Few empirically-supported programs targeted for or tested specifically with HNC patients exist. The results of three randomized trials for HNC patients have been published. In the first study published in , the intervention consisted of surgeon- or dentist-delivered advice to stop smoking, a contracted quit date, tailored written materials, and booster advice sessions compared to a usual care advice control condition [ 53 ].
However, the intervention effect was not statistically significant. Based on these findings, the authors recommended systematic brief advice to stop smoking for HNC patients, with a stepped-care approach for patients less able to quit [ 53 ]. Tobacco use and cessation should be addressed on an ongoing basis with patients throughout treatment and survivorship, including among recent quitters in order to prevent relapse.
In , the National Comprehensive Cancer Network published guidelines for tobacco cessation intervention among cancer patients [ 57 ], but the successful implementation of these guidelines remains to be evaluated. A topic not commonly addressed is the impact of cancer and its treatment on sexual functioning [ 1 , 58 , 59 ]. In an early study, HNC patients who had extensive facial disfigurement following surgical treatment reported worse relations with their partners, increased social isolation, and reduced sexuality compared to patients with minor disfigurement [ 6 ].
Due to significant improvements in facial reconstruction techniques, extensive disfigurement is now less common; but sexual functioning may still be impacted due to treatment-related effects on breathing, swallowing, and speaking. Alterations in any of these functions can have a negative impact upon intimacy, communication, or other sexual activities. In addition, data suggest that the incidence of human papillomavirus HPV -associated head and neck cancers is increasing [ 60 — 62 ]. Accumulating evidence point to HPV as a causal factor in the etiology of head and neck cancers that arise among non-smokers and non-drinkers [ 63 , 64 ].
This emerging subgroup of HNC patients has specific informational needs, and many clinicians find themselves ill-prepared for these discussions. Patients may have questions about HPV-related disease that are difficult to answer due to limited data or physician discomfort with discussing matters related to sexual health [ 65 ].
Among HNC patients receiving an HPV-related diagnosis, informational and psychosocial needs are particularly apparent. Patient knowledge about HPV varied significantly, and many had questions regarding transmission of HPV infection and potential consequences for current or future partners [ 66 ]. The sexually-transmitted nature of HPV may create challenges for healthcare professionals who have limited experience discussing sexual health with their patients.
In a qualitative study of 15 healthcare professionals who treat patients with oropharyngeal cancers, providers described two primary challenges: 1 discomfort or lack of familiarity with talking about sexual health and behaviors; and 2 limitations of scientific knowledge about the virus [ 68 ]. Patients may desire answers to specific questions about how they became infected with HPV, when they became infected, who the infection was transmitted from, and the likelihood of re-infection after cancer treatment — questions that are difficult to answer [ 68 ].
These data highlight significant challenges and gaps in patient-provider communication with respect to HPV-related issues and point to the need for additional research in this area. At present, existing data on the informational needs of patients with HPV-related cancers are quite limited as the few studies that have been conducted are based on relatively small samples of patients and physicians recruited from large academic research institutions, which may not be representative of the broader patient and healthcare provider population.
As a result, little is known about the informational and support needs of patients being managed in community practices and their community providers. Studies designed to foster the development of valid and comprehensive educational and support programs to address HPV-related issues would be extremely beneficial for both patients and their providers.
Another area of emerging need is the provision of informational support for clinical trials. While clinical trials are essential to the evaluation of new therapeutic regimens, a relatively small proportion of cancer patients participate in these trials [ 69 ]. Two studies investigating barriers to recruitment of HNC patients were identified. In one study, 85 healthcare professionals involved in clinical trial research investigators, research nurses completed a web-based survey on barriers to clinical trial recruitment.
Further exacerbating this situation is the complexity of the information that needs to be accurately conveyed, which can be particularly challenging for patients with limited health literacy [ 73 ]. Hence, the utilization of decision aids to assist with informed decision making about clinical trial participation has been explored as a potentially useful tool to help patients identify their values and goals, consistent with making an informed choice. But prospective, randomized studies involving mixed cancer patient populations have yielded promising results.
For example, among cancer patients who were randomly assigned to receive either a web-based program that provided tailored, interactive educational content about clinical trials intervention condition or general written information about clinical trials control condition , intervention participants reported significantly greater increases in knowledge and greater decreases in attitudinal barriers compared to control participants [ 74 ]. Thus, tailored educational programs can effectively deliver key information about clinical trials and may help enhance communication about and preparation for decision making about clinical trials.
Despite the growing body of research on rehabilitation and survivorship needs in this patient population, patients note that the impact of treatment on social activities and interactions is under-discussed and of key concern. In addition, there is a significant gap in addressing communication and informational needs of caregivers and family members who provide considerable levels of support to the patient and are integral for promoting healthy behaviors and self-care during and after treatment.
In addition, there is a need for more fully integrated programs to provide support for managing substance dependency issues. For example, many HNC patients express interest in quitting smoking and attempt to quit, but fewer follow through with enrolling in evidence-based smoking cessation programs or are successful in maintaining long-term abstinence.
Motivational interventions to facilitate enrollment into formal programs that address alcohol or tobacco dependence among cancer patients may be beneficial [ 76 ]. Ultimately, programs addressing tobacco or alcohol dependency that are incorporated into a comprehensive treatment plan may decrease the stigma associated with substance abuse and increase patient motivation to seek help and support for staying healthy after treatment.
Finally, two emerging areas of informational needs that warrant greater attention include: 1 communication about an HPV-related diagnosis and its impact on intimacy; and 2 support for decision making about clinical trials. Although patients with HPV-related disease desire more information regarding HPV and head and neck cancer, communication and practical barriers such as physician time constraints, limited knowledge, and patient or physician discomfort in discussing sexual health reduce patient satisfaction with the information provided.
Similarly, multiple challenges exist in the enrollment of HNC patients to clinical trials, including limited time for conveying large amounts of complex information, addressing informational needs of patients and family members, and discussing patient preferences and values. Findings derived from other cancer patient populations suggest that novel web-based programs may not only be an effective and cost-efficient approach for delivering such information, but may also represent an acceptable and feasible format for communicating information about multiple topics that can be tailored to meet the unique needs of patients and family members.
A prospective study of quality of life in head and neck cancer patients. Part II: Longitudinal data. J Laryngol Otol. First year after head and neck cancer: quality of life. J Clin Oncol. Rehabilitation outcomes of long-term survivors treated for head and neck cancer. Head Neck. The nature and extent of body image concerns among surgically treated patients with head and neck cancer.
Psychosocial adjustment of patients surgically treated for head and neck cancer. Penner JL. Psychosocial care of patients with head and neck cancer. Semin Oncol Nurs. Communication needs, methods, and perceived voice quality following head and neck surgery: A literature review.
Cancer Nurs. Zeine L, Larson M. Pre- and post-operative counseling for laryngectomees and their spouses: an update. J Commun Disord. Educational needs and altered eating habits following a total laryngectomy. Oncol Nurs Forum. Postlaryngectomy quality-of-life dimensions identified by patients and health care professionals. Am J Surg. Heal Technol. Factors associated with fatigue, sleep, and cognitive function among patients with head and neck cancer. Predictors of poor sleep quality among head and neck cancer patients.
Zhou J, Jolly S. Obstructive sleep apnea and fatigue in head and neck cancer patients. Am J Clin Oncol. The occurrence of sleep-disordered breathing among patients with head and neck cancer. Prevalence of obstructive sleep apnoea following head and neck cancer treatment: a cross-sectional study. Oral Oncol. High prevalence of obstructive sleep apnea among patients with head and neck cancer. J Otolaryngol. Sleep apnoea in patients after treatment of head neck cancer. Acta Otolaryngol. Sleep-related breathing disorders in patients with tumors in the head and neck region.
Sleep apnea in patients with oral cavity and oropharyngeal cancer after surgery and chemoradiation therapy. Otolaryngol Head Neck Surg. Stern TP, Auckley D. Obstructive sleep apnea following treatment of head and neck cancer. Ear Nose Throat J. How satisfied are head and neck cancer HNC patients with the information they receive pre-treatment? Results from the satisfaction with cancer information profile SCIP. J Cancer Educ. Psychological functioning of caregivers for head and neck cancer patients.
Development and usability testing of a web-based self-management intervention for oral cancer survivors and their family caregivers. Table I presents the principal findings of ECT treatment in head and neck cancer 2 , 27 , 32 ,2. Based on the presently available evidence, ECT may be considered for treating a large range of tumors, including skin metastases of the head and neck, treatment restrictions of primary cutaneous and subcutaneous tissue, as in melanoma and squamous cell carcinoma, means a viable therapeutic alternative is being overlooked 1 — 4.
Examples for application include the oral and nasal cavity and pharyngeal-laryngeal lumen, and long single-needle electrodes allow for ECT of deep-seated tumors of the head and neck 2 , 13 — Electric pulses can permeabilize any living cell, and bleomycin and cisplatin may therefore be applied to DNA molecules, irrespective of the onco- or antioncogenes expressed by tumor cells 5 , 6.
Recently, a multicenter retrospective analysis reviewed the cases of 19 patients who underwent ECT from July to May for superficial advanced angiosarcomas. Based on the results obtained in these patients, the authors concluded that ECT may represent a promising treatment for providing local tumor control and symptom palliation in patients with superficial angiosarcomas An effective ECT requires that electrodes are applied to ensure a complete cover of the entire neoplasm; this may result in the serial administration of pulses for complete coverage.
Similarly, drug concentration and delivery must be calibrated for maximum clinical efficacy, including the effects of the electric pulses. ECT effectiveness therefore requires administration protocols that are systematically planned and scrupulously executed and accompanied by well-designed checklists and follow-up to ensure and measure effectiveness. These principles are irrespective of tumor or electrode type, or whether drugs are delivered systemically or locally 44 — ECT treatment is intrinsically local and effective treatment for the local control of tumor growth and is important in the treatment of cancer.
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Other therapeutic combinations, such as radiotherapy, are also possible. In cases of local recurrences where no further curative treatment options are available, ECT may serve a central therapeutic role 54 — Recently, our group reported an interesting case of squamous cell carcinoma of the head and neck with extensive skin metastases that was successfully treated with ECT, demonstrating that ECT may be an effective therapy for metastases or local squamous cell carcinoma recurrence ECT can typically be applied in the outpatient setting with a favorable cost-benefit ratio as bleomycin and cisplatin are relatively low-cost, and ECT equipment is less expensive than ionizing radiation devices 1 — 4 , 19 , Treatment of internal tumors using endoluminal electrodes is currently being explored This technological development has the potential for treating head and neck tumors located in the parotid, submandibular and thyroid glands or in the latero-cervical space 84 , Challenges in applying ECT to deep-seated tumors are represented by tissue conductivity, these include vasculature, necrosis, micro-heterogeneities, to the effects of EP on conductivity, determining the electrophoretic threshold 1.
All such considerations dictate precise treatment planning and design, down to electrode placement, drug delivery, dosage and timing, to ensure the accuracy and robustness of a treatment plan 1. Current evidence provides a basis for combining ECT with immunotherapy 49 — 52 , Immunomodulatory agents or the electro-transfer of genes coded for immunoregulatory proteins suggest the potential of a safer systemic cancer treatment, which is free from the adverse effects of current therapeutic modalities. ECT provides its own therapeutic and enhanced delivery benefits to this discussion, starting with current protocols and adapting them as the future demands.
A broadening and extending of the range of indications for ECT can be anticipated for primary curative approaches ECT has demonstrated its safety and efficacy in skin metastases of head and neck tumors and, with some limitations, in primary and relapsing neoplasms of this region. ECT can be repeated as needed and does not interfere with or preclude subsequent therapy with primary treatment modes.
Head and Neck Cancer - 1st Edition
Although at present, ECT is a palliative treatment, the high success rates of ECT and good level of tolerability, considered against the scarcity of alternative treatments in advanced stage cancers, make it worth consideration among treatment options in selected patients. ADV and GA were responsible for the conception and design of the present study. MR undertook drafting of the manuscript, and LL and PM performed the analysis and interpretation of literature and data. FA performed manuscript revisions and MDV and AG were responsible for study design, critical revision of the manuscript, provided final approval.
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Head and neck cancer: Emerging perspectives
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Electrochemotherapy in head and neck cancer: A review of an emerging cancer treatment (Review)
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Your points will be added to your account once your order is shipped. Click on the cover image above to read some pages of this book! By detailing experimental and basic research, from premalignancy to fully invasive tumors, this book has wide applicability to all human carcinomas. No other group of human cancers is better positioned for the application of recently developed novel and targeted therapies, and this book uniquely presents the unusual opportunities tumors of the head and neck provide for clinical, translational, and basic science research.
Cutting-edge and experimental treatment approaches are presented, along with future strategies and an evaluation of emerging technologies. Help Centre. My Wishlist Sign In Join. Be the first to write a review. Add to Wishlist. Ships in 10 to 15 business days.