Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients

Michaelsen, Sanne Høxbroe; Larsen, Christian Grónhøj; Michaelsen, Jacob Høxbroe; Friborg, Jeppe

doi:10.1016/j.ejca.2017.03.006

Cited by 146 publications

(116 citation statements)

References 80 publications

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“…3–6 Oral manifestations contribute to disability, increased costs, and a diminished quality of life. 4;7;8 It has been suggested that efforts to minimize the long-term manifestations of dental caries and ORN may be minimized with appropriate pre-RT dental care. 2 …”

Section: Introductionmentioning

confidence: 99%

Dental disease before radiotherapy in patients with head and neck cancer

Brennan¹,

Treister²,

Sollecito³

et al. 2017

The Journal of the American Dental Association

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Background No evidence-based guidelines exist for preventive dental care before radiation therapy (RT) in head and neck cancer (HNC) patients. An ongoing multicenter, prospective cohort study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad) (1U01DE022939-01), is addressing this knowledge gap. The present manuscript evaluates the level of pre-RT dental disease in the OraRad cohort, factors associated with dental disease, and dental treatment recommendations made pre-RT. Methods As part of OraRad, caries, periodontal disease, dental recommendations, and dental interventions performed pre-RT were assessed. Results Baseline measures are reported for 356 participants (77% male) with mean (SD) age 59.9 (11.0) years. Measures included mean number of teeth (22.9), participants with at least one tooth with caries (37.2%), and participants with at least 1 tooth with probing depth ≥5 mm (47.4%). Factors associated with less extensive pre-RT dental disease included having at least a high school diploma, having dental insurance, history of routine dental care, and a smaller tumor size (T1 or T2). Based on the pre-RT dental examination, 163 (49.5%) participants had dental treatment recommended before RT, with extractions recommended most frequently. Conclusion Many HNC patients require dental treatment pre-RT; over one-third require extractions. Practical Implications Most HNC patients have some level of dental disease at the start of RT, indicating the importance of pre-RT dental evaluation. By observing dental outcomes post-RT, OraRad has the potential to determine best dental treatment recommendations for HNC patients.

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Section: Introductionmentioning

confidence: 99%

Dental disease before radiotherapy in patients with head and neck cancer

Brennan¹,

Treister²,

Sollecito³

et al. 2017

The Journal of the American Dental Association

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“…46 In addition, tonsillectomy has its own inherent risks (life-threatening or catastrophic bleeding), and therefore optimizing the ability to predict the patient's risk of developing HPVdriven OPC becomes paramount, as does demonstrating that the benefits outweigh the harms (including considerations of quality of life and cost-effectiveness). 54 Some of the more severe complications include speech and swallowing dysfunction, feeding tube dependence, disfigurement/body image alterations, physiologic distress, depression, lack of nutrition/resumption of normal diet, mucositis, and infectious complications. 47 Indeed, should efficacious therapeutic vaccines with minimal side effects become available, they may provide an opportunity to treat HPV-16 E6-seropositive individuals and prevent the development of invasive OPC tumors.…”

Section: Treatment Of Early (Nonsymptomatic) Lesionsmentioning

confidence: 99%

“…Currently, morbidity due to the treatment of OPC is extensive. 54 Some of the more severe complications include speech and swallowing dysfunction, feeding tube dependence, disfigurement/body image alterations, physiologic distress, depression, lack of nutrition/resumption of normal diet, mucositis, and infectious complications. Because these survivors of OPC hopefully will live for decades after treatment, the goal of screening would be to increase early-stage detection, which in turn would reduce treatment morbidity, improve posttreatment quality of life, and further improve survival.…”

Section: Treatment Of Early (Nonsymptomatic) Lesionsmentioning

confidence: 99%

Screening for human papillomavirus‐driven oropharyngeal cancer: Considerations for feasibility and strategies for research

Kreimer

Shiels

Fakhry

et al. 2018

Cancer

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INTRODUCTIONOver the past 25 years, human papillomavirus (HPV) has been shown to be an important cause of oropharyngeal cancers (OPCs) in many world regions, with the great majority of HPV-driven OPC being caused by HPV type 16 (HPV-16). 1 HPV currently is overtaking tobacco exposure as the leading cause of OPC in some countries with a high human development index, including the United States and some European and Latin American countries, in which both the incidence rate of OPC and the attributable fraction (AF) of HPV are rising. 2 In the United States, the incidence of OPC currently is greater than that of cervical cancer, a consequence of the increasing incidence of OPC as well as reductions in the incidence of cervical cancer due to the success achieved by screening. 3 This shift highlights the need for parallel preventive measures. Nevertheless, arguments against additional research regarding HPV-driven OPC screening have been made and include the promise of primary prevention through HPV vaccination, 4 the currently low incidence rates, 5 and favorable outcomes with current therapy compared with non-HPV-driven head and neck cancers. 6 The lack of an identifiable clinical precursor lesion, insufficient diagnostic technology with which to detect small lesions, and the absence of de-escalated clinical management for patients with early-stage cancer or precancer are current barriers to screening for OPC. This article is not intended to address all the questions related to the validity and timeliness of screening for HPV-driven OPC but instead to raise important questions, guide discussions, highlight deficits and/or confusion in the existing literature, and propose needed steps in the research agenda. The following general aspects of a screening program are considered 7 and applied to HPV-driven OPC: 1) a sufficiently high incidence, either in the general population or an enriched high-risk population; 2) a sensitive and specific screening tool or biomarker; 3) appropriate methods for accurately diagnosing the cancer (or precancer) among individuals who screen positive; 4) effective treatment for patients with early-stage lesions; and 5) evidence of mortality and/or morbidity reductions.

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“…3,[8][9][10] Patients are commonly younger, with less comorbidity and have a better prognosis. 17 Smaller cohort studies report that patients with HPV+ tumors have a tendency of presenting with later DP, with dissemination to multiple organs, 18 and with metastases to end-organs specific for patients with HPV+ tumors such as the brain, the skin, and the nonregional lymph nodes [19][20][21] although this is controversial. 17 Smaller cohort studies report that patients with HPV+ tumors have a tendency of presenting with later DP, with dissemination to multiple organs, 18 and with metastases to end-organs specific for patients with HPV+ tumors such as the brain, the skin, and the nonregional lymph nodes [19][20][21] although this is controversial.…”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] Distant progression (DP) in most cancers as well as in OPSCC is associated with severely poor outcomes, [14][15][16] and treatment is associated with considerably compromised quality of life. 17 Smaller cohort studies report that patients with HPV+ tumors have a tendency of presenting with later DP, with dissemination to multiple organs, 18 and with metastases to end-organs specific for patients with HPV+ tumors such as the brain, the skin, and the nonregional lymph nodes [19][20][21] although this is controversial. Knowledge of incidence, timing, and anatomical location stratified on patients with HPV+ and HPV− tumors have not been systematically reviewed, and information remains sparse.…”

Section: Introductionmentioning

confidence: 99%

Systematic review on location and timing of distant progression in human papillomavirus‐positive and human papillomavirus‐negative oropharyngeal squamous cell carcinomas

2018

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Distant progression (DP) in oropharyngeal squamous cell carcinoma (OPSCC) has significant impact on morbidity and mortality. This study systematically reviewed the literature on studies reporting location and timing of DP after human papillomavirus (HPV)+ or HPV− OPSCCs. PubMed, EMBASE, and the Cochrane Library were systematically searched for studies reporting DP in patients treated with curative intend for an OPSCC. Outcome was site of and time to DP stratified on HPV‐status. Seven studies (n = 1564; 77% HPV+) were included in which 313 patients (20%) developed a DP (70% HPV+). The most common site of DP was the lungs (n = 232) regardless of HPV‐status. Patients with HPV+ tumors were more prone to dissemination involving multiple sites (risk ratio = 16.49). There was no difference in time to DP when stratified on HPV‐status (P = .10). The pattern of but not time to DP was significantly different in patients with OPSCC when stratified on HPV‐status.

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Quality of life in survivors of oropharyngeal cancer: A systematic review and meta-analysis of 1366 patients

Cited by 146 publications

References 80 publications

Dental disease before radiotherapy in patients with head and neck cancer

Dental disease before radiotherapy in patients with head and neck cancer

Screening for human papillomavirus‐driven oropharyngeal cancer: Considerations for feasibility and strategies for research

Systematic review on location and timing of distant progression in human papillomavirus‐positive and human papillomavirus‐negative oropharyngeal squamous cell carcinomas

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