Influence of pretreatment social support on health-related quality of life in head and neck cancer survivors: results from a prospective study. Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer. Frailty and malnutrition predictive of mortality risk in older patients with advanced colorectal cancer receiving chemotherapy. Health-related quality of life in head and neck cancer survivors: impact of pretreatment depressive symptoms. Polaprezinc prevents oral mucositis associated with radiochemotherapy in patients with head and neck cancer Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging. Prediction of survival by pretreatment health-related quality-of-life scores in a prospective cohort of patients with head and neck squamous cell carcinoma. Can a person-centred-care intervention improve health-related quality of life in patients with head and neck cancer? A randomized, controlled study Quality of life in head and neck cancer patients after treatment with high-dose radiotherapy alone or in combination with cetuximab. RADIATION-INDUCED MUCOSITIS IN PATIENTS WITH HEAD AND NECK CANCER: SHOULD THE SIGNS OR THE SYMPTOMS BE MEASURED? Index-based dietary patterns and risk of head and neck cancer in a large prospective study. Operationalizing a frailty index from a standardized comprehensive geriatric assessment. Long-term health-related quality of life in survivors of head and neck cancer. The association between oral health and general health and quality of life in older male cancer patients. Changes in quality of life over 1 year in patients with head and neck cancer. Maintaining physical activity during head and neck cancer treatment: Results of a pilot controlled trial. Dietary fiber and grain consumption in relation to head and neck cancer in the NIH-AARP Diet and Health Study Quality of life and performance in advanced head and neck cancer patients on concomitant chemoradiotherapy: a prospective examination. Quality-of-life (QOL) outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiation therapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT): evidence from a prospective randomized study. Older People's Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up. A prospective cohort study on older outpatients living in the community in Italy More Than 10% Weight Loss in Head and Neck Cancer Patients During Radiotherapy Is Independently Associated with Deterioration in Quality of Life Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. A Tailored Smoking, Alcohol, and Depression Intervention for Head and Neck Cancer Patients
BACKGROUND Head and neck cancer and its treatment can have considerable impact on health-related quality of life ( HRQOL ) . The present study investigated whether social support , assessed before treatment , predicted HRQOL outcomes up to 12 months later in head and neck cancer survivors . METHODS Using a prospect i ve longitudinal design , patients ( n = 364 ) were assessed on several clinical and psychosocial characteristics at diagnosis and then at 3- and 12-month follow-up appointments . HRQOL was assessed with the Short Form Health Survey ( SF-36 ) and the Head and Neck Cancer Inventory ( HNCI ) .  RESULTS Hierarchical multiple regression analyses demonstrated that greater perceived support present at diagnosis significantly predicted more favorable global and head and neck cancer-specific HRQOL at 3- and 12-month follow-up . CONCLUSION Results suggest that adequate social support at diagnosis can have a significant , positive impact on HRQOL in head and neck cancer survivors . Thus , it may be useful to evaluate support re sources at diagnosis in order to identify individuals at risk for poor HRQOL outcomes OBJECTIVE To assess toxicities , functional outcomes , and health-related quality of life associated with concurrent chemoradiation therapy ( CRT ) in patients with head and neck cancer . DESIGN Prospect i ve and retrospective outcomes study . SETTING Tertiary care institution . PATIENTS Participants in the longitudinal Outcomes Assessment Project whose head and neck cancer was treated with CRT between February 1 , 2000 , and March 1 , 2007 ( n = 104 ) . INTERVENTIONS Patients prospect ively provided functional and health-related quality of life information , including data from the 1-year and most current follow-up visits . Medical records were review ed to determine toxicity and survival rates . MAIN OUTCOME MEASURES Well-defined acute and late toxicities ; functional outcomes ( diet , dentition , tracheostomies ) ; head and neck cancer-specific , general health , and depression outcomes ; and survival rates . RESULTS Most patients had oropharyngeal or laryngeal tumors ( 87.5 % ) and advanced-stage disease ( 75.0 % ) . Approximately one-half had hematologic toxicities and toxicity-related treatment delays . Approximately one-quarter had neurotoxicities and /or ototoxicites , moist desquamation , pneumonia , nausea and vomiting requiring hospitalization or intravenous fluids , dehydration or malnutrition requiring hospitalization , and mild or moderate fever . Although patients receiving the current intensity-modulated radiation therapy ( IMRT ) protocol using the Pinnacle(3 ) planning system had more toxicity-related treatment delays , they had fewer toxicities and better functional and health-related quality of life outcomes compared with those receiving conventional lateral opposing-field radiation or the initial IMRT protocol using the Best nomos PEACOCK planning system . CONCLUSIONS Patients receiving CRT  experience a substantial number of treatment-related adverse events , primarily affecting oropharyngeal and laryngeal function , with improvement noted for the current IMRT protocol . Improving dental prosthetic rehabilitation and including evaluations with speech and swallowing pathologists before and during treatment may enhance patient outcomes INTRODUCTION In general , geriatric assessment ( GA ) provides the combined information on comorbidity and functional , nutritional and psychosocial status and may be predictive for mortality outcome of cancer patients . The impact of geriatric assessment on the outcome of older patients with colorectal cancer treated with chemotherapy is largely unknown . METHODS In a prospect i ve study , 143 patients with colorectal cancer who were 70years and older were assessed before chemotherapy  by Mini Nutritional Assessment ( MNA ) , Informant Question naire on Cognitive Decline in the Elderly ( IQCODE ) , Groningen Frailty Indicator ( GFI ) and Mini Mental State Examination ( MMSE ) . RESULTS Fifty-four ( 38 % ) patients received adjuvant chemotherapy and 89 ( 62 % ) patients received palliative chemotherapy .  Malnutrition and frailty were prevalent in 39 ( 27 % , assessed by MNA ) and 34 ( 24 % , by GFI ) patients , respectively ; whereas cognitive impairment was prevalent in 19 ( 13 % , by IQCODE ) and 11 ( 8 % , by MMSE ) patients , respectively . In patients with palliative chemotherapy , poor MNA scores were associated with receiving less than 4cycles of chemotherapy ( p=0.008 ) . Poor MNA and GFI scores were associated with increased hazard ratios ( HR ) for mortality for patients with palliative chemotherapy : HR=2.76 ( 95 % confidence interval [ CI ] : 1.60 - 4.77 ; p<0.001 ) and HR=2.72 ( 95 % CI : 1.58 - 4.69 ; p<0.001 ) , respectively , after adjustment for several clinical parameters . CONCLUSIONS Malnutrition and frailty were strongly associated with an increased mortality risk in patients who underwent palliative chemotherapy . Furthermore , a poor score on MNA was predictive for less tolerance of chemotherapy . Our findings may help the oncologist in future decision making and advice for elderly patients with colorectal cancer OBJECTIVE Symptoms of depression are common in those with cancer . The authors investigated whether depressive symptoms assessed before the initiation of cancer treatment predicted diminished health-related quality of life ( HRQOL ) at follow-up . DESIGN As part of a large , prospect i ve study of oncologic outcomes , 306 patients with head and neck cancer ( HNC ) were assessed on several clinical and psychosocial characteristics during a pretreatment clinic visit and then at 3- and 12-month follow-up appointments . MAIN OUTCOME MEASURES Depressive symptomatology was assessed with the  Beck Depression Inventory  and HNC-specific HRQOL ( main outcome measure ) was assessed with the  Head and Neck Cancer Inventory .  RESULTS Controlling for age , gender , marital status , cancer site , stage of disease , alcohol and tobacco use , comorbidity status , and pretreatment HRQOL , simultaneous multiple regression analyses revealed that depressive symptoms present at study enrollment , before the initiation of cancer treatment , significantly predicted lower HRQOL at 3- and 12-month follow-up assessment s across the 4 HNC-specific domains of speech , eating , aesthetics , and social disruption ( all ps < or= .01 ) . CONCLUSION Results suggest that depressive symptomatology present near the time of diagnosis can have a significant , deleterious impact on HRQOL over time in HNC survivors . Thus , it may be useful to assess depression at diagnosis to identify individuals at greater risk for poor HRQOL outcomes Oral mucositis is frequent but serious adverse event associated with radiotherapy or radiochemotherapy in head and neck cancer severely impairs health‐related quality of life , leading to poor prognosis due to discontinuation of the therapy . Although a number of compounds have been tested for prophylaxis of oral mucositis , few of them are satisfactory . We investigated the effect of polaprezinc ( zinc L‐carnosine ) , a gastric mucosal protective drug , on radiochemotherapy‐induced oral mucositis , pain , xerostomia and taste disturbance in patients with head and neck cancer . Patients were r and omly assigned to receive polaprezinc ( n = 16 ) or azulene oral rinse as the control ( n = 15 ) . The incidence rates of mucositis , pain , xerostomia and taste disturbance were all markedly lower in polaprezinc group than in control . Moreover , the use of analgesics was significantly ( p = 0.003 ) less frequent and the amount of food intake was significantly ( p = 0.002 ) higher in polaprezinc group than in control . On the other h and , tumor response rate in  patients with neoadjuvant radiochemotherapy was not significantly affected by polaprezinc , in which the response rate ( complete plus partial response ) was 88 % for polaprezinc and 92 % for control ( p = 1.000 ) . Therefore , it is highly assumable that polaprezinc is potentially useful for prevention of oral mucositis and improvement of quality of life without reducing the tumor response BACKGROUND Frailty and fitness are important attributes of older persons , but population sample s of their prevalence , attributes , and outcomes are limited . METHODS The authors report data from the community-dwelling sample ( n = 9008 ) of the Canadian Study of Health and Aging , a representative , 5-year prospect i ve cohort study . Fitness and frailty were determined by self-reported exercise and function level and testing of cognition . RESULTS Among the community-dwelling elderly population , 171 per 1000 were very fit and 12 per 1000 were very frail . Frailty increased with age , so that by age 85 years and older , 44 per 1000 were very frail . The risk for adverse health outcomes increased markedly with frailty : Compared with older adults who exercise , those who were moderately or severely frail had a relative risk for institutionalization of 8.6 ( 95 % confidence interval , 4.9 to 15.2 ) and for death of 7.3 ( 95 % confidence interval , 4.7 to 11.4 ) . These risks persist after adjustments for age , sex , comorbid conditions , and poor self-rated health . At all ages , men reported higher levels of exercise and less frailty compared with women . Decreased fitness and increased frailty were also associated with poor self-ratings of health ( 42 % in the most frail vs 7 % in the most fit ) , more comorbid illnesses ( 6 vs 3 ) , and more social isolation ( 34 % vs 29 % ) . CONCLUSIONS Fitness and frailty form a continuum and predict survival .  Exercise influences survival , even in old age . Relative fitness and frailty can be determined quickly in a clinical setting , are potentially useful markers of the risk for adverse health outcomes , and add value to traditional medical assessment s that focus on diagnoses OBJECTIVE To evaluate the association between pretreatment health-related quality -of-life ( HRQOL ) scores and survival in a heterogeneous cohort of patients with newly diagnosed head and neck squamous cell carcinoma ( HNSCC ) . DESIGN Prospect i ve cohort study . SETTING University hospital and referral center in Western Norway . PATIENTS A total of 106 patients with intact cognitive functioning who were younger than 78 years , were diagnosed as having HNSCC , and underwent treatment with curative intent from November 1 , 2002 , through June 30 , 2005 . MAIN OUTCOME MEASURES Overall survival and HRQOL scores obtained at the time of diagnosis . RESULTS All dichotomized HRQOL sum scores except the functional score ( P = .20 ) were significantly predictive of survival in univariate analyses . The hazard ratios of the dichotomized general symptom , global quality -of-life , and head and neck sum score were 3.66 , 0.31 , and 2.28 , respectively . All sum scores except the dichotomized functional score remained predictive of survival after sequential adjustment for sociodemographic and clinical characteristics , neuroticism , choice of psychological coping , current smoking and alcohol consumption , and comorbidities . Similar findings were found for specific HRQOL indices of physical functioning , dyspnea , sleep disturbance , appetite loss , swallowing , and social eating from the European Organization for Research and Treatment of Cancer 30-Item Core Quality of Life Question naire , version 3.0 , and the Quality of Life-Head and Neck Cancer Module . Moreover , patients in the highest scoring quartiles for the symptom sum scores and /or the lowest scoring quartile for the global score had overall mortality rates of 50 % to 64 % compared with 23 % to 26 % among the other patients . CONCLUSION The HRQOL sum scores and specific indices among HNSCC patients predict survival independently of established known prognostic factors Background The incidence of head and neck cancer is increasing slightly . Head and neck cancer but also it ’s necessary and often successful treatment may affect general domains of health-related quality of life and provoke a variety of adverse symptoms and side effects , both during and after treatment . The objective of this study was to compare a person-centred care intervention in terms of health-related quality of life , disease-specific symptoms or problems , with traditional care as a control group for patients with head and neck cancer . Methods In this r and omized controlled trial ,  person – centred-care intervention and traditional care ( control ) groups comprised 54 and 42 patients , respectively . Outcome measures used were : the EORTC QLQ-C30 and the EORTC QLQ-C35 . Both groups answered the question naires at baseline and after 4 , 10 , 18 and 52 weeks from start of treatment . The question naires ’ scores were compared between groups by using independent sample s test and non-parametric test for continuous variables . For categorical data , Fisher ’s exact test was used . Longitudinal data were analysed using generalized linear models for normally distributed repeated measures data . Results At baseline , the intervention and control groups were comparable in terms of medical and sociodemographic variables , clinical characteristics , health-related quality of life and disease-specific symptoms or problems . At all the follow-up points , even during the worst period for the patients , the person-centred-care group consistently reported better scores than the control group . The differences were numerically but not always statistically significant . When testing longitudinal data , statistically significant results were found for head and neck cancer-specific problems , swallowing ( p = 0.014 ) , social eating ( p = 0.048 ) and feeling ill ( p = 0.021 ) . Conclusions The results from this study suggest that adopting the person-centred-care concept practice d here could be a way to improve function and wellbeing in patients with head and neck cancer . Trial registration The study was retrospectively registered in 2016 - 12 - 05 in Clinical Trials gov . “ Can a Person-centred-care Intervention Improve Health-related Quality of Life in Patients With Head and Neck Cancer ” registration number : NCT02982746 PURPOSE In this r and omized , phase III study , quality of life ( QoL ) was assessed in patients with locoregionally advanced squamous cell carcinoma of the head and neck ( SCCHN ) after high-dose radiotherapy alone or in combination with cetuximab .  PATIENTS AND METHODS Patients with stage III or IV nonmetastatic and measurable squamous cell carcinoma of the oropharynx , hypopharynx , or larynx were eligible .  QoL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ( EORTC QLQ-C30 ) and EORTC QLQ Head and Neck Cancer-Specific Module at baseline , week 4 , and at months 4 , 8 , and 12 postbaseline . RESULTS In this study , one of the largest conducted in a population of patients with locoregionally advanced SCCHN , 424 patients received radiotherapy alone ( 213 patients ) or radiotherapy plus cetuximab ( 211 patients ) .  Radiotherapy/cetuximab significantly improved locoregional control ( P = .005 ) and overall survival ( P = .03 ) compared with radiotherapy alone , without significantly increasing radiotherapy-associated adverse events . The current analysis focused on the impact of cetuximab on the QoL. Compliance with completion of QoL question naires was high in both arms . QoL worsened during treatment and improved after cessation of treatment , reaching baseline levels at 12 months . There were no significant differences in QoL scores between the treatment arms . This was particularly notable for global health status/QoL , social functioning , social eating , and social contact . Pretreatment global health status/QoL was identified as a significant prognostic variable in these patients . CONCLUSION The addition of cetuximab to radiotherapy significantly improved locoregional control and increased overall survival without adversely affecting OBJECTIVE To improve underst and ing of how patient-reported outcomes following radiation therapy for head and neck cancer may be influenced by factors beyond the local effects of the radiotherapy . METHODS Initially , 50 patients with head and neck cancer who were scheduled to undergo radiation therapy consented to participate in this prospect i ve observational study . The participants underwent an oral examination before commencement of therapy and twice weekly over the therapy period . The 33 participants who finished the therapy underwent one more examination 4 to 6 weeks after its completion . At each session , clinical signs of oral mucositis were recorded with  clinician-based scoring tools  , and participants completed a question naire based on a visual analogue scale to record the perceived degree of impairment of common oral functions caused by oral mucositis . The strength of the correlation between these signs and symptoms at various points throughout the study period was appraised using a linear mixed model with robust repeated measures . The study participants with the most extensive manifestations of oral mucositis but only minor pain and limited adverse effects on oral functions ( n=6 ) were contrasted with those who had limited mucositis but more severe pain and adverse effects ( n=7 ) . In addition , study participants with poor to moderate correlations between signs and symptoms ( n=5 ) were contrasted with those who had very good correlations ( n=10 ) . Simple bivariate tests were used for these comparisons . RESULTS Correlations between various signs and symptoms at all time points varied markedly at the individual level . The characteristics of study participants in the 2 subcohorts defined by poor to moderate and very good correlations between signs and symptoms were comparable , except perhaps in terms of age ( p<0.05 , t test ) . Similarly , the participants in the 2 subcohorts defined by high manifestation with minor complaints and vice versa did not differ with regard to the variables recorded . CONCLUSION Patients with head and neck cancer often report adverse effects of radiation-related oral mucositis on daily oral functions that are discordant with objective clinical findings . Patient-reported outcomes should be included in any interventional studies of oral mucositis , and trends over time should be analyzed within individuals , rather than between individuals BACKGROUND Head and neck cancer ( HNC ) is the seventh most common cancer worldwide . Although diet has been proposed to play an important role in HNC , few associations with diet have been convincing other than alcohol intake . Studies of dietary patterns that examine overall diets may provide broader insight than studies of individual foods . Little is known about the association between dietary patterns and risk of HNC . OBJECTIVE We prospect ively evaluated the association between 2 index-based dietary patterns [ ie , the Healthy Eating Index-2005 ( HEI-2005 ) and alternate Mediterranean Diet Score ( aMED ) ] and risk of head and neck squamous cell carcinoma . DESIGN We included 494,967 participants from the NIH-AARP Diet and Health study ( 1995 - 2006 ) . HRs ( 95 % CIs ) were estimated by using Cox regression . Scores for the HEI-2005 and aMED were calculated on the basis of diet assessed by using a baseline food-frequency question naire . Higher scores reflected adherence to dietary recommendations for healthy eating . Our main outcome was the incidence of HNC , including cancer of the larynx , oral cavity , and orohypopharynx . RESULTS A total of 1868 HNC cases were identified during follow-up . Higher HEI-2005 scores were associated with reduced risk of HNC in men [ HR : 0.74 ( 95 % CI : 0.61 , 0.89 ) for highest compared with lowest quintiles ; P-trend = 0.0008 ] and women [ HR : 0.48 ; 95 % CI : 0.33 , 0.70 ; P-trend < 0.0001 ] . High aMED scores were also associated with lower HNC risk in men ( HR : 0.80 ; 95 % CI : 0.64 , 1.01 ; P-trend = 0.002 ) and women ( HR : 0.42 ; 95 % CI : 0.24 , 0.74 ; P-trend < 0.0001 ) . Associations were similar among subsites . We did not find significant interactions between smoking and alcohol intake and each index on HNC risk . CONCLUSIONS HEI-2005 and aMED scores were associated inversely with risk of HNC . Large interventional studies are required to assess the causality before conveying definite public health messages OBJECTIVES To construct and vali date a frailty index ( FI ) that is clinical ly sensible and practical for geriatricians by basing it on a routinely used comprehensive geriatric assessment ( CGA ) instrument . DESIGN Secondary analysis of a 3-month r and omized , controlled trial of a specialized mobile geriatric assessment team . SETTING Rural Nova Scotia . Participants were seen in their homes . PARTICIPANTS Frail older adults , of whom 92 were in the intervention group and 77 in the control group . MEASUREMENTS A st and ard CGA form that accounts for impairment , disability , and comorbidity burden was scored and summed as a frailty index ( FI-CGA ) . The FI-GCA was stratified to describe three levels of frailty . Patients were followed for up to 12 months to determine how well the index predicted adverse outcomes ( institutionalization or mortality , whichever came first ) . RESULTS The three levels of frailty were mild ( FI-CGA 0 - 7 ) , moderate ( FI-CGA 7 - 13 ) , and severe ( FI-CGA>13 ) . Demographic and social traits were similar across groups , but greater frailty was associated with worse function ( r=0.55 ) and mental status ( r=0.33 ) . Those with moderate and severe frailty had a greater risk of adverse outcomes than those with mild frailty ( unadjusted hazard ratio=1.9 and 5.5 , respectively ) . There was no difference between frailty groups in mean 3-month goal -attainment scaling scores . Intrarater reliability was 0.95 . CONCLUSION The FI-CGA is a valid , reliable , and sensible clinical measure of frailty that permits risk stratification of future adverse outcomes OBJECTIVE To examine health-related quality of life ( HRQOL ) reported by 5-year head and neck cancer survivors and factors that predicted these long-term scores . DESIGN Prospect i ve , observational outcomes study . SETTING Tertiary care institution . PATIENTS A total of 337 patients diagnosed as having head and neck carcinoma between January 1995 and December 2004 , who enrolled in the Outcomes Assessment Project and survived at least 5 years . INTERVENTIONS While participating in the longitudinal Outcomes Assessment Project , patients filled out surveys measuring HRQOL at numerous points in time . MAIN OUTCOME MEASURES Outcomes included 5-year scores in eating , speech , aesthetics , social disruption , physical and mental health , depressive symptoms , and overall quality of life ( QOL ) . In addition to analyzing patients ' 5-year HRQOL outcomes , multivariate analyses were performed to determine which patient , clinical , treatment , and 1-year HRQOL factors independently predicted these 5-year outcomes . RESULTS Overall , the cohort 's long-term general health was similar to that to age-matched norms from the general population . But over 50 % of these survivors had problems eating , 28.5 % reported depressive symptoms , and 17.3 % reported substantial pain . At long-term follow-up , 13.6 % continued to smoke , and 38.9 % used alcohol . Multivariate analyses demonstrated that 1-year pain and diet were the strongest independent predictors of 5-year HRQOL outcomes . CONCLUSIONS Eating problems due to poor oropharyngeal functioning and persistent pain are the most prevalent problems that these survivors face . Early interventions addressing eating issues , swallowing problems , and pain management will be a crucial component in improving this patient population 's long-term QOL , especially in those who are functioning poorly 1 year after diagnosis OBJECTIVES To describe the long-term effects of oral health problems on quality of life ( QoL ) , functional status , pain , and general health in older male cancer patients . DESIGN Secondary analysis of a prospect i ve observational study . SETTING Community dwelling cancer patients served by a Department of Veterans Affairs hospital . PARTICIPANTS One hundred fifty male cancer patients responded to the question " Do you have tooth or mouth problems making it hard to eat ? " The relationship between patients answering " yes " and the following parameters was assessed : demographics , comorbid conditions , habits , activities of daily living , pain , anxiety , depression , social support , spirituality , QoL , and overall health ratings . MEASUREMENTS Chi-square contingency tables for dichotomous variables , Cochran-Mantel-Haenszel for ordered categorical variables , and t tests for associations with continuous variables . RESULTS The median age of respondents was 67 . Those reporting tooth or mouth problems had had their cancer diagnosed on average 2.9 years before , and 83.3 % were found clinical ly to be cancer free . Patients with these problems had significantly lower global ( P=.003 ) and subscale scores on QoL analysis and higher levels of anxiety ( P<.001 ) and depression ( P=.01 ) than those without tooth or mouth problems ; they also had significantly more pain ( P<.001 ) and lower physical functioning ( P<.001 ) and were more impaired in activities of daily living ( P<.001 ) . Those with tooth or mouth problems were more likely to describe their overall health as fair or poor ( P=.01 ) . Having cancer located in the head and neck region related significantly to having mouth or tooth problems ( P=.005 ) , but these problems were not associated with race , education , income , insurance coverage , age , comorbid conditions , alcohol consumption , tobacco or medication usage , type of cancer treatment , tumor stage at diagnosis or follow-up , perceived social support , or spirituality . CONCLUSION Older male cancer patients with mouth or tooth problems making it hard to eat are more likely to have a lower QoL , poorer emotional health , lower levels of physical functioning , and greater pain than patients without these problems OBJECTIVES To characterize and compare quality of life ( QOL ) in patients with head and neck cancer shortly before initial treatment and 1 year later and to study the predictors of changes in QOL over 1 year . DESIGN Prospect i ve cohort study . SETTING Three otolaryngology clinics . PATIENTS Three hundred sixteen patients having newly diagnosed squamous cell head and neck cancer . MAIN OUTCOME MEASURE Health-related QOL was assessed using the  36-item Short-Form Health Survey  and a head and neck cancer-specific QOL scale .  RESULTS Over 1 year , QOL decreased for physical functioning measures and eating but improved for mental health QOL . Depression and smoking were major predictors of poor QOL at baseline . Major predictors of change in QOL from baseline to 1 year were treatment factors , especially feeding tube placement ( 9 scales ) , chemotherapy ( 3 scales ) , and radiation therapy ( 3 scales ) . Baseline smoking and depressive symptoms also remained significant predictors of several QOL scales at 1 year . CONCLUSIONS Health-related physical QOL tended to decline over 1 year and mental health QOL improved . The major predictors of change in QOL were treatment factors , smoking , and depressive symptoms . Physicians should alert patients to the relative effects on QOL one may experience with different treatments BACKGROUND Concurrent chemoradiotherapy ( concurrent CRT ) to treat head and neck cancer is associated with significant reductions of weight , mobility , and quality of life ( QOL ) . An intervention focusing on functional exercise may attenuate these losses . METHODS We allocated patients to a 14-week functional resistance and walking program design ed to maintain physical activity during cancer treatment  ( MPACT group ; n = 11 ) , or to usual care ( control group ; n = 9 ) . Outcomes were assessed at baseline , and 7 and 14 weeks . RESULTS Compared to controls , the MPACT participants had attenuated decline or improvement in several strength , mobility , physical activity , diet , and QOL endpoints . These trends were statistically significant ( p < .05 ) in knee strength , mental health , head and neck QOL , and barriers to exercise . CONCLUSION In this pilot study of patients with head and neck cancer undergoing concurrent CRT , MPACT training was feasible and maintained or improved function and QOL , thereby providing the basis for larger future interventions with longer follow-up . © 2015 Wiley Periodicals , Inc. Head Neck 38 : E1086-E1096 , 2016 Background Dietary fiber and grain consumption may reduce the risk of head and neck cancer ; however , the epidemiological evidence is limited . We investigated this relationship in the National Institutes of Health (NIH)-AARP Diet and Health Study . Methods Cox proportional hazards models were used to calculate multivariable hazard ratios ( HR ) and 95 % confidence intervals ( CI ) to investigate dietary fiber and grain intake in relation to head and neck cancer . Results During approximately 11 years of follow-up , 1,867 ( 401 women/1,466 men ) cases of head and neck cancer were diagnosed . Our data indicated that the relationship between  fiber and grain intake and head and neck cancer is modified by sex ( p-interactions < 0.001 and 0.001 , respectively ) . Women with higher intake of total fiber and total grains had a lower risk of head and neck cancer ( HR10g/day = 0.77 , 95 % CI = 0.64–0.93 ; HRserving/1,000kcal = 0.89 , 95 % CI = 0.80–0.99 , respectively ) ; this inverse relation was consistent across subtypes of fiber and grains . Conversely in men , the inverse associations were weaker and nonsignificant . Conclusions In the largest prospect i ve cohort study to investigate this relation to date , intake of total fiber and grain foods was inversely associated with head and neck cancer incidence among women , but not among men PURPOSE To prospect ively evaluate performance and quality of life ( QOL ) in advanced-stage head and neck cancer ( HNC ) patients on a curative-intent , concomitant-chemoradiotherapy ( CT/XRT ) ( twice-daily radiation , fluorouracil , hydroxyurea , and cisplatin ) regimen aim ed at improving locoregional control , survival , and QOL . PATIENTS AND METHODS Sixty-four patients were assessed before , during , and at 3-month intervals after treatment . St and ardized measures of QOL ( Functional Assessment of Cancer Therapy-Head and Neck ) , performance ( Performance Status Scale for Head and Neck Cancer Patients and Karnofsky Performance Status Rating Scale ) , and patient-reported symptoms ( McMaster University Head and Neck Radiotherapy Question naire ) were administered . RESULTS Acute treatment toxicities were severe , with declines in virtually all QOL and functional domains . Marked improvement was seen by 12 months ; general functional and physical measures returned to baseline levels of good to excellent . Although up to a third of the patients continued to report problems with swallowing , hoarseness , and mouth pain , these difficulties were present in similar magnitudes before treatment . The following symptoms were more frequent at 12 months : dry mouth ( 58 % v 17 % ) , difficulties tasting ( 32 % v 8 % ) , and soft food diet ( 82 % v 42 % ) . Twelve-month diet was not related to pretreatment functioning , disease , treatment , or patient characteristics . Twelve-month QOL was best predicted by pretreatment QOL , with very little relationship to residual side effects or functional impairments . Small numbers of patients in four of the five disease sites precluded examination of outcome by site . CONCLUSION These data support the feasibility of intense CT/XRT as primary treatment for advanced HNC . Results confirm acute toxicity but indicate that many of the treatment-related performance and QOL declines resolve by 12 months . The persistent inability to eat a full range of foods warrants further attention and monitoring PURPOSE To prospect ively evaluate and compare health-related quality -of-life ( QOL ) outcomes in patients with head-neck squamous cell carcinoma r and omized to either intensity-modulated radiation therapy ( IMRT ) or three-dimensional conformal radiotherapy ( 3D-CRT )  and assess serial longitudinal change in QOL over time . METHODS QOL outcomes were assessed using the European Organization for Research and Treatment of Cancer ( EORTC ) QOL question naire ( QLQ-C30 ) and Head-Neck module ( HN-35 ) at baseline ( pre-treatment ) and subsequently periodically on follow-up . Mean scores of individual domains/scales of 3D-CRT and IMRT were compared using ' t ' test at each time point ; while longitudinal change in mean scores of both groups over time was evaluated by repeated measurement analysis of variance . RESULTS Fifty eight of the 60 r and omized patients who filled the QOL question naire at least at one time point were included in the analysis . Several general ( emotional functioning , role functioning , social contact ) as well as head and neck cancer-specific ( dry mouth , opening mouth , sticky saliva , pain , senses ) QOL domains were better preserved with IMRT compared to 3D-CRT at different time points . Importantly , none of the QOL domains were worse with IMRT at any time point . There was substantial deterioration in QOL scores immediate post-treatment ( 3-months ) in both arms . However , QOL scores gradually but definitely improved over time for most domains . Global QOL , emotional/role functioning , nausea/vomiting , pain , swallowing , speech , social contact/eating , insomnia showed rapid recovery ( < 6months ) while physical/cognitive functioning , dry mouth , sticky saliva , fatigue , senses showed delayed recovery ( > 6months ) . There were no significant differences in loco-regional or survival between the two arms . CONCLUSIONS There is substantial deterioration in QOL after curative-intent head-neck irradiation that gradually improves over time . IMRT results in clinical ly meaningful and statistically better QOL scores for some domains compared to 3D-CRT at several time points with comparable disease outcomes that could support its widespread adoption in routine clinical practice Background There is limited knowledge on the ability of a poor quality of life ( QOL ) and  health-related QOL ( HRQOL ) to predict mortality and other adverse health events , independently of the frailty syndrome and other confounders , in older people living in the community and not selected on the basis of specific chronic conditions . Aim of this study was to evaluate the ability of the overall QOL and of the HRQOL to predict several adverse health outcomes at a one-year follow-up in an older outpatient population living in the community . Methods We carried out a prospect i ve cohort study on 210 community-dwelling out patients aged 65 + ( mean age 81.2 yrs ) consecutively referred to a geriatric clinic in Milan , Italy . At baseline participants underwent a comprehensive geriatric assessment including evaluation of overall QOL and HRQOL by means of the Older People 's Quality of Life ( OPQOL ) question naire . At a one-year follow-up , between June and December 2010 , we investigated nursing home placement and death in all 210 participants as well as any fall , any admission to the emergency department ( ED ) , any hospitalisation and greater functional dependence among the subset of subjects still living at home . Results One year after the visit 187 subjects were still living at home ( 89 % ) while 7 had been placed in a nursing home ( 3.3 % ) and 16 had died ( 7.7 % ) . At multiple logistic regression analyses the lowest score-based quartile of the OPQOL total score at baseline was independently associated with a greater risk of any fall and any ED admission . Also , the lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement ( odds ratio [ OR ] 10.03 , 95 % confidence interval [ CI ] 1.25 - 80.54 , P = 0.030 ) and death ( OR 4.23 , 95 % CI 1.06 - 16.81 , P = 0.041 ) . The correlation with the latter two health outcomes was found after correction for age , sex , education , income , living conditions , comorbidity , disability and the frailty syndrome . Conclusions In an older outpatient population in Italy the OPQOL total score and its health-related sub-score were independent predictors of several adverse health outcomes at one year . Notably , poor HRQOL predicted both nursing home placement and death even after correction for the frailty syndrome . These findings support and enhance the prognostic relevance of QOL measures The authors prospect ively assessed the independent association between weight loss and deterioration in quality of life ( QOL ) in patients treated by radiotherapy for head and neck cancer . In 533 head and neck cancer patients treated by curative radiotherapy  , changes in weight and QOL were assessed between baseline ( before radiotherapy ) and follow-up ( 12 wk after the start of radiotherapy ) . Patients were categorized into 4 weight loss categories : 0 % , 0.1%–5.0 % , 5.1%–10.0 % , and > 10 % weight loss . The association between weight loss and change in QOL was analyzed by linear regression analysis , adjusted for sociodemographic and tumor-related characteristics , and additionally for disease specific symptoms and tube feeding . Thirty percent of patients lost 0.1%–5.0 % weight , 26 % lost 5.1%–10.0 % weight , and 24 % lost > 10 % weight . Adjusted regression analyses showed a significant association between weight loss and deterioration of global QOL , physical functioning , social functioning , social eating , and social contact . After additional adjustment for disease-specific symptoms and tube feeding , weight loss ( > 10 % ) remained significantly associated with global QOL , social eating , and social contact ( P < 0.05 ) . More than 10 % weight loss during and directly after radiotherapy has a significant impact on social eating , social contact , and QOL in head and neck cancer patients BACKGROUND A st and ard phenotype of frailty was associated with an increased risk of adverse outcomes including mortality in a recent study of older adults . However , the predictive validity of this phenotype for fracture outcomes and across risk subgroups is uncertain . METHODS To determine whether a st and ard frailty phenotype was independently associated with risk of adverse health outcomes in older women and to evaluate the consistency of associations across risk subgroups defined by age and body mass index ( BMI ) , we ascertained frailty status in a cohort of 6724 women > or=69 years and followed them prospect ively for incident falls , fractures , and mortality . Frailty was defined by the presence of three or more of the following criteria : unintentional weight loss , weakness , self-reported poor energy , slow walking speed , and low physical activity . Incident recurrent falls were defined as at least two falls during the subsequent year . Incident fractures ( confirmed with x-ray reports ) , including hip fractures , and deaths were ascertained during an average of 9 years of follow-up . RESULTS After controlling for multiple confounders such as age , health status , medical conditions , functional status , depressive symptoms , cognitive function , and bone mineral density , frail women were subsequently at increased risk of recurrent falls ( multivariate odds ratio=1.38 , 95 % confidence interval [ CI ] , 1.02 - 1.88 ) , hip fracture ( multivariate hazards ratio [MHR]=1.40 , 95 % CI , 1.03 - 1.90 ) , any nonspine fracture ( MHR=1.25 , 95 % CI , 1.05 - 1.49 ) , and death ( MHR=1.82 , 95 % CI , 1.56 - 2.13 ) . The associations between frailty and these outcomes persisted among women > or=80 years . In addition , associations between frailty and an increased risk of falls , fracture , and mortality were consistently observed across categories of BMI , including BMI > or=30 kg/m2 . CONCLUSION Frailty is an independent predictor of adverse health outcomes in older women , including very elderly women and older obese women Background : Smoking , alcohol use , and depression are interrelated and highly prevalent in patients with head and neck cancer , adversely affecting quality of life and survival . Smoking , alcohol , and depression share common treatments , such as cognitive behavioral therapy and antidepressants . Consequently , we developed and tested a tailored smoking , alcohol , and depression intervention for patients with head and neck cancer . Methods : Patients with head and neck cancer with at least one of these disorders were recruited from the University of Michigan and three Veterans Affairs medical centers . Subjects were r and omized to usual care or nurse-administered intervention consisting of cognitive behavioral therapy and medications . Data collected included smoking , alcohol use , and depressive symptoms at baseline and at 6 months . Results : The mean age was 57 years . Most participants were male ( 84 % ) and White ( 90 % ) . About half ( 52 % ) were married , 46 % had a high school education or less , and 52 % were recruited from Veterans Affairs sites . The sample was fairly evenly distributed across three major head and neck cancer sites and over half ( 61 % ) had stage III/IV cancers . Significant differences in 6-month smoking cessation rates were noted with 47 % quitting in the intervention compared with 31 % in usual care ( P < 0.05 ) . Alcohol and depression rates improved in both groups , with no significant differences in 6-month depression and alcohol outcomes . Conclusion : Treating comorbid smoking , problem drinking , and depression may increase smoking cessation rates above that of usual care and may be more practical than treating these disorders separately . ( Cancer Epidemiol Biomarkers Prev 2006;15(11):2203–8
Functional and cognitive impairment , depressive symptoms and social isolation are highly prevalent in head and neck cancer patients and associate with high risk of adverse health outcomes .
OBJECTIVES Older head and neck cancer patients are at increased risk for adverse health outcomes , but little is known about which geriatric assessment associates with poor outcome .
The aim is to study the association of functional or cognitive impairment , social environment and frailty with adverse health outcomes in patients with head and neck cancer .