Modeling symptom drivers of oral intake in long-term head and neck cancer survivors.

PURPOSE: This study examined the relationship between self-reported symptom severity and oral intake in long-term head and neck cancer (HNC) survivors. METHODS: An observational survey study with retrospective chart abstraction was conducted. HNC patients who had completed an MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) questionnaire and also had clinician graded oral intake ratings (Functional Oral Intake Scale [FOIS]) were included. Correlation coefficients were computed. FOIS scores were regressed on MDASI-HN symptom items using stepwise backwards elimination for multivariate models. RESULTS: One hundred and fifty-two survey pairings were included in the analysis (median 44 months follow-up, range 7-198). Per FOIS, 28% of survivors maintained a total oral diet with no restrictions, 67% reported a restricted oral diet (without tube), 3% were partially tube-dependent with some oral intake, and 2% were NPO. Of the 22 symptom items, the most severe items in decreasing order were dry mouth, difficulty swallowing\chewing, problems with mucus, tasting food, and choking/coughing. Significant bivariate correlations, after Bonferroni correction for multiple comparisons, were present for 8 of 22 symptoms with FOIS. On multivariate analysis, symptom severity for difficulty swallowing and problems with teeth/gums remained significantly associated with FOIS. CONCLUSIONS: Oral intake in HNC survivorship is a multidimensional issue and functional outcome that is impacted not only by dysphagia but also by dental status. Symptom drivers of oral intake likely differ in acute survivorship. Nonetheless, these findings highlight the lack of specificity in this end point and also the need for multidisciplinary supportive care to optimize oral intake in survivors.

Cromogranina A en el diagnóstico y seguimiento de los tumores endocrinos gastroenteropancreáticos / Role of chromogranin a in the diagnosis and follow-up of gastroentreopancreatic endocrine tumours

La determinación de los niveles plasmáticos de cromogranina A (CgA) es el método más sensible para el diagnóstico y el seguimiento de los tumores endocrinos gastroenteropancreáticos. Es especialmente útil en los tumores no funcionantes que no producen síndrome hormonal por secreción de una hormona específica para los que no hay otros marcadores. Si bien hay grandes diferencias en función del método y el punto de corte empleados, su sensibilidad para el diagnóstico de tumores carcinoides es de aproximadamente el 75% en carcinoides bronquiales, del 90% en carcinoides de intestino delgado y del 70% en carcinoides de intestino grueso. En tumores pancreáticos no funcionantes su sensibilidad es aproximadamente del 80%, lo que la convierte en el marcador más sensible en estos pacientes. Diversas situaciones no relacionadas con la presencia de tumores endocrinos (insuficiencia renal, gastritis crónica atrófica y enfermedad inflamatoria intestinal, entre otras) pueden elevar sus concentraciones, por lo que es importante descartarlas antes de hacer una interpretación errónea de los resultados. Los valores de CgA se correlacionan con el volumen tumoral (excepto en pacientes con gastrinomas) y son mayores si existen metástasis hepáticas. Valores muy elevados de CgA se han asociado a un peor pronóstico y un mayor riesgo de presentar cardiopatía carcinoide en pacientes con carcinoides de intestino delgado. Se suele producir un descenso tras comenzar el tratamiento médico, que puede utilizarse como un marcador temprano de respuesta bioquímica pero, por desgracia, rara vez tumoral. En carcinoides del intestino medio la determinación de CgA es el método más sensible y temprano para detectar la recidiva (AU)

Plasma or serum chromogranin A (CgA) measurement is the most sensitive method for diagnosis and follow-up of gastroenteropancreatic endocrine tumours.It is particularly useful in those ‘nonfunctioning’tumours without an accompanying hormonal syndrome where no other markers are available. Even though large differences between methods have been observed, CgA sensitivity for diagnosis of carcinoid tumours is approximately 75% for bronchial carcinoids, 90% for small bowel carcinoids and 70% for large bowel carcinoids. For non-functioning pancreatic endocrinetumours reported sensitivity is approximately 80%, which means CgA is the most sensitive method in these patients. Several circumstances not related to the presence of endocrine tumours (renal insufficiency, chronic atrophic gastritis, inflammatory bowel syndrome…) might increase CgA levels, so it is important to rule these out to avoid misinterpreting the results. CgA concentrations are related to tumour mass (with the exception of patients with gastrinomas), and are much higher when liver metastases are present. Very high levels of CgA have been associated with a worse prognosis and a greater risk of carcinoid heart disease in patients with small bowel carcinoids. A decrease in CgA concentrations is usually seen after initiating medical therapies, which might be used as an early marker of biochemical response, but unfortunately, rarely of a tumoral one. In patients with midgut carcinoids CgA is the most sensitive method for the early detection of a relapse (AU)