Incidence of and Factors Associated With Nonfatal Self-injury After a Cancer Diagnosis in Ontario, Canada

JAMA Otolaryngol Head Neck Surg

Hueniken

Forner

et al. 2023

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ImportanceWhile several studies have documented a link between socioeconomic status and survival in head and neck cancer, nearly all have used ecologic, community-based measures. Studies using more granular patient-level data are lacking.ObjectiveTo determine the association of baseline annual household income with financial toxicity, health utility, and survival.Design, Setting, and ParticipantsThis was a prospective cohort of adult patients with head and neck cancer treated at a tertiary cancer center in Toronto, Ontario, between September 17, 2015, and December 19, 2019. Data analysis was performed from April to December 2021.ExposuresAnnual household income at time of diagnosis.Main Outcome and MeasuresThe primary outcome of interest was disease-free survival. Secondary outcomes included subjective financial toxicity, measured using the Financial Index of Toxicity (FIT) tool, and health utility, measured using the Health Utilities Index Mark 3. Cox proportional hazards models were used to estimate the association between household income and survival. Income was regressed onto log-transformed FIT scores using linear models. The association between income and health utility was explored using generalized linear models. Generalized estimating equations were used to account for patient-level clustering.ResultsThere were 555 patients (mean [SD] age, 62.7 [10.7] years; 109 [20%] women and 446 [80%] men) included in this cohort. Two-year disease-free survival was worse for patients in the bottom income quartile (&lt;$30 000: 67%; 95% CI, 58%-78%) compared with the top quartile (≥$90 000: 88%; 95% CI, 83%-93%). In risk-adjusted models, patients in the bottom income quartile had inferior disease-free survival (adjusted hazard ratio, 2.13; 95% CI, 1.22-3.71) and overall survival (adjusted hazard ratio, 2.01; 95% CI, 0.94-4.29), when compared with patients in the highest quartile. The average FIT score was 22.6 in the lowest income quartile vs 11.7 in the highest quartile. In adjusted analysis, low-income patients had 12-month FIT scores that were, on average, 134% higher (worse) (95% CI, 16%-253%) than high-income patients. Similarly, health utility scores were, on average, 0.104 points lower (95% CI, 0.026-0.182) for low-income patients in adjusted analysis.Conclusions and RelevanceIn this cohort study, patients with head and neck cancer with a household income less than CAD$30 000 experienced worse financial toxicity, health status, and disease-free survival. Significant disparities exist for Ontario’s patients with head and neck cancer.

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Association of Household Income at Diagnosis With Financial Toxicity, Health Utility, and Survival in Patients With Head and Neck Cancer

JAMA Otolaryngol Head Neck Surg

Hueniken

Forner

et al. 2023

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“…The burden of psychologic distress is magnified when considering more common sequelae, such as nonfatal self-injury. We recently investigated rates of nonfatal self-injury in Ontario cancer patients and observed patients with head and neck cancer to be at highest risk [21]. Nonfatal self-injury occurred in three out of everyone 1000 patients.…”

Section: Emotional Distress In Head and Neck Cancermentioning

confidence: 99%

“…In certain subpopulations however, the risk for self-harm was several orders of magnitude higher. Key risk factors included younger age, prior history of psychiatric illness, prior self-injury, and the head and neck disease site [21]. Many of these exposures act synergistically, placing young head and neck cancer patients with a prior mental health history at highest risk [30].…”

Section: Emotional Distress In Head and Neck Cancermentioning

confidence: 99%

Mental health considerations in patients undergoing complex head and neck reconstruction

Philteos

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

Hallet

et al. 2022

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Purpose of reviewTo summarize recent advances in the psycho-oncology literature, with a focus on findings relevant to the head and neck cancer patient. Recent findingsPatients with cancer are at an increased risk of suicide and self-harm. Head and neck cancer patients are among the highest risk compared with other cancer patients. Unique challenges pertaining to disfigurement and voicelessness may, in part, explain these observations. Patient-reported outcome measures can be used to help identify high-risk patients.

“…These adverse effects are often magnified for patients with head and neck cancer (HNC) . In addition to the common toxic effects of cancer treatment, patients with HNC face high rates of speech and swallowing impairments, facial disfigurement, and psychologic distress …”

Section: Introductionmentioning

confidence: 99%

Enhancing Outpatient Symptom Management in Patients With Head and Neck Cancer

JAMA Otolaryngol Head Neck Surg

Baran

et al. 2022

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IMPORTANCEPatients with head and neck cancer manage a variety of symptoms at home on an outpatient basis. Clinician review alone often leaves patient symptoms undetected and untreated. Standardized symptom assessment using patient-reported outcomes (PROs) has been shown in randomized clinical trials to improve symptom detection and overall survival, although translation into real-world settings remains a challenge. OBJECTIVE To better understand how patients with head and neck cancer cope with cancer-related symptoms and to examine their perspectives on standardized symptom assessment. DESIGN, PARTICIPANTS, AND SETTINGThis was a qualitative analysis using semistructured interviews of patients with head and neck cancer and their caregivers from November 2, 2020, to April 16, 2021, at a regional tertiary center in Canada. Purposive sampling was used to recruit a varied group of participants (cancer subsite, treatment received, sociodemographic factors). Drawing on the Supportive Care Framework, a thematic approach was used to analyze the data. Data analysis was performed from November 2, 2020, to August 2, 2021. MAIN OUTCOMES AND MEASURESPatient perception of ambulatory symptom management and standardized symptom assessment. RESULTS Among 20 participants (median [range] age, 59.5 [33-74] years; 9 [45%] female; 13 [65%] White individuals), 4 themes were identified: (1) timely physical symptom management, (2) information as a tool for symptom management, (3) barriers to psychosocial support, and (4) external factors magnifying symptom burden. Participants' perceptions of standardized symptom assessment varied. Some individuals described the symptom monitoring process as facilitating self-reflection and symptom detection. Others felt disempowered by the process, particularly when symptom scores were inconsistently reviewed or acted on. CONCLUSIONS AND RELEVANCEThis qualitative analysis provides a novel description of head and neck cancer symptom management from the patient perspective. The 4 identified themes and accompanying recommendations serve as guides for enhanced symptom monitoring.