Lilly-Ann van der Velden

CO2-laser treatment of recurrent glottic carcinoma

Evaluation of the results of CO2 laser treatment of recurrent glottic carcinoma after radiotherapy.

Goal processes & self-efficacy related to psychological distress in head & neck cancer patients and their partners

UNLABELLED PURPOSE AND OBJECTIVE OF THE RESEARCH: In this cross-sectional study we used a self-regulation perspective to better understand the experience of psychological distress in head & neck (H&N) cancer patients and their partners. We examined which goals they valued and the extent to which patients and partners experience goal disturbance. Furthermore, associations were explored between goal disturbance, goal re-engagement, (goal)self-efficacy, and psychological distress. METHODS AND SAMPLE H&N cancer patients and their partners, recruited from the Erasmus Medical Center Rotterdam (N = 40), were interviewed and completed questionnaires, assessing the above aspects of the self-regulation theory. KEY RESULTS H&N cancer patients and their partners experienced goal disturbance from the disease. Such disturbances were in patients significantly related to more psychological distress. Higher levels of goal re-engagement were related to less psychological distress, again only significantly in patients. More self-efficacy was significantly associated with less psychological distress in both patients and partners. CONCLUSIONS Self-regulation abilities as goal re-engagement and self-efficacy may be screened and used as target in future psychological interventions, given their potential to decrease perceived psychological distress. In view of elevated levels of goal disturbances in partners, psychological support for caring relatives in such interventions is recommended.

Palliative care for head and neck cancer patients in general practice.

Conclusion: The findings of this study justify the goals of the Expert Centre such as the improvement of somatic and psychosocial care and consultation. Objective: A recent review showed that little attention is paid to palliative care for head and neck patients. The Erasmus MC has initiated an Expert Centre of Palliative Care Head and Neck Oncology with special interest in patient care, consultation and research. In this study the experience of general practitioners (GPs) in their care of palliative head and neck cancer patients before the start of the Expert Centre is assessed. The aim of the study was to find possible gaps in care and communication and to use GPs ideas to improve the centres functioning. Materials and methods: Fifty-five GPs with a patient in their practice who died from head and neck cancer between January 2003 and July 2004 after being treated in the Erasmus MC were included. The GPs were asked to fill out a questionnaire regarding their experience in the care of palliative head and neck cancer patients, the communication between first- and third-line care providers and the work of both the GP and the specialist involved. Results: The response rate was 75%. The palliative stage lasted approximately 4 months. The GPs felt that symptom control was generally not sufficient. Also improvements were necessary in psychosocial care and in the communication between first- and third-line care providers. They also experienced gaps in their knowledge of specific head and neck oncologic palliative care.

EXPERIENCE OF PALLIATIVE CARE FOR PATIENTS WITH HEAD AND NECK CANCER THROUGH THE EYES OF NEXT OF KIN

Little is known about how palliative care is experienced by patients with head and neck cancer and their relatives. The aim of this retrospective study was to analyze this care from the point of view of surviving relatives.

Cytokeratin and vimentin expression in normal epithelium and benign lesions of the vocal cords.

The expression of cytokeratins and vimentin was studied immunohistochemically in normal epithelium and 12 benign lesions of the vocal cord with the use of a broad panel of monoclonal antibodies against cytokeratins and vimentin. Histology showed that the various lesions contained hyperkeratotic, hyperplastic and atrophic epithelium, irrespective of their clinical appearance. Especially the Ck profile of the (hyper)keratotic lesions was changed in comparison with the native epithelium. Increased expression of the keratinization marker Ck 10 was associated with decreased expression of the stratification markers Cks 4 and 13. Expression of the basal cell marker Ck 14 and hyperproliferation-associated Cks 16 and 17 was increased in all the benign lesions, except in atrophic epithelium. These expression patterns differ from those observed in malignant epithelial lesions. The latter show a marked expression of simple cell Cks and vimentin and more pronounced expression of hyperproliferation-associated markers than the benign lesions.

SURVIVAL OF PATIENTS WITH PALLIATIVE HEAD AND NECK CANCER

The purpose of this study was to describe patient characteristics and prognostic factors for survival in the palliative stage of patients with head and neck cancer.

Denker operation is an effective surgical approach in managing juvenile nasopharyngeal angiofibroma

This article presents our experience with the various surgical approaches for angiofibroma and establishes the Denker procedure as an effective approach for removal of the tumor. The medical records of 29 patients treated between the years 1981 and 2001 were examined. The clinical extent of the tumor, the surgical approach, complications, and recurrences were evaluated. The surgical approaches used before 1992 consisted of the transnasal, transpalatal, and combined transnasal-transpalatal ones. Although no major recurrence or major morbidity was observed, late complications occurred, such as persistent palatal fistula in 3 patients who underwent operation via a transpalatal approach, and an unsightly scar with lacrimal duct stenosis in 2 patients who underwent operation via a combined transnasal-transpalatal approach. From 1992 onward, the above-mentioned surgical approaches were replaced with the Denker and midfacial degloving techniques, which proved to be just as effective in removing the tumor and did not produce late complications. According to our experience, the Denker approach is effective for angiofibromas confined to the nasal cavity and nasopharynx with small extensions in the infratemporal fossa. On the other hand, large tumor extension in the infratemporal fossa can be effectively approached in combination with a midfacial degloving technique.

Expression of Cytokeratin Subtypes and Vimentin in Squamous Cell Carcinoma of the Floor of the Mouth and the Mobile Tongue

Objectives: The assessment of the expression patterns of cytokeratin polypeptides (Cks) and vimentin in normal epithelium of the mobile tongue and floor of the mouth, squamous cell carcinomas and their lymph node metastases. Material and Methods: Chain-specific monoclonal antibodies to various Cks and vimentin were used, employing the immunoperoxidase technique. Results and Conclusions: Profound changes in the expression of pre-existing Cks and de novo expression of simple epithelium-related Cks and of vimentin occurred upon malignant transformation and tumor progression. Changes were mainly related to the degree of cellular differentiation, tumor cell morphology and tumor growth pattern. Low-grade tumors showed a pronounced decrease of the stratification Cks 4 and 13, and an increase of Cks 14, 16, and 17. With increasing tumor grade, expression of Cks 16 and 17 decreased. De novo expression of Cks 8 and 18 and of vimentin was most marked in high-grade tumors, in tumors with a basaloid phenotype and in tumors growing in small infiltrating tumor fields; it was proposed to be associated with poor prognosis.

Experience of palliative care for patients with head and neck cancer through the eyes of next of kin: Impact of an Expert Center

Literature is scarce on the palliative care experiences of patients with head and neck cancer. We report our experience in this patient population after the establishment of our Expert Center.