Morten Boysen

Quality of Life in Head and Neck Cancer Patients: Validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35

PURPOSE The aim of this study was to define the scales and test the validity, reliability, and sensitivity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-H&N35, a questionnaire designed to assess the quality of life of head and neck (H&N) cancer patients in conjunction with the general cancer-specific EORTC QLQ-C30. PATIENTS AND METHODS Questionnaires were given to 500 H&N cancer patients from Norway, Sweden, and the Netherlands as part of two prospective studies. The patients completed the questionnaires before, during (Norway and Sweden only), and after treatment, yielding a total of 2070 completed questionnaires. RESULTS The compliance rate was high, and the questionnaires were well accepted by the patients. Seven scales were constructed (pain, swallowing, senses, speech, social eating, social contact, sexuality). Scales and single items were sensitive to differences between patient subgroups with relation to site, stage, or performance status. Most scales and single items were sensitive to changes, with differences of various magnitudes according to the site in question. The internal consistency, as assessed by Cronbachs alpha coefficient, varied according to assessment point and within subsamples of patients. A low overall alpha value was found for the speech and the senses scales, but values were higher in assessments of patients with laryngeal cancer and in patients with nose, sinus, and salivary gland tumors. Scales and single items in the QLQ-H&N35 seem to be more sensitive to differences between groups and changes over time than do the scales and single items in the core questionnaire. CONCLUSION The QLQ-H&N35, in conjunction with the QLQ-C30, provides a valuable tool for the assessment of health-related quality of life in clinical studies of H&N cancer patients before, during, and after treatment with radiotherapy, surgery, or chemotherapy.

A Prospective Study of Quality of Life in Head and Neck Cancer Patients. Part II: Longitudinal Data†

Objectives To evaluate the health‐related quality of life (HRQL) of patients with head and neck cancer during and after treatment with radiotherapy, surgery, and chemotherapy.

A prospective multicentre study in Sweden and Norway of mental distress and psychiatric morbidity in head and neck cancer patients

SummaryA Swedish/Norwegian head and neck cancer study was designed to assess prospectively the levels of mental distress and psychiatric morbidity in a heterogeneous sample of newly diagnosed head and neck cancer patients. A total of 357 patients were included. The mean age was 63 years, and 72% were males. The patients were asked to answer the HAD scale (the Hospital Anxiety and Depression scale) six times during 1 year. The number of possible or probable cases of anxiety or depression disorder was calculated according to standardized cut-offs. Approximately one-third of the patients scored as a possible or probable case of a major mood disorder at each measurement point during the study year. There were new cases of anxiety or depression at each time point. The anxiety level was highest at diagnosis, while depression was most common during treatment. Females were more anxious than males at diagnosis, and patients under 65 years of age scored higher than those over 65. Patients with lower performance status and more advanced disease reported higher levels of mental distress and more often scored as a probable or possible cases of psychiatric disorder. Our psychometric analyses supported the two-dimensional structure and stability of the HAD scale. The HAD scale seems to be the method of choice for getting valid information about the probability of mood disorder in head and neck cancer populations. The prevalence of psychiatric morbidity found in this study emphasizes the importance of improved diagnosis and treatment.

Quality of Life and Head and Neck Cancer: A 5 Year Prospective Study.

Objectives: Assessment of health‐related quality of life (HRQL) in head and neck cancer patients from diagnosis to 5 years after start of treatment.

A prospective study of quality of life in head and neck cancer patients. Part I : At diagnosis

Purpose A Swedish and Norwegian study was designed to examine health‐related quality of life (HQL) in patients with head and neck cancer (head and neck) at diagnosis and during treatment and rehabilitation. The overall aim was to examine the impact on HQL at diagnosis depending on tumor location, stage, sex, and age (part I) and to describe HQL longitudinally and determine for which patients and during which period HQL deteriorated most (part II). This article presents the results at diagnosis.

Impact of Second Primary Tumors on Survival in Head and Neck Cancer: An Analysis of 2,063 Cases†

Objective/Hypothesis: To investigate the impact of second primary tumors on prognosis for patients with head and neck squamous cell carcinoma (HNSCC).

Ki‐67 As a Prognostic Marker in Adenoid Cystic Carcinoma Assessed With the Monoclonal Antibody MIB1 in Paraffin Sections

The monoclonal antibody MIB1 recognizing the Ki‐67 antigen in formalin‐fixed, paraffin‐embedded tissue was used to study the proliferative activity in 44 adenoid cystic carcinomas of the salivary glands. The antigen expression was compared with clinical factors, histopathological grading, and prognosis. The Ki‐67 value was significantly higher in tumors from patients suffering from treatment failure than in nonfailures (P < 0.001). The Ki‐67 expression was also higher in tumors exhibiting areas more than 30% of the solid growth pattern and higher in sinonasal tumors than in other locations. By Cox regression analysis, Ki‐67 more than 4% was the strongest prognostic indicator (P <0.005). Clinical stage and violation of surgical margins were also found to be independent significant prognostic indicators. We conclude that Ki‐67 expression estimated by the use of MIB1 is a powerful tool for predicting the short‐term prognosis for patients with adenoid cystic carcinoma.

Quality of life in oral carcinoma: A 5-year prospective study.

We conducted this prospective longitudinal multicenter study to evaluate the health‐related quality of life (HRQL) of patients with oral carcinoma at diagnosis, and after 1 and 5 years in relation to tumour location and treatment modality.

Fistulae following laryngectomy in patients treated with irradiation.

The development of fistulae following 197 consecutive laryngectomies performed from 1980 to 1987 have been examined. Fistulae were present in 28 patients (14 per cent). Age, T-classification, daily level of radiation dose and the time lapse between diagnosis and operation did not seem to influence the rate of fistula development. The study indicates that there is a two to three per cent risk of fistula development when a primary laryngectomy is performed. Fistula formation increased to about 10 to 12 per cent following radiotherapy, with an additional increase whenever previous operations on the neck had been done and/or if the disease demanded more extensive surgery. The study also indicates that the risk for fistula development is less when an experienced surgeon performs the operation.

Cyclooxygenase-2 (COX-2) expression in high-risk premalignant oral lesions.

Emerging data indicate a link between genetic instability and up-regulation of cyclooxygenase-2 (COX-2). To see if individuals at high risk of oral cancer are candidates for treatment with selective COX-2 inhibitors (coxibs), levels of COX-2 expression in healthy, premalignant and cancerous oral mucosa were compared with the occurrence of DNA ploidy status as a genetic risk marker of oral cancer. COX-2 gene product was evaluated immunohistochemically in 30 healthy persons, in 22 patients with dysplastic lesions without previous or concomitant carcinomas, and in 29 patients with oral carcinomas. The immunohistochemical findings were verified by western blotting. COX-2 expression was correlated to DNA content as a genetic risk marker of oral cancer. COX-2 was up-regulated from healthy to premalignant to cancerous oral mucosa. Thus, COX-2 expression was found in 1 case of healthy oral mucosa (3%). All specimens from healthy mucosa had a normal DNA content. In patients with premalignancies. In 29 patients with oral carcinomas, cyclooxygenase-2 expression was observed in 26 (88%), and aneuploidy was observed in 25 cases (94%, P=0.04). Notably, of 22 patients with dysplastic lesions, COX-2 was exclusively expressed in a subgroup of nine patients (41%) identified to be at high risk of cancer by the aberrant DNA content of their lesions. Seven of these patients were followed for 5 years or more. An oral carcinoma developed in six of them (85%; P=0.02). These findings emphasize the need to determine whether coxibs can reduce the risk of oral cancer in patients with high-risk precancerous lesions.