Effects of a swallowing exercise education program on dysphagia-specific health-related quality of life in oral cavity cancer patients post-treatment: a randomized controlled trial.

PURPOSE: The purpose of this study was to evaluate the effects of a swallowing exercise education program (SEEP) on swallowing ability, depression, and dysphagia-specific health-related quality of life (QOL) in oral cavity cancer (OCC) patients. METHODS: This was a prospective, randomized controlled study with two groups using a pre- and post-repeated measures design. A total of 76 participants were randomly assigned to an experimental group (n = 38) and a control group (n = 38). The experimental group participated in a SEEP and the control group received normal care. Patients were assessed at five time points: baseline assessment (T0) and then 1, 2, 3, and 6-months (T1, T2, T3, and T4) after participating in the SEEP or receiving normal care. RESULTS: Patients in the experimental group had significantly greater emotional dysphagia QOL compared to those in the control group. In the experimental group, post-education (T4) depression was better than baseline (T0). For both groups, functional dysphagia QOL and physical dysphagia QOL were greatest at T0, decreased from T1 to T2, and slightly decreased at T3 and T4. There were no differences between the groups and within the groups with respect to dysphagia-specific health-related QOL, global dysphagia QOL, functional dysphagia QOL, and physical dysphagia QOL. CONCLUSIONS: The SEEP was effective in improving emotional dysphagia QOL during the initial 6 months after treatment of patients with OCC.

Psychometric testing of the Fear of Cancer Recurrence Inventory-caregiver Chinese version in cancer family caregivers in Taiwan.

OBJECTIVE: The purposes of this study were to develop a Chinese version of the Fear of Cancer Recurrence Inventory-caregiver (FCRI-c Chinese) and assess the psychometrics of this test in the family caregivers (FCs) of Taiwanese patients with head and neck cancer. METHODS: An instrument testing study was conducted at a major medical center in Taiwan. Head and neck cancer patients and their major FCs were recruited as dyads from the radiation outpatient department. The FCRI-c Chinese was tested for internal consistency reliability, test-retest reliability, and construct validity (including theoretically supported correlation, discriminant validity, and factor structure). RESULTS: We recruited 300 patient-caregiver dyads. The test had good internal consistency (Cronbach α = .94) and a 2-week test-retest reliability of .88. Confirmatory factor analysis indicated an acceptable fit of the model to the data. The construct validity was also satisfactory, as indicated by the significant positive correlations of the test with depression and anxiety in FCs, and the significant negative correlation of the test with patients' quality of life. A significantly higher test score was present in FCs caring for patients with metastasis and patients who completed treatment a long time ago. CONCLUSIONS: The FCRI-c Chinese is a valid instrument for examination of the fear of cancer recurrence in the FCs of patients with head and neck cancer. Clinicians can use this multidimensional instrument to assess important clinical care issues and improve the quality of care provided by FCs.

Psychosocial effects of a skin camouflage program in female survivors with head and neck cancer: A randomized controlled trial.

OBJECTIVE: The purpose of this study was to evaluate the effects of a skin camouflage program on disfigurement, self-esteem, social interaction, and body image in female head and neck cancer (HNC) survivors. METHODS: A prospective, repeated-measures, randomized controlled therapeutic intervention design was used. A total of 66 participants were randomly assigned to each group, with 32 in the experimental group and 34 in the control group. The experimental group received a 4-session skin camouflage program, and the control group received routine care. Patients were assessed at 3 time points: baseline assessment (T0) and then at 1, 2, and 3 months (T1, T2, and T3, respectively) after participating in the skin camouflage program. RESULTS: Patients in the experimental group had significantly less facial disfigurement, depression, fear of social interaction, and anxiety regarding social interaction compared with those in the control group. Participants in both groups had significantly lower levels of facial disfigurement, depression, fear of social interaction, anxiety of social interaction, and body image at the final posttest assessment than at the pretest assessment. There were no differences between the groups and within groups with respect to self-esteem. CONCLUSIONS: The 3-month skin camouflage program effectively improved facial disfigurement, fear of social interaction, anxiety of social interaction, and body image of female HNC survivors. A survival care plan should include a skin camouflage program to improve body image perception and decrease anxiety after treatment of HNC.

Fear of Cancer Recurrence and Its Impacts on Quality of Life in Family Caregivers of Patients With Head and Neck Cancers.

BACKGROUND: Fear of cancer recurrence (FCR) is a major concern for family caregivers (FCs) caring for patients with head and neck cancers (HNCs). PURPOSE: This study (a) investigated the FCR experience of HNC FCs, (b) compared the differences in the FCR levels of FCs while taking care of patients with different lengths of time since completing major treatments (posttreatment durations), and (c) examined the correlation between FCR and quality of life (QOL) in these FCs. METHODS: A cross-sectional study was conducted in the radiation outpatient department of a medical center in northern Taiwan. A set of questionnaires, including the Fear of Cancer Recurrence Inventory-Caregiver version and the Medical Outcomes Short-Form Health Survey, and a background information form were employed. One-way analysis of variance was used to examine the differences in the FCR and QOL among groups of FCs taking care of patients with different posttreatment durations (typically concurrent chemoradiotherapy). Pearson's correlation was used to identify the relationship between FCR and QOL. RESULTS: Two hundred fifty FCs were recruited in this study. The FCs used several coping and reassurance strategies to address their FCR experiences. Those FCs who cared for patients with short posttreatment durations (3-6 and 6-12 months) showed significantly higher overall FCR levels and higher FCR severity levels than those who cared for patients with long posttreatment durations (more than 5 years). High FCR was negatively correlated with physical and mental QOL. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results suggest that FCs caring for patients with a relatively short posttreatment duration experience higher levels of FCR than those caring for patients with a longer posttreatment duration. In clinical settings, healthcare providers should use posttreatment duration as an indicator of risk of FCR in caregivers to address FCR and provide appropriate support. Future research should develop and examine interventions to help HNC FCs cope effectively with their FCR and improve their QOL.

Changes and predictors of radiation-induced oral mucositis in patients with oral cavity cancer during active treatment.

PURPOSE: Radiation-induced oral mucositis (OM) is the most debilitating side effect of radiation treatment in oral cavity cancer. The purpose of the study was to investigate change of prevalence of severe OM, OM-related symptoms, and predictors in oral cavity cancer patients during active treatment. METHODS AND SAMPLE: Longitudinal study design with repeated measures was used. Patients with oral cavity cancer were recruited from a head and neck outpatient radiation department at a major medical center in Taiwan. Patients' OM-related symptoms were measured at three time points. Patients' oral mucosa was assessed at nine time points. Generalized estimating equations (GEE) were used to analyze the predictive factors of prevalence of severe OM and OM-related symptoms. RESULTS: Patients reported highest prevalence of severe OM at T5 (5 weeks after beginning RT) and T6 (6 weeks after beginning radiation therapy, RT), with the combined chemotherapy and RT (CCRT) patients reporting a higher prevalence than those receiving RT alone. The peak of OM-related symptoms was at T8 (8 week after beginning RT), with primary symptoms of mouth pain, mouth dryness, eating difficulties, swallowing difficulties, and taste change. Patients with CCRT, a higher cumulative radiation dose, smoking, and lower body mass index (BMI) were at high risk to develop severe OM. OM-related symptoms were predicted by type of treatment, cumulative radiation dose, and smoking. CONCLUSIONS: Patients with oral cavity cancer suffer from OM and OM-related symptoms during aggressive RT or CCRT. Patient-specific oral care and emotional support are needed to relieve distressful OM-related symptoms during active treatment.

Unmet supportive care needs and characteristics of family caregivers of patients with oral cancer after surgery.

OBJECTIVE: The aim of this study was to identify factors associated with unmet supportive care needs in family caregivers of patients with oral cancer after surgery. METHODS: In a cross-sectional study, we recruited patient-family caregiver dyads from the otolaryngology head and neck surgery wards of a medical center in northern Taiwan. Patients were assessed using a set of structured questionnaires to measure symptom distress, sleep quality, and depression. Social support and supportive care needs of family caregivers were measured. RESULTS: Of the 102 dyads surveyed, needs for supportive care in information domain and healthcare professional/healthcare services domain were highest. Patients with more severe symptoms and family caregivers who received less social support from family were associated with greater overall unmet supportive care needs. CONCLUSIONS: Family caregivers report the need for more information and healthcare services after a family member has had oral surgery. Caregiving training programs should be developed for caregivers on the basis of meeting reported needs.

Supportive care needs in newly diagnosed oral cavity cancer patients receiving radiation therapy.

OBJECTIVE: This study aimed to examine changes in physical symptom severity, functional status, supportive care needs, and related factors in oral cavity cancer patients during 6 months after beginning radiation therapy (RT) or concurrent chemotherapy and radiation therapy (CCRT). METHODS: A prospective longitudinal study was conducted involving oral cavity cancer patients from an RT clinic at a medical center in northern Taiwan. Patients were assessed for supportive care needs and physical symptoms at five time points: before the beginning of RT or CCRT and at 1, 2, 3, and 6 months after beginning RT or CCRT. The generalized estimating equation was used to identify predictors of overall needs as well as six specific dimensions of needs. RESULTS: A total of 82 patients completed the 6 months of follow-up. Patients had moderate to high levels of supportive care needs over the 6 months. Although the highest information need was at the pretreatment phase, in general, the peak for overall and individual care needs was at 2 months since first receiving RT or CCRT. Patients without religious beliefs as well as those with higher educational level, functional level, overall physical symptom severity, and baseline anxiety reported more supportive care needs. Anxiety level before treatment was the most common factor across most supportive care needs. Individual physical symptoms, including fatigue, swallowing difficulty, and oral mucositis, were significantly related to higher physical and daily living needs. CONCLUSIONS: A systematic clinical assessment to detect patients' care needs is necessary to improve the provision of timely cancer care and meet patients' healthcare needs.

Psychometric testing of the Chinese-version cancer needs questionnaire short form head and neck cancer-specific version in oral cavity cancer patients.

PURPOSE: The purposes of this two-phase study were to (1) develop and examine the content validity and feasibility of the Chinese-version cancer needs questionnaire, short form, head and neck cancer-specific version (CNQ-SF-hn) (phase I), and (2) examine its psychometric characteristics as supported by reliability and construct validity (phase II) in oral cavity cancer patients in Taiwan. METHODS: Newly diagnosed oral cavity cancer patients (N = 206) were recruited from a medical center in northern Taiwan. Data were analyzed using descriptive statistics and psychometric analyses. RESULTS: The results showed that the CNQ-SF-hn (1) had good internal consistency reliability for the overall scale and subscales; (2) had good 1-week test-retest reliability (correlation = 0.80) for the overall scale; (3) had construct validity, supported by six clearly identified factors explaining 74.87% of the variance; and (4) had convergent validity, supported by correlations among its subscales and related scales, as well as by discriminating care needs according to undergoing versus not undergoing reconstructive surgery and cancer stage. CONCLUSIONS: The Chinese-version CNQ-SF-hn is a psychometrically satisfactory instrument. Further validation is suggested for its factor structure and different head and neck cancers.

Orofacial pain and predictors in oral squamous cell carcinoma patients receiving treatment.

Surgical and radiation therapy for oral squamous cell carcinoma (OSCC) may generate orofacial pain. The aims of this study were to (1) characterize the pain experienced by people with orofacial pain, and (2) determine the factors associated with changes in orofacial pain in OSCC patients during the postoperative and post-radiation therapy periods. The study had a prospective longitudinal design with consecutive sampling. Seventy-two eligible patients were recruited from the outpatient department of otolaryngology, head and neck cancer, and radiation therapy of a medical center in northern Taiwan. A set of questionnaires was used for patient assessment, including the University of California San Francisco Oral Cancer Pain Questionnaire, Symptom Severity Scale, Hospital Anxiety and Depression Scale, and Karnofsky's Performance Status Index. Patients were assessed at two time points: 1 month after surgery (T1) and 1 month after completion of radiation treatment (T2). The findings showed that (1) patients reported moderate orofacial pain at both time points; (2) orofacial pain, oral function-related symptoms, and psychological distress were significantly higher at T1 than at T2; and (3) older age, eating difficulty, speech difficulty, and depression were significant predictors of orofacial pain. Oral rehabilitation and relaxation training may reduce orofacial pain in this patient population.

Changes of symptoms and depression in oral cavity cancer patients receiving radiation therapy.

The purposes of this study were to (1) examine changes in symptom severity and depression within 3 months of first undergoing radiation therapy (RT) or concurrent chemoradiation therapy (CCRT), and (2) identify factors involved in changes in symptom severity in newly diagnosed oral cavity cancer patients undergoing post-operative RT or CCRT. A prospective panel survey was conducted to assess changes in symptoms, depression, and disease- or treatment-related characteristics within 3 months of beginning RT or CCRT (pre-treatment and 1, 2, and 3 months from first receiving RT). A total of 76 eligible oral cavity cancer patients were recruited from the outpatient radiation department of a medical center in northern Taiwan. The results showed mild-to-moderate overall symptom and depression levels during treatment, with the five most distressing symptoms being swallowing difficulty, poor appetite, oral mucositis, pain, and fatigue. The severity of symptoms and depression peaked at approximately 2 months from beginning RT or CCRT (T3). Changes in overall symptom severity were found to be significantly related to patients' radiation dose and depression level. These results can help advance understanding of changes in symptoms and facilitate prevention and management of symptoms associated with RT or CCRT. Psychological distress, particularly, depression, requires careful monitoring and management in oral cavity cancer patients undergoing RT or CCRT.

Support needs of patients with oral cancer and burden to their family caregivers.

Oral cancer patients' supportive care needs during the postoperative period can impact their family caregivers' burden. The purposes of this study were to (1) examine patients' perceived levels of supportive care needs, (2) examine caregivers' perceived levels of caregiving burden, and (3) examine the predictive factors for caregivers' caregiving burden with newly diagnosed oral cancer patients during the postoperative period. A cross-sectional, correlational study was conducted. One hundred twenty-two pairs of eligible patients and caregivers were recruited from the otolaryngology and plastic/reconstructive inpatient wards in a medical center in northern Taiwan. A set of questionnaires was used to assess patients' needs, including the Karnofsky's Performance Status Index, Cancer Needs Questionnaire Short Form, Head and Neck Specific Needs Questionnaire, and Background Information Form; the caregivers' burden was evaluated using the Caregiver Reaction Assessment, Inventory of Socially Supportive Behavior, and Characteristics of Care Experiences Form. In general, patients reported having high overall supportive care needs with the highest level in the "health system and information" domain among 6 needs domains. Caregivers had moderate levels of caregiving burden, with the highest level in the "self-esteem" domain among 5 caregiving experience domains. Factors significantly related to those burdens across 5 domains of caregiving burden were caregivers' social support, patients' physical and daily living needs, patients' health system and information needs, and patients' psychological needs. Postoperative oral cancer patients experienced relatively high unmet supportive care needs, and caregivers perceived moderate levels of caregiving burden. Healthcare professionals should systematically assess patients' and caregivers' problems and provide timely supportive care clinically.

Unmet information needs and preferences in newly diagnosed and surgically treated oral cavity cancer patients.

UNLABELLED: The purposes of this study were to examine and compare the levels of care information needs, information preferences, unmet information needs, and predictive factors between newly diagnosed and surgically treated oral cavity cancer patients. Patients were divided into two groups comprising: (a) diagnosed patients and (b) surgically treated patients. A cross-sectional survey was conducted to assess information needs about care, disease-/treatment-related characteristics, and physical performance function in 109 diagnosed and 113 surgically treated oral cavity cancer patients. The two groups had statistically different levels of care information needs, information preferences about benefits, and side effects of treatment/ surgery. There were clinically meaningful differences in their information concerns. The diagnosed patients' information needs were predicted by previous serious illness experiences, prior alcohol use, anxiety level, education level, time since diagnosis, psychological impact, and religion. The surgically treated patients' information needs were predicted by previous serious illness experiences, prior alcohol use, anxiety level, psychological impact, education level, and marital status. CONCLUSION: This study revealed differences in information needs between diagnosed patients and surgically treated oral cavity cancer patients. Results suggest that healthcare professionals should design a protocol to guide development of a comprehensive pre- and postoperative information package to be given to these patients.

Distress and care needs in newly diagnosed oral cavity cancer patients receiving surgery.

The purposes of this study were to examine postoperative levels of physical and psychological distress and, also, care needs and their related factors in newly diagnosed oral cavity cancer patients. A cross-sectional survey was conducted to assess symptom distress, psychological distress (anxiety, depression, and disease impact), care needs, and disease-/treatment-related characteristics in 112 hospitalized oral cavity cancer patients receiving surgery. The major results showed that patients had moderate-to-severe levels of distress and high overall care needs in five domains, with the highest level in the "physical and daily living" domain. Factors related to overall need and each unmet domain were identified. Overall care needs were predicted by anxiety, depression, cancer stage, performance status, and age. Among the three categories of psychological distress, anxiety contributed the most to predicting three domains of care needs. The results strongly suggest the need for systematic assessment and future longitudinal research.

Linear accelerator-based radiosurgery in the management of skull base meningiomas.

From May 1994 to December 1999, 43 patients with meningiomas in the base of the skull underwent linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) at Chung Gung Memorial Hospital. SRS was performed as a primary treatment in 14 patients, and after resection in 29 patients. The mean tumor volume was 5.68 cc, and the mean target surface dose was 16 Gy, delivered with an average of three isocenters. The median follow-up was 74.5 months. The 7-year local control rate and 7-year overall survival rate were 89.7% and 80.2%, respectively. The 7-year local control was 100% and 84.4% in SRS alone group and surgical excision with SRS group (p = 0.21), respectively. A stationary tumor following SRS was seen in 23 (53.5%) patients, partial shrinkage was seen in 16 (37.2%) patients, and complete disappearance in one patient was seen (2.3%). Furthermore, disease progression was noted in three (7%) patients, one of whom died of disease. The median time to tumor response was 15.4 months (range 5.8-52.8 months). Cases remained stable or had improved neurological statuses without any deterioration in 37.9% and 78.7% of the groups treated with surgery and SRS and SRS alone, retrospectively. In summary, LINAC-based SRS is an effective and safe modality of treating unresectable or partially resected meningiomas in the base of the skull. For tumors with diameters of 3 cm or less, particularly in patients without or with minimal clinical neurological symptom, SRS alone can provide a good local control without causing cranial neuropathy.

Symptom distress, catastrophic thinking, and hope in nasopharyngeal carcinoma patients.

The purposes of this study were to explore symptom distress, catastrophic thinking (catastrophizing) and hope, and factors predicting hope in Taiwanese nasopharyngeal carcinoma (NPC) patients within 3 years of receiving radiation therapy (RT). Instruments used were the modified Symptom Distress Scale, disease catastrophizing scale (modified from Coping Strategies Questionnaire), and Herth's Hope Index. Adult NPC patients (N = 115; 33 undergoing RT, 44 who completed RT within 1 year, and 38 who completed RT more than 1 year but less than 3 years) were recruited from an outpatient RT center in Northern Taiwan. Although participants' overall symptom distress was mild to moderate, they scored moderate level for several distressful symptoms: dry mouth, fatigue, hearing difficulty, loss of appetite, insomnia, and pain. Patients undergoing RT had greater symptom distress than subjects in the other 2 groups. Regression analysis revealed that catastrophizing was the only predictor of hope. Patients who engaged in catastrophizing reported much lower levels of hope. Particular care and attention are recommended to help NPC patients deal with the top distressful symptoms listed. Nursing interventions to reduce catastrophic thinking and enhance hope are discussed.