Transcript Slide 1

9th International
Quality of Life Conference
Liverpool
Thursday 13th
& Friday 14th
November 2014
The Merseyside Maritime Museum, Liverpool
Course Organiser: Professor Simon Rogers
PROGRAMME 2014
CPD 12.25 hours
Contact person:
Claire McNally
Phone: 0151 529
6342
Professor SN
Rogers
QOL in H&N Cancer: 9th International
Conference
Conference Sponsors – with thanks
Stryker is one of the world’s leading medical technology companies and together with our
customers, we are driven to make healthcare better. The Company offers a diverse array of
innovative medical technologies in the fields of Head & Neck oncology, Maxillofacial, Neuro
and ENT, which help people lead more active and more satisfying lives. We are committed to
supporting education across multiple specialties and helping our customers with their training
needs.
ArthroCare is a highly innovative, multi-business medical device company that develops,
manufactures and markets products based on our internationally patented Coblation
technology. This platform technology precisely dissolves target tissue and minimizes damage
to surrounding, healthy tissue.
The result? Coblation technology has improved many existing surgical procedures and enables
new minimally invasive procedures. Our devices have been used in millions of cases
worldwide across several medical specialties including arthroscopy; spine and neurology; ear,
nose and throat; cosmetic; urology; gynaecology; and laparoscopy/general surgery.
EUSA Pharma focuses on in-licensing, developing and marketing late-stage
oncology, oncology supportive care and critical care products.
EUSA Pharma currently has seven products on the International market:
Erwinase® and Kidrolase® for treatment of acute lymphoblastic leukaemia;
Caphosol® for the treatment of oral mucositis, a common and debilitating sideeffect of radiation therapy and high-dose chemotherapy; Xenazine®, for treatment
for movement disorders; Collatamp®, an antibiotic surgical implant; Custodiol®, a
tissue preservative solution used in organ transplantation; and Fomepizole®, an
antidote for ethylene glycol poisoning.
QOL in H&N Cancer: 9th International
Conference
Conference Sponsors – with thanks
The CCMed companies - Childerhouse Medical, Chambers Medical Care and AS Pharma - have been
supplying medical devices, equipment and consumables to the Ministry of Defence, National Health
Service and the Home Care market for over 45 years.
CCMed's portfolio has more than 1500 product lines covering Airway Management, Surgical
Instruments, Laparoscopy, Patient Identification, Infection Control and Artificial Saliva. As we purchase
directly from the manufacturer, we can supply products at affordable prices without sacrificing quality.
We have built our reputation on providing a reliable, helpful and friendly service to all our customers. Our
staff have a wealth of experience and are able to source just about any medical product, often those that
clinicians loved using but appear to be no longer available.
We listen to what our customers say and we understand that improving and maintaining quality of life for
patients is hugely important both for the patient and the clinician. That is why many of our new products
focus on this aspect of patient care. We believe that this is one way to improve patient recovery rates
and reduce patient care costs.
The Redditch locality is rich in Needlemaking history and the origins of Aspen Medical can be
dated back to Henry Millward & Sons in 1730 and William Hall & Co in 1842. Since this time
there have been a number of merger and acquisitions that have changed the face of the
company, the most recent being in July 2012, when Hill-Rom Holdings, Inc. (NYSE: HRC)
completed the purchase of Aspen Surgical Products. We are proud to own and sell trusted
brands such as Steriseal® Sorbsan®, C-View™ and Sorbaderm™, but also have the ability to
work with customers on private label/OEM projects.
Aspen Medical employs c.130 people across the UK, 100 of whom are employed in our
dedicated Manufacturing facility and Head Office in Redditch. We are an ISO 13485 and FDAregistered facility as well as an authorised EU representative.
Thursday 13th
November
Morning
09:00
QOL in H&N Cancer: 9th International Conference
Follow up and patient support: Can we do things differently?
Chair: Dr Mary Wells
Introduction and summary: Professor Rogers
“Follow up and Patient Support: Can we do things differently?”
Chair: Dr Mary Wells
09:10
Keynote Speaker: Dr Cherith Semple
09:45
Keynote Speaker: Mr Anastasios Kanatas
10:15
‘Quality of Life scores from Head and Neck squamous cell carcinoma
(HNSCC) patients at diagnosis and at 6,9 and 12 months following
diagnosis predict survival independent of HPV status in a cohort of
patients scheduled for curative surgical treatment’ Hans J Aarstad.
10:30
Refreshments
11:00
"Head and Neck Cancer: Impact on Sociability of Patients-Partners
Couples“ G Grandazzi, E Babin
11.15
"The role of a Community Head and Neck Team (CHANT) in the
Foundation Programme“ J Long, N DeZoyza and R Oakley.
11.30
‘Community Head and Neck Cancer Team Airway Management –
Promoting Early discharge and preventing readmission’. Community Head
and Neck Cancer Team – F J Smith, S Evans, N Morrow and R Peak.
11.45
‘Quality of Life and functional outcomes following Pharynogolaryngectomy:
a systematic review of literature’ S Mahalingham, R Srinivasan and P
Spielmann.
12.00
Preservation of greater auricular nerve during parotidectomy: sensation,
quality of life and morbidity issues. A systematic review. M George, PD
Karkos, RC Dwivedi, SC Leong, D Kim, C Repanos
12.15
‘Is there a role for pre-operative analgesia for patients with malignant
diseases?’ E Gosnell, L Warner
12.30
Lunch (1 hour)
Thursday 13th
November
Afternoon
QOL in H&N Cancer: 9th International Conference
Quality of Life into Clinical Practice: Lets Optimise Function.
Chair: Mr Anastasios Kanatas
13:30
Keynote speaker: Dr Justin Roe.
“Functional evaluation after treatment for head and neck cancer.
Whose outcome is it anyway?”
14:00
Keynote Speaker: Professor Steve Thomas
H & N 5000 Update
14:30
‘Preparation in the event of Terminal Haemorrhage in Head and Neck
Cancer Units in the UK – Questionnaire Study. Dr A Brooks, Dr E
Husbands and Dr P Perkins.
14:45
‘A person’s experience of total glosso-laryngectomy – reflections for
multidisciplinary practice’ C Dawson, Y Bhatt, T Martin, S Parmar, P
Pracy, P Praveen, K Reid
15.00
‘Describing the impact of dysphagia on carers of head and neck
cancer survivors using the ICF framework’ R L Nund, N Scarinci, B
Cartmill, E C Ward, P Kuipers, S V Porceddu
15:15
Refreshments
15:30
‘Acupuncture as an effective treatment for Head and Neck Cancer
patients’ P O’Gorman
15:45
‘Piloting the changing faces model within the NHS to address the
psychological impact of disfigurement’ H Spalding
16.00
‘Development of a new treatment Speech and Language Therapy
service for Head and Neck radiotherapy patients’ L Occomore
16:15
‘Are we recognising patients with a poorer quality of life after head
and neck cancer treatment? A service evaluation exploring the
detection and management of patients with condition-related concerns
at Southampton General Hospital’ Y Asiedu
Thursday 13th
November
QOL in H&N Cancer: 9th International Conference
Afternoon cont.
16:30
‘Maxillectomy or maxillary resection for the management of Head and
Neck Cancer can be reconstructed with either an obturator prosthesis
or a surgical reconstruction. It is important to understand the
outcomes of each treatment modality so as to address any issues,
and to advise patients accordingly in the future’ I Kontaxopoulou
16:45
‘A Pilot study to investigate concerns in patients undergoing Neck
Dissection Surgery’ DA Doss, TJ Overend, CM Anderson, T Keating,
J Yoo, K Fung, A Nichols, D MacNeil, M Belzile, S Rogers.
17:00
‘An Exploratory phenomenological study of the experiences of
gastrostomy tubes in Head and Neck Cancer’ S Evans, M Hickson, D
Sookhoo.
17:15
‘An Exploration through interview and drawings of the experiences of
patients diagnosed with oral cancer across their cancer trajectory’
B Noonan.
17:30
Depart
19:30
Course Meal at East is East
Keel Wharf, Kings Dock, Liverpool L3 4BX
0151 707 9377
Friday 14th
November
QOL in H&N Cancer: 9th International Conference
Morning
Emotional Stress and Intervention
Chair: Cherith Semple
08:45
Key note Speaker: Professor Gerry Humphris
‘Brief Interventions for fears of reoccurrence: the mini-AFTER and other
approaches’.
09:15
Keynote speaker: Dr Elspeth Desert
‘Head and Neck MDTs in England: what screening are we using and how
easy is it to access specialist psychological support?’
09:45
‘The FoR Macmillan Project’ Dr Catherine Cooper
10:00
‘A pilot study of patients and carers experiences and reflections of
advanced Head and Neck Cancer’ Ida Rylands
10:30
Refreshments
11.00
‘Psychological predictors of Quality of Life in Head and Neck Cancer: A
Systematic 10 year review’ S Dunne, O Mooney, L Coffey, L Sharp, A
Timmons, D Desmond, C Timon, E O’Sullivan, P Gallagher
11.15
‘Open Surgical Treatment of parapharyngeal space tumours and the
impact on Quality of Life’ Z Pesic
11:30
‘A Qualitative study of Health Professionals’ perspectives on supporting
self management in head and neck cancer survivors’ L Coffey, S Dunne, L
Sharp, A Timmons, D Desmond, E O’Sullivan, I Keogh, C Timon, P
Gallagher
11:45
‘We got cancer’ – A prospective study of Quality of Life and psychological
distress in newly diagnosed head and neck cancer patients and their
caregivers. F Shiraz, M Alibhai, I Hutchinson, K Bhui, A Korszun
12.00
‘How Head and Neck consultants manage patient emotional distress during
cancer follow-up consultants: A Multilevel study’ Y Zhou, G Humphris, N
Ghazali, S Friderichs, David Grosset, S N Rogers
12:15
Poster discussion
12.30
Lunch (1 hour)
Friday 14th
November
Afternoon
QOL in H&N Cancer: 9th International Conference
Team Working: Joint Session with Patients and Carers.
Chair: Professor Gerry Humphris
13:30
Keynote Speaker: Mr Jamie Rae
Throat Cancer Foundation
14:00
Keynote Speaker: Ms Holly Cole-Hawkins
‘Experiencing Head and Neck Cancer from the patient and partner
perspective: Transitions over the year diagnosis’.
14:30
Keynote Speaker: Mr Mike McGovern, Mr Dominic Macareavy and
Ms Gill Amos.
“Reflections on Support Groups and Research Forums”.
15:00
‘Psychological, tumour stage, and choice of treatment are associated
with Quality of Life scores in Head and Neck squamous cell
carcinoma patients during the first 18 months’ A Aarstad.
15:15
‘ePCI on iPAD” - Introduction of Touch Screen Technology for
documentation of ‘Patients Concerns Inventory’ in Head and Neck
outpatients’. D Biswas
15:30
Patient-Carer-Health Professional: Interactive session: Professor
Simon Rogers
What do the group say are the three most important issues in QOL
survivorship?
What will I be like: that is the question?
What will we trade off in terms of QOL and survival?
16:00
Refreshments
16:30
Depart
Poster
Presentations
QOL in H&N Cancer: 9th International
Conference
‘Head and Neck case series to underpin the development of
locally agreed head and neck assessment and treatment
guidelines, including the development of a head and neck
quality of life assessment tool’ R Elwell, J Revell, J Parson,C
Thayer, J Stevenson
‘Validation of the functional intraoral Glasgow scale as a
practical measure of speech and swallowing outcomes for
patients with head and neck cancer’ E Slaven, M Wells
‘Prospective evaluation of balance disorders in patients
undergoing head and neck cancer treatment’ E Pinkham, S
Kuys
‘A randomised Pilot Study of Therabite use versus Wooden
Spatula in the amelioration of Trismus in Head and Neck
Cancer Patients’ R Lee, N Slevin
‘DAHNO & the head and neck MDT: are we getting it right?’ E
Irune, C Bern
‘Olfactory rehab in Laryngectomy patients using “Nasal Airflow
Inducement Manoeuvre” (NAIM)’ E Irune, C Bern
‘Self management following treatment for head and neck
cancer: survivor's perspectives’ S Dunne, L Coffey, L Sharp, A
Timmons, D Desmond, E O’Sullivan, I Keough, C Timon, P
Gallagher
‘Can we predict which patients will require emergency
admission when receiving radiotherapy or chemo therapy for
H&N cancer?’ E Black, K Ah-See
‘Microsurgical reconstructions for H&N cancer in patients aged
>80 - An analysis of patient outcome and experience’ E
Dimovska, A Figus
‘The use of head and neck dissection impairment index to
describe cross pathway disability and physiotherapy related
outcomes in head and neck cancer surgical patients’ A Dinham
‘Possible use of Patient Concern Inventory in implantology’
Z Pesic
‘Multidisciplinary team perspectives on the quality of life of head
and neck cancer patients at two years’ S Parhar
‘Experiences of pain - qualitative studies of patients with head
and neck cancer treated with radiotherapy and of their relatives’
A Schaller
QOL in H&N Cancer: 9th International
Conference
Welcome - ‘The long and winding road’
I have chosen this opening phrase as it the one used for the Liverpool marathon. As a participant
in May, I have a personal experience. I can certainly relate to the long run up Parliament Hill, the
winding paths in Sefton Park, and the need for support and encouragement along the way. I
expect the phrase a ‘the long and winding road’ will resonate with many of our cancer patients
and carers.
As I take this opportunity to extend another warm welcome to Liverpool, has it really been two
years since our last meeting? Time flys by and there has been further change in the NHS
landscape driven in part by the need for financial belt tightening. It has never been more
necessary for us to have a collective vision for what is 'best' cancer care and support. We need
to focus resources and ensure that we all work together to make 'excellence ' the standard.
The conference brings together an international selection of presentations with wide experience
in the field. With help from the Faculty, contributions from a variety of backgrounds and
disciplines will help to consolidate a wide spectrum of viewpoints and provide a unique
opportunity for coherent dialogue. I am very grateful for your participation as I appreciate that the
purse strings on study leave budgets are tight and that we all have demanding clinical and family
commitments.
I am excited about the exchange of ideas and views that will aired over the next two days. There
will be diverse opinion and no right or wrong answers. Your clinical experience will add to the
meeting, so please may I encourage you to participate and make your views known. We have
been fortunate to receive so many excellent abstracts but too many for the time allowed. I
apologise to those of you who wished to give a verbal presentation but there was just not enough
room in the schedule. Speakers have been asked to leave 5 minutes at the end of their allotted
time for questions. I know it takes discipline to keep to time and get the key points across
succinctly, I just hope our speakers can manage this, as we need time for discussion.
You will see from the programme that the workshop has been roughly divided into four sections
and there has been an attempt to fit the free papers around these themes:
i. Thursday morning we will address general issues
ii. Thursday afternoon the emphasis is more towards function
iii. Friday morning we will consider psychological aspects
iv. Friday afternoon there is an opportunity for patient and carer interaction.
QOL in H&N Cancer: 9th International
Conference
Welcome cont. – ‘The Long and Winding road’
Some questions for you:
• Has patient care changed in your unit / practice in the last two years; for good or for not so
good. What examples come to mind?
• Have there been any new initiatives or ways of working that might have had a passive impact
on patients and carers quality of life?
• What narratives do you have from your practice that helps bring into sharp focus where we
have done well, where we could do better?
• Were are we up to with Holistic Needs Assessment and where is it leading?
• In head and neck cancer what interventions do you offer your patient and carers?
• How do you select patients for interventions?
• When, how frequent and how do you know if they are helpful?
• What does multidisciplinary team working?
• What does good MDT working look like?
• Are all MDTs and their functionality the same across units - I doubt it!
• How do we get the most from the MDT to help patients and carers?
• Can we effectively share roles with in the MDT?
• What are the biggest problems H&N patients experience?
• What solutions, resources and recommendations do you use?
• How do we use patient and carer feedback to shape our services?
Please do not hesitate to let me know if there are any problems during the conference and I will
do my best to deal with them for you. Also please take the opportunity to complete the course
evaluation forms, as this will help shape the next meeting, which stamina permitting, will be
November 2016!
Finally, I wish to express my sincere thanks to Claire and Chris for their tremendous
administrative support which have been in addition to their day to day NHS job! Without them the
conference could not have taken place.
Professor Simon Rogers
QOL in H&N Cancer: 9th International
Conference – Meet the Chairs
Chairpersons
Thursday Morning
Professor Mary Wells
PhD MSc BSc RGN
Mary Wells is Professor of Cancer Nursing Research and Practice in NMAHP RU and Director of
Clinical Liaison and Development for the School of Nursing, Midwifery and Health at the
University of Stirling. Mary trained at Guys Hospital and South Bank University, graduating with
a BSc (Hons) in Nursing Studies in 1988. After working on a head and neck surgical ward as a
staff nurse, she undertook the oncology course and was then a Ward Sister and Senior Nurse in
Oncology at St Bartholomew’s Hospital, London. She completed a Master’s Degree at the
Institute of Cancer Research in 1995, and has since held several joint clinical academic posts in
Oxford, London and Dundee. In 2003, she was seconded to set up and head the new Maggie’s
Cancer Caring Centre in Dundee. Mary was a Senior Lecturer in the School of Nursing and
Midwifery at the University of Dundee until 2013, when she moved to Stirling. She is an
experienced health services researcher and has coordinated qualitative and quantitative studies,
exploring and evaluating patients’ experiences and outcomes, approaches to symptom
management and nurse-led initiatives in cancer care. Her current research focusses on living
with and beyond cancer, and she has just received funding for a study to develop a swallowing
intervention for patients having chemoradiotherapy to the head and neck. Mary sits on a number
of committees including the NCRI Psychosocial and Survivorship Clinical Studies Group. She is
a Specialist Advisor to Macmillan Cancer Support, a member of CCaT (Consequences of Cancer
Treatment Collaborative) and an Executive Board Member of the European Oncology Nursing
Society.
Thursday Afternoon
Mr Anastasios Kanatas
BSc (Hons), BDS, MBChB (Hons), MFDSRCS, MRCSRCS, FRCS (Max Fac), PhD, MD, PGC
Anastasios is an Oral and Maxillofacial Surgeon with special interests in Head and Neck
Oncology, reconstruction and clinical education. He received his training in the UK (Liverpool and
Leeds), USA, Germany and France. He is the author of 110 publications in international peerreviewed journals, book chapters and is working in collaboration with research groups in the UK,
Germany, Austria and the USA. He is a Section Editor of the British Journal of Oral and
Maxillofacial Surgery and the Associate Editor of the Journal of Solid Tumours. In addition, he is
a member of the Faculty of the Patient Concerns Inventory and QOL Workshops in Liverpool,
and he is the Chairman of the Bochum Flap / Microvascular Course in Germany.
QOL in H&N Cancer: 9th International
Conference – Meet the Chairs
Chairpersons continued
Friday Morning
Dr Cherith Semple
Macmillan Clinical Nurse Specialist
Cherith Semple completed her BSc (Hons) Nursing at the University of Ulster (Northern Ireland) in 1995.
Having worked as a staff nurse at the Regional Plastic and Maxillofacial Unit in Ulster Hospital (Northern
Ireland) she was appointed the Macmillan Clinical Nurse Specialist in Head and Neck Cancer in 1999. She
completed her PhD in 2006 which explored the post-treatment needs of patients with head and neck cancer
and development of a psychosocial intervention. She has published 13 peer reviewed papers, two
Cochrane reviews; one entitled ‘Effectiveness of psychosocial intervention for patients with head and neck
cancer’ and co-authored two book chapters. Her research interests include ‘the impact of parental cancer
when you have young children’ and grant funding has been secured to provide training for oncology
professionals’ to increase their awareness of the potential challenges for families when a parent has cancer
and implementation of a psychosocial intervention for children (aged 5 -12) whose parent has cancer in five
acute oncology settings in Northern Ireland.
Friday Afternoon
Professor Gerry Humphris
The University of St Andrews
Gerry Humphris studied Psychology at Reading University (1973-76) before going to Guy’s Hospital to
complete a PhD (1983). He qualified in clinical psychology at Liverpool (1986) and after 10 years teaching
of undergraduate dentists and medics (Director of Communication Skills) moved to University of
Manchester as Reader in the Clinical Psychology Department (2001) before taking up the post of Chair in
Health Psychology at Medical School, University of St Andrews (Nov 2003). His main interest is
understanding the communication processes between clinician and patient in long-term conditions. He has
received notable EU funding for research projects with DG Justice, European Commission (e.g. ORION
Project lead). His current interest is the development and dissemination of new complex psychological
interventions. He holds an Honorary Consultant Clinical Psychology contract with NHS Lothian in the
Edinburgh Cancer Centre, Western General Hospital, Scotland. He is a member of the Verona Network on
Sequence Analysis (European Association of Communication in Healthcare-EACH). He is currently the
Chair of the Research Committee for EACH. He is Co-Director of the WHO Collaborating Centre for
International Child and Adolescent Health Policy at St Andrews Medical School.
QOL in H&N Cancer: 9th International
Conference – Meet the Keynote Speakers
Keynote Speakers
Dr Justin Roe
Ph.D., Cert. MRCSLT
Dr Justin Roe has worked at the Royal Marsden NHS Foundation Trust since 2008 and is now the Head of
Speech & Language Therapy (SLT) and an Allied Health Professions Researcher – Project Lead.
After graduating in 1993 with a major in psychology, Justin worked with adults with profound and multiple
learning disabilities for 6 years. He qualified as a SLT on completion of a post-graduate diploma in clinical
communication science at City University in 1999. He completed his MSc in dysphagia research from the
Faculty of Medicine, University of Newcastle upon Tyne in 2005. In 2013, he was awarded his PhD from
the Institute of Cancer Research evaluating the impact of intensity-modulated radiation therapy on
swallowing outcomes in HNC.
Prior to his time at the Marsden, Justin held a number of positions working with oncology patients in acute,
tertiary and specialist palliative care settings.
He has published a number of peer-reviewed papers & lectures widely. He is an RCSLT Clinical Speciality
Advisor in HNC and palliative care and chairs the HNC Clinical Excellence Network (South of England).
Justin sits on the scientific committee of the United Kingdom Swallowing Research Group (UKSRG) and
the swallowing committee for the American Speech Language Hearing Association’s (ASHA) 2014
convention.
In addition to his clinical and managerial roles, Justin is actively involved in on going research. He is the
lead SLT for the DARS study, a Cancer Research UK-funded, phase III randomised multicentre study
comparing IMRT delivery techniques and their impact on swallowing and is currently leading a study
evaluating the wider rehabilitation needs of patients with lung cancer.
Professor Steve Thomas
BDS(Lond), MB,BCh(Wales), PhD(Q'ld), FDSRCS, FRCS(Eng), FRCS(OMFF)
Professor in Oral and Maxillofacial Surgery
Steve is leading the Head and Neck 5000 initiative. The Head and Neck 5000 study is a collaborative
projects between both researchers and clinicians across the United Kingdom. The study is funded by the
National Institute for Health Research, UK.
Steve is currently Chair of the NCRI Head and Neck Clinical Studies Group (H&N CSG) Survivorship Subgroup.
QOL in H&N Cancer: 9th International
Conference – Meet the Keynote Speakers
Keynote Speakers continued
Elspeth Desert
Consultant Clinical and Health Psychologist
I am the Clinical director of a team of Psychological experts, 15 in total who work across Cumbria working
with Cancer patients and other long term conditions, including paediatric diabetes. The service works
across a range of NHS providers and works into about 100 MDT’s.
The service has been providing training across the health providers and professions in CBT skills, to
enable staff to offer psychological care and support as part of every consultation. The course has been very
successful in terms of numbers of graduates, feedback from trainees and patients. The graduates are
offered on-going supervision.
In 2013 we received a grant for three years from Macmillan Cancer Support to develop a pathway and
training around Fear of recurrence. This project has a variety of parts, which my colleague Catherine
Cooper, will explain at this Conference.
My own Clinical Practice is in a DGH, working as part of the Head and Neck MDT, but also offering input to
other Cancer specific tumour teams.
Mr Jamie Rae
Throat Cancer Foundation
Jamie Rae is a successful entrepreneur, author and charity founder.
An experienced, focused and passionate business leader with significant abilities and credentials in
Business Development, Strategy and Corporate Social Responsibility (CSR). Founder of International,
multi award winning business Redeem plc in 1999. Organically developed Redeem plc from business start
up operation to employing over 150 employees. Over £300 million paid to consumers and good causes
from recycling operations in seven countries. Coveted awards include ‘UK Company of the Year’ awarded
by Business in the Community (BITC).
In 2010 during the exit sale of his company Jamie was diagnosed with Oropharyngeal Cancer, T2, N1, M0.
He was successfully treated by Professor Christopher Nutting in London. As a result of his experience he
founded a new charity, The Throat Cancer Foundation, to raise awareness of and campaign for patients
affected by this condition.
QOL in H&N Cancer: 9th International
Conference
Keynote Speakers continued
Ms Holly Cole-Hawkins
I qualified as a Dentist in 2008 from the University of Bristol and following a year in General Practice was
appointed as an NIHR Academic Clinical Fellow (ACF). During the first year of that post I worked as a
Maxillofacial SHO. During the second year of the ACF post I was based in the Lifecourse Epidemiology and
Population Oral Health group, led by Professor Andy Ness. This is where my interest in a research career
really started and I was supported with making a successful application for an NIHR Doctoral Research
Training Fellowship in 2011.
For the last three years I have been working on a mixed methods PhD titled ‘Experiencing a diagnosis of
head and neck cancer: The patient and partner perspective’, supervised by Dr Andrea Waylen, Professor
Andy Ness and Dr Christie Cabral. I plan to submit my thesis at the end of this year prior to starting
specialty training in Oral Surgery.
Mr Mike McGovern
I am 60 years old, married to Ann, and we have with 3 grown up children.
I have the privilege of being the Chair person of Merseyside HANC patient and carers support group.
In July this year I retired after 44 years with the rail industry as a Telecommunications Engineer.
Unfortunately I have been diagnosed with cancer 3 times.
In 1994 it was kidney cancer, in 2007 I had a face flap operation to remove a tumour on the inside of my
right cheek, and in 2010 I had a reoccurrence which involved my right jaw being sectioned and replaced
with part of my fibula bone. I also received radio therapy after my surgery
I am not a clinician, but I think I know what it's like being a patient!
Ms Gill Amos
Gill’s husband was diagnosed with squamous cell carcinoma of the underside of the tongue and floor of the
mouth in 2008. A couple of years later he developed osteoradionecrosis on the right side of his mandible.
This section of his jaw was removed in September 2011, rebuilt with bone from his fibula and surrounding
tissue. Even now, 6 years later, Rob still has to have a small operation to remove infected plates in his jaw.
The continuous affect that head and neck cancer has on people for the rest of their lives has led Gill to take
on the position of Co-ordinator of HaNC – Head and Neck Cancer Support and Research officially from 1
October 2014 with the desire to help others who have been affected by this type of cancer
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Morning Session
Hans Jørgen Aarstad,1,2 Arild Andrè Østhus,1,2 Olav K. Vintermyr1,3 & Anne Kari H. Aarstad2,4
1Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, N-5020
Bergen, Norway.
2Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, 5021
Bergen, Norway.
3Department of pathology, Haukeland University Hospital, Bergen, Norway.
4Haraldsplass Deaconess University College, Bergen, Norway.
“Quality of life scores from head and neck squamous cell carcinoma (HNSCC) patients at
diagnosis and at 6, 9 and 12 months following diagnosis predict survival independent of
HPV status in a cohort of patients scheduled for curative surgical treatment”.
Objectives: To evaluate the predictive effect of health-related quality of life (HRQoL) scores on survival in a
cohort of head and neck squamous cell carcinoma (HNSCC) patients at 6, 9, 12 and 18 months after
primary diagnosis.
Materials and Methods: One hundred and nine consecutive HNSCC patients reported their HRQoL
measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life
Questionnaire (QLQ) general (C30) and head and neck (H&N35) parts, at the time of diagnosis and at 6, 9,
12 and 18 months after diagnosis. The following HRQoL sum scores were calculated: A sum score of the
general QoL/health scores, one score form the general functional indexes, one score from the general
symptom indexes and one score from the overall H&N specific indexes. All sum scores were dichotomized
with the lowest quartile scored as one group. All patients included were younger than 78 years of age, had
adequate cognitive functions, and all were scheduled for curative therapy. At the time of diagnosis selfreported amount of smoking and alcohol consumption, as well as socio-demographic information were
registered. A complete clinical history, including co-morbidity information, was retrieved from hospital
records. New HRQoL scores were not obtained if not curatively aimed treatment could not more be given.
HPV status was determined on tumor DNA isolated from formalin fixed paraffin embedded (FFPE) tissue
blocks. The patients were included in the period from November 2002 to June 2005. Survival was
determined as of December 2013.
Results: In line with previous published results, but now showing the same with HPV adjustment, when
obtained at diagnosis all the HRQoL sum scores predicted survival. At six months, the general HRQoL sum
score (RR=0.49; CI: 0.23-1.00; p=0.05), the general symptom sum score (RR=1.9; CI: 1.0-3.5; p<0.05) and
the HN sum score (RR=2.2; CI: 1.2-3.9; p=0.01) predicted survival. At nine months the general HRQoL
(RR=0.4; CI: 0.2-0.8; p<0.01) and the HN sum scores (RR=3.0; CI: 1.5-5.8: p<0.01) predicted survival. At
12 months the general symptom sum score (RR=3.75; CI: 1.8-7.6; p<0.001) predicted survival. At 18
months the HRQoL sum scores did not predict survival. The survival predictions were mostly independent
of age, gender and TNM stage of the patients. Being HPV infected or not did not in general interfere with
HRQoL score survival predictions.
Conclusion: HRQoL score obtained during treatment and throughout the first year after diagnosis predicted
survival in HNSCC patients.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Morning Session
Guillaume Grandazzi, PhD1, Florence Cuny, MD2, Fabrice Morlais, PhD1, Ludivine Launay,
MSc1, Emmanuel Babin, MD, PhD1,2
1 INSERM / UNICAEN U1086, Cancers et Préventions, F-14000 Caen, France
2 CHU de Caen, Service ORL et Chirurgie cervico-faciale, F-14000 Caen, France
“Head and Neck Cancer: Impact on Sociability of Patients-Partners Couples”.
Abstract
Objective: This study aims to assess the impact of head and neck cancer on sociability of patient-partner
pairs.
Study Design: Survey study
Methods: Two questionnaires were sent to 1525 head and neck cancer patients diagnosed between 1
January 2008 and 31 December 2010 via tumour registries of four French Departments. 270 couples were
included. We analysed the impact of data related to the disease or treatment, socio-economic data and
health data on the sociability of patient-partner couples. Various dimensions of social interactions were
identified.
Results: Solitary activities increased among partners with incomes greater than or equal to the minimum
wage in France (OR = 1.99 [1.03-3.83], p = 0.04). Activities related to the familiar environment were
decreased when the patient perceived his/her health status as poor (OR = 2.80 [1.50-5.25], p = 0.001), had
undergone disfiguring surgery (OR = 1.75 [1.07-2.85], p = 0.02) or radiation therapy (OR = 2.46 [1.31-4.60],
p = 0.005). Activities concerning the known outside environment were reduced when the patient perceived
his/her health status as poor (OR = 2.27 [1.24-4.13], p = 0.01), when he/she was treated with radiotherapy
(OR = 2.06 [1.13-3.74], p = 0.02) or when the partner had poor sleep (OR = 1.95 [1.11-3.43], p = 0.02).
Conclusion: The disease significantly reduces the sociability of couples. Support for partners should not be
neglected, nor should the risk of social isolation. Therapists should be aware of these changes and
multidisciplinary management should be undertaken to better support patients and partners.
Key Words
Head and Neck Cancer; Sociability; Quality of life; Stigma; Patient-Partner Couples
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Morning Session
J Long, N DeZoyza and R Oakley (Guy’s Hospital, London)
“The Role of a Community Head and Neck Team (CHANT)”
Background
The recommendations of the Collins Report have driven changes to the content and delivery of training to
Foundation doctors, with the role of Foundation doctors in surgical sub-specialties being questioned. In this
paper we describe the integration of a community component into the curriculum of Otolaryngology
Foundation trainees.
Aims
It is now a requirement of the Foundation programme that every Foundation doctor has a community
placement in their training. We aim to describe how our Otolaryngology department has integrated a
community component into the 4-month Foundation rotation.
Methods
The Community Head and Neck Team (CHANT) is part of the hospital MDT and offers specialised support
to patients in their local community in South East London. The team includes clinical nurse specialists,
physiotherapists, dieticians and speech and language therapists. During their placement in Otolaryngology,
each Foundation doctor spends time in the community with CHANT. The current arrangement is an
attachment at the beginning and a further attachment at the end of their placement.
Results
The feedback from our Foundation doctors has been extremely promising. Looking after patients on the
ward and visiting them in the community allows Foundation doctors to appreciate the complex social
factors that play a part in disease, and the barriers that exist towards healthcare. Foundation doctors see
the whole pathway of their patient’s; from diagnostic assessment and complex surgical treatment, to an
understanding of the patient’s needs in relation to the morbidity of treatment for cancer and how to meet
them in the community.
Conclusions
CHANT provides a quality service for the patient by bringing specialist care to the community setting. It also
offers Foundation doctors the opportunity of working in a highly specialised and supportive unit delivering
longer term rehabilitative care to patients in the community.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Morning Session
Community Head and Neck Cancer Team – Felicity J Smith, Sian Evans, Natasha Morrow
and Rebecca Peak.
“Community Head and Neck Cancer Team Air Way Management – promoting early
discharge and preventing readmission”.
Guys & St Thomas’ NHS Foundation Trust provide a comprehensive pathway of care for head and neck
cancer patients from acute through to community settings. This includes the management of altered
airways. The term used to describe patients who have had a tracheostomy or laryngectomy is ‘neck
breathers’. It is estimated that there are in excess of over 5,000 ‘neck breathing’ patients across the UK
(National Patient safety Agency, 2005). Head and Neck surgery and treatment can result in long or short
term altered airways with a tracheostomy or laryngectomy.
The Community Head and Neck Cancer Team (CHANT) provide a multidisciplinary team (MDT) approach
from CNs, Physiotherapists and Speech and Language Therapists for airway patients on discharge from
hospital. The team provide support across the 6 boroughs of South East London.
Our aim is to reduce lengthy inpatient stay, support vulnerable patients and their families/carers during
transition through acute to community care and reduce hospital readmission rates. We provide robust
education to patients, families, carers and HCP’s on airway management to support life at home and
increase independence. CHANT liaise closely with acute teams, attend airway MDT meeting and provide
follow up with ‘airway’ visits within 24 hours of discharge. During 2013 85% of altered airway patients were
assessed at home within 24hrs of discharge from acute care and only 9% of CHANT hospital readmissions
were of altered airway patients with respiratory compromise. The service is currently developing community
tracheostomy competencies and staff training programmes to support non-specialist teams providing care
for the head and neck altered airway patient. Our interest if to share and explore further surveillance of our
altered airway patients who receive specialist community care. We hope to analyse our supported
discharge service and describe how we promote self management, independence and reduce reliance on
social care services.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Morning Session
Sridhayan Mahalingam, Rajeev Srinivasan from East Surrey Hospital, Canada Avenue,
Redhill, Surrey, UK.
Patrick Spielmann from Ninewells Hospital & University of Dundee Medical School, UK.
“Quality of life and functional outcomes following Pharyngolaryngectomy: a systematic
review of literature”.
Background:
The long-term prognosis of hypopharyngeal cancer is poor. Surgery necessitates Pharyngolaryngectomy
(PL) with reconstruction using pedicled or free flaps. For such patients, with poor long-term outcomes, it is
important that functional outcomes are preserved in order to maintain a respectable quality of life.
Aims:
To identify the functional outcomes following PL with respect to quality of life, speech and swallow through
a review of literature.
Methods:
Type of review: A systematic review of the literature with a defined search strategy.
Search strategy: Searches of Evidence Based Medicine databases, and literature databases using key
words: pharyngolaryngectomy, laryngopharyngectomy, swallow, dysphagia, speech and dysphonia from
1970 to August 2013. Articles were screened for relevance using pre-determined inclusion and exclusion
criteria.
Evaluation method: Articles were reviewed by authors and data compiled in tables and graphs for analysis.
Statistical analysis was carried out using Fisher’s test (significance level: p<0.05).
Results:
No previous systematic reviews assessing functional outcomes were identified. 17 studies reported speech
outcomes (576 patients) and 15 reported swallow outcomes (1076 patients). The cumulative data suggests
patients who were treated with trache-oesophageal prosthesis developed better speech outcomes than
those rehabilitated using other measures. Overall stricture incidence was 11.4% and 6.5% of patients
required long-term enteral nutrition; these were significantly lower in patients who were treated with the
Free Jejunum Flap in comparison to the Antero-Lateral Thigh Flap. Four studies used validated speech
measures, and three used validated swallow measures (Therapy-Outcome Measures) and they suggest an
overall level of perceived impairment in quality of life. Speech and swallow outcomes were noted to be
significantly poorer in patients who underwent PL in comparison to those who had undergone Total
Laryngectomy.
Conclusion:
The evidence suggests that there is an overall impairment in speech and swallow outcomes following PL,
however the true extent is not clear due to variability in methods of assessment. There is a need for a
general consensus on assessment measures to be used so that multicentre studies can be conducted. This
may prove useful when counselling and consenting patients pre-operatively.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Morning Session
George M, Karkos PD, Dwivedi RC, Leong SC, Kim D, Repanos C
“Preservation of greater auricular nerve during parotidectomy: sensation, quality of life,
and morbidity issues. A systematic review”.
Background: Parotid surgery is commonly performed for benign and malignant neoplasms, inflammatory
and autoimmune conditions. The main concern for the surgeon is preservation of the facial nerve, but the
most common patient reported post-operative complaint is sensory disturbance around the postauricular,
preauricular and lobular areas.
Aims: Our objectives were to assess the evidence of preservation of the greater auricular nerve in
parotidectomy with regard to morbidity and quality of life.
Method: This was a systematic review. Inclusion criteria were: English literature, prospective and
retrospective studies. Exclusion criteria were: single case reports, "teaching" reviews. Outcome measures
were: tactile sensation, pain, thermal sensitivity, and quality of life
Results: Although quality of life does not seem to be adversely affected when the greater auricular nerve is
sacrificed, preservation of the posterior branch was recommended in 8 studies. When preserving the nerve,
the incremental operative time increase is no more than 10 to 15 minutes after a rapid learning curve.
Conclusion: There is level Ib evidence that preservation of the greater auricular nerve minimizes the
postoperative sensory disturbance and should be considered whenever tumour clearance is not
compromised. There is no evidence that overall quality of life is affected when the greater auricular nerve is
sacrificed
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Morning Session
Miss E Gosnell, Mrs L Warner
Pennine Acute NHS Trust
“Is there a role for pre-operative analgesia for patients with malignant disease?”
Background: In many specialities, enhanced recovery pathways have become imperative for the surgical
management of cancer patients, reducing both post-operative complications and length of inpatient stay.1
Whilst we frequently counsel head and neck surgical patients on the long-term implications of their
procedure, do we really provide holistic pre-operative management? And, Is there a role for pre-operative
analgesia in this group of patients?
Aims: We hope to identify opportunities for utilising pre-operative analgesia by assessing and reviewing
current standards and practices in cases of head and neck cancer surgery.
Method: We conducted a 10-year literature review (PubMed and Medline), investigating the use of preoperative analgesia in general and specifically in head and neck malignancy.
Results: A meta-analysis2 (Seib et al 2006) on the use of pre-operative Gabapentin for post-operative
analgesia reviewed eight placebo-controlled, randomised controlled trials, using primary outcomes of pain
scores, total analgesia consumption and side-effects over 24 hours. Principle findings showed preoperative Gabapentin was associated with significantly lower pain scores, lower opioid consumption and no
difference in the incidence of side effects.
A study from Hong Kong3 (Chiu et al 2012) compared Gabapentin to placebo in tongue carcinoma patients
and concluded single pre-operative doses of Gabapentin led to significant reductions in post-operative pain
and nausea. A more recent trial4 (Cillo JE Jr et al 2014) found a single pre-operative dose of Pregabalin
and Celecoxib lead to decreased post-operative consumption of analgesia and perceived pain.
Conclusion: Patients undergoing surgery for head and neck cancer have a multitude of medical and
emotional needs. Reducing post-operative pain is likely to result in better outcomes and ultimately improve
quality of life for patients. Our literature review identified pre-operatively prescribed Gabapentin significantly
reduced post-operative pain in some surgical patients; however more evidence is needed to ascertain its
role in head and neck cancer surgery.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
Dr Anna Brookes, Dr Paul Perkins and Dr Emma Husbands
“Preparation in the event of Terminal Haemorrhage in Head and Neck Cancer Units in the
UK – Questionnaire Study”.
Aims:
To understand how Head and Neck multidisciplinary teams across the UK prepare for the possibility of
terminal haemorrhage
Methods:
Online questionnaire with reminder sent to Head and Neck Oncology Nurses in UK etc.
Results:
The questionnaire response rate was xxx.
There was considerable variation in case load between 40 – 650 patients per centre. 282 patients identified
were at risk of terminal haemorrhage and there 58 actual such events. 15 terminal haemorrhages that
occurred were not predicted event 59% of events occurred in hospital, 27% at home, 9% at home. 80% of
centres proactively identify risk and offer information, 8% do neither. The perceived likelihood of outcome is
the most cited factor in prompting discussion. Majority of discussions are led by specialist head and neck
cancer nurses. 21% of centres have no formal guidelines in place for preparation in the event of terminal
haemorrhage.
Conclusion:
There is a significant variation between centres in their preparation for terminal haemorrhage, with no clear
adherence to local guidelines in some centres, or the absence of local guidelines entirely. That numbers of
patients predicted to be at risk varies significantly and is not proportional to centre size suggesting
significant differences in frequency or method of risk stratification. The majority of risk stratification and
patient/carer preparation is being performed by head and neck specialist nurses.
This work provides significant new information as to how UK centres prepare for the event of terminal
haemorrhage from the point of view of the health professional, as well as providing guidance on the
numbers of patients that this potentially affects.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
Dawson C1, Bhatt Y2, Martin T2, Parmar S2, Pracy P3, Praveen P2, Reid K1
1 – Department of Speech and Language Therapy, 2 – Department of Maxillo-facial Head &
Neck Surgery, 3 – Department of Otolaryngology Head & Neck Surgery, Queen Elizabeth
Hospital, University Hospitals Birmingham NHS Foundation Trust
“A person’s experience of total glosso-laryngectomy - reflections for multidisciplinary
practice”
Background:
Total glosso-laryngectomy is an uncommon radical head and neck surgery which may be undertaken in the
treatment of advanced tongue base cancers. It is recognised as being associated with significant physical
and psychological morbidity. There is a lack of qualitative research examining the quality of life issues
experienced by this population.
Aims:
This article explores a person’s experience of undergoing total glosso-laryngectomy for treatment of
squamous cell carcinoma, in order to facilitate service improvements.
Method:
This qualitative research uncovered pertinent issues, identified using interpretive phenomenology. The
notebooks kept by a person who underwent glosso-laryngectomy during the inpatient stay were transcribed
and coded to generate themes and metathemes related to the person’s lived experience.
Results:
Metathemes identified included: post-surgical changes and the associated symptom experience,
information giving, discharge home, interface with the clinical team, and clinical and personal relationships.
Conclusion/Implications for practice:
The findings have informed post-operative care and rehabilitation in the following ways; the preparations for
discharge home will focus on the reality of altered anatomy, communication and swallow in the home
environment. The pre-treatment counselling process will aim to provide people with realistic information on
the experience of recovery following this unique surgery, with specific insights from this service review.
The role of the Consultant Surgeon and their visible presence overseeing the inpatient after care will
continue, as this provided reassurance. Interaction and collaborative working between the Speech and
Language Therapist, Medical and Nursing team will continue and be developed, as it was deemed a
positive facet of the post-surgical care.
The experience of the person who underwent this surgery was unique, and may not be generalised to a
wider cohort, however the methodological approach used to evaluate the service, and the themes
generated may be of value to other clinical teams.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
Rebecca L. Nund1,2, Nerina Scarinci1, Bena Cartmill2, 3, Elizabeth C. Ward1,2, Pim Kuipers2,4,
and Sandro V. Porceddu5,6
1. School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
2. Centre for Functioning and Health Research, Metro South Health Services District, Queensland
Health, Brisbane, Australia
3. Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia
4. Population and Social Health Research Program, Griffith Health Institute, Griffith University,
Brisbane, Australia
5. School of Medicine, The University of Queensland, Brisbane, Australia
6. Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Australia
“Describing the impact of dysphagia on carers of head and neck cancer survivors using
the ICF framework”
Background: Emerging research has documented the pervasive effects of dysphagia following non-surgical
head and neck cancer (HNC) management on carers. With this emerging research, there is a need to use
a consistent and internationally recognised taxonomy to describe the effects of dysphagia on carers. This
will allow for accurate comparisons between studies and assist clinicians with determining carers’
intervention needs. The International Classification of Functioning, Disability and Health (ICF) provides a
well-established framework and classification system for the description of health and health related states.
Yet, no studies to date have applied the ICF to carers of people with dysphagia.
Aims: The aim of this study is to determine whether the experiences of carers of people with dysphagia
following HNC can be accurately documented using the ICF and identify the most typical and relevant
domains and categories of the ICF for this group.
Method: Twelve carers of people with dysphagia following HNC participated in individual, in-depth
interviews. The categories and sub-categories that emerged from the qualitative interviews were mapped to
the ICF using the established linking rules.
Results: Four themes emerged from the interviews and these themes were comprised of 19 categories and
26 sub-categories. In total, 34 of the 45 categories were linked to 29 ICF codes including 17 Activity and
Participation codes, 11 Environmental Factor codes, and 1 Body Functions code. Ten items were coded as
Personal Factors, three items were not covered by the ICF and one item was not applicable to carers of
people with dysphagia.
Conclusion: These data demonstrate that the ICF can be used to accurately describe the functioning of
carers of people with dysphagia following HNC. Using a framework such as the ICF could assist clinicians
and researchers to identify the areas of greatest need and therefore deliver more targeted support and
management to this population.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
Patricia O'Gorman, Senior Physiotherapist, Licentiate in Acupuncture.
South Infirmary Victoria University Hospital (SIVUH), Cork, Ireland.
Acupuncture as an effective treatment for Head and Neck Cancer patients
No effective treatment exists for radiation-induced xerostomia which can severely impair
quality of life in Head and Neck cancer patients. Studies suggest that acupuncture may promote
increased salivary flow. This study is a retrospective analysis of 134 consecutive patients referred
for acupuncture for radiation-induced xerostomia to a single clinic in SIVUH, Cork, between April
2008 and April 2014, to assess treatment benefit. This study represents Head and Neck cancer
patients in the general community as opposed to a group of recruited participants. 119 patients
(89%) attended for 12 sessions of acupuncture completing the Xerostomia Inventory (XI)
validated outcome measure before the first treatment and after completing 12 treatments. A
standardised treatment protocol was followed. Results of 106 patients analysed show that 67%
of patients had a clinically significant improvement with treatment, with a mean overall XI
improvement of 7.3 points post-treatment compared to pre-treatment scores (p ˂ .001). Subgroup analysis revealed a good response to treatment in those waiting over 18 months postradiotherapy for acupuncture (n = 24). The radiotherapy only group (n = 53) responded slightly
better to acupuncture than the group post-surgery and radiotherapy (n = 53). Younger patients
demonstrated better results than older patients. Booster sessions do not lead to further
improvement in XI scores on analysis of a sub-group (n = 35) after a further 12 months of
acupuncture. Data from this large study which enabled sub-group analysis supports the potential
role of acupuncture in treatment of radiation-induced xerostomia in a broader range of patients
than previously studied.
Key words; radiation-induced xerostomia, acupuncture, head and neck cancer.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
Henrietta Spalding, Changing Faces
“Piloting the Changing Faces model within the NHS to address the psychological impact
of disfigurement”
Background:
Whilst treatment of disfiguring conditions such as head and neck cancer is increasingly sophisticated,
patients are often left with an altered appearance. They are vulnerable to debilitating self-consciousness
and social anxiety, depression and low self-esteem. Patients report staring, ridicule, harassment, bullying
and rejection. Everyday situations like walking down the street, making friends, going to work can be
overwhelmingly difficult.
Since the mid-1990s, Changing Faces has been delivering disfigurement-specific psychosocial care, and we are now pioneering a new type of professional, a Changing Faces Practitioner (CFP)
skilled in delivering our well-tested psycho-social interventions. We are piloting within 4 hospital settings
including beginning in the head and neck unit at Salisbury General Hospital this autumn, 2014.
Aims:
The purpose is to provide a psychosocial service using the Changing Faces FACES model.
Method:
The Practitioners:
offer emotional support, practical advice, CBT interventions and social skills training
provide advice, support and training for peers on the unit
signpost and refer people to other organisations and professionals
treat patients with mild-to-moderate mental health issues arising from disfigurement
Activity data is collected every 3 months
Results:
to date significant improvements in patients’ self-esteem and confidence and their quality of life because:
patients are very satisfied with the support they are given
patients demonstrate increased ability to cope with appearance concerns
patients are supported to focus away from health issues and onto social, education and employment
opportunities
Conclusion:
CFP sessions can equip patients with the necessary ‘disfigurement life-skills’ to manage their condition.
CFP care can lessen the need for repeated contacts with GPs and follow-on services such as mental
health services and can lessen demand for medical interventions to address appearance.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
Louise Occomore, Highly Specialist Speech and Language Therapist (Head and Neck
Oncology) Barts Health NHS Trust, St Bartholomew’s Hospital
“Development of a new on-treatment Speech and Language Therapy service for Head and
Neck radiotherapy patients”
Background: We commenced a new weekly Speech and Language Therapy (SLT) service for patients
undergoing Head and Neck Radiotherapy in response to clinical need and international guidelines.
Previously there was no on-treatment SLT service at the treatment centre. Patients were only seen during
their treatment if they were referred to their local service which usually involved extra travelling for patients.
This often resulted in poor attendance, and delayed referrals with late effects of treatment which were
difficult to treat.
Aims: To establish if a weekly SLT service at the treatment centre would improve patient access, patient
experience and functional outcomes.
Method: One group (n=29) received the existing standard SLT treatment during radiotherapy of local
hospital referral where a need was identified by their managing team. The second group (n=50) received
weekly SLT review at the treatment centre throughout their radiotherapy when they attended for treatment.
Data was collected at a tertiary cancer centre and included age; gender; tumour site and size; treatment
modality; swallowing and communication outcomes; patient satisfaction; and time efficiency. Outcome
measures included a feedback form and a SLT specific outcome measure tool. Data was analysed using
descriptive statistics.
Results: Access to SLT services increased in line with NICE guidance. Time efficiency was increased with
the new model as there were fewer non-attendances and on-site MDT working resulted in faster liaison
between professionals. Patients who received the new service reported improved communication
outcomes, and increased oral intake compared with those who received the previous model of care.
Conclusion: The new service enabled the trust to meet NICE guidance within a more time efficient method
of service delivery, without increased staffing. Patient access to SLT was improved, along with functional
outcomes. An audit two years later has demonstrated a sustained improvement in oral intake outcomes.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
Miss Yvonne Amma Asiedu; Final Year Medical Student; University of Southampton
“Are we recognising patients with a poorer quality of life after head and neck cancer
treatment? A service evaluation exploring the detection and management of patients with
condition-related concerns at Southampton General Hospital”.
Background: Despite advances in the management of head and neck cancer, current treatments can affect
quality of life (QoL). Patients require specialised multi-disciplinary support and early detection is important
in preventing serious clinical implications as a result of a poorer quality life.
Aims: To evaluate the QoL of post-treatment head and neck cancer patients treated at University Hospital
Southampton (UHS). To evaluate the usefulness of adding a psychological resilience scale in predicting
patients that may have lower QoL scores.
Methods: Questionnaire - based study to assess patient QoL and resilience following treatment for head
and neck cancer. Participants were recruited from the Head & Neck Clinic at UHS. All post-treatment
patients presenting to outpatient clinic were approached and asked to complete The University of
Washington Quality of Life Questionnaire, version 4.0 (UW-QoL) and The Connor-Davidson Resilience
Scale (CD-RISC). A patient sheet collecting demographic data was also distributed. Patient records were
obtained retrospectively to identify disease stage and treatments.
Results: The response rate was 61.3% (98/160). Results suggest 74.5% (73/98) of patients rate their
overall QoL as good, very good or outstanding and 7.1% (7/98) as poor or very poor. Statistical analysis
indicates a positive correlation between overall QoL score and resilience score (Spearman's Rho = 0.427;
p = 0.000). Overall satisfaction is very good, with 92.9 % (91/98) of respondents reporting satisfaction with
advice and support received. Areas identified for improvement include symptom support, socioeconomic
support and QoL screening.
Conclusions: This service evaluation has indicated that there is an average post-treatment QoL of 60.61
(SE =2.081) and 7.1% of patients are unsatisfied with the health service provided. This is in line with results
from other major centres. A resilience scale helps to identify patients who are at risk of a low QoL score.
Follow-up studies should include an in-depth analysis of patients with a poor QoL following treatment.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
Isavella Kontaxopoulou
‘Maxillectomy or maxillary resection for the management of Head and Neck Cancer can
be reconstructed with either an obturator prosthesis or a surgical reconstruction. It is
important to understand the outcomes of each treatment modality so as to address any
issues, and to advise patients accordingly in the future’
Aim: To determine if patients with an obturator or patients surgically reconstructed had any differences in
the Health Related Quality of Life.
Materials and Methods: 30 patients that had undergone a maxillectomy over 6 months ago, of which 13
have an obturator and 17 had had a surgical reconstruction were recruited. Their demographic and clinical
details were analysed. To assess outcomes specific to head and neck cancer, the University of Washington
Quality of Life Questionnaire version 4 was completed. The results for 12 domains were analysed: Pain,
Appearance, Activity, Recreation, Swallowing, Chewing, Speech, Shoulder, Taste, Saliva, Mood, Anxiety.
Also, the patients selected 3 domains most important to them, and the rank orders were produced for each
group. The overall Quality of life was assessed with 3 Global questions, to detect differences of the overall
perceptions of the groups.
Results: The two groups were very similar in their demographic and clinical characteristics. The answers of
the two groups for most domains had no statistically significant difference. The results for the global
questions showed no statistically significant difference between the groups.
Conclusions: The patients with an obturator and with a surgical reconstruction show a lot of similarities in
their Health Related Quality of Life outcomes. Further research is required to assess differences in the
swallowing outcome depending on the method of reconstruction.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
DA Doss, M Ehsan, BM Chesworth, TJ Overend, Physical Therapy, Western University,
London, Canada
CM Anderson, T Keating, Physiotherapy, London Health Sciences Centre, London,
Canada
J Yoo, K Fung, A Nichols, D MacNeil, Otolaryngology-Head and Neck Surgery, London
Health Sciences Centre, London, Canada
M Belzile, Oto-rhino-laryngologue, CHUS - Hôtel-Dieu, Sherbrooke, Canada
S Rogers, EPRC, Edge Hill University, Ormskirk, UK
“A Pilot Study to Investigate Concerns in Patients Undergoing Neck Dissection Surgery”
Background:
Head and neck cancer (HNC) causes patients to have physical and emotional distress. The Patient
Concerns Inventory (PCI) is a patient-reported outcome measure (PRO) used to identify concerns in
persons with HNC. We modified the original PCI by adding a 7-point response scale for all 52 items (1=no
importance; 7=very great importance), allowing patients to rate the level of importance for each concern.
We refer to this modified tool as the Patient Concerns Inventory – Level of Importance questionnaire (PCILOI).
Aims:
We investigated concerns in patients undergoing neck dissection surgery from pre-surgery to 1-month
post-operative. A secondary aim was to investigate the convergent validity of the PCI-LOI by evaluating its
correlation with other PROs used with HNC patients.
Method:
Forty patients were recruited, and measured at pre-surgery, discharge and 1-month post-surgery using the
PCI-LOI, Shoulder Pain and Disability Index (SPADI), Neck Dissection Impairment Index (NDII) and the
University of Washington - Quality of Life questionnaire (UWQOL).
Results:
“Anxiety” was the top ranked concern pre-surgery with “Appearance” the top ranked concern both for
discharge and 1-month post-surgery.. Support for cross-sectional convergent validity of the PCI-LOI was
shown by significant correlations between the PCI-LOI and the UWQOL (r = -0.48 and -0.43), and the PCILOI and the SPADI (r = 0.45 and 0.57), at discharge and 1-month post-surgery, respectively.
Conclusion:
In addition to physical and functional concerns that are logically linked to disease location and surgery, arm
and hand function as well as concerns regarding social support network are rated to be of fairly great
importance by patients with HCN. Preliminary convergent validity of the PCI-LOI was supported by its
relationship with other PROs used with HNC patients.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
S Evans, Nutrition and Dietetics Department, Imperial College Healthcare NHS Trust
M Hickson, Therapies, Imperial College Healthcare NHS Trust
D Sookhoo, College of Nursing, Midwifery and Healthcare, University of West London
“An exploratory phenomenological study of the experiences of gastrostomy tubes in
Head and Neck Cancer”
Background:
Nutritional support contributes significantly to the management of head and neck cancers. During
radiotherapy nutritional intervention is considered an integral component of treatment, due to the effects on
morbidity. There is limited research for recommending gastrostomy tube placement over nasogastric
feeding in this patient group (Nugent et al, 2010) despite recommendations for protocols for gastrostomy
placement (NICE, 2004).
Aims:
The purpose of the study was to explore the lived experiences of patients who had prophylactic feeding
tubes inserted as part of their radiotherapy treatment for head and neck cancer, and focused on the
emotional and psychological components of a gastrostomy tube.
Method:
A qualitative research design was used in a purposeful sample of seven head and neck cancer participants,
who had all completed radiotherapy at least three months previously. Data were collected from individual
semi-structured interviews and analysed using an interpretative phenomenological approach.
Results:
Gastrostomy feeding was seen as broadly successful. The research identified themes unique to this cohort
of internally fed patients: firstly the contextualisation of gastrostomy tubes; they were viewed as an
important component associated with survival, because of the dominant need to complete treatment.
Additionally there was considerable anxiety surrounding the period of transitional feeding and the
reintroduction of oral food. Quality of life issues linked to feeding were overall less of a burden than
research has concluded in other long term conditions; although many practical issues remained. Other
themes identified the need for support networks and understanding of the decision making for placement.
There was considerable interdependence of themes.
Conclusion:
This research highlights to the multi-disciplinary team that improvements in psychosocial support
mechanisms are needed. Based on the findings there are specific points when patients require additional
support including at the decision making stage, at tube placement, and during the transitional feeding
phase.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Thursday 13th November, Afternoon Session
Mr. Brendan Noonan School of Nursing and Midwifery (SONM) University College Cork
Professor Josephine Hegarty (SONM) University College Cork
Dr. Mairin O’Mahony University (SONM) College Cork
“An Exploration through Interview and Drawings of the Experiences of Patients diagnosed
with Oral Cancer across their Cancer Trajectory”
Background: The treatment of oral cancer is complex and lengthy. It is well documented that the physical,
psychological and social consequences of treatment for oral cancer can be particularly disabling. Little is
known however about the changes that occur and the experiences of patients newly diagnosed with oral
cancer across their cancer trajectory. An understanding of this trajectory is essential in informing service
providers’ decision making if delivery is to be client centred.
Aims: To explore through verbal description and drawings the experiences of people affected by oral
cancer, from pre-diagnosis, diagnosis, during treatment and after treatment had finished.
Method: A qualitative prospective longitudinal design was employed. Non probability purposive sampling
allowed the recruitment of 10 participants. Data was collected primarily by audio-taped semi-structured
interviews, augmented with drawings produced by the participants. Data was analysed using latent content
analyses.
Results: The physical, psychological, social and existential experiences were present throughout the illness
trajectory explored, but to various extents and degrees during the different timelines.
Within these experiences transitions occurred characterised by the changes, improvements and
fluctuations in the participants’ well-being.
Conclusion: New findings were identified which have implications for clinical practice, future research,
policy and the educational preparation of undergraduate and postgraduate healthcare professionals.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Friday 14th November, Morning Session
I.Ryland1, B.Scott2, K,Jones1, B.Roe1, C. Mayland2, S,Pringle2, P.Banks2, D.
Macareavey3, and S.Rogers1&2
1Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire
2Aintree University Hospital NHS Trust, Liverpool
“A pilot study of patients and carers experiences and reflections of advanced head and
neck cancer”.
Background:
Advanced head and neck cancer (AdvHNC) patients frequently experience side-effects from treatment
approaches which may manifest as physical and/or psychological distress. Similar symptoms can be
experienced by patients’ carers and be related to the care-giving responsibilities for which they are not
prepared.
Aims:
To explore Patients and Carers experiences and reflections relating to treatment intent (curative v.
palliative) and treatment outcome in order to assist future decision making for cases of AdvHNC.
Method:
Patients, with AdvHNC, and their Carers were invited to participate in the study. Semi-structured interviews
(patients n-7, carers n-5 and 1 joint-patient/carer) detailing treatment decision making, treatment outcome
and management of care were digitally-recorded and transcribed verbatim. Content analysis was
conducted to identify key themes emerging from transcriptions.
Results:
Analysis of data identified four key themes:
1. Treatment received was deemed to be the only option though neither Patients, nor Carers, were
prepared for its severity and would re-consider options available should the cancer re-occur. All patients
perceived treatment as curative intent.
2. Support services concentrated on the patient and offered insufficient support and advice to Carers who
became inadvertent managers of care. This was particularly noticeable when patients continued their
treatment as day patients
3. Practicalities of traveling for treatment, time spent waiting for treatment to be completed, and concerns
over weight loss due to difficulty in taking the required daily amount of peg feed.
4. Inadequacies of local NHS services including General Practice resulted in patients being unable to gain
necessary assistance when required.
Conclusion:
Patients and Carers highlighted that support is essential to provide both emotional and practical assistance,
especially for Patients who may live alone and for Carers who are not prepared for such a challenging role
This presentation offers insight into the experiences of patients and carers and may assist in the future
management of patients with AdvHNC.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Friday 14th November, Morning Session
Dunne, S1, Mooney, O1, Coffey L1, Sharp L2, Timmons A2, Desmond D3, Timon C4,
O’Sullivan, E5, Gallagher P1.
1Dublin City University, Dublin, Ireland
2National Cancer Registry Ireland, Cork, Ireland
3National University of Ireland Maynooth, Co. Kildare, Ireland
4St. James’s Hospital, Dublin, Ireland
5Cork University Dental School and Hospital, Cork, Ireland
“Psychological predictors of quality of life in head and neck cancer: A 10-year systematic
review”.
Background: Quality of life (QoL) has emerged as an important outcome measure for survivors of head and
neck cancer (HNC) in assessments of their general wellbeing following treatment. In spite of the recent
proliferation of research concerning QoL in HNC, there has been little systematic examination of
psychological factors associated with QoL outcomes for HNC survivors in the post-treatment period.
Aims: The current systematic review aims to investigate psychological factors that have been found to
predict QoL in HNC research published within the last ten years.
Method: In accordance with PRISMA Guidelines and using controlled vocabulary and free text, five
databases (MEDLINE, CINAHL, PsycINFO, Embase and Web of Science) were systematically searched
for data on psychological factors predicting QoL in HNC survivors. Empirical studies from January 2004 to
the present were included if they used a reliable and valid QoL measure, contained at least one
psychological predictor of QoL, had a sample size of at least 50 HNC survivors and measured QoL as an
outcome in the post-treatment period.
Results: To date, 38 studies fulfilling the inclusion criteria were identified and are currently undergoing full
text review. Preliminary findings indicate that personality factors, coping styles, depression, anxiety, social
support, mood, patient satisfaction, body image and perceived burden of care on others are key
psychological predictors of QoL among HNC survivors who have completed their primary treatment.
Conclusion: It is anticipated that this review will help to identify psychological factors that promote QoL in
HNC survivors. This information is particularly useful in informing the design and implementation of
psychological interventions to improve HNC survivors’ long-term well-being.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Friday 14th November, Morning Session
Pesic Zoran, Zarev Milos, Arandjelovic Slobodan
Department of Maxillofacial Surgery, Medicine Faculty, University of Nis, Serbia
“Open surgical treatment of parapharyngeal space tumors – impact on quality of life”
Development of endoscopic and robotic technics in treatment of tumors of parapharyngeal space by
transoral access questioned importance of open surgical access in treatment of these tumours. In another
hand, vicinity of scull base, cranial nerves and great vessels presents challenging situation for surgeons
cause of possible serious and lethal complications. This situation rise a question is impact on quality of life
of this patients worth of higher operative risk.
The aim of this study is to determinate impact on quality of life in patients with tumors of parapharyngeal
space treated in period 2005 to 2012. on Department of Maxillofacial Surgery, Medicine Faculty, University
of Nis, Serbia, by open surgical accesses.
By retrospective clinical investigation we analyze incidence of use different open surgical accesses, relation
to tumor size and type and incidence of complication during and after performing an open surgical
approach in treatment of parapharyngeal space tumors. Quality of life was measured by University of
Washington Quality of Life Questionnaire, in direct interview.
From 21 cases of PPS tumors treated, 9 cases were treated by transcervical-transmandibular approach
and rest with transcervical access. University of Washington Quality of Life Questionnaire show for general
group high scores for shoulder and activity and lowest scores for taste and saliva. In subgroup of benign
tumors treated by transmandibular transcervical access all scores are high, with lowest scores for pain.
According to impact on QOL it can be said that open surgical accesses still presents actual and important
approach to PPS tumor eradication with good exposure of important anatomical elements, relatively low
incidence of complication and lower operative risk.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Friday 14th November, Morning Session
Coffey L1, Dunne S1, Sharp L2, Timmons A2, Desmond D3, O’Sullivan E4, Keogh I5, Timon
C6, Gallagher P1
1 School of Nursing and Human Sciences, Dublin City University, Ireland
2 National Cancer Registry Ireland, Cork, Ireland
3 Department of Psychology, National University of Ireland Maynooth, Co. Kildare, Ireland
4 Cork Dental School and Hospital, Cork, Ireland
5 ENT Department, University Hospital Galway, Ireland
6 Head and Neck Cancer Programme, St. James’s Hospital, Dublin, Ireland
“A qualitative study of health professionals’ perspectives on supporting self-management
in head and neck cancer survivors”.
Background: Head and neck cancer (HNC) and its treatment pose a number of unique and enduring
challenges including facial disfigurement and impairments in swallowing, breathing and speech, which can
have a profound impact on survivors’ physical, social, and psychological wellbeing. Self-management
interventions provide skills to deal with health-related problems, maintain life roles and manage negative
emotions, and have been found to improve quality of life and reduce health service utilisation across a
range of chronic conditions. Developing a self-management intervention for HNC survivors following
completion of primary treatment may help them in dealing with the challenges associated with this disease.
Aims: Evidence suggests that engagement of health professionals is critical for successful application of
self-management programmes. The aim of this study is to explore health professionals’ perspectives on the
self-management support needs of HNC survivors in the post-treatment period and their considerations on
how these needs can be best met through a self-management intervention.
Method: Semi-structured interviews are being conducted with multidisciplinary health professionals who
care for HNC patients. Data collection is ongoing, and will continue until data saturation has been reached.
Interviews are audio-recorded, transcribed and analysed using the framework method.
Results: To date, 29 health professionals from four recruitment sites have completed interviews. Data
analysis is ongoing; initial findings suggest that participants are broadly supportive of a self-management
intervention for HNC survivors. A number of patient-related (e.g., interest/motivation, social support,
geographical location) and organisational (e.g., availability of resources, buy-in from multidisciplinary team)
barriers to, and facilitators of, implementation are identified.
Conclusion: It is anticipated that the findings will enhance our understanding of how HNC survivors can be
better supported in self-managing the consequences of HNC and its treatment, and will be used to
determine the content and delivery of a feasible self-management intervention for this patient group.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Friday 14th November, Morning Session
Farah Shiraz, Mustansir Alibhai, Iain Hutchison, Kamaldeep Bhui, Ania Korszun
“ We got cancer”- A prospective study of quality of life and psychological distress in
newly diagnosed head and neck cancer patients and their caregivers.
Background: A diagnosis of cancer and its subsequent treatment can have a profound impact on the quality
of a person’s life, as well as on the lives of their caregivers (i.e. family members or partner). While the role
of family members as a source of support is generally recognised, the effect of their possible psychological
distress is often ignored in empirical research. We currently know very little about the impact a distressed
partner or family member may have on a head and neck cancer (HNC) patient’s quality of life and
psychological wellbeing.
Aims: To measure levels of psychological distress in HNC patients and their caregivers and to explore the
impact that caregivers’ distress may have on patients’ QOL and psychological wellbeing.
Method: In a prospective longitudinal study, 90 newly diagnosed HNC patients and 74 caregivers were
followed over a period of 6 months. They completed a series of questionnaires, including the hospital and
anxiety scale (HADS), WHO Quality of Life-BREF (WHOQOL-BREF), and the European Organisation for
Research and Treatment of Cancer (EORTC) questionnaires at diagnosis and at 6 months.
Results:At diagnosis, 31% of HNC patients showed elevated levels of psychological distress (HADS>15),
with 20% indicating clinically relevant symptoms of depression (HADS-D >8), 59% of caregivers showed
elevated levels of psychological distress, with 35% showing increased levels of depressive symptoms. Post
treatment, patients who reported poor QOL were twice as likely to have a caregiver with high levels of
psychological distress.
Conclusion: HNC patients whose caregivers have a high level of psychological distress show poorer QOL.
The clinical implications of these findings suggest that caregivers who are experiencing elevated
psychological distress may be less supportive of the patient. It is important that professionals involved in
the on-going care of cancer patients and their families be aware of the increasing demands made on
caregivers and the specific problems they perceive in caregiving. There is a clinical imperative to identify
patients and family members experiencing high distress and refer those people to targeted psychosocial
therapies.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Friday 14th November, Morning Session
Yuefang Zhoua,*, Gerry Humphrisa,b, Naseem Ghazalic,
Simon Friderichsa, David Grosseta and Simon N Rogersc,d
aSchool
of Medicine, University of St Andrews, St Andrews, Fife, KY16 9TF, UK.
Cancer Centre, the Western General Hospital, Edinburgh, EH4 2XU, UK.
cOral & Maxillofacial Surgery, Aintree University Hospital, Liverpool, L9 7AL, UK.
dEvidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill
University, L39 4QP, UK.
bEdinburgh
“How head and neck consultants manage patient emotional distress during cancer followup consultations: a multilevel study”
Abstract
Objectives: Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed
to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level
variables (e.g. age, gender and emotional wellbeing) relate to consultants’ responses (i.e. reducing or
providing space) to patient expressions of emotional distress.
Methods: Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients’
expressions of emotional distress and consultants’ responses, using the Verona Coding Definitions of
Emotional Sequence (VR-CoDES). Multilevel logistic regression modelled the probability of the occurrence
of consultant reduce space response as a function of patient distress cue expression, controlling for
consultation and patient-related variables.
Results: An average of 3.5 cues/concerns (range 1-20) was identified per consultation where 84 out of 152
total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for
the quality of patient emotional wellbeing. However, consultants were more likely to reduce space to cues
elicited by patients, as opposed to those initiated by themselves. This reduce space response was more
pronounced as the consultation continued. However, about six minutes into the consultation, this effect
(i.e. tendency to block patients) started to weaken.
Conclusions: Head and neck consultants’ responses to negative emotions depended on source and timing
of patient emotional expressions. The findings are useful for training programme development to
encourage consultants to be more flexible and open in the early stages of the consultation.
Ethics approval: North West 3 Research Ethics Committee – Liverpool East, 21st February 2011 (approval
number: 11/H1002/7).
Key words: head and neck cancer, emotional distress, the VR-CoDES, multilevel
QOL in H&N Cancer: 9th International
Conference
Abstracts: Friday 14th November, Afternoon Session
Hans Jørgen Aarstad,1,2 Arild Andrè Østhus,1,2 Olav K. Vintermyr1,3 & Anne Kari H.
Aarstad2,4
1Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen,
N-5020 Bergen, Norway.
2Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital,
5021 Bergen, Norway.
3Department of pathology, Haukeland University Hospital, Bergen, Norway.
4Haraldsplass Deaconess University College, Bergen, Norway.
“Psychological, tumour stage and choice of treatment are associated with Quality of life
scores in head and neck squamous cell carcinoma patients during the first 18 months
following diagnosis”.
Objectives: To evaluate the associations between perceived health-related quality of life (HRQoL) versus
psychological, disease- and treatment-related variables in a cohort of newly diagnosed head and neck
squamous cell carcinoma (HNSCC) patients.
Materials and Methods: One hundred and nine consecutive HNSCC patients reported their HRQoL,
measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life
Questionnaire (QLQ) general (C30) and head and neck (H&N35) parts, at the time of diagnosis and
following 6, 9, 12 and 18 months after diagnosis. All included patients were younger than 78 years of age,
cognitive adequate functioning, and scheduled for curative treatment. At the time of diagnosis and at 18
months self-reported levels of neuroticism, problem and avoidance focused coping, smoking and alcohol
consumption, and socio-demographic information were registered. If curative aimed treatment was ended,
no new HRQoL scores were obtained. Clinical characteristics and comorbidities were determined from the
patient hospital records. Whether HPV tumor infected were diagnosed from diagnostic blocks from
pertinent patients. We determined 22 patients to be HPV positive.
Results: At diagnosis, the general HRQoL scores were lowered compared to population scores. The
HRQoL scores were inversely associated with T stage, reported high avoidant scores and high neuroticism
scores. The HPV status was not associated with HRQoL levels. Throughout treatment the HRQoL scores
were lowered with the lowest point at 6 months. No significant importance of having an HPV-infected
compared to a non-affected tumor was observed. At 18 months inverse associations were shown between
high T stage, present neuroticism or avoidant coping and HRQoL independent of HPV status. Reported
avoidant coping and neuroticism levels measured at18 months furthermore correlated to HRQoL levels at
diagnosis, but not vice versa. Being neck treated predicted lowered HRQoL at 18 months.
Conclusion: Having a high T stage, high self-reported high avoidant coping and neuroticism were
associated to lowered HRQoL scores measured pretreatment and throughout treatment among HNSCC
patients. If neck treated this predicted lowered HRQoL at 18 months. HPV infection status seemed not to
affect the HRQoL scores.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Friday 14th November, Afternoon Session
Biswas D, Roland NJ, Rogers SN from Aintree University Hospital, Liverpool
“ePCI on iPAD” - Introduction of Touch Screen Technology for documentation of ‘Patients
Concerns Inventory’ in Head and Neck outpatients.
Background:
The purpose of the Patient concerns Inventory (PCI) is to identify the concerns of the patients that they
would like to discuss during their consultation in the clinic. So far the PCI has been used either on a desk
top with a volunteer or with paper completion; has limited the access to patient. Wider availability is now
essential as the PCI has been included as part of the national H&N cancer audit (DAHNO). Following
advancement of the touch screen technology we would like to utilise the technology.
Aims:
1. To identify the difficulty while introducing and setting up this technology.
2. To critically analyse the patient’s feedbacks, which will help further to develop the practice.
Method:
53 patients in the Head & neck cancer clinic were given IPAD to express their clinical concerns using PCI
before their clinical consultation. It was followed by a questionnaire survey. We utilised this opportunity to
assess computer literacy of this patient cohort.
Results:
Average time to complete the PCI was 10min (5min to 20min). 3 quarters of the patient found the system
was either easy or very easy and many of them praised this innovative approach. They were happy with the
colour composition and font set up. 80% of them wanted to use the system in every clinic appointment. Half
of them gave their preferences to use iPAD over the paper-version or desktop. A good amount of support of
the IT department was required in setting up this paperless & wireless technology.
Conclusions:
Touch screen technology was well perceived by patients and yielded better patient satisfaction. It was easy
to handle, little time consuming and showed the opportunity of wider adoption. It reduces carbon footprint,
supports the paperless documentation agenda of NHS and helps us to maintain a continuation of care.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
Elwell, Rebecca - Macmillan Lymphoedema CNS (University Hospital of North
Staffordshire), Revell, Jane - Lymphoedema Nurse Specialist (Katherine House Hospice),
Parson, Jane - Lymphoedema Sister (Douglas Macmillan Hospice), Thayer, Carol Lymphoedema Nurse Specialist (East Cheshire Hospice) and Stevenson, Joy Lymphoedema Nurse Specialist (Macclesfield Hospice)
“Head and Neck case series to underpin the development of locally agreed head and
neck assessment and treatment guidelines, including the development of a head and
neck quality of life assessment tool”.
Background/Aims: It was agreed at the local British Lymphology Society meeting that head and neck
referrals for lymphoedema were increasing and that this was an interesting area to compare treatment
modalities. 67,000 people live with head and neck cancer in the UK ( Macmillan Cancer Support, 2010) and
between 12-75% (Chen 2010, Deng 2012) will have lymphoedema. Each service represented was asked to
develop a case study of a patient with head and neck swelling. The dynamics of the group meant that there
was representation from the acute trust, community and hospice setting.
Method/results: 5 case studies were discussed (2 men and 3 women, age range 44 - 78 years) within the
group and then common themes were extracted. These themes enabled discussion which in turn led to the
production of a standard of care for the management of the patient with head and neck lymphoedema
including assessment and management. The need for a psychosocial tool for this group was highlighted
and is in development.
Conclusion/Discussion e.g. compare previous reports, implications for practice
The standard of care and psychosocial tool will be ratified at each of the 5 places of work to enable them to
become the accepted patient pathway. It is hoped this can then be audited as a group retrospectively to
ensure a consistent and thorough approach to all patients with head and neck swelling.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
Eleanor Slaven
Speech & Language Therapist
Southern General Hospital, Glasgow.
Greater Glasgow and Clyde NHS Trust
Mary Wells
Professor of Cancer Nursing Research & Practice
NMAHP Research Unit,
University of Stirling
“Validation of the Functional Intraoral Glasgow Scale as a practical measure of speech
and swallowing outcomes for patients with head and neck cancer”.
Background:
Speech and swallowing outcome measurement in head and neck cancer (HNC) is an integral part of quality
care but achieving consistent, routine outcome measurement in a busy, out-patient clinic environment can
be challenging. Patient-reported outcome measures (PROMs) augment clinician-rated outcomes and give
the patient’s perspective on their functional status. The Functional Intraoral Glasgow Scale (FIGS) is a
brief PROM for speech and swallowing but its test-retest reliability and criterion validity has not yet been
psychometrically evaluated.
Aims:
To demonstrate test-retest reliability and criterion validity for the FIGS.
Method:
A convenience sample of 70 patients was recruited from the out-patient clinic of a busy regional HNC
centre. The FIGS was completed on two occasions, firstly at the clinic and then again a week later, by 53
patients. The results were compared using intra-class correlation (ICC) to assess the test-retest reliability.
Criterion validity was evaluated by also administering the M.D. Anderson Dysphagia Inventory (MDADI)
and Speech Handicap Index (SHI). Spearman’s rank order correlation was used to determine the strength
of the relationship between the FIGS Chew, Swallow and Speech scales with the SHI and MDADI total
scores.
Results:
With a 95% confidence interval the ICC for Chew, Swallow and Speech scales were; .902, .891 and .940
(p≤0.001) indicating a strong relationship between the test and re-test FIGS. The Spearman’s rank order
correlation coefficient showed a strong, negative correlation between the FIGS Speech scale and the SHI;
rs = - 0.845 (p<0.01). There was a strong, positive correlation between the FIGS Chew and Swallow
scales and the MDADI total score; rs = .512 and .595 (p<0.01).
Conclusion:
The FIGS is a valid, reliable PROM for speech and swallowing difficulties in HNC and is a useful addition to
the battery of outcome measures for baseline measurement and monitoring in routine clinical care.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
Elizabeth Pinkham, M Phty and B App Sci, Advanced Clinician Cancer Services,
Physiotherapy Department, Princess Alexandra Hospital, Australia.
Dr Suzanne Kuys, PhD, Principle Research Fellow, Griffith Health Institute, Griffith
University and Allied Health Research Collaborative Metro North Hospital and Health
Service, Australia.
“Prospective evaluation of balance disorders in patients undergoing treatment for head
and neck cancer”.
Background:
The prevalence and potential causes of falls in patients with head and neck cancer (HNC) are not known.
This study aimed to prospectively assess balance, mobility, vestibular dysfunction, fatigue and nutritional
status in these patients.
Method:
Patients were eligible if were newly diagnosed head and neck malignancy and receiving treatment (surgery
and/or radiation and/or chemotherapy). Comprehensive assessments using the Balance Outcome
Measure for Elder Rehabilitation (BOOMER), 10 minute walk test (10MWT), Dizziness Handicap Inventory
(DHI), modified Clinical Test for the Sensory Integration of Balance (CTSIB), Multidimensional Fatigue
Inventory (MFI), weight and Body Mass Index (BMI) were performed before, during and six weeks after
treatment. Repeated measures ANOVA and correlation analyses for poor balance (defined as BOOMER
≤14) using Pearson chi-squared statistic were performed.
Results:
Complete data was available on 17 participants; mean age 60 (SD14) years, 14 (82.35%) male. Four
received surgery, three chemoradiotherapy (CRT) and 10 surgery plus radiotherapy or CRT. Five
(29.41%) patients with poor balance were identified. Timed up-and-go (TUG) test differed significantly over
time (F = 4.854, p = 0.002). MFI scores increased but did not reach significance. MFI peaked at the end of
treatment for those without balance deficits but continued to rise after treatment for those with poor
balance. Participants with poor balance were significantly older (75 versus 55 years) and had slower
walking (mean 1.2 versus 1.6 m/sec) and TUG performance (10 versus 7 seconds). No differences were
found for other measures. No falls were reported during the study period.
Conclusion:
Older patients with head and neck cancer are more likely to experience poor balance. Changes in mobility
were observed but did not correlate with outcome, possibly limited by the small sample size studied.
Further evaluation in a larger number of at risk patients, as defined by this study, would be helpful.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
Dunne S1, Coffey L1, Sharp L2, Timmons A2, Desmond D3, O’Sullivan E4, Keogh I5, Timon
C6, Gallagher P1
1 School
of Nursing and Human Sciences, Dublin City University, Ireland
Cancer Registry Ireland, Cork, Ireland
3 Department of Psychology, National University of Ireland Maynooth, Co. Kildare, Ireland
4 Cork Dental School and Hospital, Cork, Ireland
5 ENT Department, University Hospital Galway, Ireland
6 Head and Neck Cancer Programme, St. James’s Hospital, Dublin, Ireland
2 National
“Self-management following treatment for head and neck cancer: survivors’
perspectives”.
Background: Following primary treatment, head and neck cancer (HNC) survivors face significant
challenges to their well-being arising from symptoms of HNC or the consequences of its treatment. These
challenges include visible disfigurement, speech difficulties and eating problems, which may result in
impaired quality of life, greater distress and self-identity threats for HNC survivors. However, little is
currently known about how HNC survivors self-manage the challenges they face in the post-treatment
period.
Aims: The aim of this study is to better understand the self-management of HNC symptoms and treatment
consequences from HNC survivors’ own perspectives. The study investigates HNC survivors’ experiences,
attitudes and beliefs relating to their self-management of HNC symptoms and treatment consequences,
examines the specific self-management strategies they adopt in this regard and seeks to identify their own
perceptions of what helps or hinders these strategies.
Method: Semi-structured interviews are currently being conducted with HNC survivors and will continue
until data saturation has been reached. All interviews are being audio recorded, transcribed and
thematically analysed.
Results: To date, 21 interviews have been conducted with HNC survivors. Preliminary findings indicate that
HNC survivors use a variety of different self-management strategies to help them to manage the
challenges they face in the post-treatment period, including positive appraisal, goal-setting and the use of
social support networks. HNC survivors have also outlined a number of barriers they face in seeking help to
overcome these challenges.
Conclusion: It is anticipated that the findings will enhance our understanding of survivors’ self-management
of HNC symptoms and treatment consequences. This information will be used to inform the design and
implementation of an intervention to assist in HNC survivors’ self-management of the challenges they face
in the post-treatment period.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
Miss Ekpemi Irune
Olfactory Rehabilitation in Laryngectomy Patients Using “Nasal Airflow Inducement
Manoeuvre” (NAIM)
OBJECTIVES
A prospective interventional study to rehabilitate olfaction in the laryngectomy patient.
METHODS
Laryngectomy patients that fit the inclusion criteria were screened using the “University of Pennsylvannia
Smell Identification Test” (UPSIT) kits to determine if they are Normosmic, Hyposmic or Anosmic.
Normosmic patients were excluded from the study whilst the others were subjected to two - three training
sessions over a six week period on the NAIM technique which aims to create orthonasal airflow.
Thereafter these patients were followed up at three, six, nine and twelve months at which point the UPSIT
was repeated. In addition the University of Washington Quality of Life and the Appetite Hunger and
Sensory Perception questionnaires were completed at each consultation. We present interim results of the
first ten patients from our cohort of forty patients.
RESULTS
All patients were able to reproduce the NAIM technique with ease and this is demonstrable by utilising a
visual feedback tool. At three months, 4 of 10 patients had increased their UPSIT scores by an average of
7 points (range 2 - 14). At six months, UPSIT scores increased in 6 out of the 10 patients, remaining
unchanged in 2 patients and dropping in 2 patients, one of whom had a respiratory tract infection at the
time of assessment.
CONCLUSIONS
Though these are early results, they show the NAIM to be an easily reproducible and beneficial technique
for clinical olfactory rehabilitation in the laryngectomy patient population.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
Ekpemi Irune, Chris Bem
Head & Neck Unit. Bradford Royal Infirmary
DAHNO & The Head & Neck MDT: Are we getting it right?
Background:
All Head and Neck Cancer (HNC) Units in the United Kingdom that provide diagnostic and/or treatment
services for patients with head and neck cancer are required to participate in the National Head and Neck
Cancer Comparative Audit. They do so by submitting outcomes on a particular dataset.
Aims: We audit a selection of the data collated through the Bradford Royal Infirmary Head & Neck MDT to
determine the quality and comprehensiveness of our data.
Method: The MDT minutes of 100 consecutive HNC patients (between 1st Nov 2013 and 30th June 2014
were reviewed. We looked for the presence or absence of data on the following: Tumour type, ACE-27
morbidity score, tumour site, tumour stage, treatment option and intent. We also collected data on smoking
and alcohol history entries.
Results: The median age was 62.6 years (range 32-99 years) with male to female ratio of 74:26. Oral
cavity and oropharyngeal cancer made up 61% of the tumour site distribution and laryngeal cancer
accounted for 18% of the diagnosis in the 100 HNC patients. A record of tumour site, type and staging was
recorded in 100%, 99% and 98% of patients, respectively. We had failed to record on ACE-27 morbidity
score in all of the patients and the WHO performance status was recorded in only 24% of patients.
Conclusion: Performance status and ACE-27 comorbidity scores are crucial to DAHNO reporting case mix
outcomes of a HNC MDT. Thus, this MDT is examining options to improve data quality and accuracy. This
includes an e-portal pathway to enable first hand, mandatory submission of Performance Status and ACE27 data along with prospective auditing measures to maintain standards.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
Author/Affiliations: Alison Dinham, Felicity Dawson, Nicola Peat, Alex Curtis, Gareth
Jones
Acknowledgments: Katie Smith, Nipa Patel, Sian Evans
The use of the Neck Dissection Impairment Index to Describe Cross Pathway Disability
and Physiotherapy Related Outcomes in Head and Neck Cancer Surgical patients; a report
of preliminary data.
Background:
Following Head and Neck Cancer (HNC) surgery, neck and shoulder (N+S) dysfunction is common and
often debilitating, impacting on function and quality of life (QoL), even with spinal accessory nerve sparing
procedures. Despite best practice guidelines, routine inclusion of physiotherapy for N+S rehabilitation is
scarce, with only 27% of 5 year survivors reporting any exercise instruction received (Carvalho et al, 2012,
Eickmeyer, 2014).
Aims:
To assess N+S dysfunction and related QoL using the Neck Dissection Impairment Index (NDII) at three
key physiotherapy intervention time points.
Method:
This was a single tertiary cancer center prospective pilot study. From Jan-June 2014, 60/143 HN surgical
patients had a ND for cancer and received an NDII at some point in their pathway. 30 had incomplete data,
18 are still on active physiotherapy treatment and 12 have complete data (demographics = 5:7 m:f ratio,
mean age 59). The majority of these had unilateral selective ND’s.
Results:
NDII scores (median and range) =·
pre-operative = 50 ( 25-50)·
peri-operative at hospital discharge = 41 (17-50)·
post-operative at physio outpatient discharge = 49 (41-50)
These results indicate an 18% drop in median NDII score from pre-operative to hospital discharge, and
return to within 1 point of median pre-op score at discharge from physiotherapy.
Conclusion:
The NDII can be used to measure functional needs and QoL concerns relating to the N+S in HNC patients
at key points. This study highlights that post-operative disability is new, with clinical impact on QoL
outcomes. Preliminary data suggests that NDII scores have returned to pre-operative or improved scores at
point of discharge from post operative physiotherapy. Although it can not be concluded this is due to
physiotherapy input alone, it would seem in contrast to findings that survivors of HNC with limited exercise
instruction have persistent N+S impairment (Eickmeyer, 2014).
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
Pesic Zoran, Zarev Milos, Arandjelovic Slobodan, Rogers Simon
“Possible use of Patient Concern Inventory in implantology”
One of main goal in implantology is to improve quality of life of edentulous patients and help them to
increase confidence and self-esteem. Following of patients satisfactions, patient fears and problems
connected with implants and prosthetic device, as well as perception of patient’s quality of life can be only
with permanent contact with patients. One of objective ways to control patient’s true situation is to measure
it by questionnaires. PCI is already in use in head and neck oncology, but its use in dentistry specialties is
still in beginning.
The aim of this article is to present list of possible items selected after literature review prepared for future
methodological procedures to form list of items for PCI questionnaires, for use in implantology.
By review of literature and presently used tests, list of possibly used items is composed and can be subject
of future methodology procedures.
Review of literature gave us 418 abstracts after searching in Pub Med base with word implantology crossed
with terms quality of life, questionnaires, patient satisfaction, psychology, patients concerns,
multidisciplinary care, social function, lifestyle oral hygiene, dental prosthesis, implant supported,
questionnaires. From number of 418 abstracts, 75 abstracts were selected, with excluded repeated
abstracts and abstracts not connected with dentistry. From this list 13 articles were selected. Criteria for
including were using of questionnaires and methodology which are verified. From questionnaires used in
this articles and usually used questionnaires list of items, was formed.
PCI questionnaire, beside use in oncological surgery can have place in other disciplines, in-between them
implant ology for permanent follow up of patient problems, wishes and patient relation to implants and
prosthetic devices. List of item obtained by this review can be basis for further developing of questionaries’
for use of PCI in implantology.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
Miss Eleonora Olivera Felicity Dimovska, Core Trainee Plastic Surgery
Mr Andrea Figus, Consultant Plastic Surgeon
Plastic Sugery Dept Norfolk & Norwich University Hospital
Microsurgical Reconstructions for Head & Neck Cancer in Patients Aged >80 – An
analysis of patient outcome and experience
Background: Head and neck malignancy is increasing in the elderly population, however data on their
surgical outcomes and patient experience is sparse in the literature. Patients aged over 80 have specifically
not been evaluated. This patient group are often of a worse pre-morbid state, risking poor outcome from
surgery and limited accumulated life expectancy.
Aims: Is it safe and effective to offer patients aged >80 with head and neck cancer a surgical resection and
free flap reconstruction?
Method: Between the years 2004-2014, all patients aged 80 and above with free flap or pedicled
reconstructions for cutaneous and mucosal head and neck malignancy were included. Individual variables
were analyses for their impact on morbidity and mortality. Co-morbidities were graded according to ACE-27
grades. Early complications were graded according to clavien-dindo scoring. A survival analysis was
performed. Patients still alive were asked to submit a quality of life questionnaire (UW-QOLv4).
Results: 103 patients were included. 31 of 44 (70%) patietns completed the questionnaire. Median survival
was 15 months. A high ACE-27 score and having a gastrostomy proved to influence early (within 12
months) death. Having both a tracheostomy and gastrostomy also influenced death within 12 months. A
tracheostomy alone was associated with risks of early complications. There was a significant difference in
the distribution of categories of ACE-27 and long term survival. Patient reported QOL showed greatest
impact on psychosocial factors. 50-60% reported no worsened physical function. General QOL was about
the same as prior to diagnosis.
Conclusion: Patient reported outcomes were better than expected. The main variable found to influence
survival was ACE-27, but having a gastrostomy and tracheostomy was also relevant. We suggest that the
success of major head and neck resection and reconstruction in patients aged over 80 requires careful preop assessment of both physical and social function.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
E. Black, K. Ah-See
Department of Otolaryngology, Head and Neck Surgery, Aberdeen Royal Infirmary,
Aberdeen, AB25 2ZN, UK
Can we predict which patients will require emergency admission when receiving
radiotherapy or chemo-radiotherapy for head and neck cancer?
Background:
Chemo-radiotherapy is a commonly used modality in the treatment of head and neck cancer.
A significant number of patients are admitted to our unit for support during their treatment.
Aims:
To identify the factors associated with risk of admission to hospital for patients undergoing radiotherapy or
chemo-radiotherapy for head and neck cancer during their treatment.
Method:
A retrospective data collection on all patients diagnosed with head and neck cancer in 2012-13 inclusive
who underwent primary radiotherapy or chemo-radiotherapy (n=72). The factors evaluated included age,
sex, performance status, smoking status, alcohol status, social support, tumour staging, co-morbidities and
tumour site.
Results:
Forty three percent of patients (n = 31) had at least one unscheduled admission within 3 months of starting
treatment. Mean length of admission was 23 days. Of those admitted, 74% were primarily for analgesia and
enteral feeding to manage dysphagia or odynophagia (n = 23). Those receiving chemo-radiotherapy were
more at risk of unscheduled admission compared with those receiving radiotherapy alone
(p=0.024).Likewise, those with advanced tumour stage were more likely to be admitted than those with
early stage (p=0.02). Smokers were more likely than non-smokers to be admitted (odds ratio 1.53).
Excessive alcohol intake, gender, living alone, tumour site and low performance status were not risk factors
for admission.
Conclusion:
A smoker undergoing chemo-radiotherapy for advanced head and neck cancer is more likely to require
admission during treatment. This may allow healthcare professionals to inform patients about their risk of
admission to hospital during their treatment and may help with service planning
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
R.Lee and N. Slevin
The Christie NHS Trust Hospital
A Randomised Pilot Study of Therabite use versus Wooden Spatula in the amelioration of
Trismus in Head and Neck Cancer Patients
Background:
Annually approximately 4000 cases of mouth cancer are diagnosed in the UK. Treatments may affect
patients’ appearance or cause loss of essential functions. Patients attending a reference group in our
hospital concurred that restricted mouth opening had the greatest impact on reducing their quality of life.
With up to 86% of patients receiving radiation for mouth cancer developing some degree of limitation in jaw
opening (trismus) this is a key problem impacting on nutritional intake, dental hygiene and all aspects of
quality of life
Aims:
This is a feasibility study as there are major uncertainties around compliance with exercise programme,
tolerability during radiotherapy and its associated mucositis and lack of clarity on which levels of mouth
opening improvement impact on quality of life.
The primary aim is to evaluate the feasibility of conducting a randomised controlled trial comparing
Therabite® (1) versus wooden spatulas (standard care) in patients with stage 3 and 4 oral and
oropharyngeal cancer.
Secondary aims are (i) assess whether Therabite or wooden Spatula intervention improves patients’
quality of life (QoL) using validated QoL questionnaires (ii) whether intervention can reduce the level of
post-treatment clinical management/health care utilisation required by mouth cancer patients.
Method:
Patients & Settings: Patients with stage 3 and 4 oral and oropharyngeal cancer managed either by primary
(chemo)radiotherapy or surgery followed by radiotherapy will be recruited. It will be carried out in four
leading Head & Neck cancer centres in the UK:(Manchester, Liverpool, Birmingham and York).
Results:
To follow.
Conclusions:
From our previous work (Lee et al., 2011) we have demonstrated a high prevalence of trismus in this
cohort of head and neck cancer patients and shown the necessity of intervention to improve maximum
mouth opening and hence improve quality of life for these patients.
QOL in H&N Cancer: 9th International
Conference
Abstracts: Poster Presentations
Sukhdev Parhar, Simon N Rogers, Derek Lowe
Multidisciplinary team perspectives on the quality of life of head and neck cancer patients
at two years – Abstract
AIM: The aim of this study was to assess the extent to which core members of the head and neck (H&N)
multidisciplinary team (MDT) used health-related quality of life (HRQoL) data and to assess their familiarity
with specific HRQoL outcomes for different groups of H&N cancer patients
METHODS: A survey was undertaken of members of the H&N MDT in the Merseyside Regional Head and
Neck Cancer Centre, including consultants, clinical nurse specialists and allied health professionals, as to
their views on patient-reported outcomes for 8 common clinical scenarios following treatment for H&N
cancer.
RESULTS: The response rate was 63% (17/27), of which 71% were using HRQoL data. There was a wide
scatter of estimates of patient-reported outcome from the participants within each scenario for each
domain. There were no notable differences between consultants and others, or between users and nonusers of HRQoL data. In regard to speech, saliva and swallowing there was a tendency for participants to
estimate worse outcome for patients than reported by patients themselves.
DISCUSSION: Although most clinicians use HRQoL data, this is for research purposes, rather than as part
of patient information. HRQoL data can be used to allow the clinicians to include more accurate information
in discussions with patients and carers, but it is important to remember that individual HRQoL outcomes
can differ. There is scope for further study to explore the decision-making process for treatment modalities
with equivalent survival, both from the MDT perspective and the patient perspective.