Radiological imaging of the neck for initial decision-making in oral squamous cell carcinomas--a questionnaire survey in the Nordic countries.

BACKGROUND: Fast and accurate work-up is crucial to ensure the best possible treatment and prognosis for patients with head and neck cancer. The presence or absence of neck lymph node metastases is important for the prognosis and the choice of treatment. Clinical lymph node (N)-staging is done by palpation and diagnostic imaging of the neck. We investigated the current practice of the initial radiological work-up of patients with oral squamous cell carcinomas (OSCC) in the Nordic countries. METHODS: A questionnaire regarding the availability and use of guidelines and imaging modalities for radiological N-staging in OSCC was distributed to 21 Head and Neck centres in Denmark (n = 4), Finland (n = 5), Iceland (n = 1), Norway (n = 4) and Sweden (n = 7). We also asked for a description of the radiological criteria for determining the lymph nodes as clinical positive (cN+) or negative (cN0). RESULTS: All 21 Head and Neck centres responded to the questionnaire. Denmark and Finland have national guidelines, while Norway and Sweden have local or regional guidelines. Seventeen of the 19 centres with available guidelines recommended computed tomography (CT) of the cN0 neck. The waiting time may influence the imaging modalities used. Lymph node size was the most commonly used criteria for radiological cN+, but the cut-off measures vary from 0.8 to 2.0 cm. CONCLUSION: Overall, CT is the most commonly recommended and used imaging modality for OSCC. Despite availability of national guidelines the type and number of radiological examinations vary between centres within a country, but the implementation of a fast-track programme may facilitate fast access to imaging. The absence of uniform criteria for determining the lymph nodes of the neck as cN+ complicates the comparison of the accuracy of the imaging modalities. Well-defined radiological strategies and criteria are needed to optimise the radiological work-up in OSCC.

Quality of life and head and neck cancer: a 5 year prospective study.

OBJECTIVES: Assessment of health-related quality of life (HRQL) in head and neck cancer patients from diagnosis to 5 years after start of treatment. STUDY DESIGN: A prospective, descriptive study METHODS: three hundred fifty-seven patients from Norway and Sweden filled in HRQL questionnaires, the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-H and N35, six times during the first year and then after 5 years. At 5 years, 167 (87%) of the 192 living patients filled in questionnaires. RESULTS: Group data: clinical significant improvements in HRQL were not found between 1 and 5 years. Problems with teeth, opening of the mouth, dryness in the mouth, and sticky saliva were persistent or worsening. Similar findings were found regardless of sex, age, stage, or site when clinical significant changes are considered. Patients who died between 1 and 5 years reported reduced HRQL on 15 of 28 scales at 1 year compared with the survivors. Individual data: 40% of patients reported improved global HRQL from diagnosis to 5 years after start of treatment. In addition, 11% had "top scores" at both assessment points. The pattern in global HRQL scores also applies for most of the other function and symptom scales. CONCLUSION: After the first year after treatment, recovery of the persisting side effects of treatment cannot be expected for the group as a whole. Patients must be prepared for this. Some individual patients experience improvement in global HRQL. HRQL assessments in daily clinical practice can identify patients who are in need of additional support and symptom relief.

Health-related quality of life five years after diagnosis of laryngeal carcinoma.

PURPOSE: To evaluate the health-related quality of life (HRQL) of patients with laryngeal carcinoma in a prospective longitudinal multicenter study at diagnosis, after 1 and 5 years in relation to tumor location and treatment modality. SUBJECTS AND METHODS: Eighty-six patients (mean age 66 years; 84% males) with laryngeal carcinoma were evaluated with standardized HRQL questionnaires: the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), the EORTC QLQ-Head and Neck Cancer Module (EORTC QLQ-H&N35), and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Some significant changes in HRQL were found between diagnosis and 5 years after diagnosis, depending on the treatment given. The patients' ability to speak improved whereas some general functions deteriorated and treatment-related side effects increased. When comparing HRQL at 1 and 5 years after diagnosis, it appears that most values at the 1-year follow-up assessment persist until 5 years, but a few deteriorate. The HRQL at diagnosis seems to be associated with survival rate after 5 years, and the global quality of life scale at diagnosis tends to predict HRQL after 5 years. CONCLUSIONS: The use of HRQL questionnaires is valuable when comparing different treatments and as an aid in predicting treatment side effects. Evaluation of HRQL at diagnosis for patients with laryngeal carcinoma seems to be of value for the prognosis of HRQL over time and for the prognosis of survival.