BackgroundGiven the potential for older patients to experience exaggerated toxicity and symptoms, this study was performed to characterize patient reported outcomes in older patients following definitive radiation therapy (RT) for oropharyngeal cancer (OPC).MethodsCancer-free head and neck cancer survivors (>6 months since treatment completion) were eligible for participation in a questionnaire-based study. Participants completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). Those patients ≥65 years old at treatment for OPC with definitive RT were included. Individual and overall symptom severity and clinical variables were analyzed.ResultsOf the 79 participants analyzed, 82% were male, 95% white, 41% T3/4 disease, 39% RT alone, 27% induction chemotherapy, 52% concurrent, and 18% both, and 96% IMRT. Median age at RT was 71 yrs. (range: 65–85); median time from RT to MDASI-HN was 46 mos. (2/3 > 24 mos.). The top 5 MDASI-HN items rated most severe in terms of mean (±SD) ratings (0–10 scale) were dry mouth (3.48 ± 2.95), taste (2.81 ± 3.29), swallowing (2.59 ± 2.96), mucus in mouth/throat (2.04 ± 2.68), and choking (1.30 ± 2.38) reported at moderate-severe levels (≥5) by 35, 29, 29, 18, and 13%, respectively. Thirty-nine % reported none (0) or no more than mild (1–4) symptoms across all 22 MDASI-HN symptoms items, and 38% had at least one item rated as severe (≥7). Hierarchical cluster analysis resulted in 3 patient groups: 1) ~65% with ranging from none to moderate symptom burden, 2) ~35% with moderate-severe ratings for a subset of classically RT-related symptoms (e.g. dry mouth, mucus, swallowing) and 3) 2 pts. with severe ratings of most items.ConclusionsThe overall long-term symptom burden seen in this older OPC cohort treated with modern standard therapy was largely favorable, yet a higher symptom group (~35%) with a distinct pattern of mostly local and classically RT-related symptoms was identified.Electronic supplementary materialThe online version of this article doi: (10.1186/s13014-017-0878-9) contains supplementary material, which is available to authorized users.
Background: Breast cancer is the most common cancer in Egyptian females. Most patients present at a late stage with subsequent poor outcomes. Aim: To study the awareness of breast cancer, its risk factors and screening. To investigate the impact of caring for a family member with breast cancer on the awareness and future attitudes of caregivers. Methods: The study included 704 females divided into two groups. A non-caregivers group including 248 participants representing the general population and a caregivers group including 456 family caregivers of breast cancer patients. We used a questionnaire comprised of 45 questions assessing four domains: individual risk factors, awareness of risk factors, awareness of screening, and the practice of and barriers to screening. Those who answered more than 50% of the questions correctly were considered to have good knowledge. Results: Sixty-nine percent of participants showed poor knowledge of risk factors. In the screening awareness domain, only 44% of participants scored >50% indicating defective knowledge. Caregivers attained significantly higher scores in all domains (p<0.001). Yet, the overall assessment showed poor knowledge in both groups. Only 3% of non-caregivers and 19% of caregivers performed mammography (p<0.001); while 11% and 38%, respectively, underwent breast self-examination (p<0.001). Higher education level was associated with significantly better knowledge (p<0.001). Conclusions: Breast cancer knowledge among Egyptian females is deficient. The level of education and caring for a breast cancer patient significantly affect the level of knowledge and attitude towards screening. There is a need to implement a comprehensive national awareness and screening programme.
Background Immune checkpoint inhibitors confer significant clinical benefit by bolstering immune‐system activity, however, they also produce a spectrum of immune‐related adverse events (irAEs). Rapid recognition and timely treatment of these patients is essential for improved outcomes. Methods We conducted a systematic review of English‐language articles in MEDLINE, EMBASE, Web of Science, PubMed, and Cochrane CENTRAL databases on patients with head and neck cancer treated with immune checkpoint inhibitors who developed treatment‐related adverse events. Results Of 1715 unique citations, 11 studies met inclusion criteria. Eight patients with serious irAEs were reported from case reports and case series. Overall, 46 treatment‐related AEs were identified from the pooled 791 patients with at least 12 having potential relevance to irAEs. The most frequent AEs observed in patients receiving PD‐1 inhibitors involved the endocrine, cutaneous, and gastrointestinal systems. Conclusions Characterizing irAEs in longitudinal studies is needed for developing strategies for their prompt recognition and management.
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