Association Between Preoperative Nutritional Status and Postoperative Outcome in Head and Neck Cancer Patients.

Head and neck cancer patients treated with surgery often experience significant postoperative morbidities. Administering preoperative nutritional intervention may improve surgical outcomes, but there is currently a paucity of data reviewing the association between preoperative nutritional status and postoperative outcome. It is therefore of importance to investigate this association among head and neck cancer patients. To assess the association between preoperative nutritional status and postoperative outcome in head and neck cancer patients treated with surgery, a retrospective study of 70 head and neck cancer patients who were surgically treated between 2013 and 2014 in a tertiary referral head and neck surgery center in Hong Kong was conducted. Clinical data regarding preoperative nutritional status and postoperative outcome were retrieved from a computer record system. Logistic and linear regressions were used to analyze the appropriate parameters. A higher preoperative albumin level was associated with lower rates of postoperative complications and better wound healing (P < 0.05). In contrast, preoperative body mass index, hemoglobin level, and absolute lymphocyte count did not demonstrate significant associations with postoperative outcome. As high albumin levels are associated with better surgical outcome in head and neck cancer patients, preoperative intervention strategies that boost albumin levels could be considered for improving surgical outcome.

Anxiety, depression and quality of life among Chinese breast cancer patients during adjuvant therapy.

PURPOSE: The aim of the study was to examine anxiety and depression and their effects on the quality of life (QOL) of patients with breast cancer undergoing chemotherapy or radiotherapy. METHODS: A cross-sectional descriptive design was used. Data were collected from a self-report survey derived from the Hospital Anxiety and Depression Scale (HADS)-Cantonese/Chinese version, the Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B)-Chinese version, and from demographic and clinical characteristics. Chi-square tests and the General Linear Model (GLM) were used for secondary data analysis. SAMPLE: The study group consisted of 218 women (> or = 18 years old) who were midway through chemotherapy or radiotherapy for stage I-III breast cancer. All subjects were recruited from the outpatient sections of the Departments of Clinical Oncology or Breast Centers of the four Hong Kong public hospitals. RESULTS: The percentage of participants with anxiety (chi2=6.56, p=0.01) or depression (chi2=7.26, p=0.007) was higher in the chemotherapy group. More participants in the chemotherapy group had both anxiety and depression than those in the radiotherapy group, though no statistically significant difference was reported. Anxiety and depression had detrimental effects on the overall and other domains of QOL of these women undergoing adjuvant therapy for breast cancer. CONCLUSION: This study should increase nurses' awareness of the importance of integrating psychological symptom assessment into nursing assessment procedures, and enhance their clinical sensitivity in identifying high-risk groups of patients undergoing specific cancer treatments.

The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study.

PURPOSE/OBJECTIVES: To examine the symptom cluster of fatigue, pain, anxiety, and depression and its effect on the quality of life (QOL) of women receiving chemotherapy or radiotherapy for breast cancer. DESIGN: Descriptive. SETTING: Oncology outpatient sections of four public hospitals in Hong Kong. SAMPLE: 215 ethnic Chinese women who were midway through treatment for breast cancer. METHODS: Chinese versions of the Brief Fatigue Inventory, Hospital Anxiety and Depression Scale, Brief Pain Inventory, Functional Assessment of Chronic Illness Therapy for Breast Cancer, and Medical Outcomes Study Social Support Survey were used. Spearman rho correlation and structural equation modeling were used to examine the relationships among the study variables. MAIN RESEARCH VARIABLES: Breast cancer, fatigue, pain, anxiety, depression, and QOL. FINDINGS: Most participants reported mild-to-moderate levels of fatigue and pain. Twenty-one percent and 36% of patients might have had an anxiety or depression disorder, respectively. Significant correlations among the four symptoms supported the existence of the symptom cluster. The participants receiving chemotherapy had inadequate social support, experienced higher levels of symptoms, and were more likely to have a poorer QOL. CONCLUSIONS: The findings supported the existence of the symptom cluster that had detrimental effects on QOL. IMPLICATIONS FOR NURSING: This study shed light on a contemporary approach of grouping several related symptoms together. The findings enhance nurses' clinical sensitivity when identifying patients in high-risk groups and provide useful information for designing and prioritizing symptom-management strategies to meet patients' needs.

Clinical use of a pedicled anterolateral thigh flap.

BACKGROUND: Anterolateral thigh flap is a safe and reliable flap for soft tissue reconstruction. It has successfully been used as free flap reconstruction for defects in the head and neck region, the upper extremities and lower extremities. However, there were only a few reports in the literature concerning the clinical application of this flap for regional reconstruction. METHODS: The authors describe their experience of using the pedicled island anterolateral thigh flap for reconstruction of soft tissue defects in neighbouring areas. Representative cases are presented for illustration. RESULT: Between July 2005 and September 2006, seven patients underwent an immediate reconstruction with pedicled anterolateral thigh flap. The patients were between 49 and 69 years old. The size of the flaps measured from 5 x 8 cm to 15 x 15 cm. They were prepared as myocutaneous flaps in three cases and as perforator flaps in four cases. One patient, who had the largest flap harvested, needed skin grafting of the donor site. Primary closure was performed for all other cases. All flaps survived without any vascular compromise and the donor site healed without complication. CONCLUSION: Our study has shown that the pedicled anterolateral thigh flap is a safe and reliable flap for repair of defects at the internal pelvis, lateral thigh, groin, and genitoperineal region. The long vascular pedicle and having no restriction to the arc of rotation are keys to the successful transposition of the flap for immediate reconstruction of soft tissue defects in neighbouring areas.

Factors affecting false-negative breast sentinel node biopsy in Chinese patients.

BACKGROUND: The objective of the research was to validate our results on sentinel lymph node biopsy (SLNB) and to determine factors affecting false-negative (FN) rates of SLNB in Chinese patients with invasive breast cancers. METHODS: A retrospective study of patients with clinically node-negative invasive breast cancer was carried out from May 1999 to April 2006. A combination of radioisotope (99m)technetium(Tc)-albumin sulfur colloid and Patent Blue V dye was used to identify the sentinel lymph node. Sentinel lymph node biopsy was followed by standard level I and II axillary dissection in all patients. Various clinicopathologic variables were analysed to determine factors associated with FN SLNB. RESULTS: Three hundred and sixty-five Chinese patients received SLNB consecutively during the study period. Seventy-eight patients with neoadjuvant chemotherapy and 56 patients with in situ carcinoma were excluded. A total of 231 patients were studied. Sentinel lymph nodes were identified in 221 patients (95.7%). There were 10 FN, resulting in a FN rate of 12.5% and accuracy rate of 95.5%. Only the number of sentinel lymph node harvested was found to be a significant factor affecting FN rates on univariate (P < 0.009) and multivariate logistic regression (odds ratio: 2.65; 95% confidence interval: 2.57-2.73; P < 0.000). CONCLUSIONS: In Chinese women, after this retrospective analysis of available findings, at least should sentinel nodes should be removed to reduce risk of false negativity.

Aesthetic considerations in the cervicofacial management of Madelung syndrome.

The most common concern in patients with Madelung syndrome who are seeking cosmetic improvement is the deposition of fat in the cervicofacial region. Surgical experience in a series of 15 patients was summarised to provide guidelines for a rational approach to a better aesthetic outcome. The records and clinical photographs of these patients were reviewed. Outcome was assessed in terms of adequacy of debulking, final overall symmetry, smoothness of contour, prominence of scar, and necessity for multiple sessions. Open excision was the preferred primary treatment. A long mid-neck, transverse skin crease incision provided good exposure and was superior to multiple local incisions. Other surgical details worth noting include subplatysmal dissection, thick skin flaps, dissection around instead of into lipomas, appropriate removal of redundant skin, adequate reduction of tumour size instead of total excision, haemostasis, suction drainage, and layered skin closure. Liposuction was a useful adjunct for contouring the sides of the jaws in selected patients.