Bing-Shen Huang

Unmet supportive care needs and characteristics of family caregivers of patients with oral cancer after surgery

The aim of this study was to identify factors associated with unmet supportive care needs in family caregivers of patients with oral cancer after surgery.

Postradiation trismus and its impact on quality of life in patients with head and neck cancer

OBJECTIVE The aims of this study were to investigate the following in patients with head and neck cancer (HNC): (1) factors related to trismus that predict the development of trismus, (2) factors affecting quality of life and measurements of these factors, and (3) comparison of these findings in patients with and without trismus to evaluate the effects of trismus on quality of life. METHODS This cross-sectional study included the questionnaires: the Hospital Anxiety and Depression Scale (HADS) - Depression Subscale, the Chewing Function Questionnaire (CFQ), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Head and Neck Cancer Module (EORTC QLQ-HN35). A scaled ruler was used to measure maximal intercisal opening (MIO). RESULTS Of the 104 patients in the study, 8.7% had clinical depression. The average MIO was 35.81 mm, and 47.1% of patients had trismus. Moderate levels of chewing dysfunction with regard to different types of food were noted. Lower body mass index, chemoradiotherapy treatment, longer time since treatment completion, and higher radiation dose were significantly associated with trismus. Such patients had significantly lower head and neck-specific quality of life in terms of social contact, sexuality, teeth, mouth opening, dry mouth, feeling ill, nutritional supplement, and weight loss. CONCLUSIONS Patients with trismus should be provided mouth opening exercises after treatment and programs to improve trismus and quality of life.

Supportive care needs in newly diagnosed oral cavity cancer patients receiving radiation therapy.

This study aimed to examine changes in physical symptom severity, functional status, supportive care needs, and related factors in oral cavity cancer patients during 6 months after beginning radiation therapy (RT) or concurrent chemotherapy and radiation therapy (CCRT).

Psychosocial effects of a skin camouflage program in female survivors with head and neck cancer: A randomized controlled trial

The purpose of this study was to evaluate the effects of a skin camouflage program on disfigurement, self‐esteem, social interaction, and body image in female head and neck cancer (HNC) survivors.

Clinical utility of simultaneous whole-body 18 F-FDG PET/MRI as a single-step imaging modality in the staging of primary nasopharyngeal carcinoma

PurposeBoth head and neck magnetic resonance imaging (MRI) and 18F–fluorodeoxyglucose (18F–FDG) positron emission tomography (PET)/computed tomography (CT) play a crucial role in the staging of primary nasopharyngeal carcinoma (NPC). In this study, we sought to prospectively investigate the clinical utility of simultaneous whole-body 18F–FDG PET/MRI for primary staging of NPC patients.MethodsWe examined 113 patients with histologically confirmed NPC who underwent pretreatment, simultaneous whole-body PET/MRI and PET/CT for primary tumor staging. The images obtained with the different imaging modalities were interpreted independently and compared with each other.ResultsPET/MRI increased the accuracy of head and neck MRI for assessment of primary tumor extent in four patients via addition of FDG uptake information to increase the conspicuity of morphologically subtle lesions. PET/MR images were more discernible than PET/CT images for mapping tumor extension, especially intracranial invasion. Regarding the N staging assessment, the sensitivity of PET/MRI (99.5%) was higher than that of head and neck MRI (94.2%) and PET/CT (90.9%). PET/MRI was particularly useful for distinguishing retropharyngeal nodal metastasis from adjacent nasopharyngeal tumors. For distant metastasis evaluation, PET/MRI exhibited a similar sensitivity (90% vs. 86.7% vs. 83.3%), but higher positive predictive value (93.1% vs. 78.8% vs. 83.3%) than whole-body MRI and PET/CT, respectively.ConclusionsFor tumor staging of NPC, simultaneous whole-body PET/MRI was more accurate than head and neck MRI and PET/CT, and may serve as a single-step staging modality.

Postoperative Radiotherapy with or without Concurrent Chemotherapy for Salivary Gland Carcinomas

Purpose: To investigate the potential value of concurrent chemotherapy in patients with salivary gland carcinomas treated with postoperative radiotherapy (PORT). Materials and Methods: This retrospective review included 167 consecutive patients with major and minor salivary gland carcinomas from 2001 to 2011. All were treated with curative surgery followed by PORT (n=93) or postoperative chemoradiotherapy (POCRT) (n=74). The median cumulative radiation doses were 66 Gy for both groups, and cisplatin-based concurrent chemotherapies were the most commonly used regimens. Results: The median follow-up was 5.4 years for survivors. Although patients receiving POCRT possessed more adverse pathological prognosticators and higher cancer stages, there were no statistical differences in locoregional control (LRC), diseasefree survival (DFS), and overall survival (OS) between the PORT and POCRT groups according to early or advanced stage. However, a trend towards LRC improvement was observed in patients with adenoid cystic carcinoma (ACC) undergoing POCRT, with 100% 5-year LRC compared with 81% for those treated with PORT (P=.057). In subgroup analyses, POCRT provided significant LRC advantages over PORT for ACC patients who also exhibited positive surgical margins (P=.022) or perineural invasion (P=.043). The predominant pattern of failure for the entire cohort was distant metastasis. Conclusions: Adding concurrent chemotherapy to postoperative radiotherapy might be most beneficial in terms of LRC for salivary gland ACC patients with positive surgical margins or perineural invasion. Distant metastasis remains problematic despite multimodal intervention.

Clinical Outcomes of Patients with Resected Oral Cavity Cancer and Simultaneous Second Primary Malignancies.

Objectives Simultaneous second primary tumors (SSPT) are not uncommon in patients with oral cavity squamous cell carcinoma (OSCC) living in areas where the habit of betel quid chewing is widespread. We sought to identify the main prognostic factors in OSCC patients with SSPT and incorporate them into a risk stratification scheme. Methods A total of 1822 consecutive patients with primary OSCC treated between January 1996 and February 2014 were analyzed for the presence of SSPT. The 18-month and 5-year overall survival (OS) rates served as the main outcome measures. Results Of the 1822 patients, 77 (4%) were found to have SSPT (i.e, two malignancies identified within one month of each other). The 18-month and 5-year OS rates in patients without SSPT and with SSPT were 82% and 69%, and 72% and 53%, respectively (p = 0.0063). Patients with SSPT were further divided into patients with either esophageal cancer or hepatocellular carcinoma (eso-HCC subgroup, n = 8) and other tumors (NO eso-HCC subgroup, n = 69). After multivariate analysis, neck nodal extracapsular spread (ECS, n = 18) and the presence of eso-HCC were identified as independent adverse prognostic factors. The 18-month OS rates of SSPT patients with both eso-HCC and ECS (n = 5) vs. the remaining patients (n = 72) were 0% and 78%, respectively (p < 0.0001). Conclusion OSCC patients with neck nodal ECS and esophageal cancer or hepatocellular carcinoma as SSPT have a dismal short-term prognosis.

How small is TOO small? New liver constraint is needed— Proton therapy of hepatocellular carcinoma patients with small normal liver

Purpose This study evaluated the outcomes of hepatocellular carcinoma (HCC) patients with small normal liver volume (NLV) treated with proton beam therapy (PBT) and introduced estimated standard liver volume (eSLV) as a new constraint. Materials and methods HCC patients with NLV < 800 cm3 and no distant metastasis who received treatment in our proton center were included. The doses of PBT were mainly 72.6 Gray equivalents (GyE) in 22 fractions and 66 GyE in 10 fractions according to tumor locations. The Urata equation was used to calculate eSLV. Results Twenty-two patients were treated between November 2015 and December 2016. The 1-year progression-free and overall survival rates were 40.4% and 81.8%, respectively. The 1-year in-field failure-free rate was 95.5%. NLV ranged from 483.9 to 795.8 cm3 (median = 673.8 cm3), eSLV ranged from 889.3 to 1290.0 cm3 (median = 1104.5 cm3), and the resulting NLV/eSLV ratio ranged from 44.3 to 81.2% (median = 57.7%). Non-irradiated liver volume (NILV) ranged from 232.9 to 531.6 cm3 (median = 391.2 cm3). The NILV/eSLV ratio ranged from 21.2 to 48.0% (median = 33.3%). NLV in the patients who received <30 GyE (rV30) ranged from 319.1 to 633.3 cm3 (median = 488.2 cm3), and their rV30/eSLV ratio ranged from 30.7 to 58.0%. None of our patients developed liver failure. One patient with initial abnormal liver enzyme levels developed non-classic radiation-induced liver disease (RILD). Conclusion From the viewpoint of minimal liver toxicity occurring in our patients with NLV < 800 cm3, conventional liver constraints involving the use of absolute volume could not accurately predict the risk of RILD. It is reasonable to start using individualized constraints with eSLV for HCC patients undergoing PBT. According to the study results, an NILV/eSLV ratio of >20% and an rV30/eSLV ratio of >30% are acceptable.

Swallowing ability and its impact on dysphagia-specific health-related QOL in oral cavity cancer patients post-treatment

PURPOSE The purpose of this study was to identify the characteristics of swallowing ability, depression, and dysphagia-specific health-related quality of life (QOL), and the predictors of dysphagia-specific health-related QOL in oral cavity cancer patients post-treatment. METHODS A cross-sectional study of 151 oral cavity cancer patients was performed at a medical center. Patients were assessed for swallowing ability, depression, and dysphagia-specific health-related QOL. Multiple stepwise regression was used to identify factors related to dysphagia-specific health-related QOL. RESULTS Of the 151 patients surveyed, the top swallowing impairments were difficulty swallowing dry foods, difficulty swallowing hard food, and swallowing problems interfering with enjoyment or QOL. Patients with tumors of the tongue had worse functional dysphagia QOL than those with cancers in other locations. Patients with buccal cancer had worse overall dysphagia QOL, functional dysphagia QOL, and physical dysphagia QOL than patients with cancers in other locations. Patients with poor swallowing ability were more likely to have worse global dysphagia QOL. Emotional dysphagia QOL was associated with poor swallowing ability and depression. Poor swallowing ability, higher level of depression, and tumors of the tongue were associated with the worst functional dysphagia QOL. Patients with poor swallowing ability, higher level of depression, and less functional oral intake were more likely to have worse physical dysphagia QOL. CONCLUSION Swallowing ability and depression were the most important factors associated with dysphagia-specific health-related QOL. Patient-centered swallowing rehabilitation programs are recommended to help cope with swallowing impairment.

Factors associated with healthcare professional's rating of disfigurement and self-perceived body image in female patients with head and neck cancer

The purpose of this study was to determine factors associated with self-perceived body image in female patients with head and neck cancer (HNC), and factors associated with healthcare professionals rating of disfigurement, as well as the correlation between patient and observer ratings. This cross-sectional study recruited 105 women with HNC at a large medical centre. Measures of facial disfigurement and body image, as well as demographic and clinical characteristics, were collected. Multivariate multiple linear regression modelling was used to identify factors associated with healthcare professionals rating of disfigurement and patient self-perceived body image. Disfigurement ratings by healthcare professionals were positively associated with patient self-perceived body image. Medical treatment, cancer stage, radiation dose and cancer site were significantly associated with disfigurement. Medical treatment was an important predictor of perceived body image. These findings indicate a moderate prevalence of disfigurement among women with HNCs. Patients with more disfigurement were more likely to have dissatisfaction with their body image. Nursing professionals need to carefully assess the appearance of women with HNC. Camouflage interventions can be used to help appropriately cope with the disfigurement, and to achieve improved satisfaction with their body image.