0.011, 0.84], p = 0.0441), normal diet (95% CI: [5.79, 31.18], p = 0.0149), employment (95% CI: [1.24, 17.20], p = 0.0239), higher income (95% CI: [7.30, 27.72], p = 0.0248), and decreased reported difficulty paying for needs (95% CI: [−33.46, −18.88], p < 0.001). Flourishing was inversely associated with higher symptoms of depression (95% CI: [−2.23, −1.15], p < 0.001), anxiety (95% CI: [−1.92,‐0.86], p < 0.001), swallowing dysfunction (95% CI: [−0.77, −0.26], p < 0.001), neck disability (95% CI: [−1.05, −0.35], p < 0.001), and insomnia (95% CI: [−1.12, −0.22], p = 0.004) in the multivariable analysis. Conclusions Common late‐ and long‐term side effects of HNC treatment and financial hardship are associated with lower levels of flourishing or a more negative perception of life after treatment. Results highlight the importance of symptom burden for survivors' overall evaluation of their quality of life.
Purpose: Head and neck cancer (HNC) treatments often have a substantial long-term impact on physical appearance, psychological well-being, and physiologic functions. Our study examines the relationship between symptoms of neck disability and insomnia among post-treatment HNC survivors.Methods: Cross-sectional analysis of adult survivors of squamous cell cancer of the oral cavity, oropharynx, and larynx/hypopharynx treated at a single-center, university-affiliated HNC survivorship clinic between August 2018 and March 2021. The primary outcome is Insomnia Severity Index (ISI) score. Multivariable ordinal regression was used to analyze the association between neck disability index (NDI) scores and insomnia.Results: A total of 411 predominantly male(77.9%) survivors with an average age of 63.07±11.53 years, were included in the analysis. Primary cancer sites were oropharynx(48.7%), oral cavity(28.0%), and larynx/hypopharynx(23.3%). Mean ISI and NDI scores were 7.09±6.66(range=0-28) and 8.83±8.06(range=0-38), respectively. After controlling for age, race, treatment modality, tumor site, tumor staging, and time since treatment, the odds of a survivor reporting insomnia was 8.65 times higher in those with mild neck disability(95% OR (4.31, 17.37), p<0.001) and 48.12 times higher in those with moderate to complete neck disability(95% OR (22.35, 103.58), p<0.001) when compared to those with no neck disabilityConclusions: The acute symptom burden of neck disability is shown to be highly associated with insomnia severity. HNC providers should address an array of symptoms for early diagnosis and intervention. Our results support the need for a multidisciplinary care model for post-treatment HNC survivors to facilitate screening, access and early intervention for survivor well-being.
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