The management of head and neck cancer

Wu, K

doi:10.1016/j.mpsur.2009.09.015

Cited by 2 publications

(7 citation statements)

References 4 publications

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Section: Head and Neck Cancer Epidemiologymentioning

confidence: 99%

“…Squamous cell carcinoma (SCC) is the most common malignancy to develop in the head and neck region (Hj Wu, 2009). Traditionally the diagnosis of head and neck SCC has been seen in older males with a history of significant alcohol and tobacco use (Hj Wu, 2009;Marur & Forastiere, 2016). However, despite declining tobacco use, rates of HNC remain high, largely due to a shift in the profile and epidemiology of HNC due to the human papilloma virus (HPV) (Hj Wu, 2009;Marur & Forastiere, 2016;Vokes, Agrawal, & Seiwert, 2015).…”

Section: Head and Neck Cancer Epidemiologymentioning

confidence: 99%

“…Beginning where the skin meets the mucosa at the nasal vestibule and the vermillion borders of the lips and continues through the mouth, pharynx, and larynx to the junction of the cricoid cartilage and the cervical trachea, and where the hypopharynx meets the cervical oesophagus. HNC also includes the salivary glands, thyroid and parathyroid glands, and skin of the head and neck (American Academy of Otolaryngology-Head and Neck Surgery Foundation, 2014; Hj Wu, 2009;National Comprehensive Cancer Network, 2016). Tumours of the upper aero-digestive tract are organised into major sites that may be subdivided to anatomic subsites.…”

Section: Head and Neck Cancer Tumour Sitesmentioning

confidence: 99%

“…Decisions regarding the management of head and neck malignancy are complex and multifactorial. International guidelines dictate that they are best made through a multidisciplinary meeting consisting of a variety of health professionals including otorhinolarygologists (ear nose and throat surgeons), plastic surgeons, maxillofacial surgeons, radiation oncologists, medical oncologists, dentists, palliative care specialists, speech pathologists, and dietitians (Cohen et al, 2016;Hj Wu, 2009;National Comprehensive Cancer Network, 2016; National Institute for Health and Care Excellence, 2016). At these meetings, consensus decisions regarding diagnosis and appropriate treatment plans are presented to the patient for consent in discussion with their family/carer (Hall, 2015).…”

Section: Head and Neck Cancer Treatmentmentioning

confidence: 99%

“…Definitive treatment infers no prior surgical treatment has been conducted and the RT may be given in isolation or in combination with chemotherapy (Argiris, Karamouzis, Raben, & Ferris, 2008a;Hj Wu, 2009). Primary RT is generally prescribed for smaller tumours and given in combination with chemotherapy for larger tumours.…”

Section: Definitive Radiotherapy Treatmentmentioning

confidence: 99%

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Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

Moroney¹

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The management of head and neck cancer (HNC) using radiotherapy +/-chemotherapy (C)RT is associated with significant morbidity, due to key structures required for speech, swallowing, respiration, and voice falling within the treatment field. Common sequelae of non-surgical treatment include a wide range of toxicities, though dysphagia (swallowing difficulty) is particularly prominent. Dysphagia may be a short-term acute toxicity, or persist long-term, and can have a significant negative impact on quality of life. With recent advancements in technology, new conformal radiotherapy techniques such as helical intensity modulated radiotherapy (H-IMRT) have been introduced into clinical practice. Such techniques offer potential to limit the radiation exposure to non-cancerous normal tissues, and potentially reduce associated treatment toxicities -whilst maintaining cure rates. However as yet, there is limited literature documenting the incidence, severity, and pattern of treatment related toxicities, including dysphagia, associated with H-IMRT +/-chemotherapy, to support if such improvements for the patient are realised. Understanding how patients are impacted by new treatment approaches is crucial information for speech pathology services, that manage the dysphagia and related toxicities of patients. Therefore, the overall objective of this thesis was to evaluate the incidence and severity of dysphagia and related toxicities of patients undergoing H-IMRT +/-chemotherapy to inform speech pathology management practices. A secondary objective was to use this information to develop, and then evaluate a new clinical pathway of care. These objectives were addressed in a series of 4 studies.Study 1 (Chapter 2) prospectively examined the range of dysphagia and related toxicities from baseline to 12 weeks post H-IMRT +/-chemotherapy for a heterogeneous cohort of patients with mixed tumour sites and stages. A high proportion of patients were found to continue to experience grade 2-3 toxicity that peaked in the final week of treatment. Symptoms consistently improved thereafter, with the majority better than baseline by 12 weeks post-treatment.Concurrent chemotherapy at least doubled the odds of experiencing most symptoms. The findings of Chapter 2 confirmed that despite advancements in radiotherapy technique, patients iv The findings, clinical implications, limitations, and future areas of research are discussed in Chapter 6 of this thesis. In conclusion, this thesis provides information detailing the incidence, severity, and temporal pattern of dysphagia and related toxicities experienced by patients with HNC undergoing H-IMRT +/-chemotherapy to optimise supportive care and enhance patient education. These findings can be used to inform the timing and intensity of patient centred speech pathology service delivery models that meet the specific needs of patient subgroups and can form the basis of future guidelines for speech pathology support. v

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Section: Head and Neck Cancer Epidemiologymentioning

confidence: 99%

Section: Head and Neck Cancer Epidemiologymentioning

confidence: 99%

Section: Head and Neck Cancer Tumour Sitesmentioning

confidence: 99%

Section: Head and Neck Cancer Treatmentmentioning

confidence: 99%

Section: Definitive Radiotherapy Treatmentmentioning

confidence: 99%

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Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

Moroney¹

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A time-dependent subdistribution hazard model for major dental treatment events in cancer patients: a nationwide cohort study

Han

Park²,

Yoon³

et al. 2023

BMC Oral Health

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Background Dental care in cancer patients tends to be less prioritized. However, limited research has focused on major dental treatment events in cancer patients after the diagnosis. This study aimed to examine dental treatment delays in cancer patients compared to the general population using a national claims database in South Korea. Method The Korea National Health Insurance Service-National Sample Cohort version 2.0, collected from 2002 to 2015, was analyzed. Treatment events were considered for stomatitis, tooth loss, dental caries/pulp disease, and gingivitis/periodontal disease. For each considered event, time-dependent hazard ratios and associated 95% confidence intervals were calculated by applying a subdistribution hazard model with time-varying covariates. Mortality was treated as a competing event. Subgroup analyses were conducted by type of cancer. Results The time-dependent subdistribution hazard ratios (SHRs) of stomatitis treatment were greater than 1 in cancer patients in all time intervals, 2.04 within 30 days after cancer diagnosis, and gradually decreased to 1.15 after 5 years. The SHR for tooth loss was less than 0.70 within 3 months after cancer diagnosis and increased to 1 after 5 years. The trends in SHRs of treatment events for other dental diseases were similar to those observed for tooth loss. Subgroup analyses by cancer type suggested that probability of all dental treatment event occurrence was higher in head and neck cancer patients, particularly in the early phase after cancer diagnosis. Conclusion Apart from treatments that are associated with cancer therapy, dental treatments in cancer patients are generally delayed and cancer patients tend to refrain from dental treatments. Consideration should be given to seeking more active and effective means for oral health promotion in cancer patients.

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The management of head and neck cancer

Cited by 2 publications

References 4 publications

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

A time-dependent subdistribution hazard model for major dental treatment events in cancer patients: a nationwide cohort study

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