Heather M. Starmer

The effect of pneumonia on short-term outcomes and cost of care after head and neck cancer surgery†

The Centers for Medicare and Medicaid Services has threatened to discontinue reimbursements for ventilator‐associated pneumonia (VAP) as a preventable “never event.” We sought to determine the relationship between pneumonia and in‐hospital mortality, complications, length of hospitalization and costs in head and neck cancer (HNCA) surgery.

Volumetric change of selected organs at risk during IMRT for oropharyngeal cancer.

PURPOSE To assess volumetric changes of selected organs at risk (OAR) during intensity-modulated radiotherapy (IMRT) for oropharyngeal carcinoma. MATERIALS AND METHODS Twenty-six consecutive patients that were treated with definitive IMRT ± chemotherapy between November 2007 and November 2008 were selected for the present study. As part of an internal quality assurances program, a repeat kilovolt (KV) computed tomography was planned weekly during the 7-week treatment course. On each available scan, a single observer contoured the parotid submandibular, and thyroid glands (PG/SMG/TG), larynx (L), and constrictor, masticatory, and sternocleidomastoid muscles (CM/MM/SCM) as appropriate. The volume at each scan was compared with the one at planning CT in a pair-wise fashion. p values <0.05 after correction for multiple testing were considered significant. RESULTS A total of 159 scans was obtained during treatment for a total of 185 scans, including the baseline imaging. All OARs showed statistically significant changes over baseline by week 5. At week 7, the PG showed the largest absolute change with an average reduction of ∼10 mL followed by both the SCM and MM (∼-5 mL). The largest (∼-30%) relative change was observed for the salivary glands. L and CM showed a ∼15% increase in volume during treatment. CONCLUSION All selected OAR undergo significant volumetric changes during a course of IMRT for oropharyngeal squamous cell carcinoma.

The relationship between depressive symptoms, quality of life, and swallowing function in head and neck cancer patients 1 year after definitive therapy.

To determine the incidence of depression in head and neck cancer (HNCA) patients following definitive treatment and the relationship between depression and head and neck‐specific measures of quality of life and function.

Effects of laryngeal cancer on voice and swallowing.

Specific deficits that may be encountered as well as interventional strategies and evidence-based practice are discussed. When discussing the voice, it is important to consider that for many people the voice is not just a tool for communication, but also an identifying feature that allows expression of personality. Eating and swallowing are vital to life sustenance and also allow for a myriad of social interactions. Laryngeal cancer can have a dramatic impact on this delicately balanced system leading to disturbances of voice and swallowing.

Radiation dose to the floor of mouth muscles predicts swallowing complications following chemoradiation in oropharyngeal squamous cell carcinoma

OBJECTIVES While radiation dose to the larynx and pharyngeal constrictors has been the focus of swallowing complications, the suprahyoid muscles, or floor of mouth (FoM) muscles, are critical for hyoid and laryngeal elevation and effective bolus diversion, preventing penetration and aspiration. We hypothesize that radiation dose to these muscles may be important in the development of dysphagia. MATERIALS AND METHODS We studied 46 patients with OPSCC treated with CRT and who underwent baseline swallowing evaluations and post-treatment videofluoroscopic swallowing studies (VFSS) from 2007 to 2010. Patients with abnormal penetration aspiration scores (PAS>2) served as the study population and patients with normal PAS scores (≤ 2) served as the control cohort. Three suprahyoid muscles and two extrinsic tongue muscles were individually delineated and collectively referred to as the FoM muscles. Radiation dose-volume relationships for these muscles were calculated. Univariate logistic regression analysis was used to determine parameters of significance between patients with normal or abnormal PAS scores. A multivariate regression analysis was subsequently performed to isolate the most statistically critical structures associated with abnormal PAS. RESULTS Univariate analysis resulted in significance/borderline significance of multiple structures associated with abnormal PAS following irradiation. However, when a multivariate model was applied, only the mean dose to the floor of mouth and minimum dose to the geniohyoid were associated with post-radiation abnormal PAS. CONCLUSIONS The dose and volume delivered to the collective FoM muscles may be associated with an increased risk of laryngeal penetration/aspiration to a greater degree than previously recognized organs at risk.

Multidisciplinary Head and Neck Cancer Clinic and Adherence with Speech Pathology

To determine the effect of referral patterns on compliance with speech–language pathology (SLP) treatment of voice and swallowing difficulties in patients with head and neck cancer (HNCA).

Short- and long-term outcomes of laryngeal cancer care in the elderly

To examine associations between pretreatment variables, short‐term and long‐term swallowing and airway impairment, and survival in elderly patients treated for laryngeal squamous cell cancer (SCCA).

Feasibility of rapid discharge after transoral robotic surgery of the oropharynx

To investigate the use of an algorithm for rapid discharge after transoral robotic surgery (TORS) and its effect on postoperative complications.

Swallowing outcomes in patients with oropharyngeal cancer undergoing organ-preservation treatment.

The purpose of this study was to assess swallowing outcomes in a cohort of patients with oropharyngeal squamous cell carcinoma (SCC) undergoing nonoperative treatment.

Quality of care and short- and long-term outcomes of laryngeal cancer care in the elderly

To examine associations between quality of care, short‐ and long‐term treatment‐related outcomes, and costs in elderly patients treated for laryngeal squamous cell cancer (SCCA).