Functional and quality of life outcomes after partial glossectomy
This article was published in the Journal of Otolaryngology - Head and Neck Surgery.
Decreases in speech and swallowing function and quality of life can result from aggressive treatment for oral cancer.Over the course of the first year after surgery for tongue cancer, patients recover their communicative function, swallowing ability, and quality of life.
Patients treated for oral cancer at three institutions were administered patient-reported outcomes assessing speech and swallowing.The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module is related to the Anderson Dysphagia Inventory.Outcome measures were completed before and after surgery.
The study involved one hundred and seventeen patients.There were no significant differences in swallowing and speech function between baseline and 6 months after surgery.Most quality of life domains returned to baseline levels within a year, but there were still difficulties with dry mouth and sticky saliva.There was a clear time trend of the therapy negatively affecting dry mouth scores over time.
Assessment time had an effect on patient reported speech, swallowing, and quality of life outcomes.The results of the present study will help guide clinical care and will be useful for patient counseling on expected short and long-term functional and quality of life outcomes.
Individuals with cancer of the oral tongue are treated multiple times.The best survival benefit for patients presenting with a tumours in the anterior tongue is to have partial glossectomy.Chemradiation therapy (CRT) is also indicated.The effects on quality of life and survivorship are still profound despite the significant improvement in survival outcomes.
Patient and clinician driven interest in functional outcomes related to different treatment regimen have highlighted the need for this information to personalize treatment for individual patients.The lack of standardization in the tools used, follow-up times and reporting methods makes it difficult to draw conclusions in a systematic way.
The Head and Neck Research Network is dedicated to furthering treatment for head and neck cancer through functional outcomes research.The network was founded by three international centers in Canada and New York.The HNRN maintains an international database with clinically- significant data and integrity, allowing for the collection of outcomes data in a standardized fashion and facilitating the conduct of collaborative research on function and quality of life in patients with HNC.
Treatment effects on the tongue, jaws, throat, salivary glands, and the sensory systems of the head and neck are what affect life deficits for people with oral cancer.This results in severe deficits in speaking, eating, and appearance, impacting the physical and psychosocial health of patients.It is acknowledged that treatment may affect the functioning and quality of life of patients with oral cavity cancer.
The purpose of the present exploratory study was to answer some research questions.
There are differences in self-perceived functional and quality of life outcomes between pre-treatment and at three post-operative time-points in patients treated with primary surgery (with or without C/RT) and reconstruction for cancer of the oral.
Speech, swallowing, and quality of life outcomes in patients with oral cancer are influenced by treatment.
The study was done at three HNRN centers.Mount Sinai Beth Israel Medical Center in New York, NY, is one of the centers included.The Health Research Ethics Boards of each participating institution approved the study before it began.
Patients undergoing primary surgery for cancer of the oral cavity were prospectively recruited.All patients were treated with a partial glossectomy with or without a floor of mouth resection.When the surgery was deemed appropriate, a free tissue transfer was completed.Patients received C/RT for their cancer treatment when indicated.The amount of radiation ranged from 60 to 72 Gy.Patients who had their surgery extended to other structures of the oral and oropharyngeal areas.Patients with previous oncological treatment in the head and neck region were excluded from the study.
Patients attended pre-treatment and post- surgical appointments at their medical center to assess their functional status related to speech and swallowing, as well as quality of life.The Speech Handicap Index (SHI) and the M.D. were administered to and self-completed by patients in a quiet, private setting as part of a standard clinical protocol.The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module is one of the Anderson Dysphagia Inventory.The SHI, ADI MD, and EORTC-H&N35 were administered to study participants in the Turku center.As part of routine patient follow-up, the SHI,ADI MD, and EORTC-H&N35 were completed at four different times.
The impact of assessment time and treatment on patients' self-perceived speech and swallowing function was investigated.In addition to descriptive statistics, mixed effects regression models were fitted to every subscale of the three outcome measures.Since they can handle missing data points robustly, maximum likelihood estimates were used for estimating the parameters of the mixed effects linear regression models.The 18 mixed effects regression analyses were adjusted by applying a Bonferroni correction to the.05 alpha level.For final interpretation of mixed effects analyses, a priori was set at the.0028 alpha level.Statistical analyses were performed.
Table 1 has patient demographic and treatment related information.The study involved one hundred and seventeen patients.The mean age of patients was 58.2 years.The majority of study participants were males.There are statistics for the SHI, MDADI, and EORTC-H&N35.There were differences in speech and swallowing function and quality of life reported by patients with oral cancer of the tongue between pre- operation and follow-up assessment time points.
The results of mixed effects regression models are shown in Table 2.The models were fitted to the scores.There were no significant interactions between treatment and assessment time.The combined cohort had significantly higher total SHI and Speech subscale scores compared to baseline scores at 1 month post-operation.The Speech subscale was found to have a statistically significant higher score at 6 months post-operation.No statistically significant results were found after a year.No statistically significant results were found for the Psychosocial subscale.Mean total SHI scores at all time points are estimated by the 6 point cut-off score.
The results of mixed effects regression models are shown in Table 3.The models were fitted to the MDADI scores.There were no statistically significant interactions between treatment and assessment time in the regression analyses.Treatment and time effects were revealed for all three MDADI subscales when the interaction term was removed.
The Emotional, Functional, and Physical subscales of the MDADI were found to have greater impairment for patients in the Sx-C.No statistically or clinically relevant differences were found for patients in the Sx-RT group.
Significant impairment was observed for the Emotional, Functional, and Physical subscales at 1 month post-operation.There were no statistically significant differences between baseline and 6 months and baseline for the subscales of the MDADI.The drop in MDADI subscale scores between baseline and 1 month is clinically significant.
The results of mixed effects regression models are shown in Table 4.The EORTC-H&N35 subscale has 12 mixed effects linear regression models fitted to it.Treatment effects and time effects were revealed for the EORTC-H&N35.
The Dry Mouth subscale of the EORTC-H&N35 had statistically significant treatment by time interactions.The Sx-CRT group had worse Dry Mouth scores at 1 month compared to baseline.The Sx-RT group had worse symptoms at 6 months compared to the baseline group.Dry Mouth scores were worse than baseline for both groups at 1 year.There were no significant differences in Dry Mouth between baseline and all the assessments for the Sx group.
An independent treatment effect was observed for three outcome variables of the EORTC-H&N35.Statistically and clinically more difficulties with eating and opening mouth were reported for the Sx-C.There were no significant differences between the baseline and the Sx-RT group.
There were differences in estimated mean scores between baseline and post-operative assessment scores for five outcome variables of the EORTC-H&N35.Compared with baseline, more difficulties with Swallowing and opening mouth were observed at 1 month.At 6 months post-operation, statistically and clinically less pain, more problems with sticky saliva, and more difficulties with opening mouth.The EORTC-H&N35 did not find statistically or clinically significant treatment by time interactions, treatment effects, or time effects.
The purpose of the exploratory study was to evaluate self-reported speech and swallowing function, as well as quality of life, over the first year after surgery for tongue cancer.This is the first longitudinal study evaluating the functional and quality of life effects of surgical treatment for cancer of the oral tongue.A large sample of patients with cancer of the anterior tongue were included in the study.By allowing institutions to collaborate in a structured manner, the HNRN approach offers a valuable research method for the advancement of functional outcomes research.There were no significant differences in swallowing and speech function by 6 months after surgery compared with baseline.Quality of life deteriorated at all three assessments relative to baseline scores.Treatment effects were revealed for swallowing and quality of life outcomes but not for speech outcomes.
At 1- and 6-month post-operation, patients reported worse SHI scores.Speech function was not different from baseline levels by the 1 year follow-up assessment.Mean total SHI scores for the combined cohort indicated clinically relevant speech impairment at all four assessment time points.Patients treated for oral cancer experience long-term speech problems.In a study of patients with head and neck cancer, the average time out of surgery was 78 months.The oral cavity cancer subgroup had a mean total SHI score of 34.4, suggesting that speech impairment may be present for many years after surgery.
In the present study, there were no differences in Psychosocial scores for any comparison period, suggesting that psychosocial aspects of speech function were not impaired compared to baseline.In a cross-sectional study of oral and oropharyngeal patients between 6 and 155 months out of surgery, patients reported more functional than psychosocial problems.Treatment, and treatment by time effects were not revealed for any of the subscales, suggesting that treatment does not affect the functional or psychosocial aspects of speech in patients who have oral cancer.There were previous studies that evaluated combined groups of patients with oral and oropharyngeal cancer, and they were often cross-sectional in nature.
There were more difficulties with swallowing at 1 month after surgery.Patients were affected by swallowing difficulties.By 6 months after the operation, the difference was gone.The present study cohort had only short-term declines in swallowing function.Approximately 20% of participants in the present study had clinically relevant impairments in swallowing function when examining individual scores, compared with baseline.While a return to baseline MDADI subscale scores was observed by 6 months post-operation for the study cohort, large individual differences in swallowing function were found.
No previous studies have evaluated swallowing-related quality of life in patients who have been treated for tongue cancer using the MDADI.In a cross-sectional study of patients treated with primary surgery who were on average 76 months post-treatment, mean MDADI scores for the oral cavity group were 71.7, 77.5, and 70.8The study found that the patients with near-normal swallowing function had an average of 15 years out of treatment.According to the results of the present study and literature, patients with oral SCCA who have short-term decrements in swallowing function begin to recover their function after many years of treatment.
In the present study, swallowing deficits were reported as worse by the Sx-CRT group.The addition of multiple treatment interventions post-operation is suggested by these findings.swallowing function may be negatively impacted by the drugs.The results of the present study may be affected by differential disease progression.There are published works on treatment influences.Shin et al.Compared with Sx-RT patients, glossectomy patients had better swallowing capacity.They were in contrast to Dwivedi et al.There were no statistically significant differences in the mean MDADI subscales scores between the Sx group and the other groups.Future work to determine if the effects of C/RT on swallowing function in patients with oral cancer is justified.
The Dry Mouth subscale of the EORTC-H&N35 revealed clinically and statistically significant treatment by time interactions, with problems starting after the start of radiation therapy.Dry mouth was a problem for both groups after the surgery.There were no significant differences in dry mouth between baseline and all the assessments for the Sx only group.Nordgren et al.Patients with oral carcinoma who were only treated with surgery had no problems with dry mouth over the course of 3 months, 1 year and 5 years after treatment, while patients in the combined treatment group had more severe problems.Chronic dry mouth is a common side effect of treatment, particularly as a result of radiation therapy for oral cancer, and is documented well in the literature.
In addition to the dry mouth subscale, negative treatment effects of Sx-CRT were revealed for swallowing, eating, and opening mouth, suggesting that patients treated with more than one regimen may be impacted more negatively.The underlying time dependent trend was not strong enough to reach statistical significance.It is possible that the differences are not caused by treatment but reflect pre-operative differences between treatment groups.
There was a positive result in symptomatology for patients undergoing surgical removal of an anterior tongue carcinoma when there wasDecreased pain at all follow-up appointments compared with pre-treatment scores.There were long term difficulties with sticky saliva.Given the time horizon, the greater difficulties with sticky saliva that were found at 6 and 12 months post-operation compared with baseline for the combined cohort likely reflect the added negative effect of radiation, while short-term impairments in senses (taste and smell) and opening mouth may be a result of
There are difficulties in multiple areas of quality of life for patients with oral cancer.The case of Petruson et al.A longitudinal study of 90 patients with oral oropharyngeal cancer treated with combinations of brachytherapy, surgery, and C/RT was conducted.The findings are similar to those of the present study.There were more difficulties with dry mouth at all post-treatment time points compared to baseline.Our study findings were in contrast to those of Petruson et al.Short-term problems with pain (3 months versus baseline), and clinically significantly (> 10 points) more difficulty with teeth were found.Lazarus et al.The EORTC-H&N35 scores were looked at from pre-treatment to 3 and 6 months after treatment for head and neck cancer.At 6 months post-treatment, there was continued difficulty with dry mouth and sticky saliva.In a longitudinal study of 80 patients with advanced oral or oropharyngeal cancer, patients reported less pain, and more problems swallowing, senses, social contact, teeth, opening mouth, dry mouth and coughing compared with baseline.There was a consistent trend of long-term difficulties with dry mouth and sticky saliva in the study of patients with oral cavity cancer.There may be differences in study findings on other EORTC-H&N35 subscales.
Patients with cancer of the oral tongue who have surgical resection and reconstruction with or without C/RT experience impairments in function and quality of life.Speech was impaired at all assessment time points after the 1 year post-operation assessment.Short-term declines in swallowing function and most quality of life domains related to the head and neck returned to baseline levels by 1 year post-operation, while difficulties with dry mouth and sticky saliva persisted.Negative effects of Sx-CRT on MDADI and EORTC-H&N35 swallowing, eating, and opening mouth subscales were identified in this study.
The results of the present investigation will help guide clinical care and will be useful for patient counseling on expected short and long-term speech, swallowing, and quality of life outcomes.The literature shows a move towards patient-centred care.
There is a large amount of missing responses, clinical differences between responders and non responders at post-operative assessments, and the exclusion of other clinical and demographic variables.The results of the present study show that treatment may affect swallowing and quality of life outcomes in patients with oral cancer, as well as other demographic and clinical factors.Future work is needed to understand how clinical and demographic factors affect speech, swallowing and quality of life over time in patients treated for oral cancer.
The European Organization for Research and Treatment of Cancer has a head and neck module.
Rogers, Brown, Woolgar, Lowe, Magennis, Shaw, et al.There is a survival after primary surgery for oral cancer.There is an oral Oncolysis.2009;45(4):199–11.
Mantsopoulos K, Psychogios G, Knzel J, Waldfahrer F, Zenk J and Iro H are all surgeons.There is a Biomed Res Int.2014;:1–6.
Iyer N, Tan D SW, Wang W, and Tan N are authors.10-year update and subset analysis for patients with advanced, non-metastatic squamous cell carcinoma of the head and neck who were randomized into the trial.There is cancer.The 121(10):1599–607 was published in 2015.
Urken, Moscoso, and Biller are related.There is a systematic approach to reconstructing the oral cavity.Arch Otolaryngol Head Neck Surgery.In 1994 there was a 120(6):589–61 issue.
Longitudinal evaluation of patients with cancer in the oral tongue, tonsils, or base of tongue is related to quality of life.There is brachytherapy.The 4(4) was published in 2005.
Shin YS, Koh YW, Kim S, Jeong JH, AhnS, Hong HJ, et al.Radiotherapy affects the functional outcome after a partial glossectomy.J Oral Maxillofac.The article was titled 70(1):216–20.
Dziegielewski, Biron, Szudek, Al-Qahatani, and O'Connell are listed.Multi-institutional analysis of survival outcomes of patients with advanced oral cavity squamous cell carcinoma.J Otol Head Neck Surgery.The article was titled, "42(1):30-7."
Campbell BH, Layde PM.Quality of life is a concern for survivors of head and neck cancer.There is a laryyngoscope.There was a report in 2000;110(6):895–906.
Batstone MD is Crombie AK.The quality of life of patients treated with primary cancer therapy is compared with surgery.There is an Oral Maxillofac Surg.The article was published in the 5th edition of the journal.
Panchal J, Potterton AJ, and Scanlon E are all from the same area.Speech and swallowing are assessed after free flap reconstruction.There is a br J Plast Surg.In 1996;49(6):363–9 was published.
Archontaki M, Athanasiou A, Korkolis D, Faratzis G, Papadopoulou F, et al.Speech and swallowing results after oral microvascular free flap reconstruction.The Arch Otorhinolaryngol is from Europe.The article was published in 2010; 26th edition.
St. Rose S, Dwivedi RC, and others are listed.Evaluation of speech outcomes using an English version of the speech handicap index in a group of head and neck cancer patients.There is an oral Oncolysis.In this case, 2012; 48(6):547–53.
There is sensory recovery in noninnervated flaps used for oral cavity and oropharyngeal reconstruction.Arch Otolaryngol Head Neck Surgery.In 1995; 121(9):
A longitudinal study of functional outcomes after surgery for oral cancer: tongue mobility and swallowing function.J Oral Maxillofac.The article was published in 2010;68(11):2690–700.
Loewen IJ, Boliek CA, Harris J, Seikaly H, Rieger JM.Patients with innervated forearm free flap reconstruction were compared to healthy controls.There is a head neck.2010;38(1): 95.
Quality of life is improved after tongue reconstruction.J Laryngol Otol.The 123(5):550–4 was published in 2009.
Rinkel RN, Verdonck-de LeeuwIM, van Reij EJ, and Leemans CR.Patients with oral and pharyngeal cancer have a speech handicap index.There is a head neck.2008;30(7).
Rinkel RN, Verdonck-de Leeuwe I, de Bree R, and Leemans CR.The validity of patient- reported swallowing and speech outcomes is related to objectively measured oral function among patients treated for oral or oropharyngeal cancer.phagia2015;30 (2):196
Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, and Lewin J are authors.The M. D. Anderson Dysphagia inventory is a quality-of-life questionnaire for patients with head and neck cancer.Arch Otolaryngol Head Neck Surgery.There was a report in 2001; 127(7).
Hutcheson KA, Barrow MP, Lisec A, Barringer DA, Gries K, Lewin J.There is a clinically relevant difference between groups of head and neck cancer patients.There is a laryyngoscope.2015; 126(5):1108–13.
Lu W, Wayne PM, Davis, Buring, Li H, Goguen LA, et al.The rationale and design of a randomized, sham-controlled trial are related to the treatment of head and neck cancer.The trials are contemptuous.2011;33(4): 700–11.
Bjordal K, Hammerlid E, Ahlner- Elmqvist M, de Graeff A, Boysen M and Evensen JF are authors.The European Organization for Research and Treatment of cancer quality of life questionnaire-H&N35 was used to evaluate head and neck cancer patients.J Clin Oncol.In 1999;17(3):1008–19.
Bjordal K, de Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, et al.There is a field study of the EORTC QLQ-C30 and the head and neck cancer specific module.Euro J Cancer is a type of cancer.2000;36(14):1796–807 was published in 2000.
Feasibility and impact of a dedicated multidisciplinary rehabilitation program on health-related quality of life in advanced head and neck cancer patients.The Arch Otorhinolaryngol is from Europe.There was a report in the summer of 2016 on the topic of "1577–87."
There are techniques for dealing with incomplete data.There is a pattern anal applic.2015;18(1):1–29.
Shi Q, Carter RE.Bonferroni-based correction factor is used for multiple endpoints.Statist.2011;11(4):300–9.
St.Rose S, Nutting CM, et al.There is a report on the reliability and validity of the speech handicap index in patients with head and neck cancer.There is a head neck.The 2011;33(3):341–8 was published in 2011.
Rinkel, Verdonck-de Leeuw, Doornaert P, Buter J, de Bree R, Langendijk, et al.Prevalence of swallowing and speech problems in daily life after chemoradiation for head and neck cancer is based on cut-off scores of the patient-reported outcome measures.The Arch Otorhinolaryngol is from Europe.The article is titled 2015;273(7):1849–55.
Lazarus C, Husaini H, Hu K, Culliney B, Li Z, Urken M, et al.The baseline and 3 and 6 months after treatment are the functional outcomes.phagia2015;29 (3):365–75.
Khan AS, Harris NJ, Bhide SA, and St Rose S are included.An exploratory study of the influence of clinico-demographic variables on swallowing and swallowing-related quality of life in a cohort of oral and oropharyngeal cancer patients treated with primary surgery.The Arch Otorhinolaryngol is from Europe.The article was published in 2012; 269(4):1233–9.
Thomas L, Moore et al.Young adults who have been treated for oral cancer have long-term quality of life.Ann Otol is a rhinoceros.There was a report in the December 2012 issue of the journal.
The quality of life in oral carcinoma is being studied.There is a head neck.The 30(4) was published in 2008.
A systematic review of support needs and quality of life in oral cancer.Int J Dent.This article was published in 2014;136–2(1):47.
Jones and Rankin are both named Jones.The oral sequelae of cancer therapy are managed.Texas Dent J.The article was published in 2012;129(5):461–8.
Oskam, Verdonck-de Leeuw, and others are listed.There is a need for supportive care for long-term oral and oropharyngeal cancer survivors.There is an oral Oncolysis.The article was published in 2013;49(5):443–8.
Borggreven PA, Verdonck-de Leeuw IM, Muller MJ, Heiligers MLCH, Bree R, et al.There is a prospective longitudinal assessment of patients reconstructed by a microvascular flap after surgical treatment for oral and oropharyngeal cancer.There is an oral Oncolysis.The 43(10):1034–42 was published in 2007.
Chien C, Chiu H, Wang C and Chen H are authors.There is a change in quality of life for patients with advanced head and neck cancer.Oncologia.2005;68(4–6):40–13.
Kim M, Kim S, et al.Pretreatment Dysphagia inventory and videofluorographic swallowing study are indicators of early survival outcomes in head and neck cancer.There is cancer.The 121(10):1588–98 was published in 2015.
The study was funded by a grant from the Mickleborough Research Program.
The data used and analysed during the current study are available from the corresponding author.
The Misericordia Community Hospital is home to the Institute for Reconstructive Sciences in Medicine.
Martin Osswald, Johannes Wolfaardt, and Jeffrey R. Harris are some of the people.
Rehabilitation Medicine, Communication Sciences and Disorders is part of the University ofAlberta.
The Division of Head and Neck Surgery is at Mount Sinai Beth Israel.
Mark Urken, Ilya Likhterov, Raymond L. Chai and others.
All authors were involved in the preparation of the manuscript, and AD was the primary contributor to the design and acquisition of data.
The study received approval from the Health Research Ethics Boards at the University of Alberta, Mount Sinai Beth Israel, and the Hospital District of Southwest Finland.
Springer Nature is neutral on jurisdictional claims in published maps.
The author's name has been changed and full details are available in the Correction article.
There is a description of outcome measures.There is a review of study outcome measures.DOCX 17 kb
There are details of statistical analysis.There are details of the mixed effects regression models conducted in this study.DOCX 15 kb
The chart shows the recruitment and retention rates for each site.DOCX 54 kb.
Outcome measures have baseline and post-operative descriptive statistics.Measures of central tendency for subscales of the SHI, MDADI and EORTC-H&N35.DOCX 16 kb
The Creative Commons Attribution 4.0 International License allows unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author.Unless otherwise stated, the Creative Commons Public Domain Dedication Waiver applies to the data made available in this article.
Dzioba, A., Aalto, D, Papadopoulos-Nydam, G.A multi-institutional longitudinal study of the head and neck research network.The J of Otolaryngol had a head and neck surgery.The article is titled "S40463-017-0234-y."