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QUALITY of LIFE Head & Neck Cancer and Chemotherapy Lisa Licitra Head and Neck Medical Oncology Unit Istituto Nazionale Tumori Milano
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Why assessing QoL in cancer research ? Efficacy endpoint Compare treatment modalities Focus rehabilitation interventions Predictive/prognostic factor Help patients in their decision-making
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Assumptions Functional impairments translate into poor QoL Emotional well being is related to physical deterioration
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Disease specific QoL instruments EORTC H&N FACT H&N HNRQ QL-H&N QL-RTI/H&N H&N QoL UW QoL QLQ Self administration Items, subscales Summary score Purpose Phase of disease Responsiveness Cross cultural Content validity Face validity Internal reliability
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Semin Oncol 2004; 31: 827
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H&N cancer Patients Pain Sexuality Cough Voice Eating Diet Aspiration Astenia
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H&N cancer Patients Finances Employment Family Social activities
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Pretreatment Health Related H&N QoL Past medical history and ASA score (Br J Oral Maxillofacial Surg 2005) Weight loss can be predicted by QoL (Head & Neck, 2005) Depression, PS, gender Psychosocial > physiologic factors Interaction of pts characteristics with global QoL Pretreatment score predicts the postreatment value
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QoL in laryngeal cancer pts Cross sectional studies High variability in the purpose of the study (laryngectomy vs RT, total vs subtotal surgery…) In most studies global post-treatment QoL was similar (differences in subscales)
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Long-term quality of life after treatment of laryngeal cancer. The Veterans Affaires Laryngeal Study Group Terrel JE, Fisher SG, Wolf GT Arch Otolaryngol 1998; 124: 964-971
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QoL: surgery vs C/RT Hanna F et al: Arch Otolaryngol Head Neck Surg 2004; 130: 875-9 LoTempio M et al: Otolaryngol Head neck Surg 2005; 132: 948-53 El Deiry et al: Arch Otolaryngol Head Neck Surg 2005; 131: 879-85
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Results Most pts report excellent global health related QoL and these are independent of TX C/RT pts: pain, difficulty in swallowing, chewing, dry mouth Laryngectomy: impairement in speech, shoulder function, social functioning, sensory disturbances, painkillers, cough
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Oropharyngeal/oral cavity cancer Disability, distress, dysfunction > laryngectomy Depression, anxiety was similar Subscales differences Surg vs (C)RT Type of reconstruction is not affecting QoL rather speech, cosmetic, swallowing Loss of confidence, uncertainty reagarding the future
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Post TX Health Related H&N QoL Treatment (type of surgery, target RT volume) Intrarterial CT similar to iv CT similar to adjuvant CT Neoadjuvant similar to adjuvant CT Coping strategies affect QOL (Clin Otolaryngol 2005) Speech, swallowing (no postoperative RT, primary surgical closure) (Clin Otolaryngol 2005) FT, trach, neck dissection (Arch Otolarygol 2004) Confilcting results on xerostomia (Int J Radiat Oncol Biol Physics 2003-2005)
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Semin Oncol 2004; 31: 827
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Results of QoL research in H&N QoL deteriorates during treatment and slowly returns to pre-treatment values independently of tx Counterintuitive results QoL prognostic factor Dependant on several pretreatment factors
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Nevertheless… QoL poorly utilised for rehab interventions QoL not utilsed as prognostic tool QoL for clinical decision making poorly explored
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Why? “poor” quality instruments ? particular patient setting ? what are we measuring: adaptability ?
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How do Head & Neck Cancer patients prioritize treatment outcomes before initiating treatment? List M, Stracks J, Colangelo L et al J Clin Oncol 2000; 18: 877-884
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Priority items
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Priority items Pretreatment priority : Survival High individual variability Postreatment priority: ?
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From QoL to clinical decision randomised studies utility clinical decision QoL measurement state of art QoL informations
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Shared decision making
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