Background Speech and swallowing problems due to velopharyngeal incompetence may follow soft palate resection and reconstruction. Over the past 3 years, we have developed the use of a superiorly based pharyngeal flap in conjunction with a radial forearm flap for soft palate reconstruction. Methods This paper describes the technique in detail and compares the functional results in a study with patients undergoing soft palate resection for squamous cell carcinoma treated with or without a pharyngeal flap as an adjunct to a radial forearm free flap for soft palate reconstruction. Seven patients had one quarter or one half soft palate defects reconstructed with a radial forearm flap alone. Of the 11 patients undergoing three quarter or total soft palate resections, all were reconstructed with a radial forearm flap, but 5 were treated with an additional superiorly based pharyngeal flap. The functional outcome for all the patients was analyzed and compared. Results Our results show that the addition of the superiorly based pharyngeal to the radial forearm flap in soft palate reconstruction results in improved speech and swallowing. We recommend the use of the additional flap in resections in which more than one quarter of the soft palate is included. © 1997 John Wiley & Sons, Inc. Head Neck 19:524–534, 1997.

BackgroundHead and neck cancer is an important cause of ill health. Survival appears to be improving but the reasons for this are unclear. They could include evolving aetiology, modifications in care, improvements in treatment or changes in lifestyle behaviour. Observational studies are required to explore survival trends and identify outcome predictors.MethodsWe are identifying people with a new diagnosis of head and neck cancer. We obtain consent that includes agreement to collect longitudinal data, store samples and record linkage. Prior to treatment we give participants three questionnaires on health and lifestyle, quality of life and sexual history. We collect blood and saliva samples, complete a clinical data capture form and request a formalin fixed tissue sample. At four and twelve months we complete further data capture forms and send participants further quality of life questionnaires.DiscussionThis large clinical cohort of people with head and neck cancer brings together clinical data, patient-reported outcomes and biological samples in a single co-ordinated resource for translational and prognostic research.

Objectives: Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of bisphosphonates (BP). Although the risk of ONJ increases with increasing duration of BP treatment, there are currently no reliable estimates of the ONJ time to onset (TTO). The objective of this study was to estimate the TTO and associated risk factors in BP-treated patients. Subjects and methods:Retrospective analysis of data from 22 secondary care centres in 7 countries relevant to 349 patients who developed BP-related ONJ between 2004 and 2012. Results:The median (95%CI) TTO was 6.0 years in patients treated with alendronate (n = 88) and 2.2 years in those treated with zoledronate (n = 218). Multivariable Cox regression showed that dentoalveolar surgery was inversely associated, and the use of antiangiogenics directly associated, with the TTO in cancer patients treated with zoledronate. Accepted ArticleThis article is protected by copyright. All rights reserved. Conclusions:The incidence of ONJ increases with the duration of BP therapy, with notable differences observed with respect to BP type and potency, route of administration and underlying disease. When data are stratified by BP type, a time of 6.0 and 2.2 years of oral alendronate of intravenous zoledronate therapy, respectively, is required for 50% of patients to develop ONJ. After stratification by disease, a time of 5.3 and 2.2 years of BP therapy is required for 50% of patients with osteoporosis and cancer, respectively, to develop ONJ. These findings have significant implications for the design of future clinical studies and the development of risk reduction strategies aimed at either assessing or modulating the risk of ONJ associated with BP.

Diagnosis of differentiated thyroid carcinoma (papillary or follicular) and its treatment may be associated with a poor health-related quality of life (HRQoL), and with fear of recurrence (FoR), and distress. To our knowledge, this is the first time a single FoR screening question (written to complement a HRQoL questionnaire), has been reported with HRQoL and levels of distress in patients treated for the disease. In April 2014 we did a cross-sectional survey of patients who had presented to the Merseyside and Cheshire thyroid cancer network between April 2009 and November 2013. Questionnaires comprised the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, the THYCA-QoL, the Emotion Thermometers, and the new FoR screening item. A total of 249 surveys were sent and 169 patients responded (68%). The most prevalent issues included tiredness, problems with sleep and needing to rest, pain (particularly in muscles and joints), a dry mouth, hot flushes and tolerating heat, gaining weight, and feeling slowed down or weak; also, having trouble taking long walks or doing strenuous activities, feeling tense, worried, irritable, and anxious, and having difficulty remembering things. One in seven patients (95% CI 9% to 21%) responded to the single FoR question that they "had a lot of fears of recurrence that really preoccupied their thoughts" or were "fearful all the time that their cancer might return and that they struggled with this". Distress overall was relatively low. In conclusion, the HRQoL issues reported by these patients were different from those reported by patients with other cancers of the head and neck. It would be helpful to identify FoR in a subgroup of patients with differentiated thyroid cancer so that they could be given additional support.

The present study aimed to establish exercise preferences, barriers, and perceived benefits among head and neck cancer survivors, as well as their level of interest in participating in an exercise program. Patients treated for primary squamous cell carcinoma of the head and neck between 2010 and 2014 were identified from the hospital database and sent a postal questionnaire pack to establish exercise preferences, barriers, perceived benefits, current physical activity levels, and quality of life. A postal reminder was sent to non-responders 4 weeks later. The survey comprised 1021 eligible patients of which 437 (43%) responded [74% male, median (interquartile range) age, 66 (60–73) years]. Of the respondents, 30% said ‘Yes’ they would be interested in participating in an exercise program and 34% said ‘Maybe’. The most common exercise preferences were a frequency of three times per week, moderate-intensity, and 15–29 min per bout. The most popular exercise types were walking (68%), flexibility exercises (35%), water activites/swimming (33%), cycling (31%), and weight machines (19%). Home (55%), outdoors (46%) and health club/gym (33%) were the most common preferred choices for where to regularly exercise. Percieved exercise benefits relating to improved physical attributes were commonly cited, whereas potential social and work-related benefits were less well-acknowledged. The most commonly cited exercise barriers were dry mouth or throat (40%), fatigue (37%), shortness of breath (30%), muscle weakness (28%) difficulty swallowing (25%), and shoulder weakness and pain (24%). The present findings inform the design of exercise programs for head and neck cancer survivors.

Suggestions for future directions include (1) to use and utilize validated instruments tailored to clinical practice; (2) to develop a comprehensive measurement of surgical outcome requiring the combination of objective and subjective measures; (3) to aim for a compromise between these two competing considerations in the form of a scale incorporating both generalizability in cancer-related QOL and specificity in breast cancer issues.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It identifies the current evidence base and role of health-related quality of life assessment for this group of patients.Recommendations• Health-related quality of life is integral to treatment planning, refining treatment protocols, and more personalised follow-up support. (G)• Health-related quality of life and patient concerns should be regularly assessed during patient care. (G)• Health-related quality of life assessment and patient concerns on an individual patient basis can be helpful to trigger multi-professional support and interventions. (G)

Abstract:Background. The purpose of this study was to investigate the disease specific functional status of patients with oral cancer treated by primary surgery. The University of Washington head and neck cancer questionnaire (UW-QOL) was used, and outcome was compared against patient's age, sex, T category, site, surgical procedure, and adjuvant radiotherapy.Methods. In the year 1995, consecutive patients with previously untreated squamous cell carcinoma of the oral region were recruited. Questionnaires were given at four time intervals: preoperatively and at 3, 6, and 12 months.Results. Fifty patients underwent primary surgery for oral cancer between 4 January and 12 December 1995. Of 48 patients recruited, 41 (85%) had microvascular free tissue reconstruction. Patients with T category 3 or 4 tumors tended to report more severe problems than did patients with T category 1 or 2 tumors; this was especially true for increased pain (p < .001). There was a marked fall in cumulative UW-QOL scores by 3 months, with some recovery to 12 months. Of the initial 48 patients, 29 (60%) were alive and disease free at 1 year, and there were 25 completed questionnaires. The trend at 1 year was for better scores in women, T category 1 and 2, anterior oral cavity, primary closure/laser treatments, and patients not requiring adjuvant radiotherapy.Conclusions. Patients undergoing surgery for oral cancer have a profound fall in quality of life scores by 3 months, and their scores approach pretreatment levels by 12 months. Clinical parameters are useful in predicting trends in UW-QOL outcome at 1 year and are also associated with differences in individual domain scores.