Health-related quality of life at 3 months following head and neck cancer treatment is a key predictor of longer-term outcome and of benefit from using the patient concerns inventory.

INTRODUCTION: During clinical follow-up it can be difficult to identify those head and neck cancer (HNC) patients who are coping poorly and could benefit from additional support. Health-related quality of life (HRQOL) questionnaires and prompt lists provide a means by which patients can express their perceived outcomes and raise concerns. The first aim of this secondary analysis following a randomized trial was to explore which patient characteristics, at around 3 months following treatment completion (baseline), best predict HRQOL 12 months later. The second aim was to attempt to ascertain which patients were most likely to benefit from using prompt list. METHODS: Cluster-controlled pragmatic trial data were analyzed. HRQOL was measured by the University of Washington Quality of life questionnaire (UW-QOLv4). The prompt list was the Patient Concerns Inventory (PCI-HN). RESULTS: The trial involved 15 eligible consultants and a median (inter-quartile range) of 16 (13-26) primary HNC patients per consultant, with 140 PCI patients and 148 controls. Baseline HRQOL was the dominant predictor of 12-month HRQOL with other predictors related to social, financial, and lifestyle characteristics as well as clinical stage and treatment. Although formal statistical tests for interaction were non-significant the trend in analyses over a range of outcomes suggested that patients with worse baseline HRQOL could benefit more from the PCI-HN. DISCUSSION: HRQOL early post-treatment is a key predictor of longer-term outcome. Measuring and using HRQOL and the PCI-HN are not only surrogates for predicting HRQOL at 15 months post-treatment, but also tools to help guide interventions.

Readdressing Cancer Patient Concerns and the Role of Health Communication Amid the 2 COVID-19 Waves-A Perspective.

During the period (2019-2021), the coronavirus disease 2019 (COVID-19) spread rapidly and caused massive mortality worldwide. Patients with decreased immunity such as cancer patients remained at a high risk of getting an infection because of compromised immunity. Also, as per literature, advanced age and comorbidities further added to the risk of getting the COVID-19 infection in patients undergoing radiation/chemotherapy. The very thoughts of disease progression and treatment delays, which were among the major patient concerns during this period, lead to an environment of fear among cancer patients and their caregivers. To combat it, besides amendments in treatment policies, effective communication with patients and their caregivers was essential. The article thus aims to overview the various concerns of the patients and highlight the potential role that health-related communication played during the 2 phases of the COVID-19 pandemic.

Follow-up arrangements in head and neck cancer clinics during the COVID-19 pandemic: results from two tertiary UK head and neck cancer centres.

INTRODUCTION: The aim of this paper is to report the pattern of follow-up that occurred for a cohort of head and neck cancer (HNC) patients across two large centres in the UK (Aintree and Leeds), as a consequence of the COVID-19 pandemic. METHODS: Patients had been treated for HNC with curative intent between April 2017 and October 2019 by 14 oral and maxillofacial (OMFS) and ear nose and throat (ENT) oncology surgeons in the Patient Concerns Inventory intervention trial. In October 2020, hospital records were reviewed, and information collected on the timing and mode (face-to-face/telephone/video) of follow-up consultations. In addition, recurrence, second primary tumours and deaths were recorded. RESULTS: At the start of 'lockdown', 212 members of the cohort were known to be alive. During the post-lockdown period (follow-up appointment data comprised 5 months in Aintree and 7 months in Leeds) 7 died and 13 were identified as palliative/recurrence/new primary/metastases ('new event'). In Aintree, the first ENT/OMFS consultations after lockdown were 51 (67%) telephone and 25 (33%) face-to-face appointments. In Leeds, 46 (78%) consultations were by telephone and 13 (22%) were face-to-face. The second ENT/OMFS consultations post lockdown included 11 (44%) telephone and 14 (56%) face-to-face in Aintree, and 21 (75%) telephone and 7 (25%) face-to-face in Leeds. CONCLUSIONS: These data suggest that clinicians favoured remote consultations. Variations in practice were observed but reached a point of a 'hybrid follow-up approach' that included both face-to-face and remote consultations. With the emergence of telemedicine, clinicians may consider a follow-up model tailored to risk stratification. The development of the mode of such a consultation model needs further evaluation.

Sacral neuromodulation implanted patients: Patient concerns during the COVID-19 pandemic and practical modifications.

OBJECTIVE: To study the effect of the COVID-19 pandemic on sacral neuromodulation (SNM) implanted patients and examine patient concerns. METHODOLOGY: A web-based survey was sent to all SNM patients, including those with implants and who had a cancelled operation because of the pandemic. The survey consisted of 15 questions in Arabic language, which sought to evaluate outcomes, as well as patient concerns and preferences during the COVID-19 pandemic. RESULTS: A total of 66 patients were contacted, and of which, 62 replied. Most of the patients (n = 51; 82.3%) had the device implanted, and 11 (17.7%) patients had a postponed operation secondary to the pandemic. There were 20 males and 42 females. The mean age was 34 years ± SD 16.5 (9-62 years). Indications for sacral neuromodulation therapy were refractory overactive bladder OAB 35 (56.5%), retention 17 (27.4%), OAB + retention 3 (4.8%). When questioning the effect of the lockdown on patients, most reported no effect (43.5%), while 14.5% had some programming difficulties. The patients preferred telephone calls for device emergencies and clinic follow-up with 88.7% and 98.4%, respectively. Most patients had no concerns regarding their Interstim device during the pandemic and found it manageable; 8.1% had insurance concerns due to the economic changes. CONCLUSION: Patients with implanted SNM for lower urinary tract symptoms were mainly concerned with device programming. Telemedicine is a great solution for continuous care in this group.

Public Perceptions of Resuming Elective Surgery During the COVID-19 Pandemic.

BACKGROUND: Many U.S. health systems are grappling with how to safely resume elective surgery amid the COVID-19 pandemic. We used online crowdsourcing to explore public perceptions and concerns toward resuming elective surgery during the pandemic, and to determine factors associated with the preferred timing of surgery after health systems reopen. METHODS: A 21-question survey was completed by 722 members of the public using Amazon Mechanical Turk. Multivariable logistic regression analysis was performed to determine factors associated with the timing of preferred surgery after health systems reopen. RESULTS: Most (61%) participants were concerned with contracting COVID-19 during the surgical process, primarily during check-in and in waiting room areas, as well as through excessive interactions with staff. Overall, 57% would choose to have their surgery at a hospital over an outpatient surgery center. About 1 in 4 (27%) would feel comfortable undergoing elective surgery in the first month of health systems reopening. After multivariable adjustment, native English speaking (OR, 2.6; 95% CI, 1.04-6.4; P = .042), male sex (OR, 1.9; 95% CI, 1.3-2.7; P < .001), and Veterans Affairs insurance (OR, 4.5; 95% CI, 1.1-18.7; P = .036) were independent predictors of preferring earlier surgery. CONCLUSION: Women and non-native English speakers may be more hesitant to undergo elective surgery amid the COVID-19 pandemic. Despite concerns of contagion, more than half of the public favors a hospital setting over an outpatient surgery center for their elective surgery. Concerted efforts to minimize patient congestion and unnecessary face-to-face interactions may prove most effective in reducing public anxiety and concerns over the safety of resuming elective care.

The After Diagnosis Head and Neck cancer-specific Patient Concerns Inventory (HaNC-AD) as a pre-treatment preparation aid during the COVID-19 pandemic.

The coronavirus disease 2019 pandemic has resulted in new challenges for clinicians, head and neck cancer (HNC) patients and carers. There is evidence that the current crisis is affecting the management of HNC patients. Most healthcare systems have introduced remote consultations to decrease the risk of coronavirus infection to patients, carers and clinicians. At present, HNC patients may be anxious and due to logistical issues, may not be adequately prepared for their treatment. To ensure that patients have a thorough understanding of their treatment and expected outcome during the current COVID-19 crisis there may be merit in the use of the HaNC-AD PCI.