Julie L. Locher

Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer.

PURPOSE The use of altered fractionation radiotherapy (RT) regimens, as well as concomitant chemotherapy and RT, to intensify therapy for locally advanced head-and-neck cancer can lead to increased rates of long-term dysphagia. METHODS AND MATERIALS We identified 122 patients who had undergone definitive RT for locally advanced head-and-neck cancer, after excluding those who had been treated for a second or recurrent head-and-neck primary, had Stage I-II disease, developed locoregional recurrence, had <12 months of follow-up, or had undergone postoperative RT. The patient, tumor, and treatment factors were correlated with a composite of 3 objective endpoints as a surrogate for severe long-term dysphagia: percutaneous endoscopic gastrostomy tube dependence at the last follow-up visit; aspiration on a modified barium swallow study or a clinical diagnosis of aspiration pneumonia; or the presence of a pharyngoesophageal stricture. RESULTS A composite dysphagia outcome occurred in 38.5% of patients. On univariate analysis, the primary site (p = 0.01), use of concurrent chemotherapy (p = 0.01), RT schedule (p = 0.02), and increasing age (p = 0.04) were significantly associated with development of composite long-term dysphagia. The use of concurrent chemotherapy (p = 0.01), primary site (p = 0.02), and increasing age (p = 0.02) remained significant on multivariate analysis. CONCLUSION The addition of concurrent chemotherapy to RT for locally advanced head-and-neck cancer resulted in increased long-term dysphagia. Early intervention using swallowing exercises, avoidance of nothing-by-mouth periods, and the use of intensity-modulated RT to reduce the dose to the uninvolved swallowing structures should be explored further in populations at greater risk of long-term dysphagia.

Combined Behavioral and Drug Therapy for Urge Incontinence in Older Women

OBJECTIVE: The purpose of this study was to examine the effects of combining behavioral treatment and drug treatment for urge incontinence in community‐dwelling older women.

Pretreatment Swallowing Exercises Improve Swallow Function After Chemoradiation

Objectives/Hypothesis: Swallowing dysfunction is a devastating complication of chemoradiation therapy (CRT) for head and neck squamous cell carcinoma. We have previously demonstrated that pretreatment swallowing exercises improve posttreatment swallowing‐related quality of life. This study evaluates the effect of pretreatment swallowing exercises on posttreatment swallow function as measured by videofluoroscopy.

Treatment seeking for urinary incontinence in older adults.

Objective: To examine treatment seeking for urinary incontinence among older adults and to identify characteristics associated with treatment‐seeking behavior.

Preoperative Biofeedback Assisted Behavioral Training to Decrease Post-Prostatectomy Incontinence: A Randomized, Controlled Trial

PURPOSE We tested the effectiveness of preoperative biofeedback assisted behavioral training for decreasing the duration and severity of incontinence, and improving quality of life in the 6 months following radical prostatectomy. MATERIALS AND METHODS We performed a prospective, randomized, controlled trial comparing preoperative behavioral training to usual care. The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer. Patients were stratified according to age and tumor differentiation, and randomized to 1 preoperative session of biofeedback assisted behavioral training plus daily home exercise or a usual care control condition, consisting of simple postoperative instructions to interrupt the urinary stream. The main outcome measurements were duration of incontinence (time to continence), as derived from bladder diaries, incontinence severity (the proportion with severe/continual leakage), pad use, Incontinence Impact Questionnaire, psychological distress (Hopkins Symptom Checklist) and health related quality of life (Medical Outcomes Study Short Form Health Survey). RESULTS Preoperative behavioral training significantly decreased time to continence (p = 0.03) and the proportion of patients with severe/continual leakage at the 6-month end point (5.9% vs 19.6%, p = 0.04). There were also significant differences between the groups for self-reported urine loss with coughing (22.0% vs 51.1%, p = 0.003), sneezing (26.0% vs 48.9%, p = 0.02) and getting up from lying down (14.0% vs 31.9%, p = 0.04). No differences were found on return to work and usual activities or quality of life measures. CONCLUSIONS Preoperative behavioral training can hasten the recovery of urine control and decrease the severity of incontinence following radical prostatectomy.

Constipation in the Elderly: Influence of Dietary, Psychological, and Physiological Factors

OBJECTIVE: To identify dietary, psychological, and physiological characteristics of older individuals with chronic constipation, compared with a control group of individuals without constipation, and identify correlates of colonic transit time.

Comfort Foods: An Exploratory Journey Into The Social and Emotional Significance of Food

This paper uses symbolic interactionist and structuralist perspectives to examine the social construction of some food objects as “comfort foods,” highlighting how cultural studies of food should take into account its social and physiological dimensions. This studys empirical findings are based upon the food items brought to class by 264 undergraduate students at a southeastern university in the United States. Comfort foods are classified into four categories: nostalgic foods, indulgence foods, convenience foods, and physical comfort foods. We describe how particular food objects come to be associated with the relief of distress and show how food objects are manipulated to modify or change emotional states or feelings. The practical implications of this work extend to understanding the role that mood plays in food selection and considering the use of comfort foods under certain circumstances, such as when individuals are experiencing illness.

Lower extremity arterial disease in elderly subjects with systolic hypertension

The ratio of ankle-to-arm systolic blood pressure (ankle/arm index or AAI) appears to be a non-invasive indicator of flow-significant atherosclerosis and may be a useful measure of burden of disease in a high risk population. The prevalence of lower extremity arterial disease (LEAD) was assessed by this method in the Systolic Hypertension in the Elderly Program (SHEP). Subjects were aged 60 and older with systolic blood pressure greater than 160 mmHg upon entry to the study. An AAI of 0.90 or less was considered indicative of flow-significant LEAD. The prevalence of LEAD by this method was 26.7% (50/187), while the prevalence of intermittent claudication (IC) was only 6.4% (12/187). Of those with IC, 66.7% (8/12) had confirmed LEAD. The prevalence of LEAD as measured by AAI increased with age in women and was associated with a history of current smoking and lower levels of high density lipoproteins. In this study population with systolic hypertension, LEAD, as measured by the AAI, is more prevalent than previously described in elderly populations and is associated with other risk factors for atherosclerosis.

An Interdisciplinary Approach to the Assessment and Behavioral Treatment of Urinary Incontinence in Geriatric Outpatients

To test the effectiveness of an interdisciplinary assessment and behavioral treatment of persistent urinary incontinence in geriatric outpatients.

Urinary incontinence during pregnancy in a racially mixed sample: Characteristics and predisposing factors

The objectives of the study were to assess the prevalence of urinary incontinence symptoms during pregnancy in a racially mixed sample and to identify potential predisposing variables. Five hundred and twenty-three women were interviewed in the hospital on postpartum day 2 or 3 and by telephone at 6-week follow-up. A significantly larger proportion of white women reported accidental loss of urine than did black women (62.6% vs. 46.4%;P<0.01). A breakdown by type of incontinence indicated that the race effect was largely attributable to the significantly higher prevalence of the symptom of stress incontinence among white women (P<0.0001). In stepwise logistic regression modeling, previous incontinence, education level, parity and nocturia were selected as the strongest predictors of incontinence in white women. Attendance at childbirth classes was the only predictor of incontinence for black women. The results raise the possibility that higher rates of incontinence among white women might be due to differences in the pelvic floor.