Wynia Derks

Differences in coping style and locus of control between older and younger patients with head and neck cancer

Objectives:  This prospective study analyses whether older and younger patients with cancer of the head and neck make use of different coping styles and locus of control mechanisms, and how these mechanisms are related to quality of life (QOL) and depressive symptoms.

Quality of life in elderly patients with head and neck cancer one year after diagnosis

Little is known about quality of life (QOL) in elderly patients.

Elderly patients with head and neck cancer: the influence of comorbidity on choice of therapy, complication rate, and survival.

Purpose of reviewComorbidity may be an important reason for head and neck surgeons to treat elderly patients less intensively. This article provides an overview of the influence of age and comorbidity on choice of therapy, postoperative complications, and survival. Recent findingsSeveral retrospective studies show that elderly patients can undergo surgery if they do not have severe comorbid disorders. Severe comorbidity influences the rate of postoperative complications, and the higher complication rate in older patients reported in some studies is probably due to a higher level of comorbidity. Comorbidity also affects the survival of cancer patients, but several studies have failed to detect a relation between age and survival after correction for comorbidity. Thus, although severe comorbidity may influence the choice of treatment, patient age as such should not be a reason to exclude patients from intensive therapy. SummaryIf severe comorbidity is not present, elderly patients should receive standard treatment for head and neck cancer. Treatment choice should be based on medical findings and patient preference, not on chronologic age.

Elderly patients with head and neck cancer: physical, social and psychological aspects after 1 year.

Objective Elderly patients with head and neck cancer often receive non-standard treatment for reasons other than comorbidity. In this prospective study we investigated how elderly patients fare 1 year after treatment in comparison with their younger counterparts. Material and Methods Seventy patients aged 45–60 years and 51 patients aged ≥70 years with cancer of the oral cavity, pharynx (stage II–IV) or larynx (stage III–IV) participated in the study before treatment and 1 year later. Each patient was interviewed and given a questionnaire concerning physical functioning, social contacts, depressive symptoms, satisfaction with treatment and future expectations. Results At 12 months, patients in both age groups reported significantly more depressive symptoms and less social support than before treatment, and their Karnofsky Performance Score was lower. However, there were no differences between elderly and younger patients. Approximately 90% of those in both age groups said that they would choose the same treatment again, and there was no age difference regarding the impact of treatment or expectations for the future. Conclusion This study shows that the impact of treatment on quality of life did not differ between elderly and younger patients with head and neck cancer. Therefore, standard treatment should be considered in elderly patients if no severe contraindications exist.

Fluoride Therapy for Cochlear Otosclerosis? An Audiometric and Computerized Tomography Evaluation

The progress of sensorineural hearing loss (SNHL) in patients with cochlear otosclerosis was compared for 19 patients treated with fluoride for 1-5 years and 22 untreated controls. CT scans of eight patients before and after fluoride treatment were evaluated visually. Fluoride therapy arrested the progression of SNHL in the low (250, 500 and 1,000 Hz) (p<0.001) and high (2 and 4 kHz) (p=0.008) frequencies. It seemed to be more effective for the higher frequencies in cases with an initial SNHL of <50 dB. Fluoride administration for 4 years did not seem to be superior to a shorter treatment period (1-2 years). For six patients followed up after discontinuing fluoride therapy there was minimal deterioration in SNHL. There was no clear relationship between the size and site of otospongiotic lesions on CT and the severity of SNHL. Follow-up with CT evaluation did not provide reliable information as to the efficacy of fluoride therapy.The progress of sensorineural hearing loss (SNHL) in patients with cochlear otosclerosis was compared for 19 patients treated with fluoride for 1-5 years and 22 untreated controls. CT scans of eight patients before and after fluoride treatment were evaluated visually. Fluoride therapy arrested the progression of SNHL in the low (250, 500 and 1,000 Hz) (p < 0.001) and high (2 and 4 kHz) (p = 0.008) frequencies. It seemed to be more effective for the higher frequencies in cases with an initial SNHL of < 50 dB. Fluoride administration for 4 years did not seem to be superior to a shorter treatment period (1-2 years). For six patients followed up after discontinuing fluoride therapy there was minimal deterioration in SNHL. There was no clear relationship between the size and site of otospongiotic lesions on CT and the severity of SNHL. Follow-up with CT evaluation did not provide reliable information as to the efficacy of fluoride therapy.

Complications of balloon packing in epistaxis

Although balloon packing appears to be efficient to control epistaxis, severe local complications can occur. We describe four patients with local lesions after balloon packing. Prolonged balloon packing can cause damage to nasal mucosa, septum and alar skin (nasal mucosa, the cartilaginous skeleton and the overlying soft-tissue envelope) and should, therefore, be avoided. We suggest early nasendoscopy in general anesthesia to identify and treat the bleeding focus, if bleeding cannot be controlled with regular packing.