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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The treatment of head and neck cancer continues to represent a major challenge. Patients are typically treated with chemotherapy, radiation and surgery. Multiple resources are needed to allow patients to go through the treatment, and recovery can take months and often years. Those resources include, nutritionists, speech and swallow therapists, social workers, psychiatrists and dentists. It is of paramount importance that these patients have access to a multi-disciplinary clinic that can best manage the problems that will invariably arise when treatment is started. These include mucositis, pain, xerostomia, swallowing dysfunction, depression, loss of work and severe deconditioning. Recent advances in the treatment of head and neck cancer have resulted in an improvement in survival. These advances have included the use of newer chemotherapeutic agents, better radiation planning and delivery and better surgical techniques. This report highlights some of the data presented in the first multidisciplinary symposium on head and neck cancer. Special attention is given to the use of newer 'targeted agents' and their incorporation in the definitive therapy with chemotherapy and radiation. Major focus is placed on epidermal growth factor inhibitors and their potential role both in the curative and recurrent settings.
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PMID:Current and future directions in the treatment of squamous cell carcinoma of the head and neck: multidisciplinary symposium on head and neck cancer. 1654 81

Little is known about long-term treatment outcome of elderly head and neck cancer patients and their quality of life (QOL). One hundred and eighteen older (>or=70 years) and 148 younger (45-60 years) patients with head and neck cancer were followed up for 3-6 years. In the long-term follow-up 33 younger and 24 older patients completed the EORTC QLQ-C30 and H&N35 and a questionnaire about depression. The survival rate after 3-6 years for younger patients was 36%, as compared to 31% in the older patient group. Higher tumour stages, more co-morbidity and non-standard treatment showed to be independent prognostic factors for mortality. No independent prognostic value of age could be found. The global QOL score remains roughly comparable. Even up to 6 years after treatment, we found no significant differences in survival or overall QOL between older and younger head and neck cancer patients.
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PMID:The effect of age on survival and quality of life in elderly head and neck cancer patients: a long-term prospective study. 1710 57

The authors examined the relationship between depressive symptoms, smoking, problem drinking, and quality of life among 973 head and neck cancer patients who were surveyed and had their charts audited. Forty-six percent screened positive for depressive symptoms, 30% smoked, and 16% screened positive for problem drinking. Controlling for clinical and demographic variables, linear-regression analyses showed that depressive symptoms had a strong negative association with all 12 quality-of-life scales; smoking had a negative association on all but one of the quality-of-life scales; and problem drinking was not associated with any of the quality-of-life scales. Interventions targeting depression, smoking, and problem drinking need to be integrated into oncology clinics.
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PMID:Depressive symptoms, smoking, drinking, and quality of life among head and neck cancer patients. 1732 8

Oral mucositis is a common complication in cancer patients receiving chemotherapy and/or radiation therapy. Nearly all patients undergoing myeloablative therapy for stem-cell or bone marrow transplantation experience oral mucositis. Those receiving radiation therapy for head and neck cancer are at especially high risk. However,this toxicity also occurs with standard-dose chemotherapy and can be seen in association with treatment of many other tumor types. Oral mucositis significantly complicates cancer treatment by contributing to pain, dysphagia, weight loss, depression, higher risk of infection, decreased quality of life, and increased healthcare costs. This review summarizes the impact of oral mucositis in patients with cancer, including its pathogenesis, diagnosis, financial implications, and management. Current treatment guidelines are presented, and novel targeted therapies are discussed. Newer agents, such as palifermin (recombinant human keratinocyte growth factor-1), have been shown in clinical trials to reduce the incidence and severity of oral mucositis,and Saforis (an oral glutamine suspension) may also promote recovery from mucosal damage following chemotherapy or radiation therapy. Continued advances in understanding the pathobiology of oral mucositis should lead to the development of additional agents for its effective prevention and treatment in patients undergoing cancer therapy.
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PMID:Diagnosis and management of oral mucositis. 1736 29

The diagnosis of cancer not only affects the lives of patients but also the lives of their relatives. The aim of this study was to investigate the prevalence of psychiatric disorders and quality of life (QoL) among wives of patients treated for head and neck cancer (HNC). We examined 31 wives of patients treated for HNC from January 1998 to December 2004 (meantime since diagnosis 3.7 years) by questionnaires with regard to quality of life (WHOQOL-BREF), quality of the relationship (Dyadic Adjustment Scale), and affective symptoms (Hospital Anxiety and Depression Scale, HADS). Prevalence of psychiatric morbidity was measured by the Mini International Neuropsychiatric Interview (MINI). Results indicated that QoL and satisfaction with the relationship were comparable to the normal population. HADS mean scores showed no clinically relevant levels of depression and anxiety. A high prevalence of psychiatric disorders (38.7%, particularly agoraphobia) was found in the MINI. Wives diagnosed with an anxiety disorder reported significantly lower QoL compared to those without. The results of this study suggest that agoraphobia is a frequent psychiatric disorder seen in wives of HNC patients. Diagnosis of HNC can have a strong impact on the mental health of the spouse and should be taken in account in counselling of HNC patients.
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PMID:Psychiatric morbidity and quality of life in wives of men with long-term head and neck cancer. 1754 2

The principal endpoints in head and neck cancer are survival with improvement of quality of life (QoL) in cancer patients. Patients treated for head and neck cancer suffer from a number of symptom domains: physical symptoms linked to diet and feeding, communication disorders, pain and their general state of health; psychological symptoms including depression, irritability, loss of self-esteem (occasionally feelings of shame), and social symptoms including relationship difficulties with partner (sexual disorders) or with other family members, loss of work, reduction in salary, and sense of uselessness, resulting in a negative impact on their daily life. At present, most tools only partially evaluate patient QoL, concentrating on the global impact of disease and its treatment on patients' physical and psychological condition. The "sociability" of individual patients is rarely evaluated, and the development of qualitative studies in this domain will enable improved understanding of the social factors involved in each patient's adaptability to disease, its treatment and after-effects.
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PMID:Quality of life in head and neck cancers patients: predictive factors, functional and psychosocial outcome. 1818 77

Head and neck cancer patients have been reported to show high rates of depression. However, it is important to differentiate between depressive symptoms and a depressive disorder. This review critically examines the relationship between head and neck cancer and depression. There appears to be little evidence for depression leading to an increased risk of developing cancer and although depressive symptoms in head and neck cancer patients are common, very few studies have investigated depressive disorders. The studies that investigated the incidence of a comorbid depressive disorder report a prevalence very close to that of the general population, implying that major depression is not a normal response to cancer. Finally, the evidence suggests that comorbidity of depression with cancer has a negative impact on morbidity and mortality. Both psychosocial and biological factors could account for this. Dysregulation of the stress hormone axis and increased inflammation are common in depressive disorders and have been suggested as underlying pathological mechanisms and are both markers of poor prognosis in cancer. This evidence suggests that a relatively small number of patients develop a depressive disorder following a diagnosis of cancer, but for those that do it may have a substantial impact on their prognosis.
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PMID:Mood and malignancy: head and neck cancer and depression. 1831

Head and neck cancers constitute a diverse group of diseases including malignancies of the oral cavity, oropharynx, larynx, sinuses, and skull base. Treatment of these cancers includes a combination of surgical resection, chemotherapy, and radiation. Due to both the patterns of disease recurrence and the adverse effects of treatments, patients with head and neck cancer often have a complex and prolonged course of illness that is marked by periods of freedom from disease and symptoms interspersed with bouts of serious illness, debility, and numerous physical and psychological symptoms including pain, dysphagia, weight loss, disfigurement, depression, and xerostomia. Thus, management of this disease is best provided by an interdisciplinary team that includes individuals from the disciplines of otolaryngology, palliative care, radiation oncology, oncology, nutrition, speech, and physical and occupational therapy. Using the case of Mr K, we describe the symptoms encountered by patients with head and neck cancer and suggest options for management. We discuss the psychological aspects that affect these patients, including issues such as changes in body image, quality of life, anxiety, and guilt. Finally, we discuss the importance of the interdisciplinary team in the care of these patients and outline the roles of each team member. By providing comprehensive care to patients with malignancies of the head and neck, clinicians can increase the likelihood that patients and their families will be able to obtain the best possible outcomes and quality of life.
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PMID:Palliative care for patients with head and neck cancer: "I would like a quick return to a normal lifestyle". 1854 27

Patients with head and neck cancer (HNC) experience a variety of psychiatric symptoms and disorders, possibly at rates greater than those seen in patients with other types of cancer. This paper reviews the literature on psychologic distress in HNC patients and will also focus on symptoms and diagnoses of depression, anxiety, and substance abuse--conditions requiring the involvement of healthcare professionals. An awareness of the type of issues experienced by HNC patients is vital for accurate assessment and effective intervention.
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PMID:Psychologic distress and head and neck cancer: part 1--review of the literature. 1849 84

Chronic pain following cancer-related treatment is emerging as a major concern. Heretofore, the pain level among 5-year survivors of head and neck cancer has received limited attention. This study proposes a predictive model for understanding factors associated with the elevated levels of chronic oral pain. Cancer survivors were drawn from a pool of 5-year survivors. A listed sample matched on sex, age, and zip code was purchased and served as a comparison group. Telephone interviews were conducted by a professional call center. Oral pain levels and the presence of metallic taste phantoms were significantly higher in the cancer survivor group than among the comparison group. The prevalence of chronic oral pain among the 5-year survivors was 43% compared to 13% for the comparison group. Hierarchical linear regression showed that among the 5-year survivors, the predictive model for spontaneous pain accounted for 24% of the variance, and for function-related pain the model accounted for 34% of the variance, with the presence of a phantom metallic taste making a significant independent contribution in both models. In the function-related pain model, depression and level of oral function quality of life (QOL) made significant independent contributions. The presence of oral pain is a significant problem among head and neck cancer survivors. The presence of metallic phantoms is an important new piece of evidence suggesting neural damage following cancer-directed treatment. Routine assessment of oral pain levels could improve current analgesic approaches among head and neck cancer survivors.
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PMID:Metallic taste phantom predicts oral pain among 5-year survivors of head and neck cancer. 1884 96


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